EFTA Document EFTA01380176

Email Cr'I4 olitrefidt irotaltOrarl II. Certification of beneficial owner(s) Persons opening an account on behalf of a legal entity must provide the foaming Information: a. Nance and Title of Natal a1 Pei son Oonnine cccu•a. StA,e- kktie J.tv b. Name of t.egal Ernity. Type Legal Entav, and Adthess of Lege: fiN;ty *ex Which the Acsoimt is Being Opened: L C. LA-L. lc.tt-tA (colt, t. 41 k OO 'act? Pac;olz. 0.)., a2 LaSV1 °et Tha foikmeing infexmation for each inds.:ititial, if any, or !ndirectly, through any cc,ntract. 3rrangemeat. understanding, relationship or otherwise, owns 25 percent or more of the equity interests of the legal entity fisted above: WmnG Dr.^ el)", Atoo‘of lc -ow V S Pidtooz 7,4 Noes 4$ SiCsaiStOsso:s iSied ftststry I S 41!zejt,;(• i.nrllt • '0 oc4tI Secede 4JIYItet!t; ( c- z 6( OO Cad oolc-cti..-4.n O4O- OO5O1 375-419 Hoar L'S toc0000rt.nuottot ro to a Zotortni Stoviono tivottlxt o 7orwoot ?soot*, with hoorri. Gg An shy; bef,;:kanCid, Mid DuntAit c *.iMbt; o;t1 ("vilify ofr,wmD. of amf Othr go.oxenstedsotu-xf dononem esiomainq nancrohlv or ieddenos sod Nom to a 04NOSIKS! of s4nibv Isd /gaol Monde: be. td ro irk:Mogi rosse l!:1 Otli:”Vekl). 4014.7.)Isf.3210.1 0. The toilowing Information for one individual with significant responsibility for managing the legal 4ntny listed abo.a, auch as: • An executive officer or senor menage: kg.. Chief Exc-anive Officer. Chief Financiai Officer. Chief Operating °freer. Managing Member, General Partner. President. Vice President. Treasurer); Or • Any other Mdividua! who regulany performs sk.,Ilar function -4. (If appropriate, an individual listed under section (n) Mauve may also be listed in this section (d)). .at, of birth tn-po :Wows U-SCuel E. Etch., S.,. i44::tr3 32— CAW V S. FortOod: rno -sdokf.S. aors* 5.00;t1 fc.ntrkte 1 is,iarni.” ituinet. Stdif4 Setosho t rods NuolLS, Pdemrs. 4oadddiocl to a Zuci‘tiSr“aiiv Plumber j'asspwl C,:xievry of tosunow. ips axr4sessdkasos c;3/4 paimber “ re,x... 41Nicoy/drift} islthlter* of dm also oostoonets .111 prd dtt.ailler I *sides:old imonrolste or flak's** bforinsi 2 00400140H 04 IMMler Jaltgius d Ovoid bt **visit). (name St natural person opening the account), hereby Cei dry. to toe heat of v complete and Cs-ATOr.S. etc ir 0„, 2918 Cannon ears AG MI opmvterattnto 'it/MIK/66e 0631)051314 CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e) DB-SDNY-0078397 CONFIDENTIAL SDNY_GM_00224581 EFTA01380176