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s 21.a. 21.b. 21.e. 21.d. Form I-94 Arrival Ito Passport Number Departure Record Number (if any
tate 34. Ptoyince 3+ Postal Code Csingtex lee Cade. 10.276 N1' C5rikr-es 044pgreKwdotNomoWit 4. 5. 6, Pr aterfstpayOrhe Telephone Number . Preparees.Mobile Telepbene.Number (if any) • • • .fisP.meil.Address(iciarty). Form I.765 12/26/19 Page 5 of 7 EFTA01699771 Part 5. Contact tniontnatiOn,
eturns and exemption applicakm? Web site address Ito 12 The books ore in care of le Telephone n
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completed by a third pasty preparer and complete the third parry preparer section. 4,1 Filer signatu e meiorion..fleomocronicmy simechoierimed 47 Preparees last name 48 First name 49 MI 50 Check if 51 TIN 51a TIN type 1=1 PTIN AROOSHIAN LAURA K self-employed SSWITIN In Foreign Third Party 52 Co
Entities connected to both Joi Ito and Preparees