icial Owner (If required) Please provide the following intorrration for an indeiduaks). Warw. who. cite* or Indio" through any contrfl arrwatemant, Øecdadeip,relaØshi or othwvase owns 20%& more ti the equity testate Of the Ie9al entitylisted above. 5. First Name 6. Last Name 7. M.I. 6. Date of Birth 6