Not aonficable City, S te and Zip Code City. Slate and Zip Code Nome Telephone Number Business Telephone Number brrjairth Data of Birth Name of Empioyer Name of Employer Address Address Not applicable City, State and bp Code City. State and Zip Code Notice of Customer Identification Policy I

****** Case Number . : 1-05-000368 Street Number : City ST PALM , Birth Date/Age : cupation . . : home Phone No. : Sex • Last Name . . Empioyer? . . : Oper Lic No. : Female Race Height 0 EFTA00182269 Date: 4/20/06 kflAJM BEACH POLICE DEPARTMENT. Page: 11 Time: 13:02:26 Incide