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O NOT mail cash fend entire form, completed and with $900 fee. in the self-mailer envelope, to the Department of State, Division of Corporations, 41 State Street, Albany. IT 12231-0002 9tenniar Statement, Part C — Signing .." ,o-CICC-v"• -r1;• &Niter_ PfURT OR TYPE MAW OF OGREN Se hurt( aawr " STATEIMP
ons. Please note Farm Corporations must file a paper form. PAPER FILING: • Farm corporations are exempt but must notify the Department by checking the Farm Corporation Exemption Box below. completing the signer information section and mailing this form to the Department of State at the address on the reverse side of this fo
O NOT mail cash ;end entire form completed and with $900 fee, in the self -mailer envelope, to the Department of State, Division of Corporations, 41 State Street, Albany. IT 12231-0002 9iennial Statement, Part C — Signing C1/4 tet_ PRINT OR TYPE NAME a SIGNER s e,_re.trAss-i FM" OR surrnrrtnagr :mica DE
ions. Please note Farm Corporations must file a paper form. PAPER FILING: • Farm corporations are exempt but must notify the Department by checking the Farm Corporation Exemption Box below, completing the signer information section and mailing this form to the Department of State at the address on the reverse side of this fo
NOT mail cash ;end entire form, completed and with $900 fee. in the self -mailer envelope, to the Department of State, Division of Corporations, 41 State Street, Albany. VI' 12231-0002 918=31 Statement, Part C — Signing PRINT OR TYPE NAME OF SIGNER Set— %re._ jr-Cx-lr PANT' OR All sr, mow h CAT SIGNER
ions. Please note Farm Corporations must file a paper form. PAPER FILING: • Farm corporations are exempt but must notify the Department by checking the Farm Corporation Exemption Box below. completing the signer information section and mailing this form to the Department of State at the address on the reverse side of this fo
Entities connected to both State Street and the Farm Corporation Exemption

Jeffrey Epstein
PERSON
American Express
ORGANIZATIONthe State of New York
LOCATIONSouth High Street
LOCATION
Prince Andrew
PERSONSchwartz
PERSONDarren Indyke
PERSON
MasterCard
ORGANIZATION
Columbus
LOCATION
NEW YORK NY
LOCATION
New York State
LOCATIONthe Department of State's
ORGANIZATIONthe City of Albany
LOCATIONTaxpayer Assistance Bureau
ORGANIZATIONthe Principal Executive Office
ORGANIZATIONThe Certificate of Dissolution
ORGANIZATIONParts 1
LOCATION
George W. Bush
PERSONAlbany
LOCATION
Les Wexner
PERSON