EFTA Document EFTA01387280

One sheet must be established for EACH INDIVIDUAL PARTY in Section 2. Account Ownership Summar 3A. Individual Details (for all parties) Individual's Name: Groff, Lesley - Date of Birth Country of Residence. USA Country of Otizer•sh 0 USA Address of primary residence- United Rates Has client resdeo ou:sioe of his/her country of nationality for 5 years or more? 0 Yes ,V. No Profession' Occupation. Attorney Tax ID: SSN Current Employer: Darren K lndyke PLLC Position: Title' Ran