ure -, Authorizer's Name & Ext Stamp Authorizer's Signature ClientiCalter Name: tic—CT ek,lie r- Client Telephone: _ (.51-1 in — s62-9 Back Name: JANE YOIJNG •-79 Zei Back Signature: L Call Call EFTA01591689 Call Back Date/Time % I I c...7 ia.05F.rr, Obtained E I CMS/Global Hold Approval Not App