EFTA00185601¶
NEW ACCOUNT INFORMATION¶
Page 1¶
DATE 01/16/2001¶
ACCOUNT #¶
| TITLE OF ACCOUNT | JEGE INC |
|---|---|
| JEFFREY F EPSTEIN |
TEMPORARY REPLACEMENT¶
AMOUNT OF DEPOSIT¶
Words, numbers or phrases preceded by a $X$ are applicable only if the¶
ACCOUNT OWNER NAME(S) JEGE INC JEFFREY E EPSTEIN¶
PRIMARY ACCOUNT OWNER INFORMATION PRIMARY ACCOUNT OWNER NAME AND ADDRESS JEGE INC JEFFREY E EPSTEIN¶
457 MADISON AVE 4TH FL. NEW YORK NY 10022¶
EMPLOYER NAME AND ADDRESS¶
BUSINESS PHONE HOME PHONE¶
DRIVER’S LICENSE # D.D.B.¶
UNIQUE IDENTIFIERS¶
TAXPAYER IDENTIFICATION NUMBER CERTIFICATION¶
X Under penalties of perjury, you certify that: {1} the number shown below is your correct taxpayer identification number, and {2} you are not subject to backup withholding because: {a} you are exempt from backup withholding, or {b} you have not been notified by the Internal Revenue Service (IRS) that you are subject to backup withholding as a result of a failure to report all interest or dividends, or {c} the IRS has notified you that you are no longer subject to backup withholding.¶
APPLIED FOR DECLARATION¶
[NOTE: You must cross out clause (2) above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return.]¶
Under penalties of perjury, you certify (1) that a taxpayer identification number has not been issued to you, and that you mailed or delivered an application to receive a taxpayer identification number to the appropriate Internal Revenue Service Center or Social Security Administration Office for you intend to mail or deliver an application in the near future. You understand that if you do not provide a taxpayer identification number to us within sixty (60) days, we are required to withhold federal income taxes on all reportable payments thereafter made to you until you provide a valid number and that other penalties may apply. The amount of federal income taxes withheld will be determined by applying the applicable backup withholding rate, as established by the Internal Revenue Service, to the reportable payments. (2) That you are not subject to backup withholding either because you have not been notified that you are subject to backup withholding as a result of a failure to report all interest or dividends, or the internal Revenue Service has notified you that you are no longer subject to backup withholding. NOTE: If we have been notified by the Internal Revenue Service that we are subject to backup withholding and have not been notified that backup withholding has been terminated, then we must strike out clause (2) above.¶
is marked.¶
TAXPAYER: D¶
BRANCH ✦ Palm Beach Banking OPENED BY Dottie Wilson¶
TYPE OF ACCOUNT¶
TYPE Business Checking¶
ADDITIONAL INFORMATION¶
SERVICE¶
ACKNOWLEDGMENT¶
By signing this document, the undersigned have opened the type of account designated above, acknowledge receipt of the Deposit Account Agreement and agree to be bound by it. If the type of account that has been opened is a transaction account (e.g. Checking or NOW), the undersigned acknowledge receipt of a copy of this institution’s Funds Availability Policy. If the account is designated as a consumer account, the undersigned acknowledge receipt of an Account Disclosure. If the account is in the name of a business entity, the undersigned is (are) acting on behalf of the business entity. If this account is designated as a joint account, the undersigned acknowledge they have received and read the terms related to joint accounts in the Deposit Account Agreement. Further, the undersigned authorize this institution to make inquiries about their individual credit, such as a credit report.¶
Copyright Compliance Services, Inc., 0123, 1985, 1986, 1987, 1988, 1989, 1990, 1991, 1992, 1993, 1994, 1995, 1996, 1997, 1998, 1999, 2000, 2001, 2002 (Form GS 5054) [1] [2] [3] [4] [5] [6] [7]¶
Compliance Systems, Inc. 600 463 8522 Fax 412 809 7908¶
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