(and attach to this form). fist Name Rich Data <4 Ea. C0MMIM Penes TY9ORCI. President CounarfOnantles of Tax Residence LAS! NstritKah n US Is Conlreare Pell e', a non-US Benefioaryfran-US Bentfical Owner First Wane J e ffrey Dale of Birl COMMYCOuntiket of Tax ReSalenee US Virgin Islands • Is Conflhing