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STHAMPTON NJ OFFICE PROD. & SUPPLIES PAD.MOUSE,BLACK PAD,MOUSE,PRECISE SURFACE AT&T 25FT CORD IVORY

T FOOD 07/23/04 CEST SI DON PALM BEACH FL 98.79 MISC FOOD, SPECIALTY,C0 07/23/04 PUBLIX STR# 0161 PALM BEACH FL 81.64 GROCERIES 07/26/04 GRACE'S MARKET NEW YORK NY 333.98 09GROCERIES 07/27/04 GRACE'S MARKET NEW YORK NY 107.46 09GROCERIES 07/28/04 GRACE'S MARKET NEW YORK NY 31.

ES 04/24/04 CARMINES GOURMET SPALM BEACH GARDE FL 338.79 28 GOURMET FOOD 04/26/04 PUBLIX STRIP 0161 PALM BEACH FL 64.72 GROCERIES 04/27/04 GRACE'S MARKET NEW YORK NY 362.25 09GROCERIES 04/29/04 GRACE'S MARKET NEW YORK NY 123.01 09GROCERIES 05/01/04 GRACE'S MARKET NEW YORK NY 159

Not Hispanic O American Indian/Native Alaskan O Black, Not Hispanic O Asian/Pacific Islander STUDENT

TH DATE 154) NAME OF GILD SCHOOL ATTENDING STUCENT NO (OPTIONAL) GRACE BIRTH DATE (55) NAME OF CHID SCHOOL AT HEADING STUCENT NO. (OPTIONAL) GRACE SIREN DATE ISO) I VERIFY THAT THE INFORMATION GIVEN IS TRUE AND ACCURATE TO THE BEST CF MT KNOWLEDGE. SIGNATURE OF PARENT OR AGE( GjAROIAPT WTI

AO SAN FRANCISCO CA 8778877815 10/07/16 USER BLACK LIMOUSINE INC GOSO.COM Flushing NY sguareupxon

NADEEM HAMEED BUTT NADEEM HAMEED BROOKLYN NY TAXICAB &LIMOUSINE Description TAXI: 9A44 13.04 544 11th Ave 1401 859 Madison $16.56 09/27/16 GRACE'S MARKETPLACE03000003027928S $11736 NEW YORK NY 2127370600 09/29/16 MCA 623 New York NY squareupcom/recelpts 10/02/16 EAT MADISON 54292980

/05/19 CURB MOBILITY TAXICAB & UMOUSINE London Black Taxi 1 LONDON GB 22.66 PoundsSteding $30.04

MLSS•EASTFIELDS NEW YORK NY $40.05 8002561020 01/27/19 AU. TAXI MANAGEMENT ALL TAXI MANAGE 41-2536TH ST UC NY $7.25 718-361-0055 01/27/19 GRACE'S MARKETPLACE 000000000279288 NEW YORK NY 54231 2127370600 01/27/19 BLUEMERCURY THIRD AVE 0001 NEW YORK NY 5116.60 212-988-1141 01/27/19