ment to: Katsky Korins LLP, do Midway Investors, 270 Lafayette Street, Suite 409, New York, New York 10012, Attention: Maria Gruber. 3 Purc aser's Nalme - Please Print Social Security / Tax I.D. Number ?9,C1 e-Pnior e e te til,Ki2 • 3?,(-3 oil z, Address Telephone Number "2-- 1 Address Fax Number ,