. la. la le and 19 are rdquirod. 1. Nome of Individuel (Fint Midt», Last Nome) (or Entlty Nano) ZI1L( :? f feal pi t: Ett25"rn+IN gr‘ la. Type of Ctiontatneficial OwnorlAultionzod Party: 1-`4ZIJUltkr.74 2. Has an Account for Is Indivklualtmern cstablisInd sin»0(01103 1 7 Ø • No II Vas, list Account Numbors: 3. Date of elab: , L.