<?xml version="1.0" encoding="UTF-8"?>
<!-- edited with XML Spy v4.0.1 U (http://www.xmlspy.com)-->
<ACRF xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xsi:noNamespaceSchemaLocation="ACRF_20033.xsd">
	<Form>
		<Identification>ACRF001</Identification>
		<FormCreationDate>2003-06-25</FormCreationDate>
		<FormCreationHour>14:37:04.015</FormCreationHour>
		<AttestationStatus>0</AttestationStatus>
		<TypeForm>FA</TypeForm>
		<FileReference>
			<FileName>GO.DMFA.123456.20030625.00001.R.1</FileName>
			<ReferenceOrigin>2</ReferenceOrigin>
			<ReferenceNbr>340000E59V01Q</ReferenceNbr>
		</FileReference>
		<ReceptionResult>
			<ResultCode>1</ResultCode>
		</ReceptionResult>
	</Form>
</ACRF>
