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HEXSYSTEM Repel Result I Accent file One p entity one pie and each signer, if applicable NIA rlift AR illava- /OW Business Name E Oti fat Amami Me Photocopy of original document / V Territorial EICCOOR COMMiSSiOn Certification e Account file Applies to candidates for government electiv
e Ste* 2. Coley Pat you aro ht1 to your!.;•ornctld.a 3. Clan asset vent begun wen/nape • you ant • US. 04w491 prow e ear at W. Onto, err a • US. Oaten. Ate Inetem Poo or f ee poinrap tore tom a U P. tads or blii1441114 not outtsci to he athoeiro W Cr tzar parer chant cl otiocrng =rowan nen. and &
te rend d but, nadrg to nek of loss of tee eat nonerent You <an <hinge your fradtr maul ems INN* Core Sepreos or by antacta0 your fount el Achnor Amami overview • vaLe of axe accoundpardo* Net of asses and kiaThies. • Agtil Wili4t3 444bl? ‘afh brances..ales fa fordedtaunt/ (tilted Gobi Time Depor
count value $18,674.31 $18,674.31 Dividend and interest income earned for puposes d Ws statement. taratally or honest and clMcItnd Income Rs been Oaten/tied Pane us leParbna manse Based room the residence Cl the account haat. account upe. ce pro:1W type. scene Interest Mod deklendpayments may not b
ECIAti(P3 IcieninIcatton number gARP:rnI3.75!k., REOPENS name super addles, reclisling apt. nal Cat stela and ZIP code KiflittigCnerSai .... - Amami number Poe InZ aa rsarak 164 section 409A Olden* 260 Tin not 1311Sostba 409A income 0 1 Rants $ 2 Royabee 5_ 3 OS lame $ OMB Na 1945-0113
$ I Fbenp box proceeds 3 Cthor Incas 4 Mad Mow in Medd PAYERS Weed rearm:SA.9m RECIPE/41'3 lantadal rat Mint. • 66-0585379 RECIPIENT'S dint Oaten. seal v coda ?NM aOFFHAN P.D: AiXOunlmoter (0135a130 $ 7 acre pi>ya COnt:0.1 NMn 0 Sit011u:c perils trate el theta 9 arta For Privacy Act and
GHISLA1NE MAXWELL Friendly account mime: Ind r Account number. Your Finandal Advisor: SCOTT STACK MAN/LYLE CASRIEL Oak Activity Description Amami (S) Dividend and intewstincome Taxable dividends Sep 3 Cividend UNITED PARCEL SERVICE INC CL 8 PAID ON 1061 71087 Sep 9 Cividend JOHNSON &
ame se not hi...toed - Ed Waled awl name and anent vital fa Conan VeSOI *cokes mutt etude a reit* of winciga or Gehl OM Ankh Calethe eSt Mane (aid Oaten yeld)would !powwowed - Stunted anal name aid Grew Weal aid fan artua matte ald need mght be awes hgher thm the tokwated amuses - An tritinate ol
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