EFTA01118524Set 9
4p1,169w
nctyw...ectiairos-k- C., M t, ( -
Name • • : Social Security Number/MN Number
-3 54- osvi c020)-3917c-
Address elephone Number
Check appropriate box:
❑ INDIVIDUAL O EXEMPTFROM BACKUP WITHHOLDING
O 2RUST
https://www.justice.gov/epstein/files/DataSet%209/EFTA01118524.pdf