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I OR 12/ AMOCAllON Of noarmnolt a aidw4KNyt PRIMED 'IRV NAME AND IASI NAPA CONFIDE I NAAII D DNY_GM_000 10436 EFTA 00121090 EFTA01266736 Richard Kahn 5049 Comers Go: 0444/ Amble. LaBrn Nana 03632 From 34.461SIS Faa • 34776.412 THE UNTIED STAID \ARON ISLANDS OFFICE OF THE LIEUTENANT GOVERNOR

DE N MIS APFUCATION An NOWT 10 OntSIIDADON MID MAT AN! FALSE OR OIENOMIll MIAS TO ANY ENIESTION MAY ill GROOM COPAL OA ION Of MGISTIATION. al SI Richard Kahn doh, PRINTED ARP NAME MC LAST NAME • II THE LAST WORT OOPS NOT COVER NE PEPOD tm.DONTRY PRECEDED n* WORT PERIM COVERED IT DC RIPON. A SUPPIIMEMMY WORT

C_D • _ I NNW. Rua roomy INK AND CORRECT. WI MONADS TNT Mem ItIASIMER PERJUIY. Meta DIE LAW KNOWLEDGE MU ALL ST YO ENT EVOCATION Of PS:hard Kahn OF IM110 SIAM RUGS MANDL THAT AU. SIMMONS CONTAIN° MINT ATTUCATION AND ANY OCCO NO DOCWAINIE. An NAM IN nos ANDCAna. ARE WHICT TO NAUMANN, NO NAT

IA war alit MU AU MISS C INN INAS AU Waal MAN IN MI ANOCA ial it iL et ON n DOOM Paart NIVOICASION Of IISZIAD WSIZIN,= r • -• r) L . SIGNA OF RESIDENT AGE1S O "c. rri DA CONTACT NUMBER r- 7 . O 40)779-2564 N--_____) ni r -V - -::1 • o t MAILING ADDRESS 9100 Havensight, Port

rd will be in the name of Her personal information is as follows: Date of Birth: Social Security #: Home Address: I hereby grant permission for Richard Kahn to act on my behalf with any additional information that may be needed for this new credit card. In addition please mail the new credit card to Ric

e Address: I hereby grant permission for Richard Kahn to act on my behalf with any additional informat

equest. EACH UNDERSIGNED GUARANTOR ACKNOWLEDGES HAVING READ ALL THE P Tin Qt4WNTY NO AGREES TO HS TERMS. . GUARANTOR NAME PRINTED EPS ", e • fit] SIGNA DATE //al FORM a D90003 REVISED 0499 SONYGL102771441 SUBJECT TO PROTECTIVE ORDER PARAGRAPHS 7, 8, 9, 10, 15, and 17 EFTA_00258249 EFTA0133789

follows: Date of Birth: Social Security #: Home Address: 05/17/85 301 East 66 Street, Apt 11P New York, NY 10021 I hereby grant permission for Richard Kahn to act on my behalf with any additional information that may be needed for this new credit card. In addition please mail the new credit card to Ric

, NY 10021 I hereby grant permission for Richard Kahn to act on my behalf with any additional informat

GNED GUARANTOR ACKNOWLEDGES HAVING READ ALL THE FROWN yr THIS GUARANTY AND AGREES TO OS TERtes. . GUARANTOR NAME PRINTED ;Jr -FP 2.c". E.A3S -• SIGNA DATE FORM a 990003 REVSED 0-499 EFTA00186435 LL C ,..orptEaRATE AUTHORIZATION RESOI: BY: ocS, Referred to in this document as 'Financial Inst