urity/4x ID Number 66-0799192 Social Security/Tax ID Number: (Secondary if applicable) Account Type (select one) Individual — (Non IRA) OTruSt OCOrp/SUSIneSS D0GMAUM% ElEstate El Traditional or Rollover IRA El Roth IRA K Beneficiary IRA K Beneficiary Roth IRA K Qualified Plan (401k. 4038, P