and date and sign each sheet. NG\N -PRsspoe-c- Ey laNetk0NI LDS Mll e L6S Form I-102 10/19/17 N Pogo 2 of 4 EFTA01699764 -.Taii.4 Stateinent,tlitirlOafiOns;Sitiiiiiiiiiarid. : :skulitqtjfifOrm4tion,Altke MIppliMpff, NOTE: Select the box for either Item Number la. or 1.b. If applicable, select the box for Item Number 2