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unt(s) to which this Self-Certification relates. Darren Indyke Print Name IL 04-28-2016 Data (mm-<jd>yyyy)
to which this Self-Certification relates. Darren Indyke Print Name IL 04-28-2016 Data (mm-<jd>yyyy)
unt(s) to which this Self-Certification relates. Darren Indyke Print Name IL 04-28-2016 Data (mm-<jd>
Note: Please indicate the capacity in which you are signing the form (for example Trustee, Corporate/Individual Director, etc.) Account Number(s): INTERNAL USE ONLY: WM167679 023611.041518 Page 2 of 5 Entity Self-Certification Form Appendix 1: Controlling Persons Appendix 1 must be completed for eac
unt(s) to which this Self-Certification relates. Darren Indyke Print Name cOvljLt>.^ Signature 04-28-2016 D
to which this Self-Certification relates. Darren Indyke Print Name cOvljLt>.^ Signature 04-28-2016 D
unt(s) to which this Self-Certification relates. Darren Indyke Print Name cOvljLt>.^ Signature 04-28-
ecretary Capacity Note: Please indicate the capacity in which you are signing the form (for example Trustee, Corporate/Individual Director, etc.) INTERNAL USE ONLY; Account Number(s): WM167679 023611.041516 Page 2 of 5 Entity Self-Certification Form Appendix 1: Controlling Persons Appendix 1 must
unt(s) to which this Self-Certification relates. Darren Indyke Print Name Signature 04-28-2016 Date (mm-dd-y
to which this Self-Certification relates. Darren Indyke Print Name Signature 04-28-2016 Date (mm-dd-y
unt(s) to which this Self-Certification relates. Darren Indyke Print Name Signature 04-28-2016 Date (
reasurer Capacity Note: Please indicate the capacity in which you are signing the form (for example Trustee, Corporate/Individual Director, etc.) INTERNAL USE ONLY; Account Number{s): WM167679 023611.041516 Page 2 of 5 Entity Self-Certification Form Appendix 1: Controlling Persons Appendix 1 must
Amount Sender Nm • $200.00 TALL GULNORA $300.00 INDYKE, DARRENK $200.00 KAHN. RICHARD City BK BOCA RA
2019 10:04:21 AM Lac Trans Type NYM Western Union NYM Western Union NYM Western Union Amount Sender Nm • $200.00 TALL GULNORA $300.00 INDYKE, DARRENK $200.00 KAHN. RICHARD City BK BOCA RATON St Zip Phone NY 11223 FL 33496 ■ NEWYORK NY 10021 User ID: TF14688 Page 1 of 1 EFTA00055516 D
Removed] SS 8/4 12:00 B.' 8/4 12:25 ;4141 6/5 08:34 9 NORTH 8 Annual Leave <Unassigned> (Inserted Ncsi (Sick/Annual] SHU N2 (Inserted RCS( INTERNAL 8 <Unassigned> 2 <Unassigned> (Sick / Annual) RW 8/5 08:34 [Sick/Annual( RW 8/5 08:35 [Sick / Annual( RW 8/5 08:36 10/2019 10:46:56 AM EF
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