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Au t hori7ed Autherized Physical (Home) , Signer (Complete the following informatics. Signer Maine: a tr y grey ee..s.-.., 'nr eacr authorized Stoner.) Gender: M EfiFD Corporafe Personal Mane Address: . ~en- to t Tie: Ille..L - Address: L.tcc. sr t Takeo. ( s • -- o • .. t I" Tr 0. -2
tain the folovang inform/eon and dodsnonl in the Othitoeseons at pace of Business Icon (copes on Ale): • Purpose and objective demi activities • Capri orlon gnaw* • The donee and vol niter base • Funartg and disburoment criteria • urn cordrhuthre tathiatgiLitiviabie Gnaws -'..\ I e arena th
ene> ef Do :Chime eallenoeyne a16nd le es.xeted Stone Atkin., Illy Sunt. &ale Men Ennal Addrox L
0~ a« Ire litre tMin aim wt. 14 if any' .va nnit aa... be dial name• penwil • 4.44. Ile 44 • J &Iloa' Nlltrriu bV.S carie • 0. a nee, ~Inn In Capri dial, ice% aial •• • I 4004 44.0a in net 'yin Lyn west. ova S Sow tae introit Ina tit, n'11 Dorn Ono in ern non./ rinnni It el a Ma 000810 *
try aament a Marl cleaned Lary radar hwpoNCtArps Stone frpt,J. totivr.sag akerX Cr* Cierges aux:09a" 0)
w... me " -MC <r10 i• C //IA* HIS.< Check. 1864 Amount. $2.000.00 Date: 06/12/2018 foltr -tild I li-ma• 4a04Men, -7 0 Oloilemt OCSES 4 Capri •C•3 • , Check 1862 Amount: $617.00 Date: 061312011 ii.,'•ac. t .4 M37 .. .•00 4 44 4.11 • • ta.2,- C:28"; C • . g. •••4.0,44Ifi<
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