Epstein Secrets

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etary of State SDNY_GM_00 173784 EFTA_00 195439 EFTA01305684 IRS CEPARNMIXT CF STATE - CNISICN CF ~ATKINS It atfleCO lit& glealal SI*Miallf, Pan A 1371614 0611997 I *too I r ::aturacatuar. NINE EAST 71ST S1TOF2ICORPORATION I 1 a- - I cooloteranon 72—fainar ~3 OF. THE CHEEP EXECUT

egal, valid and binding obligation of the Investor, enforceable in accordance with its terms. If the Investor lives in a community property state in the United States, either (i) the source of the Investor's Capital Contribution will be the Investor's separate property and the Investor will hold the Interest as it

r (5)-(10) set forth in Part B of Section V of this Questionnaire, the Investor may skip this Section VI. Otherwise, the Investor should proceed to Pan A below. A. FINRA Rule 5131 Covered Persons Please initial either "True" or "False" to the following statement. If the Investor initials "True" to

reign person. and pay the withholding tax. Therefore, if you are a U.S. person that is a partner in a partnership conducting a trade or business in the United States, provide Form W-9 to the partnership to establish your U.S. status and avoid withholding on your share of partnership Income. Cat. No. 10231X Form

of Rule 5130. K The investor wishes to be treated as a "Covered Person" for purposes of Rule 5131. if the Investor checks any of the boxes in this Pan A, then (i) the Investor may not be allocated profits or losses from Fund investments in "new issues" and (ii) unless the Investor also completes Par

ted in P.B. County. O O D. The parent is employed on low rent housing located In P.B. County. O O E. The parent is in the uniformed services of the United Slates. O O If E. is YES, is the parent on active duty? Check service below: 0 Air Force O Army II Coast Guard MI Marines O National Guard O New (11

Date: Temporary Medical Exemption PART B (Foe preschool children, children in day care and school childitn who are incomplete for immunizations in Pan A=l' of A-2.) Invalid without expiration date. DOE Code 2 1C0116* that the above named child har received the immunisations documented en she men* si