CONFIDENTIAL SDNY_GM_02742883 EFTA_00229532 EFTA01325076 a Wfrr""W""li IlIllPMIIIIIIIIII. g•e/ y at en--N — a e,44,-/ ,fr.;ex, ... -f- in Infant( esi - - Czrj th e 644,4-3 p/ to, _ 404,9a—frad--. ) 6 /5',/ cht,bihYreki ffri s cuintsi eTivi.. it /melts AA-I il- /Arai Cornnur ai okfie (5

within the state upon a parent or any guardian or any person having legal custody or, if the infant is married. upon an adult spouse with whom the Infant resides, or, if none are within the state„upon any other person with whom he resides, or by whom he is employed. If the infant is of the age of fou

nation U Induced termination O None Date of 4.1Rome mm/CayvYY / / Did tobacco use contribute to death? u Yes U No U Probably UN. For Infant under 1 year: Name and address of hospital or ocher place of birth EFTA00133108 co NYC OM oo of Chief Medical Examiner DEPARTMENT OF HEALTH AN

d Interest Day n period period Cap amount 0) Your total assets value on Nod 30 I» veKentege of COP EStra3ted your account IMPS (S) annual Infant (SI UnfeaSZed gan or ID% (S) Cash Cash sad money Wanes Total $3,238.24 100.00% $3,238.24 323024 100.00% 323524 SONY GM 00025316 ANP7COCR