Case File
efta-01381921DOJ Data Set 10OtherEFTA01381921
Date
Unknown
Source
DOJ Data Set 10
Reference
efta-01381921
Pages
1
Persons
0
Integrity
Extracted Text (OCR)
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IL Certification of beneficial owner(s)
Persons opening an account on beha€f of a legal entity must provide the following ir.forrnation:
:I. Hanle and Thie of Nature Pe;sor Opening Account:
TeOPIreil
‘ r let..., b. NBn1-5 of Legal Entity. Type. of Legal Entity. wid Address or Legs! Entity
the Account is Fiaint; Opened:
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r
ki nsat.uc. g ) k—D,SQ I
O
41,1a 0
- 1 it 7 ini,)Mtatir, Or .?3Ch
4t0. drretItii Or indirectly. through *Iv contrTc.t. arrangement,
understaitoing, ielationship or ott-terwiSS, Owns 25 percent ni mole of the equity Interestsof the regal entity listedabove.
Date of alrth twat, c efatylsoo P.,(114toVQ.... rcri usut bean..
p;;I. LI a P3130031
It umber set
Peierit
(.90+ tootrcu tc-ittttnallitea.
to Social Seam') S011bOt}
-Aar Non•u!..S.!isenit. zee...Avon vi 3 rkeitsi S......czutity Montero! ti !!'eanxin ff.miew !chat counly, Of .miarr..4 rso otiN.
rat.o!, rmi4
!-,!snitnt or! AY)! rTI of issalOrtti
. ett to? olfitz ;Int MA Wye!. intFOCI 006^Unlent evilest:tog ',atonality or /#70dEsttEd ann Naing a prmograoti tx
3.)lecpata stoAts t'a ce..widod.
(If 1%0 iterth!i•itml meAs d!HislIttiti. *ono !mg, e "%to:AO:table 1
ci. The following information for one inr.lividual with significant responsibility for managing the legal entity listed above.
such as:
• An OXLiCtniVti officer or senior menace! (e.g,. Chief Executive Officer. Chief Financial Officer. Chief Operating Offcat,
Managing Member, Ganef& Partner, President Vice President. Treasurer): or
• Any other who reguiariy perfixins similar !kinetics''s.
(If appropriate, an irecividual listed under section (c) above may also be listed in this section (d)).
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to
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- rot "rua.US ptA itt.;.,
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N5humint >Wrte, with Cotxr-efti ittustut,a, uen "Yin.
I :Int ter, auTfthr. or pass*, min minor, of itiWartt of sr.. 09* gowto men t 411440 dot:it/nets eviot•nrirg n liCnahh c ItleffiNit Elnl:13,41110(1.1 nIntoq:30 0! -IntulOrtotfitottul
+e t
(name of natural person opening tha account), hereby sanity. to the best of
err, nowlelge, trpt the int able onmlete and itOiier.:t.
Silts:St ktontitior (ttstt tong)
20 :81)4u:who 94o,k AO. Ali (19itts tesernm. ViM1£9866 le IS
CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e)
DB-SDNY-0081129
CONFIDENTIAL
SDNY_GM_00227313
EFTA01381921
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