4
Shared Docs
4
Same-Page
6 / 4
Mentions
• a nt or subscriber information form ot in nether document provided by Me Subscriber to the Fund or any of es Alines The Undersigned coteries that the Used States is his, her a its country of residence or principal irtrtul MN; place of business Of undersigned cannot make this overwind,, please talk to your F
de through a LABS ad.-tatty program. ON Meese check the appropriate tor below that most accurately describes the Undersigned. fAn individual mat is a United States Person (inducing his or her trims) 0 An individual that is not a United Sul& Person (including hrs or her ousts) OA br0ker-dealer O An InSuraree
only it you we • US. pence ercksang a resident Mere. to evade your correct TIN 10 the mason resetting it tee requested and. when applkaele. lo? 1. Cerny and the TIN you as Pane y cowed for you we nen° bra number 10 be earwig. 2. Orly that yea we net stated to backup wateteng. a. Cr exempren torn ba
validly completed Internal Revenue Service form W-8BEN, W-8ECI, 1/4 1-8EXP or W-13IMY or any equivalent successor form as may be appropriate to your United Stales taxable status at account opening. V. TAX REPORTING FOR U.S. CLIENTS HOLDING NON-U.S. DOLLAR SECURITIES U.S. tax laws are quite complex and constant
who is • U.S. St an or U.S. radont an, • A partnahip. corporation. oompay, a afiroation created a canton in the Van Stabs, or under the lave of nor United Slates • An beta (0•Mt than • forint settle), a • A domatc trust (as defined In Regulatko•sectkes 301.7701-7). Sad° rules for perfrenthee. Partnership, t
on away • Mho requeetery and, ern reffaceas. to 1. Certify that the TIN you as giving is cornet (or you we wailing for a number to be issued). 2. Cerny that you ere not oubeol to booing, withhold/19, or 3. Claim earrogon from backup wIthhabg If you are • U.S. exempt par Napoleon, you a see certify
EM1 mourn 11/27/01 11/21/01 BOUGHT OUINSILVER INC 20K 600 14.01000 8.457.00 EXECUTION BY BUCK COLOAISS3DN 31.00 11/28/01 11/23201 SOLD AMERICAN EAGLE OWE-TITERS INC NEW EXECUTION BY WHO SEC FEE .18 CHILORENS PLACE RE7M. STORES INC EXECUTION BY NET COIMAISSION 8.00 SEC FEE .23 GLOB
960 17.189.88 EXECUTION BY BUCK COMMISSION 18.00 TOTAL 5.1.837.488.11 51,130,413.27 DEPOSITS AND WITHDRAWALS W. Stoma Storms Cop. 1.1estach Cerny R&M flicodyn. War Rot 11201.3859 (212)2124000 INTERNATIONAL CHARITABLE sTATENERT Pesco September 29.2001 ThillOtIC20 Dabber 26.2001 ACCOurer N
07/08/04 07/08/04 BOUGHT BOUGHT UNITED STATES TREASURY NOTE MO5/1572007 03.1259991 15 0988726998099 YEN 2.908 % 10 'MUM GVER REF a G1901000 Al UNITED STATES TREASURY NOTE DUE 06/30/2006 02.750% Xi 30 0988728291099 Yon 2 521 44 To wouPirt OVER Rri ir 01 901002 A3 912828003 912828C/4D 027 25,000.000
reverse ilde for &gratin Marren 027 1601/04.077.9 p. 710 EFTA01320941 GLUM 1,00113.1 ITS %%are Owe Sei()My Ow Sows Wulies tap. One Merote:x Cerny licrth Bo P.m Yen 11201.3859 FINANCIAL TRUST CO INC 2 a•3 0 -n z C in z -H r SSLOSE00- 019- ANGS STATEMENT BACKER IS PRINTED ON THIS PAGE
Entities connected to both United States and Cerny

Jeffrey Epstein
PERSON
George W. Bush
PERSON
Ghislaine Maxwell
PERSON
New York
LOCATIONDarren Indyke
PERSON
Julie K. Brown
PERSON
Samantha Power
PERSON
New York City
LOCATION
NEW YORK NY
LOCATIONDoug Band
PERSON
Joi Ito
PERSON
Vicky Ward
PERSON
FedEx
ORGANIZATION
JPMorgan Chase
ORGANIZATION
Naomi Campbell
PERSON
Madison
LOCATION
Alaska
LOCATIONSouthern Trust Company
ORGANIZATION
Ralph Lauren
PERSON
Bear Stearns
ORGANIZATION