Precedence: ROUTINE

Precedence: ROUTINE Date: 12/09/2009 To: Miami From: Miami Contact: Approved By: Drafted By: Case ID #: 72B-MM-11327 (Pending) 188B-MM-105207-C (Pending) Title: VICTIM NOTIFICATION FORM Synopsis: To document business information. Reference: 72B-MM-111327 Serial 1 Details: VnsCase#: 72B-MM-111327 CAgtName: BusName : BusEIN : BusAcct : SSAN : VicDate : 20091023 VicDOD : VicMinor: N DOB : Race : U Sex : U Fax •. VWrkAddr: VWrkadd2: VWrkCity: VWrkSt : VWrkCtry: VWrkZip : WEmail : WPhone : WFax •. VicPager: NOKFirN : NOKMidN : NOKLastN: NOKRel : EFTA00108679 NOKAddr : NOKAddr2: NOKCity : NOKState: NOKCtry : NOKZip : NOKHEma1: NOKWEma1: NOKHPho : NOKWPho : NOKHFax : NOKWFax : NOKPager: GrdFirN : GrdMidN : GrdLastN: GrdRel : GrdAddr : GrdAddr2: GrdCity : GrdState: GrdCtry : GrdZip : GrdHEmal: GrdWEma1: GrdHPho : GrdWPho : GrdHFax GrdWFax : GrdPager: PropRet : TotLoss : 000000000 Lang. : Disable : * * EFTA00108