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EFTA01702202
ang apt no.) Rellport NY 11713 Acava Rims« fus, 15a Seellon 400A Cantata S RECIP/ERTS Idexttlicatton 2ndllN not 15b Section KRA IØ6 1 Raae 2 Bogaltrao $ 3 Other income $ S Ss:1nd bee: pm:~ 7 rederoptowa conprnade . . $ 1000.00 0 ravmode dnd Sala of 35.008 er more et Caft521M2r ROX.1.13 to
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