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K NY 212.957.9200 Description TAXI: 6G91 1039 10:52 5636 05/07/12 PURE FOOD AND WINE 8NEW YORK NY RESTAURANT TIP $5.00 $8366 05/07/12 Polo Ralph Lauren 08New York NY Polo Ralph Lauren $137431 05/07/12 CANDLE CAFE 0036 NEW YORK NY 212-472-0970 Dna IptIon FOOD/BEVERAGE $3022 05/08/12 GRACE'
TAXI: 6G91 1039 10:52 5636 05/07/12 PURE FOOD AND WINE 8NEW YORK NY RESTAURANT TIP $5.00 $8366 05/07/12 Polo Ralph Lauren 08New York NY Polo Ralph Lauren $137431 05/07/12 CANDLE CAFE 0036 NEW YORK NY 212-472-0970 Dna IptIon FOOD/BEVERAGE $3022 05/08/12 GRACE'S MARKETPLACE NEW YORK NY 212737
a Physician. The following items are hereby removed from the TERMINATION a CANCELLATION section: the date the Covered Person no longer maintains a Permanent Residence in the 50 United States of Amenca. the District of Columbia. Puerto Rico or the U.S. Virgin Islands: the date We determine that the Covered Person o
521.10 11/24/12 CHANEL 03 3 PALM BEACH FL 800-550-0005 Description WOMENSAcca, SPECIA 31,99280 11/24/12 Polo Ralph Lauren COPalm Beach FL Polo Ralph Lauren 11/24/12 Polo Ralph Lauren 00Palm Beach FL Polo Ralph Lauren $4212S 51,163.88 Fees Amount Total Frws for this Period 50.00 AMEX000424 Con
PALM BEACH FL 800-550-0005 Description WOMENSAcca, SPECIA 31,99280 11/24/12 Polo Ralph Lauren COPalm Beach FL Polo Ralph Lauren 11/24/12 Polo Ralph Lauren 00Palm Beach FL Polo Ralph Lauren $4212S 51,163.88 Fees Amount Total Frws for this Period 50.00 AMEX000424 Continued on reverse SDNY_GM_02
re and supervision. Coverage will be extended for as long as such child is incapacitated, unmarried and dependent.). All Covered Persons must have a Permanent Residence within the 50 United States of America, the District of Columbia, Puerto Rico, or the U.S. Virgin Islands. All other persons are not Covered Person
gy/12/1 2 NYC TAXI MED 9C29 09NEW HYDE PARK NY 7184100472 $940 09/12/12 AMAZON MKTPLACE PMTSAMZN.COM/BILL WA MERCHANDISE $25.85 09/12/12 Polo Ralph Lauren 00New York NY Polo Ralph Lauren $321.18 09/12/12 CONTAINERSTORELXNGTNNEW YORK NY MISC HOME FURNISHINGS $30.44 09/12/12 $235.15 BEDBAIH&BEY
EW HYDE PARK NY 7184100472 $940 09/12/12 AMAZON MKTPLACE PMTSAMZN.COM/BILL WA MERCHANDISE $25.85 09/12/12 Polo Ralph Lauren 00New York NY Polo Ralph Lauren $321.18 09/12/12 CONTAINERSTORELXNGTNNEW YORK NY MISC HOME FURNISHINGS $30.44 09/12/12 $235.15 BEDBAIH&BEYONDO0651 TOTOWA NJ 973-7854333
a Physician. The following items are hereby removed from the TERMINATION or CANCELLATION section: the date the Covered Person no longer maintains a Permanent Residence in the 50 United States of America. the District of Columbia. Puerto Rico or the U.S. Virgin Islands. the date We determine that the Covered Person
ACIOUS STYLE INC SLOS ANGELES CA 8888287170 Description Price GIFT, NOVELTY STORE $208.00 $208.00 02/19/13 Polo Ralph Lauren 00New York NY Polo Ralph Lauren $448.78 02/19/13 VERA WANG BRIDAL HOUNEW YORK NY 2125756400 Description Price WOMEN'S READY-TO-WE $4,935.00 $4,935.00 02/19/13 CHILEWICH
il Continued Amount 02/17/13 GRACIOUS STYLE INC SLOS ANGELES CA 8888287170 Description Price GIFT, NOVELTY STORE $208.00 $208.00 02/19/13 Polo Ralph Lauren 00New York NY Polo Ralph Lauren $448.78 02/19/13 VERA WANG BRIDAL HOUNEW YORK NY 2125756400 Description Price WOMEN'S READY-TO-WE $4,935.0
re and supervision. Coverage will be extended for as long as such child is incapacitated, unmarried and dependent.). All Covered Persons must have a Permanent Residence within the 50 United States of America, the District of Columbia, Puerto Rico. or the U.S. Virgin Islands. All other persons are not Covered Person
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