EXHIBIT 58 FILED UNDER SEAL¶
0 CHASE¶
JPMergan Chase Bank¶
Account Tide (accounts with oultipk worn on tiler, pot* to either Owen or the Airvhor.) Account a Account Type Account Arr. SMYTLN Date Opened¶
Opened By Deposit Amt PERSONAL SIGNATURE CARD AND APPLICATION BRANCH COPY¶
Primary Customer Inforrardion¶
‘01¶
CHASE EXTRA SAVINGS ACCOUNT¶
INDIVIDUAL¶
02, I90.004¶
PHILLIP WALTERS¶
$0.01¶
Horne Ph 1000µl00-0000¶
Malden Name¶
BinhDate RIN¶
This Account Is Not Transferable Please activate Check Coverage for the account listed above. Wive authorize you to integrate and use as the Protecting Account(s)- the account(s) identified above on this application. I/we agree to the terms and¶
conditions as contained In the Deposit Account Agreement and Disclosures.¶
Uwe agree that lave have reviewed the Information contained in this Personal Signature Card and Application and find it accurate on this date. In the payment of funds and in the transaction of all other business reative to this account. I/we agree that you are authorized to rely upon the signature(s) written below and on the --- reverse.side.-Wwe havesecenectand.agree_to_theterrns and conditions of the Deposit Amount Agreement and Disclosures currenvy m flea ano es may be amended fur the inn of at-courd ondscsMcos :Ave selccitti above. if I/we do not have a Chase Banking Card. Uwe will be Issued One/WO end Si eligible accounts will be linked to it/them. These linked accounts, whether singly or jointly owned, can be accessed by the Chase Banking Card or by telephone. Dunne the review of my/our application. you may obtain a consumer report on me/us and it the application is approved, you may at any tine In the future obtain additional consumer reports to review my/our account. Uwe have thetight to ask for the name and address of the¶
consumer reporting agency v./filch gave the consumer re •¶
lent SI nolo Joint Appease Signature¶
on¶
By signing below. I certify under penalties of penury thac (1) The number shown on this form Is my correct taxpayer identification number, and (2) I am not subject to backup withholding because (a) I have not been notified by the Internal Revenue Service (RS) that I am subject b backup withholding as a result of a failure to report at interest or dividends, or (0) the IRS has notified me that I am no longer sulalect b backuP¶
withholding; and, (3)1 am a U.S. person (including aU.S. resident assn).¶
{sup}ICheck here if you are subject b backup withholding for failure to report Interest or dividends.¶
.1Check here if you are not a U.S person (or aU.S. resident alien), and complete the appropriate Form W-8.¶
Met Applicant Signature¶
X matting or No him tatement: I e authorize you not to return pad checks with my/ott account statements. If Inv° selected the Check Imaging option. lave agree b receive Images (front only) of myiour paid checks. IANe agree that the account statement will contain information about each check paid, including check number, dollar amount and date paid, thereby enacting a proper reconciliation of the account.¶
Uppp request, photocopies of checks will be provided. You will not retain enamel CheeitS. ry Applicant Signature Joint Applicant &gnaws¶
CPIX:k two If there ere additional signers on the flreefle side of the BRANCH COPY.¶
THE AeOvE irCOAtp9/1 Alf0 . 0114.4_,SIONVIIPEO, tffillataRY AND APPAJCASIO WERE VERICE097;;”.” {sup}u Pent Na*. {sup}r-H1 u 7, brdWW-4/1 dept mak. He.: I 7-1 MANCH COP Y-Ran CPO Drool lb pa year sae moan der Then rand to nears for anclaanal ‘Sem elite yea¶
| POWER OF ATTORNEY INFORMATION | DATE POWER OF ATTORNEY RECEIVED | |
|---|---|---|
| POWER OF ATTORNEY NAME | / / | |
| POWER OF ATTORNEY SIGNATURE | X | |
| ADDRESS (Street and Number) | ||
| CITY | STATE | ZIP CODE |
| BENEFICIARY INFORMATION | ||
| ADDITIONAL ACCOUNT SIGNERS - (For Estate and Trust accounts, as needed) - Line out unused Signature boxes | ||
| PRINT NAME | TITLE | SIGNATURE |
| X | ||
| X | ||
| X | ||
| VERIFICATION | ||
| Primary Applicant: ID-1: DL ID#: [REDACTED] St: [REDACTED] Exp: 01/01/2006 | ||
| ID-2: PP ID#: [REDACTED] St: Exp: 01/30/2013 | ||
| ChexSystems: Approved Code: 9500 SSN-ST: FL YR: 2004 | ||
| TU: Override CDE: B FPH: Override Approval By: [Signature] | ||
| Joint Applicant: ID-1: ID#: St: Exp: [REDACTED] | ||
| ID-2: ID#: St: Exp: [REDACTED] | ||
| ChexSystems: Code: SSN-ST: YR: [REDACTED] | ||
| TU: CDE: FPH: [REDACTED] | ||
| NOTARY INFORMATION (For Worldwide Consumer Bank) | ||
| STATE OF _____ COUNTY OF _____ | ||
| SS.: _____ | ||
| On the _____ day of _____ before me personally came |
to me known, and known to me to be the individual described in, and who executed the foregoing instrument, and he acknowledged to me that he executed the same.¶
_____ | | | | THE ABOVE INFORMATION AND (NO.) _____ SIGNATURE(S) (POA AND ADDITIONAL SIGNERS) WERE VERIFIED BY: Print Name: _____ Initials: _____ Dept. No./Br. No.: _____ 03-94-15 ([REDACTED] Order #) FORM 113.DOC - 63 | | |¶