- VISA - Visa Purchase -7.91 2,002.90 06/28 ALI BABA ORGANIC MARKET NEW YORK NY Jun 30 Withdrawal - ATM - #003624 -400.00 1,602.90 MCU 90.15 QUEENS BLVD. MALL QUEENS NY A1A12010 Jun 30 New Balance 1,602.90 Totals For This Period: -4,546.64 5,273.46 SIGNATURE L 21 Date Transaction Late Amo

Insured's Name: TERJE ROD LARSON Please Address Inquiries to: Caring People 118-35 QUEENS BLVD. 1st Floor Forest Hills, NY 11375 Call: 00 - CaringPeople Invoice No: 245243 0 ALWAYS COSINICTFO - Ls! 'Wein NI.‘$.(1 & Fl. *** COPY *** Cli

- VISA - Visa Purchase -7.91 2,002.90 06/28 ALI BABA ORGANIC MARKET NEW YORK NY Jun 30 Withdrawal - ATM - #003624 -400.00 1,602.90 MCU 90.15 QUEENS BLVD. MALL QUEENS NY A1A12010 Jun 30 New Balance 1,602.90 Totals For This Period: -4,546.64 5,273.46 SIGNATURE L 21 Date Transaction Late Amo