Pi i .---

Pi i .--- ce,, SS-4 (rbv Apre 20333 cowmen xt me taxes, in wane soma Application for Employer Identification Number {For um by employe" corporaticeis, partnerships, nut" «tat" churches. sewernment agencies. cedar Indltelduals. and others. s«Inetructiorts.) Ili Keep a copy let your minds. ....0 T.1.11.0 tam Alt I IF 5-0003 k i I 4 å4b t i 1 da Pritt egal, mend ism noductiond A rne[Lk F 4., . Se/Woes Co - .. 2 Trade mime or Mine« ill drerent from norm on be 11 S., Executor. tuna *car:Iname 'in lor e.'" k- I. iC<7 Pnevister.-., 1 — or tuts no) Sa Badness address Of «de tram ~OM on revs 4a end 4« Qty. state. and VP code ' t•-i (It.= t-6 - k ) NY tt,caD- lb tall, state. and IlP code a County and state Mike principal buskess di K1 V- ial Yo vk 1•34_,...; tekcalc- 1 7 Marneuhpinctial °Meer mat« parragiaganthr. err. a ar--t n it ,,,g~) a rierri.—, 1/..... ..L..."Okaltn — h. ta Type of antdy :Cheek orgy one box) bee imbuctond Caution: liappieent b a ensled lebay company. see the hstructrons Or are St 0 Soh) propiaux eSSNI 0 Estate (SU of decedent) 0 Parthaship 0 rielonet awoke cap. fip li‘ adnikkestor (55l4 : o REA« D Radar« Crard ehei Carpeted:In Ispecayl ii `hi cisia ia -24 Gr So id 4 4.5 Svc c._ D Staterlocal government 0 Fare" otoperathis 0 Um D owedn or churchconeolled aganttadon 0 Federal gmernmenthrtilitary o Ode nonprofit oroonation ettanaiii l'' (ms. GEN It applicable) 0 Other (spectry) er Sb Ca corporation. name the state or tonagn country pr epplicable' where Incarnated for applying 'Check only we boo)bee insauchans) 0 Banking purport awn, purge«) a stared new business ( cely type tow. 0 Changed type « orgaantion (spotty non type) tr. 0 Purchased going imam 0 Hind erreployme (Check the Om and em In 124 El Crated a trust (specify type dmi K Created a pension plan ispecIty type' er te Other Opeard ► kas nix.„9 Vo K Foreign county to the. business started or acquired Imorith. day. yawl fsee instruchansl 11 Closing month « meaning yew bee antiunion) 5-1j- Vvota p2c4a,.la.c✓ It first data wages rannuities as paid a MI be paid gnonrh. day. yew,. Motet Kogan is a agent. enter due ~ail WI test Ad yield to nonrealent a day. Sid ► 13 highest number of employees expected in Me flat 12 months. Mott t it* applicant don net rarn9~ expect to have anyemproyees dreg drape:xi ewer instruttiond - — 4. Principoi activity bee instnictiend tiecr-rns 14 IS ta the principal business edenty inerviankring7 Yea Or I -Yes." principal product and few material used la Is SI satil slaNt «the products or «mime sold? Please check one bat CI Cosiness Inhoiesakel O Public freteM Other (specify) DWA 17. Res the ~cant arm applied tor an empeoyer identification number for des a any other badness'?' D Yes ar Mots 'Yak' «eau eorryaffde snes 17b and f 7c 171) I you checked *Yes' on the 17a. Oa epplicerirs Engel name end wade name shown on prior epplicateon. r thelerent in:abler 2 above. Legal name ► Trade rin ► tic Appmeinate date when end cad and state enare the appluatIon was wed. Enter prenous employer idwitification number Ilf known. Appel:arm" an. when sed bro. day. neel tal ene vs «we Red embus ON Acyriairmai — v'_ *household — filedu patris r ny,lztediri tut 'km enes Mil ippkam Mani eror my kinadip wee« i bmw arm are ~ea None ark tile ekes* type or print " ► -„L km ~re ~FE beiten urn rem &En >31.,,la 1 7, a_OO2.- Mom leave Wank ta Foe Privacy Act and Papetwork Reduction Act Mota, tee page 4. Ons Reason far epirtying Cs. tea. mash Published by Tax Management ha, a Sublideary of The Bureau of National Affairs, Inc. Farm SS-4 pee. satsa $8.4 CONFIDENTIAL UBSTERRAMAR00000040 EFTA00235829