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'LAC COPY TD F 90-22.1 pee mint 2011) Ociessmort et dm Maw? Do nol see meadow Salons •I liken ilnetal Filer Information 2 Type OFIler • pleat 1 O Parewhip U.s. Taper" Malatalen IMMO a Mee hears US. IdemiSralkm Number complete MOM 4. REPORT OF FOREIGN BANK AND FINANCIAL ACCOUNTS Do NOT Me with your Federal Tax Return OMB No. 1146.10111 1 The ROOM k ler Cilder Yew Ended 12131 2010 Arnended K c Derscrahhe a DCasotaild • D Macy a Oar —Fides We 4Fotemn cloadcation (Comae/ °rag I Pea 3 6 4•I ollfdidahlt) a Tam OPsesmal Danes bee*. • Ccemtry &Inn S I minded' Dam el etc, MSAttlefert 1/20/1953 I Last Parr* et Otteerendion Noose EPSTEIN Address (tiatet.Streel. ad Isenneel of Set Nece310 7 Free Pew JEFFREY E. I mace es ism 6100 Red Rook Qtr Ste 38 16 City 11 State 12 ZIPIPostal Cods 13 Osunfry St Thomas VT 00802 OS 14 Ohm he At hew • enema/ Ithemel el 2521 se kwids awes? Eke e Yee' Anus lees number olicdmad• Qr k chocked. do not complete Parlor Part Illamt ma maids of Ns Somme] on) No - J Information on Financial Account(s) Owned Separately IS Mamman rain ol mann °woo seem year reports Type el acetate • /13M" I Li Setulas • LI Ott'— ESr type OS. 17 Num.:111.ra, Iralikemn k vole it, waxed is held IS 20 Accowe Rumba or ohm detonatan 12 111-4 Meese dtsenhor. Street solo tewnbel) N Iledesesal haft:Wertheim mowed is held City 21 Slobe Mom 11 im/Pollel Co& 1 1 ..--1 •11•31 22 Cavalry M Plet Sts 41 reef ma, e M remateroa neat eat Osie gaIDIWoren FIN this form *By U.S. Department of the Treasury, P.O. Box 32621, Detroit, PM 482324621 This form should be used to report a financial interest in, signature authority or other authority over one a more financial accounts n foreign countries, as required by the Department of the Treasury Regulations 31 OFFt 1010.350 (Formerly 31 CFR 103.24). No report is required If It aggregate value of the accounts did not exceed 110,000. See Instructions For Dellonions. PRIVACY ACT AND PAPERWORK REDUCTION ACT NOTICE Pursuant to tree requirements of Pitt Law 93-579 (Privacy AM of 1974), notice is hereby oven t rat the authority la collect information on TD F 90.22.1 in accordance with 5 USC 552a (e) is Public Law 91.501 31 USC 5314; 5 USC 301; 31 CFR 1010.350 (formerly 31 CFR 103.24). The principal purpose for collecting the information is lo assure maintenance of reports where such reports or records have a high degree of usefulness in criminal, tax, or regulatory invesbgaliOns or proceedings. The information corseted may be provided to those officers arid employees of any constituent unit of the Department of the Treasury who have a need for the records in the performance of their dotes. The records may be, referred to any other deparbnerM a agency of the United States upon the request of tne head of such department or agency or use in a criminal, lax, or regulatory investigation or proceeding. The information cc lected may also be provided to appropriate slate, local, and foreign law enforcement and regulatory personnel in the perWmanee of the r official duties. Disclosure of this information is mandatory. Civil and criminal penalties, including in certain circumstances a fine of not more than $500,000 and imprisonment of not more than free years, are provided for to fie a report, information, and for ling a raise or fraudulent re port. Disclosure of Social Secur is ma failure ndatary. The authority to collect is 37 supply 0FR 1010.350 (formerlyfr 31 CFR 103.24). The Social Security number will the ity be used as a means to nurnaer identify the individual who files the report. The estimated average burden associated with this collection of information is 20 minutes per respondent or record temper, depending on individual circumstances. Comments regarcfing the accuracy of this burden estimate. and suggestions for reducing the burden should be directed to the Intern.S Revenue Service, Bank Secrecy Ad Pruicy, 5000 Elln Road C.3.242, Lanham MD 20706. FOC2)101t 0335/II APPRV e053 Form TD F 80.721 (Rev 3.2011) EFTA00617044 PbOlbCont/nued--InformationonFIrwncWIAccount4)0wmedSepandMy Form TO F 9042.1 Complete a Separate Block for Each Account Owned Separately Papa Number This side can be copied as many times as necessary in order to provide information on all accounts. 2 at 1 Fang tot 3-4 tea precorate nenthastran tear Sarre, X Mown* Idensrsceurn Nana. 2010 _ Ratko Identifealen tinter neuter Nat Is Iftelinue rake el eat ihniq abaft is., repertO 990,733. 17 Need Firendalbelibkp in Pilch acsamt HSBC Private Bank SA la Aomori pease/0Pd Openekn 6 Last Ptak cat 0rpnizalen Name EPSTEIN 16 Tane at awn' 'Bank b USectairks Wither — Enter WS bib. 19 /Pip Ada Paw, *Pt fan Plan tat) etlinetkal Irtslilutan b OA =Mid k MIp PO Box 3580 20 ay Geneva 3 IS Wasinten ware ell all dare oar pie spay 3,802,298. 17 tern. of Flak Intake lea a ant is bald HSBC Private Bank SA Ill Amount abet a oIr dedinelime 21 Ste. 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X mown 30 Ca, d Worm I it 3240, X lawn 32 Zaeostal pace, a Yawn a Coma. amass 20129101. 0321111 APPRV 3053 Form TD F 90.22.1 (flay 3-2011) EFTA00617046 fRattlarti Information on Financial Account(s) Where Filer has Signature Authority but No Financial Interest in the Account(s) Complete a Separate Block for Each Account This side can be copied ia many tones as necessary in order to ?rovide information on all accounts. 1 Farb for calendar par 34 Chat appropriate knintallon Parnber i last Naves Organization Mame Topa Idenalcaban Muer 2010 rap laniacaane babe EPSTEIN • r hart I a TYPO al maul IS Araboun atm al acoart Sunny canner yaw raprbil 17 Mama al nand" tineeitan am *Nth Kona k hob IS Aoccant lanais et caw danassaan a Ca Fern 1D F 30.2M Page Number 4 of 4 . Li bmw b Sarin e UOliim — Sabi bpi bins IS Maim Pant (Taear, SYN. Sob Numtan) al tad ISIS= le atdcli Ural aIWI RI SU; I Mop St L.r Ilanm a Organdzatea Marne a Pard Ora -r 21paosial Coda. 0 I X OM*/ 35 T.q... 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IS. rhatart) of ammo asbarlien a wank acceram n raw a coy 21 Silk 4 51 a ZorPoelal Ca d baba II Canby 14 Lay Elm or Onberlation Marna a I Ilgorad Omer a TriMmer IdairficaM None ol AMoorlOoMe a FA Maw 37 MS MSS 3I MTh's 414arkee. 5treet Amine ar Sao IX) rob a ca 41 712Pos4 41 Cc* 1 47 can, 43 fetes T4e wan nes Caper Memo. 03/22/11 APPRV 4053 Fo'rn TD F 90.22.1 (Rev 3-2011) EFTA00617047