Name lira tan-) SIGNATURE(S) WERE VERIFIED BY: Initials Dem. No /Br. No.: / 3 41 Retain earn in branch for one year alter accoum doses.Then send to Pawling for additional retention e five years. 039020' (440) BRANCH COPY • 00 NOT SEND 10 CHECK REVIEW SB1062192-F1 11 EFTA00022007 --- PAGE BREAK ---