45 PARK AVE 26TH FLOOR NY,NY10154 C137 Meng Firm ;Mons Number (Romero* 1.2 - Wig - 01t6_3 ContrarDebyering Firm Ernst Account Typo (select one) K Individual - (Non IRA) K Jaim ❑Trust ElCorpiBusIncss K UGMAfUTMA ❑Estate K Traditional or Relies IRA K Roth IRA K Beneficiary IRA K Beneficiary Roth IR

trationMtle: SOUTHERN FINANCIAL LLC iiiii i l /Tax ID Number: Social °curly ax ID timber. (Secondary. if applicable) Account Type (select one) K Individual - (Non IRA) OJoint K Trust DCOrp/BuSineSS OUGMANTMA OEstate O Traditional or Rollover IRA Ei Roth IRA O Beneficiary IRA O Beneficiary Roth I

ethod of communication: ❑E-mail ❑Fax ❑Regular Mail (Please use additional sheet, if necessary) • CATEGORY OF INVESTOR (Please select only one) K Individual U.S. Person (including his/her trusts) K Individual Non-U.S. Person (including his/her trusts) K Broker-Dealer K Insurance Company K Investment

Investor is acting as agent or nominee for a Beneficial Owner, please check the item that best describes the Beneficial Owner.) Please check one: K Individual that is a United States person— (or a trust of such a person) K Broker-dealer K Insurance company K Investment company registered with the SEC

Investor is acting as agent or nominee for a Beneficial Owner, please check the item that best describes the Beneficial Owner.) Please check one: K Individual that is a United States person— (or a trust of such a person) K Broker-dealer K Insurance company K Investment company registered with the SEC

sregarded entity name, ri different from above 3 Check appropriate box for federal tax classification; check only one of the following seven boxes: K Individual/sole proprietor or K C Corporation D S Corporation ID Partnership O TrusVestate singlemember LLC K Limited lability company. Enter the tax cla

/disregarded entity name, a different from above 3 Check appropriate box for federal tax classification; check oNyone of the following seven boxes: K Individual/sole proprietor or K C Corporation K S Corporation K Partnership K Trust/estate singlemember LLC K Limited lability company. Enter the tax clas

3 Check appropriate box for federal tax classification of the person whose name b entered on line 1. Check only one of the following seven boxes. K Individual/sole proprietor or K C Corporation K S Corporation K Partnership El Trust/estate single-member LLC K Limited liability company. Enter the tax c

Investor is acting as agent or nominee for a Beneficial Owner, please check the item that best describes the Beneficial Owner.) Please check one: K Individual that is a United States person— (or a trust of such a person) K Broker-dealer Insurance company Investment company registered with the Securities

3 Check appropriate box for federal tax classification of the person whose name b entered on erne 1. Check only one of the following seven boxes. K Individual/sole proprietor or K C Corporation K S Corporation K Partnership K Trust/estate single-member LLC K limited hablity company. Enter the tax clas

r Income lax return) Business nama/disrerfarded entity name, if difforent from above e\i Check appropriate box for federal tax classification: y' K Individual/sole proprietor K C Corporation Q^Ctwporation 8 D Partnershp Q Tnist/estate 11 n Exempt payee K Limited liability company. Biter the tax classif

Name: Phone: Phone (Work): Home K Cell Phone: Phone (Work): K Home K Cell a. Owner of Record File No: E-07871 b. Sub-file No.: c. Cause No.: K Individual @Co 2. NEW OWNER (Buyer) Note: If more owners need to be listed, attach a separate sheet Attached? K Yes Name: Cypress, Inc. Name. Contact or Age