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COMMERCIAL INVOICE (Factura Comercial) Page I or 4. SHIPPED PROM (Emit cle): Tax IDNAT Na. (No de kleraltectok Coosa Name (Norritte): Telephoto No. (TIMOtoM &MO (Chian Comps, NootaiNIMme (CottoonlailMeCtiOn): LSJE. LLC 6100 Red Hook Quarter St Thomas. VI 00802 Country (Pa): Pain b Tamale= r Related (Vostade00) I7 tionmiesod (No Vmulado) Des (Nona 6111119 a W•Malll No. (CamOrmento 8068-6745-7521 awoke ROAN° a Purchase Order No. Payment Tomo leminco ot Erman:y.4X bFORM* (No de Omen to Corroral: de Pico) FOR OPTIONS Not UM (No In Vend00) Calm (OM) IncManna Onoottiamy sit.CT cots ARROW Reason for axe SoMNeadido) SHIPPED TO Mestiseteriej: Tax OMIT No. (No a•efenelleectes): Comae Name plantaid: Leese Groff Telephone No. (Toildcro): 1.212-750-9895 taw (EMMY Cooper, RentalAdOress SOLD TO (genie a): Same as SHIPPED TO Pouel quo el donnas:to): Tax IDNAT No. (Nods IdentamtclOnt Contact Na (Noveret Telephone No. (TOIROXI) !-Mail (E.Mel): Company fflaaarsof (Cooseniocinatap Country (Psis): (CompodeeteCana Lesley Groff 9 East 71st Street New York, NY 10021 Country (Pals): NC P 0/ PC- at Ualle IN° TC) "I USX of Modems Nodal de Waal Destriadon of Goole (Meholing Katmoriod Taff No.) (DemnpoO, (lo le U.n (Coo No de GoOmocton aralarial) 0 (Poe do Orlorn Value CM (Prom uneeno) Total lfshe (Prom Tout) (Ne Pewits%) 1 I Breathing Machine Canada 1000 00 0.00 0.00 000 0.00 0.00 Total No. of Portages (Too de PSSION): 0 Sublotel 0.00 (SICIONir- Total Were Sella* PAW or icest(POIO TOM (En Ms o ICOMX KGS Addidoml Churn cantos sokonroon 000 sow.' ItaolnaRbona r spedMest laa atom* (Stigur0): 000 onstrucclome (fi t Maw 0.00 (Embalms): .00 0 0.00 Drattool: Cone Wu Fee iorKoranos Casseam) 0.00 Declaration automata.) :Cectometnleall: Personal Breathing Machine Other cora 0.00 imago Total (Tots) 0.00 gsrreRoo cierea ssa ode 1: tureTtle (Par,. Clo) DeclenamitruM0) Date t echo EFTA00316614