XXONMOBIL WEST PALM BEA FL 57.37 01/18 THE HOME DEPOT 6320W PALM BCH FL 65.57 JANUSZ BANASIAK TRANSACTIONS THIS CYCLE (CARD= 56.905.99 12/26 CMS MEDICARE SERVICE MD 314.70 This Statement is a Facsimile - Not an original X 0000001 FM3333831 OCO N I ;O, 110 PagCS3 00225 NIA OA 74336 010100:00103074335

07/02 THE OLIVE GARD00011346 GREE NACRES FL 15.68 07/03 OFFICE DEPOT #2557 LAKE WORTH FL 25.21 07/03 THAI SHOKUN LAKE WORTH FL 20.03 07/06 CMS MEDICARE SERVICE 800-633-4227 MD 314.70 07/09 PUBLIX #1144 LAKE WORTH FL 107.27 07/11 PUBLIX #1395 PALM BEACH FL 9.88 07/11 FLORAL EMPORIUM KEY WEST FL 95.4

AKE CTY UT 40.00 032313 1 Y XAA XAA 03/28 USPS 11502604329417490 GREENACRES FL 19.95 03/27 OFFICE DEPOT #102 WEST PALM BCH FL 49.38 04/02 CMS MEDICARE SERVICE 800-633-4227 MD 314.70 04/03 BED BATH & BEYOND #55 W PALM BEACH FL 81.53 04/15 PUBLIX #1144 LAKE WORTH FL 69.66 04/15 THUM.. LAKE WORTH FL

5 W PALM BEACH FL 75.18 09/12 ICEBOX CAFE AT MIA MIAMI FL 16.58 09/12 AMERICAN Al 0010288274469 ST. THOMAS 25.00 091213 1 X XAA XAE 09/14 CMS MEDICARE SERVICE 800-633-4227 MD 314.70 09/13 PUBLIX 01144 LAKE WORTH FL 72.46 TRANSACTIONS THIS CYCLE (CARD 3309) $976.76 2013 Totals Year-to-Date Total fees

ALM BEACH FL 032313 1 Y JETBLUE 2792607698466 SALT LAKE CTY UT XAA XAA USPS 11502604329417490 GREENACRES FL OFFICE DEPOT #102 WEST PALM BCH FL CMS MEDICARE SERVICE 800-633-4227 MD BED BATH & BEYOND #55 W PALM BEACH FL PUBLIX #1144 LAKE WORTH FL THE HOME DEPOT 205 LAKE WORTH FL TRANSACTIONS THIS CYCLE (CARD 3

S PALM SPRINGS FL TARGET 00011106 LAKE WORTH FL THE OLIVE GARD00011346 GREENACRES FL OFFICE DEPOT #2557 LAKE WORTH FL THAI SHOKUN LAKE WORTH FL CMS MEDICARE SERVICE 800-633-4227 MD PUBLIX #1144 LAKE WORTH FL PUBLIX #1395 PALM BEACH FL FLORAL EMPORIUM KEY WEST FL 7-ELEVEN 32254 LAKE WORTH FL PUBLIX #1144 LAKE

PALM BEA FL EXXONMOBIL 97567358 WEST PALM BEA FL THE HOME DEPOT 6320 W PALM BCH FL JANUSZ BANASIAK TRANSACTIONS THIS CYCLE (CARD IIII) $6,905.99 CMS MEDICARE SERVICE 800-633-4227 MD This Statement is a Facsimile - Not an original Page 2 of 3 000 N Z 20 13/01/20 00225 MA DA 74335 314.70 02010000010007433502