Case File
efta-01362294DOJ Data Set 10OtherEFTA01362294
Date
Unknown
Source
DOJ Data Set 10
Reference
efta-01362294
Pages
1
Persons
0
Integrity
Extracted Text (OCR)
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II. Certification of beneficial owner(s)
Persons opening an account on behalf of a legal entity must provide the following information:
a. Name and Title of Natural Person Opening Account:
Darren K. Indyke, Treasurer
b, Name of Legal Entity, Type of Legal Entity, and Address of Legal Entity for Which the Account is Being Opened:
I Gratitude America, Ltd., a U.S. Virgin Islands not-for-profit corporation and 501(c)(3) private foundation
I 6100 Red Hook Quarter, B3
St. Thomas, USVI 00802
c. The following information for each individual, if any, who, directly or indirectly, through any contract, arrangement,
understanding, relationship or otherwise, owns 25 percent or more of the equity interests of the legal entity listed above:
Name
Date of Birth
Legal Address
For V.S. Persons:
Social Security
Number
For Nal-US. Fermis:
(See Immo:el for alternatives'
to So6al Semeity Number)
Not Applicable
1
For Nen-U.S. Persons. in 00Chhal to a Social Security Number ore Paieeport Number with Country of leathers* an alien identificationodd number, or hernber
and counny of taktanC4 of any other government. issued document evidencing nationality of residence and bearing a cewitograpti or Barad set:guard should
be prciftec,
(if no individual meets this dolinitlivi Mecca Mite 'NM Aaa4Caal0.1
d. The following information for one individual with significant responsibility for managing the legal entity listed above,
such as:
• An executive officer or senior manager (e.g., Chief Executive Officer, Chief Financial Officer. Chief Operating Officer.
Managing Member, General Partner. President Vice President. Treasurer); or
• Any other individual who regularly performs similar functions.
(if appropriate, an Individual listed under section (c) above may also be listed in this section (d)).
Name
DO:a of 84th
Lea Adecess
For US. Persons: i For Non-U.S. Persons:
Social Security
(See footnote 1. for altar:views!
' Number
I to Social Seemly Number)
Darren K. indyke
02/18/1985
2 Kean Court, Livingston, NJ 07039
For Non-U.S, Pe sons. inmidden to a Social Security Number ore Passport Number yeah Canny of issuunctr, w alien identificatson card number, or number
and country of issuance of any other goverment-issued document v.:Centel notionality ce residence and beering a photograph or similar safeguard skald
be nrcvioed.
I. Darren K. Indyke
(name of natural person opening the account), hereby certify, to the best of
my knowledge, that the information p
ided above Is complete and correct.
Signature
Legal Entity Identifier (OpliOntli)
August 15, 2018
Date
02016 Deutsche Dank AG. Al Fights reserved. 94818.5666 026819.051318
CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e)
CONFIDENTIAL
DB-SDNY-0051656
SDNY_GM_00197840
EFTA01362294
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