Case File
efta-01375824DOJ Data Set 10OtherEFTA01375824
Date
Unknown
Source
DOJ Data Set 10
Reference
efta-01375824
Pages
1
Persons
0
Integrity
Extracted Text (OCR)
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Certification of beneficial owner(s)
Persons opening an account on behalf of a legal entity must provide the following information:
a. Plana and Title cf Natural Ptaw.n Octimino Account
t13.91111:10f Legal tnritv. Fipe of Legal Entity, and Address of Legal Entity inr
1-0:•:.ount iS Being Openeyd
use l
( "
a t 4-4,41
4>tiap GOA el
ildirectly. through any conbwa airangement
'He
it, tarests of the legal ender listed above:
.
.
_
ce, U9. nereAn
For non.t, S. Pawns
Smis SThrAirri
fiXerete
Number
to Sm. '441 St; i)(1:0144:»Diirl
TSP.+ *6,, I (),(s-3
Lk OO te..4-4,0v abiAel (33
S$•
c )Lsit Cx3Exa
i•Os MAA-;33,
CAiAA
SA:Wit ..A1A7t. V 4 on s,>;)0, t ;estate wen COW,ITY (If 10004" 40 gee eteetecee4., to le mete:
ryjet.,tt
and • ).:4) n rr. af issuer. 41.11At Atha gOVVIAITIOnt.otirsed
Per :rode:tine nation:WA
leteiente end be owe a plc.:Awe!) eremite tail:wee s holed
VATAt*::
I no At .thlAi mean the aefineker Mese mite tact Apreittibte."1
n. The following information for one individual with significant responsibility far mene9 inQ tha legal entity listed above.
Rrn es:
• An executive officer or serthr managerteg , Chief ftitive
Officer Chief Financial Officer. Chief Operating Oftkar,
Managing Member. General Partner, President. Vice President, Treasurer): or
• Any other in:114SW -dm regularly ixdotras &miler functions.
(if appropriate. an individual listed under section (c) above may also tya listed in this section (di).
Nit Al earn
Aar:sett.
S-c.ge_ 44)0
F-':A
k'nfen
°ore
it+en.1,1'
fACIAi
(ate Weser, I !A: ~nai
ves
PAM*/
A> Scsnol Secutity Nentei1
Fof 1e".e.;11.r. Pertene.
A SA-
--)!Sweate tiAle•eirce• a Pktew..e! Riertnewgr t1:42ner at 4C-iiala an gen ....A.net...r.atee. 4:AS nAentw.
rtAdtbk:
and C.(1.2rt:,
r:
*the: Lieneennertesa ,ea new:vent renrenting onnAneintar nneterni•Ard be 10114 A nbetweaph or *Air salt:T.41e inceet
ere!. la
5A7:11,
(Cptiar )4/
of natural parson opening the accounti, hereby ceitifv, to the bast of
,ompleie and correct.
e; 201e nir ester: (leer res, AO nohe. tre,e6. rthltoe;64 sno mostas
CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e)
DB-SDNY-0071447
CONFIDENTIAL
SDNY_GM_00217631
EFTA01375824
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