EFTA00168375



seove



201112270013220104




USAO 000401



EFTA_00018311

EFTA00168376

Cin / : GcLER





201112270013220102




USAO 000402


EFTA_00018312

EFTA00168377

CERTIFICATION

I certify that all of the items of information entered on this form are true and correct (to the best of my knowledge and belief) and understand that the making of any willful false statement of material fact herein will subject me to the provisions of the penal law relative to the making and filing of false instruments.

BUYER

BUYER'S ATTORNEY
ERIKA KELLERHALS, ESQ

BUYER SIGNATURE
DATE
9100 HAVENSIGHT, PORT OF SALE, SUITE 15/16.

LAST NAME
FIRST NAME

STREET NUMBER
STREET NAME (AFTER SALE)
ST. THOMAS

AREA CODE
TELEPHONE NUMBER
SELLER

00802

CITY OR TOWN
STATE
ZIP CODE
SELLER SIGNATURE
DATE

COUNTRY
VIRGIN ISLANDS, US

serve



2011122700132201





USAO 000403



EFTA_00018313