J. EPSTEIN FOUNDATION I 2 Erni:gayer raentif 'cation number It none, see instructicins.) lb c/o Name (it aomicaore) 3 Name are temonone number of aerson :o oe contacted if aoditional information is neeaea le Aooress (number. street. and room or suite no) 457 Madison Avenue Id City or town, state. and ZI