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ES 04/24/04 CARMINES GOURMET SPALM BEACH GARDE FL 338.79 28 GOURMET FOOD 04/26/04 PUBLIX STRIP 0161 PALM BEACH FL 64.72 GROCERIES 04/27/04 GRACE'S MARKET NEW YORK NY 362.25 09GROCERIES 04/29/04 GRACE'S MARKET NEW YORK NY 123.01 09GROCERIES 05/01/04 GRACE'S MARKET NEW YORK NY 159

TH DATE 154) NAME OF GILD SCHOOL ATTENDING STUCENT NO (OPTIONAL) GRACE BIRTH DATE (55) NAME OF CHID SCHOOL AT HEADING STUCENT NO. (OPTIONAL) GRACE SIREN DATE ISO) I VERIFY THAT THE INFORMATION GIVEN IS TRUE AND ACCURATE TO THE BEST CF MT KNOWLEDGE. SIGNATURE OF PARENT OR AGE( GjAROIAPT WTI

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5537 NY NYC-TAXI NEW YORK NY NYC-TAXI ASTORIA NY THE HEALTH NUTS NEW YORK NY NEW YORK New York NY TRANSACTIONS THIS CYCLE (CARD 2807) $7,670.05 GRACE'S MARKETPLACESSS NEW YORK NY DUANE READE #14151 NEW YORK NY EXXONMOBIL 97466866 JAMAICA NY GRACE'S MARKETPLACE NEW YORK NY GRACE'S MARKETPLACE NE