QL)
0fthe UnitedStates,
ix Oder Allow Noir per* I +Jim,
tuMtb*ace, imam domestic Marva*
pima*theMUNN /*my:
promote thepied sem.
the 81azitiqs ofLihertv to OVCrairll and
AO-&WYE.% ik onliat ad(sal& this
etublibeiewfor t/Y '71redimito afilmerinr.
SIGNATURE OF BEARER / SIGNATURE DU TITULAIRE / FIRMA DEL TITULAR
FAsist 10, o e dsaporie
Surname/Nom /Apellidos
5666 2615
EPSTEIN
Given Names / Prenoms / Nombreit.
JEFFREY EDWARD
EFTA01598006