EFTA00313896.pdf

Registration No: 1026221 Person Number: 73274 Temporary Addresses O I do NOT have a temporary address Please nob: The registrant has reported additional tempora ry addresses not displayed here 1. 358 El Brillo Way Palm Beath FL (Street Address) 33480-4730 (State) (ZO) Count), Palm Beath Oates you yell be at this address From: 07/26/2012 To: Transient Addresses Oleo NOT have a transient *diens (SbeetAddre54 or lbeaban) (Dry) IS-aw) (Zip) County Dates you will be at this address: From To: Employment I am currently unemployed. 1. Employer Financial Trust Company Occupation Owner Stan Dale 07/26/2012 Address: 000 Red Nook Quarter Ste B3 St Thomas VI (Steel morass> 00802 104)1 IS:a(e) (bpi CamtY Saint Thomas Contact Person Mailing Address Phone Numbers Please not*. The reghltrant has sported additional not displayed here. O Same as Permanent O semen Temporary O I do NOT have or use any borne or moods phone numbers 9 E 71st St 7-0- , Nu-nbc' Phone Type: (erns late 1) i `tome (Aridness Line 2) 2 Mobile New YOM NY 10021 3. Fax (OILY) . rah) G5e/ 4. Costly. New York l'i'ork Ens oar 5 =az Campus Activity CI I am NOT • student, employes. et Volimilleie al a university or institution of higher learning. 1. O Slude- ❑ Enicoyee Voluntecrr Stan Date End Date UnnersitySchool Name: Campus Address. (Street Arktrattis) (Cry) (Skye) (Zip) County Employer. Contact Professional Licenses I do NOT hare any professional licenses. 1. (Number) TyPe) issued by, Page 2 of EFTA00313896