Stipulated Preliminary Injunction Order as to Defendants Regency

Case 1:15-cv-20270-DPG Document 16 Entered on FLSD Docket 02/10/2015 Page 1 of 44

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UNITED STATES DISTRICT COURT FOR THE SOUTHERN DISTRICT OF FLORIDA

CASE NO.: 15-20270-GAYLES

FEDERAL TRADE COMMISSION

Plaintiff,

vs.

REGENCY FINANCIAL SERVICES, LLC, a Florida corporation, and

IVAN LEVY, individually and as an officer of Defendant Regency Financial Services, LLC,

Defendants.

STIPULATED PRELIMINARY INJUNCTION ORDER AS TO DEFENDANTS REGENCY FINANCIAL SERVICES, LLC, AND IV AN LEVY

Plaintiff Federal Trade Commission commenced this action by filing a complaint against

Defendants Regency Financial Services, LLC, and Ivan Levy, and also moved pursuant to Sec-

tion 13(b) of the Federal Trade Commission Act, 15 U.S.C. § 53(b) (second proviso), for an ex

parte temporary restraining order, asset freeze order, and order to show cause why a preliminary

injunction should not issue. Upon stipulation by the FTC and Defendants Regency Financial

Services, LLC, and Ivan Levy, the Court enters this Preliminary Injunction Order as to Defend

ants Regency Financial Services, LLC, and Ivan Levy.

FINDINGS

The Court finds that:

A. This Court has jurisdiction over the subject matter of this case, and there is good

cause to believe it will have jurisdiction over the parties.

B. This Court is a proper venue for this case.


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C. There is good cause to believe that Defendants have engaged in, and are likely to

engage in the future in, acts or practices that violate Section 5(a) of the FTC Act, 15 U.S.C.

§ 45(a), and Section 310.3 of the FTC's Telemarketing Sales Rule, 16 C.F.R. § 310.3, and that

the FTC is therefore likely to succeed on the merits of this action.

D. There is good cause to believe that this Preliminary Injunction Order is in the pub-

lie interest, and no private interest of the Defendants outweighs the public interest.

E. There is good cause to believe that immediate and irreparable harm will result

from continued violations by Defendants unless they are restrained and enjoined by Order of this

Court.

F. There is good cause to believe that immediate and irreparable damage to the

Court' s ability to grant effective final relief for consumers-including refunds, rescission and res

titution, disgorgement or other equitable monetary relief- will occur from the sale, transfer, or

other disposition or concealment by Defendants of assets or records unless they are restrained

and enjoined by Order of this Court.

G. Unlike private litigants, the FTC, as an agency of the United States, is not re-

quired to give security before a preliminary injunction may issue.

DEFINITIONS

For the purposes of this Order, the following definitions apply:

A. "Asset" means anything, or any interest in anything, of economic value or that

may be the subject of ownership, whether real or personal, tangible or intangible, legal or equita

ble, located within or outside the United States, or existing before or acquired after the date of

entry of this Order, including any account, account receivables, bond, cash, certificate of deposit,

chattel, check, contract, credit, currency, document, equipment, fixture, fund, good, income, in-

ventory, instrument, investment, leasehold, line of credit, list of consumer names, mail or other

deliverable, note, premises, property, receivable, revenue, security, share of stock, or trust.

B. "Defendants" means Regency Financial Services, LLC, and Ivan Levy, individu-

ally, collectively, or in any combination.

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1. "Individual Defendant" means Ivan Levy, and by whatever other names he

may be known, including but not limited to any name under which he does business.

2. "Corporate Defendant" means Regency Financial Services, LLC, and its

successors and assigns, as well as any subsidiaries, and any fictitious business entities or

business names created or used by this entity.

C. "Document" has the same meaning as the term is defined in Federal Rule of Civil

Procedure 34( a) and as the term "writing" is defined in Federal Rule of Evidence 1001, and shall

include within its meaning any and all accounts, analyses, audio recordings, books, canceled

checks, charts, check stubs, computer records, correspondence, data compilations, desk eaten-

dars, diaries, drawings, films, financial statements, graphs, inter-office memoranda or written

communications of any nature, invoices, ledgers, letters, licenses, logs, memoranda, minutes of

meetings, notes, notes of conversations, notes of meetings, notes of telephone calls, papers, pho-

tographs, receipts, recordings, recordings of conversations either in writing or by means of any

mechanical or electrical recording device, records, reports, schedules, telegrams, telephone bills,

time sheets, videotapes or video recordings, and any differing versions of the foregoing whether

denominated formal, informal or otherwise, as well as copies of the foregoing which differ in

any way, including handwritten notations or other written or printed matter of any nature, from

the original. The foregoing specifically includes information stored in any form, including elec-

tronic form, on a computer or in a computer database or otherwise, including electronic mail.

D. "Financial Institution" means any establishment dealing with financial transac-

tions of any kind, whether within or outside the United States, including any automated clearing

house processor, bank, bank debit processing agent, brokerage house, broker-dealer, commercial

mail receiving agency, commodity trading company, credit card payment processor or agent,

credit union, customer service agent, escrow agent, mail holding or forwarding company, money

market or mutual fund, network transaction processor, precious metal dealer, retirement fund

custodian, savings and loan institution, storage company, trustee, title company, or other finan-

cial institution or depository of any kind.

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E. "Person" means any individual, group, unincorporated association, limited or

general partnership, corporation, or other business entity.

I.

PROHIBITED BUSINESS ACTIVITIES

IT IS THEREFORE ORDERED that Defendants, Defendants' officers, agents, servants,

employees, and attorneys, and all other persons in active concert or participation with any of

them who receive actual notice of this Order by personal service or otherwise, whether acting

directly or indirectly, in connection with the advertising, marketing, promotion, offering for sale,

or sale of vehicle loan assistance relief services, are restrained and enjoined from:

tion:

A. Misrepresenting, or assisting others in misrepresenting, expressly or by implica-

1. That any Defendant will obtain for a consumer a loan modification that

will prevent repossession and substantially reduce the consumer's loan interest rates and

monthly payments;

2. Any Defendant's refund policy, including the likelihood that a consumer

will obtain a full or partial refund, or the circumstances in which a full or partial refund

will be provided to the consumer; or

3. Any other material fact.

II.

POSTING NOTICE OF LAWSUIT ON WEBSITES

IT IS ORDERED that Defendants, Defendants' officers, agents, servants, employees, and

attorneys, and all other persons in active concert or participation with any of them who receive

actual notice of this Order by personal service or otherwise, whether acting directly or indirectly,

are restrained and enjoined from:

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A. Failing to immediately take whatever action is necessary to ensure that any web-

site used by any Defendant in connection with the advertising, marketing, promotion, offering

for sale, or sale of vehicle loan assistance relief service, including the websites located at

www.SaveCarUSA.com, www.Credit-Yogi.com, and www.CarPaymentHelpCenter.com, shall:

1. Prominently display the following statement:

The Federal Trade Commission has filed a lawsuit against Regency Financial Services, LLC, alleging that it has engaged in deceptive practices in connection with the advertising, marketing, promotion, offering for sale, or sale of vehicle loan assistance relief service. The United States District Court for the Southern District of Florida has issued a temporary restraining order prohibiting the alleged practices. You may obtain additional information directly from the FTC at www.ftc.gov.

2. Provide a hypertext link to the FTC's home page at www.ftc.gov, or an-

other home page designated by counsel for the FTC.

III.

ASSET FREEZE





A. Alienating, assigning, concealing, converting, disposing of, dissipating, disburs-

ing, encumbering, granting or incurring a lien or security interest or other interest in, liquidating,

loaning, pledging, removing, selling, spending, transferring, withdrawing, or otherwise disposing

of any Asset, or any interest therein, that is, whether in whole or in part, directly or indirectly:

I. Controlled, managed, or owned by, or held for the benefit of, or in the ac-

tual or constructive possession of any Defendant; or

2. Controlled, managed, or owned by, or held for the benefit of, or in the ac-

tual or constructive possession of any Person that is, whether in whole or in part, directly

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or indirectly, controlled, managed, or owned by any Defendant, including any Assets held

by or for any Defendant by any Financial Institution;

B. Cashing any check or depositing or processing any payment from any consumer,

client, or customer of any of the Defendants;

C. Incurring cash advances or charges on any checking card, credit card, or debit

card issued in the name, singly or jointly, of any Defendant; Obtaining a personal or secured

loan; and

D. Opening or causing to be opened any commercial mail box, safe deposit box, or

storage facility titled in the name of any Defendant, or subject to access by any Defendant or un

der any Defendant's control.

E. Provided, however, that the asset freeze imposed in this Section shall not apply to

Assets acquired after entry of this Order that are not derived from activity prohibited by

this Order.

IV.

DUTIES OF THIRD PARTIES HOLDING DEFENDANTS' ASSETS

IT IS ORDERED that any Financial Institution or Person, which is served with a copy of

this Order, or otherwise has actual or constructive knowledge of this Order, sha11:

A. Hold and retain within its control and prohibit the assignment, conversion, dis-

bursement, dissipation, encumbrance, hypothecation, liquidation, loan, pledge, removal, sale,

transfer, withdrawal, or other disposal of any Asset held by or under its control that is:

1. Associated with charges, credits, or debits made on behalf o f any Defend-

ant including reserve funds or settlement funds held by payment processors or their

agents, insurance companies, or other Persons;

2. Held in any account maintained in the name of, or for the benefit of, or

subject to withdrawal by, any Defendant or other party subject to Section III above, ex

cept that Wells Fargo shall release $4000 to from the Wells Far-

go held in the name of

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3. Held on behalf of, or for the benefit of, any Defendant or any other party

subject to Section III, above; or

4. Subject to access or use by, or under the signatory power of, any Defend-

ant or other Person subject to Section III above.

B. Deny Defendants access to any safe deposit boxes or storage facilities that are ei-

ther:

1. Subject to access by any Defendant or other Person subject to Section III

above; or

2. Titled in the name, individually or jointly, of any Defendant, or other Per-

son subject to Section III above;

C. Provide the FTC, within three (3) business days of the date of service of this Or-

der, a sworn statement setting forth:

1. The identification number of each account or Asset titled in the name, in-

dividually or jointly, of any Defendant, or held on behalf of, or for the benefit of, any De

fendant or other Person subject to Section III above, including all trust accounts managed

on behalf of any Defendant or subject to any Defendant' s control;

2. The balance of each such account, or a description of the nature and value

of such Asset;

3. The identification and location of any safe deposit box, commercial mail

box, or storage facil ity that is either titled in the name, individually or jointly, of any De

fendant, or is otherwise subject to access or control by any Defendant or other party sub

ject to Section III above, whether in whole or in part; and

4. If the account, safe deposit box, storage facility, or other Asset has been

closed or removed, the date closed or removed and the balance on said date;

D. Within three (3) business days of a written request from the FTC, provide to the

FTC copies of all records or other documents pertaining to each such account or Asset, including

originals or copies of account applications, account statements, corporate resolutions, signature

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cards, checks, drafts, deposit tickets, transfers to and from the accounts, all other debit and credit

instruments or slips, currency transaction reports, 1099 forms, and safe deposit box logs.

Provided, however, that this Section does not prohibit the repatriation of Assets, as re

quired by Section IX of this Order.

v.

SUSPENSION OF COLLECTION ON ACCOUNTS





A. Assigning any right to collect, attempting to collect, or collecting any payment for

any vehicle loan assistance relief service.

VI.

FINANCIAL STATEMENTS AND ACCOUNTING

IT IS ORDERED that no later than three (3) business days after service of this Order:

A. Each Individual Defendant shall prepare and deliver to counsel for the FTC a

completed "Financial Statement of Individual Defendant" form, which is attached as Attach

mentA;

B. Each Corporate Defendant shall also prepare and deliver to counsel for the FTC a

completed "Financial Statement of Corporate Defendant" form, which is attached as Attach

ment B;

C. For each business entity owned, controlled, or managed by an Individual Defend-

ant, and for each trust of which such Individual Defendant is a trustee, regardless of whether it is

a defendant in this case, each Individual Defendant shall prepare and deliver to counsel for the

FTC a completed "Financial Statement of Corporate Defendant" form, which is attached as At

tachment B;

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D. Each Defendant shall also prepare and deliver to counsel for the FTC a statement,

verified under oath, of all payments, transfers, or assignments of any Assets worth $5,000 or

more since January 2001. Such statements shall include: (a) the amount transferred or assigned;

(b) the name of each transferee or assignee; (c) the date of the assignment or transfer; and (d) the

type and amount of consideration paid by or to the Defendant. Each statement shall specify the

name and address of each Financial Institution at which Defendant has accounts or safe deposit

boxes; and

E. Each Defendant shall also prepare and deliver to counsel for the FTC a detailed

accounting, verified under oath, of all gross and net profits obtained from, derived from, or relat

ed in any way to the offering for sale or sale of Internet directory listings.

VII.

PRESERVATION OF RECORDS





A. Failing to make and keep accounts, bank statements, books, cash disbursements

ledgers and source documents, cash receipts ledgers, current accountants' reports, documents

indicating title to real or personal property, general journals, general ledgers, records, and any

other data which, in reasonable detail, accurately and fairly reflect the disbursements, disposi

tions, incomes, transactions, and uses of Defendants' Assets; and

B. Altering, concealing, destroying, erasing, mutilating, transferring, or otherwise

disposing of, in any manner, directly or indirectly, any documents, including electronically stored

materials, that relate in any way to the business practices or business or personal finances of De

fendants; to the business practices or finances of entities directJy or indirectly under the control

of Defendants; or to the business practices or finances of entities directly or indirectly under

common control with any other Defendant.

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VIII.

PROHIBITION ON DISCLOSING CUSTOMER INFORMATION


attorneys, and ail other persons in active concert or participation with any of them who receive



A. Leasing, renting, selling, or otherwise disclosing the address, bank account num

ber, birth date, credit card number, e-mail address, name, Social Security number, telephone

number, or other financial or identifying personal information of any Person from whom or about

whom any Defendant obtained such information in connection with the advertising, marketing,

promotion, offering for sale, or sale of vehicle loan assistance relief services; and

B. Benefitting from or using the address, bank account number, birth date, credit

card number, e-mail address, name, Social Security number, telephone number, or other financial

or identifying personal information of any Person from whom or about whom any Defendant ob

tained such information in connection with the advertising, marketing, promotion, offering for

sale, or sale of vehicle loan assistance relief services.

Provided, however, that Defendants may disclose such financial or identifying personal

information to a law enforcement agency or as required by any law, regulation, or court order.

IX.

REPATRIATION OF ASSETS AND DOCUMENTS

IT IS ORDERED that Defendants shall:

A. Within three (3) business days following service of this Order, take such steps as

are necessary to repatriate to the territory ofthe United States of America all Documents and As

sets held by or for Defendants or under Defendants' direct or indirect control, jointly, severally,

or individually, that were transferred outside the territory of the United States from within the

territory of the United States.

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B. Within three (3) business days following service of this Order, provide the FTC

with a full accounting of all Documents and Assets that are located outside of the territory of the

United States of America or that have been transferred to the territory of the United States of

America pursuant to Subsection A above and are held by or for any Defendant or are under any

Defendant's direct or indirect control, jointly, severally, or individually, including the addresses

and names of any foreign or domestic financial institution or other entity holding the documents

and assets, along with the account numbers and balances.

C. Hold and retain all such Documents and Assets and prevent any disposition, dis-

sipation, or transfer whatsoever of any such Documents or Assets.

D. Within three (3) business days following service of this Order, provide the FTC

access to Defendants' Documents held by Financial Institutions or other entities outside the terri

torial United States, by signing and delivering to the FTC's counsel the Consent to Release of

Financial Records attached to this Order as Attachment C.

X.

INTERFERENCE WITH REPATRIATION





A. Taking any action that may result in the encumbrance or dissipation of Assets

held by or for Defendants or under Defendants' direct or indirect control, jointly, severally, or

individually, that were transferred outside the territory ofthe United States from within the terri

tory of the United States, or in the hindrance of the repatriation required by the preceding Section

IX of this Order, including:

1. Sending any e-mail, facsimile, letter, statement, or wire transmission, or

telephoning or engaging in any other act, directly or indirectly, that results in a determi

nation by a foreign trustee or other entity that a "duress" event has occurred under the

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terms of a foreign trust agreement, until all Assets have been fully repatriated pursuant to

the preceding Section of this Order.

2. Notifying any trustee, protector or other agent of any foreign trust or other

related entities of either the existence of this Order, or of the fact that repatriation is re·

quired pursuant to a court order, until all Assets have been fully repatriated pursuant to

the preceding Section of this Order.

XI.

DISTRIBUTION OF ORDER BY DEFENDANTS

IT IS ORDERED that Defendants shall immediately provide a copy of this Order to each

of their corporations, subsidiaries, affiliates, partners, divisions, sales entities, successors, as

signs, members, officers, directors, employees, independent contractors, agents, servants, attor

neys, spouses, representatives, and any other persons in active concert or participation with them.

Within five (5) business days following service of this Order, Defendants shall serve on the FTC

an affidavit identifying the name, title, addresses, telephone numbers, date of service, and man

ner of service of the persons Defendants have served with a copy of this Order in compliance

with this provision.

XII.

SERVICE OF ORDER

IT IS ORDERED that copies of this Order may be served by facsimile transmission, per

sonal or overnight delivery, first class mail, electronic mail, or personally, by agents and em

ployees of the FTC or any state, provincial, federal, or international law enforcement agency, or

by private process server, on: (1) Defendants; (2) any Financial Institution or Person that holds,

controls, or maintains custody of any Documents or Assets of any Defendant; or (3) any other

Financial Institution or Person that may be subject to any provision of this Order. Service upon

any branch or office of any Financial Institution or entity shall effect service upon the entire Fi·

nanciallnstitution or entity.

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XIII.

CONSUMER REPORTING AGENCIES

IT IS FURTHER that, pursuant to Section 604 of the Fair Credit Reporting Act, 15

U.S.C. § l681b, any consumer reporting agency shall furnish a consumer or credit report con

cerning any Defendant to the FTC.

XIV.

SERVICE UPON PLAINTIFF

IT IS ORDERED that any correspondence, papers, and pleadings related to this Order

shall be served upon Plaintiff by electronic mail, or overnight mail, courier delivery, or facsimile

if electronic mail is not feasible, to:

Federal Trade Commission Attn: Anna M. Bums 225 Peachtree Street, Suite 1500 Atlanta, GA 30303 Fax: (404) 656-1379 Email: [email protected]

XV.

RETENTION OF JURISDICTION

IT IS ORDERED that this Court shall retain jurisdiction of this matter for all purposes.

DONE AND ORDERED in Chambers at Miami, Florida this lOth day of February, 2015.

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Honorable Darrin P. Ga United States District J


SO S'I1PlJLATED AND AGRDD:

BOll PLAJNTIU PTC:

Dated ..,.'l'OVfL 201!§ •

J/.? . f{-Alma M. Bua1s No. 501982) Marcela C. Mateo' (:Bar No. ASS02036) Fcdml Trade ComiUission 2.2S Peacttt= sues, sum 1soo Atlanm, GA 30303 'l'elephono: (404) 656-1350 Fn: (404) 656--1379 Email: [email protected]; [email protected] AttonK7yl for Plaintiff PBDBRAL TRADE COMMISSION

Mag;lligan (Fl. BarNo .. ~'-4U-I' DmdMJ~Jijpn ~ l87S NB 19lst Street, SUite 600 Avcmtura, PL 33180 ~:305-907-Slll Pu.: 186-364-0243 A1ttlmlJy 1m DefimdaDtl IV111 Levy li¥l :bpncy ~ SeMce3, LLC

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Attach·ment A

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Oeftnltlons -and Jnstructfons ~

F~GEIW. TRAOE c0MMIS~ION

FJNANCIAL.STATEMENT OF INDIVIDUAl- OER;NOANT

'I Complete all «er.ns. Enter "None• cr ~Ntfa: ~Not Applioabte') in the fi~t field only of any 'Item 1hilt does oct apply to you If you canpot fully snswer.a questlonJ ~lain why.

2. •aepel"d.ants• inerude your spouSI!, rrve-in (;9fnpanion, dependel'lf chlldr:~m. or any other person, wl\om vou or your apo~se (or your ct"utdren's Qther par-eflt) .claimed .or C9Uld hav& clanned as a dependent tor tax J)!Jrpases .at ~ny time during the. past five years.

3. ~A$se'ts" and ~UabtliUesl' includa.AlL 1!$Se15 ~nd llab_llltles, ~t6d within thE': United States or ar.~y fore{g!'l ·c:otmtry or tarmory, Whethet held tndMdually oqo1ntly· and wnether held by you,:your spou$8, or your dependetl1f>, 01 held .by otflet:$ for lha benefit of you. your·spou.$8, Qt your depp11denbi.

4. ~ttach contrnuation pages a8 n~ed. On the-fiAancfakstetemant. state next to th~ Item number ~t the 1-t~m .iS being continuect. On ·the ·oontfnuation page(s), !d~tify 'the Item number(~) bemg ¢enttnued.

6 Type or prin.tle{fl.bty,

6· Initial each page In the space ptovided in the 1owerr:ight co.mw..

7. Sign ·and date the completed f\naneial statetN~nt em. ~e last page.

P-enatty for F.alse (nfom"tion:

Federal law proVIde61hat anypet$Cn maybe lmprlsonedior not. more than five y.eat&. fined, QrboUl, thuch petSOn.

{1) "'Jn any matter wahm the jur:isdfc!JQn of the execl:ltiv~ JegislafJve, or Judlclal bt81'1ch of the Govemmem,;,f the United States, ~nowing(y and wtllfuUyfatsifies; eon•!$ fX co~rs Up by any trick, eehetne. or <fev\Se a mater'tal fact; mal<esllny materially fals6, .flctilioUJ ,Of ftaodutentetatament or ~~entation~ or makes Qr. U!SGI any:false ~ qr . documentl<nowing~he same to contain 311Y rnate~Uyfalse, tletitloos. otfnii,Jdulsntttatemem ot en~· (18 u.s:e- § 10'04);

(2) •tn ar.~y _ • statement under p~nalty of ~Ury a& ,perm itt~ under ~n 1 'NS of tiOe 28, UniU.Mi.Sfatas Code, willfully subsctlb~ 'Bs tn.se ar~y matertal matter whleh he. does not :beJie<Je t~ be tru~ (18 u.s.c. §. 1621}; .or · ·

(3) "..n any ( ... atatement under ~lty of Pf!j~cy.a., psrililtted under tS«\JOn 1746 of Utte 2a: Unite~ .states Cod$) tn aoy proceedlng bfltore or.anclffaryt<~ ar.i.x~utt ot glilmd jury of .the llnited•'S1ate&,knoWiti.gly fTla.ka.anyi818e mabufal cl&dlara~ or maRes or·u.ses any .. ot~ftf m~aticn . , . I<OOWing the same to ~nball" any fafse material declaration• (1l$U.S.C. § 1e23.).

F.or alalony convfetlon 1.1t1der the proVisiOns efted above, f<Kia~ law provtd~ ·tl'la1. ·the fine may be ·not·mo.(B than ·the l}rUlerof (i) $250,000 b--an lnd'1v.idual or $500 .• 000 fora cor.pontliOn, or M lfthe~lony f'eSult$ in pecuniary .gain toM~ person or pe!funlary Joss :to ·81'\Y person -ether than the ~efendant, the ~er of twt~ lt!e .QIOS$-g~in or tWice the gro~ ·. kl91t. 1e u.s.a. ·§ 3571.

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BACKGROUND lNFORMATlON

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( 1 #. ... .

Relilil)nahlp

Jtem 6. Employn'Y!nt lnfOnnatlon/Emptc)yment lnt:Qme l'fow:te :tJe·ta~~llllormltlon tor tth Sflr-lo-O.!e and1of ~h $tilt pstmOQifiw fUll )eaa$. fOr eecn ~ rify Dl~ you,.....,., a dlrecJor, Ofllcaf. ~~. ·• «nplof" ''~ self-emp~. 'IQ44 owner. ~h41der'. tortlr~. p.tlti<;~J):Jfll ar ~!Writ ataAytrnedtllft~ 1J1pe. penod "l~' llldUCIG, uut Ill not llrm1ed to. #l'f'l ~. comin~. dlltn~, GtaWI'J. QCfiiUitirlSI ~. IOi!nli, IIHtn p!IYI'ilt:l'ltl, C9WJII'IIt".., roy.1111es, a\d beflellts for~ you did ttOt pay (e g. ne-afttlmuranQt ~. ~k kwee or laar, paymeru) ~ 11\1~ 01 ~.n,oone ~ an~benall

Compeny Name afld A4dtesa Ostes Employed lilc:ltJrM ~: -v~r .o & 6 PliDr Y11.

Year lnOol'ne From (MoOOVYeat) To ~cnlhl'fnr?

I I :10 $

Owr\eRI1p interet!? 0Ye$·0No $

PoMJons Held li"om{~-.} T~J(M~ .. l) $ I I $ I ' · $ I I S·

~~ andMdt'eU .. DaleS .EfT4110Yiid lneoma·Raceiwc(· Y·T·O & 5 PtforY!$.

F$1\ (Mot:llhiYe.t) Vw 1(\Ceme

To(Mo~NY~n J I ~0 $

OWne~ll)~? QY.,-.ONP s : POJ!!IOns HtiC! 'From (Mor!Ma~} 'To .(Mor)tt#UI) s

I I $ 7 .,

·$ ( I l

~ t;.,neand Addrlltt o.tea~ployelj .{(lccl'l'le Retei'.oed; Y:.T .0 & 5 PtiQt Yft

¥eer Intern a From (MonthlY,., To~ee~

I I .20 $ Owneratip Jrpn~at? 0 Yea D No "4 $

PO$IIIon5 Het6 FromlM~I) To (Moctmeat) s. . I I $

I I J I I l

I nit

2 of 1Q feMnll Tillie .Gommla5lon FNne~aJ Statemllill of lndlVI&JeJ Defen<!a.nt


I

i l l ~ i

1 1

ttem 7. Pending Lawsuits Fded By or Against You or Your Spouse liSt all pen.1tng ICWIU'b ~ ha'A! ~ filtod b1 C!r•gmlllot )'0\1 c.s .piJI "{!~" tn~y c-JUrt·or !>elilte an adiTlii'Uiret.ak ag..amy t.l 11-e Ursea S~ or-111 ·an) foreo9R ODUOily or IMIIOC\' Note: .V n,m , :. hl t.wSJAt-J.tNf ~sL~ 1n llnJ1JIA1gmt:tU « ~JtWRenls n ,ourftfvor At lttr-'1 .! 1 !lilt /.wJa,&; •Mt ,;llled :r. ,..,.. ,llldgme~ ('#~l'tJ ~t yd!J

eapnoo or Prooeedire Court or Arjerq and lot:a!!on ease No. Nall.lreot Relief Requtsted -St~C!I Otti)OSllion

'

Jtem a. Safe Deposit Boxes uat .. safe ~·l bill* tOColllld \4W'an 1re t~<.-1! ~~ or 111 any~ coll'llrv or~.~ held nJrw:ll.al~ <If p11111y ~ ~ h.adbj )W. you-~~ « ftfr1 'lfyCM ~·r~nl'\, artlekl b!j 0~ tOI \~be~ o1yt'O, ~~.Of 111\YOt YOU! ~ItS

Name of owneroo Na~ &·~ ofDeposrtory l~n Sax No Contentl

'

..

lrutial~:_

.8Df10


1

I I

'I

FlNANClAL lNFORMA TJON REUINOER: ~nan item ask5 ror 40fotmauon mgatrlmg .,out ·anets'' Br'd •llet:.urucnll("'..Ude & a~S&?U .L'lllltati~lbes. ~ ~n· 1b.e Ufltal4 State::a Of en an\ ~" oall"ltry OJ t~l') orlnst.l\nm. ~erMlO lldlvtdualt, or 101~1 w·~r held· by you. '{OIT ~.or <ill)' of your dependen~. ot hlttd by :1t11ers fbf the benet.t ofyov your SP"..USS. or ar.v of \'IJIJI ~ndenti II' adc:raion. provide all dOC\ITients ~il~ 11'1 U6m.24. with tourtt:lm~eted F.nanoal S!etsment

ASSETS·

Item 9. Caal1, S.ink, and Money Market Accounts t.r..t '""'" c.on ~(at. oppoeeci to ~h tn b#l"'l. iitc.DUI$ or01filr"~lel ac-:'ut~ta) 1/ld 1111 blnt.ICCOVnts, mor.ey m.trl-et ac:t:OUnt!). r:r ~¥1: l'llm:I•J .~. ti1Cbl,np boa not Lmt!.!<' til ~·a.,~. ,.....,~ ~"'uAt5. "nd~• of depa~ -n. term •.:as~~ 011 twr.r loci~ b~ ts noc limited 1o w~, 1r1 1M fMn of G1IINOcy IJJ'Q!.~ ~ . .na J1l()net( oldet~

I M'!OIJnl of Cash Oil Hand ~ \ Form of Ceah oo H111d ..

b. Nlme on hcoun\ Nan)e & ·.6iddtel$.of l'itt~ntil! lnahtu\fon AcCount No Cunen\ Sllanc::e

l

s

$

$

' ltam 10.. PubUcl!( Tnlded Se~urttles t.maD ·~tradesheGidle.s.~ butPCtJrn!itecflo.~ stocl-.opiiCra earporate ~.ft'IU!U8I~,us Oll~s~.'~ JlUl oot ~.toti•IUI) ~tt. .na treur.Jty n~J. ~·st-'M anl'.l mtJn~e~P.t borods .NsG aat '"~ u e ~c bol14il . ~nlf Securlly IOUiir t l'ype.ci1Seculfty I No. crunns QM1e.<l

SiOKer Ho!ASI, ,6pd'rost Broter AcCOUnt No

.cummt Fair Ma'tkei.VIiue 1 ~n(I)A(Iah\~ $

QI.Wllf tJ( Secli1ty l~uer 1 Type of'S'eC\lnty I No. d IJijt. C>.t.fled

Bft)ker House,.l.ddma Stoller AcQounff~).

cun.nt f-'r MMcal VI lUll l ~n{s) AQatnst~ ' .,

~i!ftSecultY Iauer llype Of Seauty ·~ No. oftk\Jta ~

8rOJIVHoull. MdntR Brel(ar~~.

CutTen\ Fair t.li(Qt vatU. I ~n(s) ~linat Sec\SI~ s

Initials.

Case 1:15-cv-20270-DPG Document 16 Entered on FLSD Docket 02/10/2015 Page 21 of 44II

Item 11. Non--Public Business and Ftnanchd fnte~ i..b~~ ~l'!WI1nt:.s w~ ~-ll'h.~~'\Dt:~W ~·Uite.Ullll ant>~~.1\!on, tu~ll..pt1lt-S~n wn~ Jll!btlltf ~ ··Ll(''), ~&I er lt:nlbt·1 !M11.~hlp.~!l:t ~ aolt ~to11hlp. mtamtllonalbullneu t:I#~DOn w ~! lf'Neslr'IW'nt ~l'P:nb'OI\ ~ Clf ,Of m11*8111\(;f &

Entit)'s Nem e & AddR:ss TYPf of-~a ot flrBlcal ~ OwneBiiP lf Oflc:ef. DAdO!. Memtlef' lntefe&t (e.g :_lLC, pfl1~p} (e g , aeff, ~se} 4 or P.lltrJet, ecat.t "fllle

-

Item 1·2. Amounts OWed to You, Your$:po\lse~ orYour·O.pendents Debtor's Na-'" A Address

: DaQ&~ · Ot!glnll Amount~ Natur• Q(Oblig.uotl (V_ the 'nllilllt of~ lnal CQUtt

lllourted·o(fllontt\l'l'eet) $ JOd.Qment '0/' alltllement, Jln:Mde G!llJtt nerne J • ..-,cl ·dotlcet~

Cunerit AmOUII·OWed ?ayment'$Chedue $ $

"'btofs Telephone ~01'1 Relat!GI'!Chfp JO VQU

Debtors roe,. & AddteN o.te'ObUpi!Oil Origlnai~LI'lt Owed . Nature of Oblg.uoQ {If the 1'81Uil of • tlnal COUJt ~ncurted~ear) ~ '

judgme(t 01' tattkNneJi. piDYICSe ewt n.Jrtle

' end dodcetn~ Current Jin)olltlt Owed P8yn'lett &:hedUI8 $ $

Oti;I\OI't ltl~Oill .o.t:Jto(s ~Uotwlip 1o You

· ftem 13. LJfe Insurance Polfcies IJ(.t IJI11!P '*."'~ ~ (~ang -.u{~J)Cl1us).'Wilt; ~CI&)h aiJ/Iendef .,we lniiUrerJCO~I N~ ~. & Telijphon~No. Beflltlil;ialy Po~cy.No. FaeeV•rue

' 1118Uii(l ·Lon AQilnsl P011c1 . ~~VIIUS '

I $ • t .. -

. ln.V~ c;iompa~ Naint. Add(eSif, & 'Tele!phcrliHlo Beoefidlt.ry Polk:y No.. F.ceValue ;

~ lpafl' •nst Pi:illcy SUITt!/lderVa • .

• s

Item 14 Deferred lhCOme ~ngemems t.at .u aetened ~n:ome ns-IJtenUi. at.1udm!J w ~1m~ to.~ llllt*llllt>~ ~ Dl•lt ~ha1111g ~n.. ~~~ ·pl.wlt, tRA$, Kqh$. 1lln8f •bl'll1'ltfii•Ooll\lllll, end~ S.ll\1'\l'l.Jiltm ~··9 &9 ~~ T~ «'Adtiiii'IISitwi.P(I Name. Adhsl.& Tefephonit-'Nb ~me on Aa:dLIOt 1M:o~No.

TypeOrP!in ne• ed i sa-ren~~~vatue tie1of\ I J Taxs 11)(1 Pwle~• ~) s .

Trv&lteOIAd~&~Jl.ddm,a'Tete¢"i!ltleNo. lJaml!oOn~l l.~tfCJ.

O.te E5tabll5'hed I JYpe of Plan l .Bur!inderValue befQfe I I TJW and P.enalrles

' I s

fnitials: __

~ ct 10 Fedenll Trade Commission FnanctatS~ent 'of ~ndfVicUl Defendant


ttem 1.5. Pen<Jtng lnsuranc::e Payments or1nfletltances U,t 4nt pel'ld!J'lV 111SU1'8nce p~$ .,.. amenterNM oY.e<t:to .'/W

'rYJl8 ~&p~ad Oatt ~ (rnmlodlyyyy)

$ t I

~ I I

$ , I

ltem1G. Vehicles ~ -'' ~rs.t'Ueka, JJ1('4QtCydea, boilbl &rplane\, ancfothetv~tudft

\tehlcle Typo I Yeilr ~tered Own!ll"8 Niime PIXthlu Price Original Loan Amount eun:.nt. 61fllll(;8 $ $ S .

Mal<f ReglslrJtjm Slat~ &~o. Aecoul1tll~Mn No. curr.ent va~Cse ~ Payri'ierif -$ s

Modtl Ad<!rea til V~'a Locati?O L.ender's Nll'(le and Adcll'eM . .

Vehfett·'fYpe I Year Reglateled Owneni Name :P>Jtd\aae Prb Orig.oaJ Loan Amount Currenl~ce $ $ s

Make ResiJitrlllor State & No. ~until.oan Np. Currtnt Value Monlhly Payrn;ent l ' Mod .!'I Ad<1ntU ofiJehiiile'I-Locatllia Lender's Nimit .and Addi9$S

Valida Type l 'i'e..- Regltt~O.W.ac'j 'NIIne -~asaPnce Orlg'fnalt:oen Amount Clltrent 13tlance $ 5 $

·Make Regis fraU en S&aio I, l.Jo. AccOunSiloarri'IO, Cl.l'te(lt V.a""' MOcl1tiiY PaYment $ $

Mbdel Addreu vf'Jti\1CI&'tl...ocl~n LMdl!lr'l !'fame .nd Addre&$

VeNda 'l'yp& I Yetr ~ CXW!e~S'N.a1Tle P\Jrehat~ Pfict OrGfrtall.r.oJJl Amblti C~l S81inr.e -s s s

Make ~lltrationS~e 4-No. Aecotlrdlloan .No, Cim!mVal.l» ~ P,.)llrieit .

• $ Model ;Address or Vllltcte:ai.OCitlon I.AJndl(s~Ji!.me anti Addresl

Item 17. Other-P.erspnaJ·Property LahM olhll petJDNJ~ notlllled J,;~ ~16 bY~teQ91)', ~~for ~Aonfr u.~. ~lltur·any Oltwf se.son. ·~ l:ut not lrrutrd tlli:Oin&, ~. Nt~ gemuonti,~lrol. Wllon ~~. COJ)'Il'lgtD. PJ1.tft'>. and CllhVIWJIBetuel p~·

P\'bpel1y CiltllgllfY (e.g .,~JIM~

N~me ofbwner ProPerty I.Dca!kln Al:qU1i111QftCost eurr.f( -vat,re

s ' $ '

I 1

I $ $

Initials:

-& ot 10 Fedelat Tr~e Commlnlon Ftnandll Stallln'leflt or fnd\\lld!Jal Defendant

l

\


t l I

I i I

! 1 l \ l

Item 18.. Real Property l-ot all 'te8l PI'QPf"Y m1erese toncluding ,m~ lallli <::QIWBct\

Pnlperty:s ~tlon TYPe of Property ~amlt(s) co Title or Cclnltect l'II'IC! 'Owro!"!~ Perc~~

Acl:julllbOn Dat,e (mi'IVdd))yyy) I ;U/Ulaae Pnce I ~ntVa~ Bul& of Valuation 7 I

LendeT'a Name ~ Addf'841 Lnan or Account No J CUmlnt Balance On First MortQ;tge 9r Conlrlct

" MontNy P8ymenl $

Othet Mor4Qage l.Oan(s) (desCtfbe)· Mon!h'li P.aymerd 0 Rental Unit $ CUneo\ BalaAc:e Monthly Rent Reo!Ned $ $

Ptcpestyls Locatkln 'l):pe of .Prope r1y Ni!me(a) bn "Title or Conllicllrld Qwnefshlp Percentag9

AcqlbJ!Oil Oete (m~) t ~rchase Price t ~Uti'~ I Val \II Bu oiVflU8tlon I I

LenCieY$· Name .nd Adclreu i.D!pl OT Aceoilnl No. -Ciirent Balance on Fktt Mot1gage or eons~ $ Morthly Payment s

Other ,.,.ge Lolln(a) (describe) Mon!Ny Paym.ent 0 Rental Unit f CurAintBalance MOiltNy Rena Received $ .s

LIABILmES

Item 19. CredJtC&rds 1Jtt ~ <:rtdll ~d ~Mid by you, YG.1f spouse, or yow ~fits .nd 4Ift ott-.- CAlC It t:ll'<k flat you; Jelir apouae. or your depeMem ~.ne. ~~by'! UltlecS Stat. orforee!n hnc2al ~

0

Name o!Ctedl( Cllrd (e.g., VIM, Mu!IIIQe.rd De~·stwe) Account No. tume(a)oA~ CuiY'erlt Salata

. os .. 0 ' l

I "

$

Item 20. Taxes ·Payable IAleJIVe), aud\ .SIIlCO!!'• ~~-Of lVI e.tste tt~. DWIKl by -.,uu. ~OOJr :tpot.!lta. 'Gf' fOl.lr'dllpP.ntleflt'l

Typaof1ex .Amowrt OWed v ftt' lnctirre::t·

s i. 0$

Initials:_


Uem 21. Qther Amounts·Owed byY~u, YourSPQ~. or Your .Dependent$· Lst d oMPr .,n.'~~\:'0. npt ~ ~re 't' ttA finar~~ ~talfmeftf ~ l)y Y'JU. ybl)1 ~CIU'J~ 01"}\'XR' ~,J6n~

l..e & Nam!l, NJdte:.v, an<1 Te!epJ»ne No Nat~.~e oTOebt!lfltla muff Of a coortjudsmentfll't&a~~ ~ eO!Jftna!lil! aodaockel ~.

LenderiC'reCIIor'is',Re\a\fonSI'ip to YOt.l '

· · ·Oa te t.iabl!ltY WilrlilQ:ll!W J ~1na1 Amoun! ~ !: CU[nlnt Amot.tt-ll Owed Pay.ml!nt Sotllldure

I I $

l~f!ld~llOc's Na·me~ A0d1818, entl TeleP.IlQhe No. HalUre of Deb(· ptt;e taiJlt Qf a CO!l1.j\JdgMentQT settJe.ment, ~ court~~~ l:foCket . number)

Lendertctedi!O(.-R&l~ to·Yo\1 "

Date' Uablllty WIIJ lncwre'd

1

. ~~~~dl Amount owed I 'C""'nt ~· CMtec1 Payment~

I I (mrrJddJyyyo/J $ . . .. .... .

OTHER FINANCIAl.lNFORMAtlON .. ltem'22. tru&t$ and &crows ~tall-llt¥X Mid eUler 111Wllstller'3rebelr,~·held mtMt.Qr~JIV J"').'r.«Mn Qr~fory.W yoo'$PO\M or~C1JI ~ ~ W1Yf89c11 r~:~Winera be~ng he!cf Ol\ vrmr bellat b;, k!!Jal r.cil.onll'l Alao.lllit d tu~ t>t· Oltll'l M~e1& fttt ate b~ he\11 lfl !JUSt 3' B~~tt«M !I; you, YCitS apo~~R, Cf you~ depe~~.-tqr-~1 pmcn (lf.er.bty

Tnli!N or actow }\Qent•s Name.& AddtJtss Date Es1ablllh8d Gr.ntor Beil~II8S Pnlaent 'Matllet Value of Aaeets• '· . . u . . ··' ... 1 I : $

I I s

'

I .f $

;

,fth.!l ~ Y.lllue.Cf.CU\Y ~et tl ~: c!~b! lh& •aset iind 1late Itt cast.lfycu.khow il ..

ftam ~. ·Transfe~·.of Assets ~ taet\-p8rcol) CJ ei'Uy to ~Y'>IJMI.e (l'~ftrtlld lh lbf-~te f!'IOI4fthln$!!01J01it fundi Gl ott~Qr·~fls dlinnJtha.~1i~ ~by kJkn ~. ~. orachet:tlartlfer ~~Ud• ~ry ~ , .. c~ i\lllg ~lid~~~ ...... pe!Cl.to.~ttled. #1ll'd Jl!lltlt:Ji F'Ot' eMt\IUC.fl ~or .i!nfrty., stltp~.fol.ll ~I!JinMisfe!Yed ~ lha! pttnod .. . ..

Tm.fer Date type oTT~~ Tranaferee't :N•~. Ad~S8S. a. Re'-110T.l$hiP. · P~erty'TrrifjthiiiJ liglj·~ Vtl~· .. {11111lld~) (•=g., ltlan, G:lft)

$ f ,.

$. I l

, ·s: " I - '

•iflhe.~et v.elue'tlf·anY asset Ia unknoWn. ~1hea~t.and-atate tt. .(!OSt. t)'9J know tt. ;

:

lnltfa(s:


I :l ·'

ltam 24. 'Document Requmsts 'Prtw'ttl ~JUJI!oi olthe tono\q d~ "4th~rtoni~ Funtel'5"""'~.t

~ Fedtnl tax tetu:'n& !Hod dLmng the l~st thr• Y~73 by or on behelf of yo11, you( .spoUse, ·or your dependants . .

All apPftcations for barik loans or 0\h~r exlens!Ons ~f credlt (oiher than credit cards) tl\at )'DU, your·f1POI:I$e, or '#JT . -deJ)Gildenlll have eVbm~ within :the last .two )'ell$, lrldl.lding by obtall'l~ng copt.es from ~ers if n~.

-l ·ttem9 for eaCh bank acr.ount hs1ed In ltem·~. -aU ac:ount statlm't&nta for the past 3 yea is.

For each bUSlness entity Us\ed tn 4tem 11. piOVIC!e (lncludtng by CGtJslng to be gene~ from liCCtJUnting recoids) 1h8 Item 11 most I'Qnt balanee liheet. tax. return. annual i1Jc!)ma '8fs~ent, the rriOst recent ~1'-to-dste inpome $.taftm1ent • .ano all

gen~t~alledg&l"fll&J .from a~t ~rds -

All appr6J51U that hava b.eefl preparect foranv property liSted m Item 17, mdudlhQ ap~ls <10M for tn~llrene& ltem17 purposes. Yo'U·I'tle~ exdl:{de'81iy ~legQfY of ~rty, where tho total appf.a\Sed vak.te of sU propecy in th~t ~gory IS

le!l_s than $2.000.

ltefn 18 All app-raiSals -~t hil\le *" pteparsd for rea! pf'operty hsted In 118m 18·

ltem21 Doc.uroentatic>n WI' all clebts ~ted JOltern :21.

!ten'\'22 Alf'execotilad -documents· ror sily trust ot e.scrow liSted m Item· 2.2 Als'~ provac:J.e $1"tY $ppral8als, Jnc;l~ilig IO~J'leij appra18fais that ha'ie been d* ~i' any a'"IS. held by any·iuch lnlst or 1t1 any <6U'*' ewow.

SUMMARY F1NAN61AL SCHEDULES Item 25. · 09mb!hed Balance Sheet for Yi)u, Your Spbu$&, rand Your Dependants

AMa1a Uabnttl•

c,tah on H~ (llem V} $ I.QifiJ Ag.at.i'lat Publcty ·naded ·Sec;untiM {Item 11:)) 1 Fundi Held lfl Flt\lll"dJIInadlllbOn!i (Item 9) $ V~clei·.Uinl Own HIJ s U,S ~tlt.Securalet (11em 1Q) s. . . · R~ p-toperty,... EA~oibrance• (!Wn 11) ,$ Pubi~Tllded ~(Item 10} $ CWJtdlt ca"" (ltl!n 1sj $ NQn-J'ubJe 8uU.lMI aoo Finer#&~ frtereals (llem 111 .. i

. - T~Pa~e(lfem20>. I Amoinl Oi'4d to You'(fteta t2) s Al'llOUnts OWtd liY You (item 21} l Ute l~Oic:IM (118m 13) $ 01tlertia!'~ll~}

' Oelerrect JI'!COr'M Me (Item H> •• , .$

Vehldea (tl•n 16) $ ' Olh8l' P-.onil. P~ftY.(IIem 17) $ ' J . Rea~ (114V111~ .. s $

Ottter ~- (ltitrn!Z&) s. s • s s . s $

\'o~t-...eit _ ·.J _· T~ ~ibllltlR $

' ttem 26. Combl"ed Current Monthty lncome$1d ·E:tpens..S for You. Your Spouse, and Your o·.,pand$nts PN\IIck> lhe·~ -ITIOI~ l!lt011lt' at)d.~ fer .'I'OU: \'!lUI rpo1M •nch!U' ~~rls 00 ~l! 111dlldfo c:tedlt·c:.ard -paymtfli.e •w.ralf'V r.tthcr, lr!efbdt! Clt!dll <:artJ ID.j)~Udill!~ itt tml "'Pfii Optla~ c.atfOOijM .

Jr~com• (4t* ~ ot .. cfl n.m) ~- . I 'Salaly ·Aftet'TSC81 s· M~ga o.t Rtlntlll P4iynieliUoc Reald~s) $ SotR&'

Faes, ectnm~nlor.. l.f'ld ~ $ ~ T~fo('rteeldence(a) -s ~. .

Interest 1 · Rertllil P.top6fty€xpentn, 'JncbJJl; Mortgage'P:tyments, Jlie$,

Sourta- -•nd "lnalll'l!* · $

OMdec'ldleRi Capital Gllt'll $

Car ot ~ Velllele1.-. en \AWl Payinents t

StiUrc:&: Gil* ~Income

., Food-&p11nan

~urce ,. s

PM!!& tvm SOle Propcfetbrlh!P' s CIOtti~ E:xpen.tiS $. Souttit:

Dl5111bu1toniS frum P~ps, 5-COtPOniiiCW, ~ .Dd llCs -$ l · Sourer.

lnitials: _


I

\

~ -

Item 26. Combined Cun e.n1. Monthly Income and Expenses for V.oq, Your SpOU$e,_ and Your bependttnts tcont.) OIStrlbu.tiCfiiS ft9in Tru&~ n EJI~es

.. Mealcal Expenses, I~ Ins~ ,, ~

·~: $ I $ ·

· OistiiOOitona from 09fe{recl !rq,me Arr!l~ls $

Olher lnsUra~Xe Prmii~ s $0tf!C~' SoCial Security P~y,menta s other T ranspottation Expenses s Alllm>nyiCflki &lpport RecalVed . $ Otll..,-'CX$1~ (ltaml:te) ... Gari)l)firQ ln¢cme s $ Other lni:Om' (tteit\J%~1 .$

- s $ .. f $ . . $ $

1'otallncome $ Tota!,ecpensas $

ATTACHMENTS

ftem 2"/. D~ment5 Attac;h&d to lhls Ffnanclal Statel11ent. ~ alii ~ thai aie bell~ aLibmllted 'AU~\ tM. fll\•!nes.l,alalePitlii. F ~ artJ Jmn 24 c!OCIJ!tlenls ttla/. ~not ~11actM>d. ~-In ~ . .

Jtem~NQ 0oclln$r( Re.la\~ IC> ~Of OCeUITleCit

.

~- ~

J am submitting ttl1s flnan~l statement with the undet$tandin.g that tl may affect ~OliQM by the F~deral T~· Commrs&ton or ·a federal ~urt. I have l,l&etl my ~t eff.01;ts to .obtain the ·intonmmon '(8Quested In thfs ~tatement.. The re~pon&es f heve provided to· the :items abOVe are true Md contatn aU the ·requ:eeted fact~ ahd infoniiatio.n of wDiclll have rlotice or knowledfe. I hiiVe pr:o\'lded all requested:dOCtJmentS 1n.mytustQdy,- possession, or~. 1 'know .of the penaJttes forfats.e ~tatementB under 18 U.S.C. ·§ too1, 18 U.$.C. §·1621, and 18 U.S;C § 1:623 {fiVe yeam Imprisonment <Sntllot flnes). I certify under pen!ilty of pe~ury ~:m~er .the lam of the Un lted $tate5 ttmt th~ for*lng is trl,le ·and co~ct.

Executed on:

{Date) Signat~re


Attachment B


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FEDRlU:L TRADE. COMMISSION

FINANCIAL STATEMEN:r OF CORPOAA TE D'EFENPANT

Jnstruptjon$:

1. Compl~te all itena. Enter ··kNone" or '~/A b ("Not.Applicabl~") Where appropriate. 1fy9u ~ot fully answer a question. ~IAifl Why.

2. The font me within. each field Will adJust automaticalty as you ty~ to accommQd~e longer responses.

3. In comp!etir}g tlltS tinanclal statement, .. the corpQration" refers ·not oply to this r.l;)rporation but als.o te eacll pf its predec~&Ot'S that ar~ not named defendant!. in this aetWJ3.

4. .Whe:it an Ite.~:n asks: for in~tion~bOuti!.ssetS or liabilltles ''held by the OOJPOratiQp~" include AU.t$Uch :asse~ ~ liab'Uities,located vifthin the United S.r,tes or elsewhere, beld b.y the eot:pQJ"atlon or held 'by -others for fho ben~fit of the corporation.

5.

6.

At.tath eo~nuation ~as needed. On-the "financial statement, 5taie pe.xt to tb·~ ltem .number that tb,e Item .is b"eing co.ntinued On the continuation ~e(~1 identify the Item number being eontinuecl

type or print legsbly.

7, Ail o:ffiCCJ. of the corporati!>n must sign and date the ~ompleted financw statement on 1h.e I~ pege ~d~ eacl\ page in the~ace p~\ltded" In tbe.lower right cctnet.

P~glty for False Information:

Pe~erallaw Pf<!l~ tb.at ~ ~~n ~Y be t~ed ~t n~t 11}0~ tbah Av~ years. ~~or b.otb.. if Mh person:

{1) "in .any· ~er:wltbin the;jurlsdicti~n of,any qep~artme'ln or ag~cy, of the \Snited'Sta,ts knowingly ind ~1\fully fal!iiie$, conceals or QOve.tS up ey any.trick, schet.oe~.or devlce a nWer.iJl fa~ or~~ f~ fict)ttous or !raudul!!ntstateulent! or ~~-t.i$s, .tll' ~.or u.c;~ ~Y fal$e ·writing :or ®o"..mltuit knowin;g the sam~ to CQ1lb}in·aey:fal4.e, fictitious. Ol'.f~dute,t stJtemQnt or·~'-(18 U.S.C, t l~l);

(~) ":iQ.s.rry •• . -stat~ment un~~ ~ty of-peijurt as ~ unqer sectibn 1746 of title .2~, Onited $tld(S Code •. W"iJli\lUy. s\lbsQfbt:$ as we-any maurial matter whicli~.dots-.Mt bdie.'le lo beb\le" (18 'U.S.C,.·§ l~lkor

~) ~'in aey ( • .• .!t41ement lq!der peiihltr of-ptljmy as permitted. under section 1146 ~f tffio 28. Ui11te4 ~tales C~) in any proceeding befote ·Gr·ancillary .t~ 41JY court·or ~d Jwy .of the United States bloWingly makes ~Y false- tnoterlal ·4,eclatatiob tlr ~Jib& or !JSeS ~ .other infonnation •.. J.mowmg the same to-tontain any·~ material declaratiott.., en u~.c, § 1-623}.

For a felony 'COOvictlon \lilder tlie provisio~ cited above. federal law pro~ des th~nlbc ~ may ~ QQt. more ~the .grelltet of(ll S2SO.ooo·for an lDclividwll Qt·ssoo,OOO·for a torporation, or ~liJ if the felony resultS in peeuruaJY gain to any peJ:SOn or pecunituy loss to .any .person other than the defenflanl, lhc greater oftWiee the gross giln:Ot twi~ the grouloss. 18 u.s.c: §3571. .


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BACKGROUND!NFOR~~ON

General !a!ormation

Corporati~m·s Full Name---------------------------

Prin1ary Business Address ---------------.-----.... From {)}ate).....---

Tetepllon.e No·---~-----......-- Fax: No._.....,. _______ _

B-Malt Ad~---"------lnt~etHOI:lle Page:....--------

AU other current addresses & previQUHddre$s.:S:fur past five }'ear$, inel~ing 'pO!it offi~e boxes ~d mall ~91'S:

Address .. _ --------------....--------From/Until._~-----

Ad~~------------~---------------F~~am~------~--

Ad~·-----------~-------------------------F~~ill~--~--------All predecessor coropenies for past-five years:

N~e&Ad~s _____________________________ ~uUUmu ______ __

Nmn~&A~s---------~------~----------------F~--------Name & AddreSs __________ _.:..... _____________ From!Until ____ -:......

F.ede;al Taxpayer ID No. _____ ..,..._ ____ s~ & D.at.t of'lhoot_ppration ---------

Stale Tax In No. St#ite Profit or Not For Profit ,___., _________ _

IfDjssolved; Date dlssolvul ______ _..__.__ByWhom ________ -.-.--.------

~m __________ ~---------------------------~------~---------Fisc-al Year~End (Mo.IDe.y) ___ _..._~corpo~tion•:) Business Aotlvtties -------------

Reptered ~eat

N~eofR~~e~A~t _____________________________________ ~-------------

Address _________ _._ ______________ t elephone No~ ---------

Pt~t2 Initials _ _,___ __


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List all pets~ns and entltie$ tha~ own at least 5% of the corporation'$ s'tOC~

'Name &. Address ·~ Owned ·

Boa.rd .MetJ~.ben

Ltst atlmelllber$ of the coiJX)ration,s.Board .o,f Directors,

% oww Term <FromNntill

List .all otthe cwp&ration 's officers, in-cfud.iJ)g. t:k/fiWto .officers (mdividuals With significant m'81i!gemeot rc:sponsiQiUty wliose ti~os do not reflect the natUre ~f their positions).

Name. & .AdfuM!f

Initial:. ---


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'Item 'Z. Businessu Rell\te.d ·ti) the. <::orpatation

List all cotpot'Stions, pertnership$,-and otb~r b~ entities in which this eorporation .b.as an-ownership intettst.

'Nome & Address Buslntss A@vities 'Y« Owned

State which of·these b'l.lSinesse~, if any: has e.v.er transacted b~inoss With the carptmitiou _ __,_ _____ ....__

List all co.rpora~om, partnerships, and other bus~ess erUilfes in which tlle COrporation's principal stockholders, board members, or officers (i.e .• the indMdua!s listed in lterns 4 - 6 abovo} ha1/~ en ownership 1n\ere$t.

Jndiyidual's Name Busjne.ss Aetivities % pw.nea

ltdat~ IndivJdllals

List~ r.elaied .ip.di'V'idb.l$ Whh wlW.m the corp0l'8t1'on has had any ous~~ ttwaeltions d~g ~ three previous iiS,i;a1 ~and curtant~cl.l ytar-to-c!Jte .. A ~lated indMdual•' is a.sp<>us~ sibling. pattnt. ~ ehi)d ~fthe prin~ipa) stocklioldm, board rnember$1 CU!d officers {i.e., the inOivlduaJs listed in It~s 4- 6 .above). ·

.B!1Sigess Aot\'vities

Til.itia~---


l.temlO.

Li$1 all outside aecoun~l)ts 'l:etained by the ce.rpomtion during the last three years.

,Firm Name C?A/PA?.

Jtem 11. Corporation's Record k-eeping

L'lst a.ll individuals wi1hin the eorp001tion with ~sponsibility f\)r keeping -t~ cerp!)!'a.tlon' s fina.t1ci~ boolcs and teeotds for tbe·1ast1hree years. ·

NBme, Address. & Ielephgne Jolwnbg Posinonfs) Held

FitmNarne

Initials----

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Item 13. Peudlng iawsu~ Filed by the Corp<>ration

List all peDdfng lawsuits that b11-ve been filed by th~ carpontJon io eoun or before an adm.tnimtive ~ncy. (List lawsuits that resulted in f~ judgments or settl('tr{~ in favot of 1be corporuion in Item 2S).

Opp6sing Party's NlUlle & Address. _______________________ _

Court'$ Name &Address. _____________________ ........ ____ _

Docket .NQ •. ____ _...___ RehefRequested. _______ N;rture ofLaws\tit._...,...._,.... ___ _

-------------~------smt~.----~----------~------------O,pposing Party's Nan:·re & Address. ______________________ _

Court's Name & Address. ____________ _ ______________ _

DoaketNo .. ______ ReliefRequested, _______ Nature ofLawsuit. _ _..... ____ _

----------------Status. ____________________ _ Opposing P!rty's Name &Ad<tre.ss, ______________________ _

Court's Name & Address. ________________________ ___,

Docket No .. ______ Relief Requested+-------Nature of Law~"--------

-------~-----------surr~.-----------------------~-Opposin~Party's Name &.Adws. __ - ___ ___, _______________ _

Court~s Name &}.ddress:__ ________________________ _

Docket No. ______ ~lief Req~ed. ___ -..-..._ _ __..· l't&ntte ofLa\\~1.,___..,...... ____ _

----~--~---~---------Smrus. ______________________________ ~-----

Opposipg Patty's Nam~ & Address.--"--------------------....._,,__

·Court'sN8Dle&Address._..... ______________________________ ~-

DOcket N~··------- ReljefRequemd. _____ __ Nature ofLaW$liit. _______ _

-------------------------Sums. __________________ ~---------------OppesingParty'sName&Ad~ss. ________________ .._ _____ _

Court"s Name &Ad~ss. _____ __,_ ___ ......_ __________________ _

DOCket No .. ______ ReliefReque!ted. ______ ___.N$Jre ofLawSJJit. __________ _

Slatus ----------------~--------- ·~-------------------------~--------

Page 6 lntlaals __ _


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ltem 14. Current Lawsuits Filel.i Against the CorpontioQ

List ~ pending lawsuits that have been tlle.d against the corporation in court or before an adminiStrative agency. {Li5t tawsurts the.t ~lted \n finaljud~ents, settl~~~ OT oxden; in Items 2~- 27),

Opposing Party's Name & Address ..... -------------------------

Court's Name & Address. _ ___________ _______ ........, ______ _

Docket No .. ______ Rtlief~uest~. _______ N81Ure of Lawsuit. ____ ~----

Status ------------------------- ·---------------------------------Opposing Party's Name & Address ________________________ _

Court's Name& Address. _________________ __,... _____________ _

Dock.etNo .. ______ ReliefRequested. __ - __ ---'_Naturc OfLawsuit~------

-----------------~-----s~~.---------------------------Oppo~P~'sNmne&A~~-~-------------------------------

Court'$ Name & Address~---------------------------------

DpclcetNo .. ______ Rel~fRequesttd. _______ Nature of4wsuit~---------

----~---------------Staros. _______________________ _

Opposing Party's Name & Add~ss~----------------------Coun's Nallle & Addtess. ___________________________ _

Docket No.:---. _____ R,elief~,---'-'-'~---Nature of Lawsuit:..... ---------

---------~------------------~- ~~s~--------------~~--~---------------------Opposiqg P!Uty's Name &.Ad&ess. __ _._.. ____________________ _

Court's Namt! & Addres$, ___________________ ____,;~-.....,...-----------

Doc:bt No .. ______ Relief'Requested. _______ Nature ofLaw~·-------

--------------------------~s~.------------------------------------------------Opposing Party•s Neme & Address. _______________________________________ _

Cvurt's NIIDlt & Aaclress. ____________________________________ _

Docket No .. ________ ReliefRequested. __ ...;._ _____ Nature ofl.awsuit. ______ _

-------------------Status, ____________________ __,.. ______ _

P111e1 ln1tials ____ _


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Item 15. »aurnptcy lnfonnation

List all state i~olvency and federal bankruptcy proceeding, mvolving tbe eorporallon.

CQmmeneement Dat.e ______ TtrminattonDatt ______ Doeket No. ______ _

IfSt~ Court· Court & County ________ lfFederil Court: District ___ __;_ _____ _

o~~Jdon ______ ~---------~--~--------------------

Item 16, Safe De.posit B.oxt!

Ll$t ~ we.deposit ~ee, 1oca.ttd wi1bii.l the United States pr e!Sewher~ hel~ by th~ CilOt:JX>ration, or held by oth~ for the. ·benefit of the t~rporatiOn 011 a .separaJt pqg,-,, de.rcrJbR the C()rJ/f71JS of f«lt /J~

Owner's. Name J3oxNo.

REMXNDR: Whu. aa ltem asb for lDtorQiition about ••iecs or UabiJitfes "held by the. corpo.~tio~~" ind~d~ ALL sucli l$Sets aQd llabttiUes, l~t~ w.ftb~ the 'Qnited States ~r elsew.h~re, ~eM by tbt. coi.po,..tion or h~d by otbm tor tht. benefit ofth..e corporation. ·

Item 11.

Pederall· Tf.X Y.oar S1ate/Botb

________ $. ____ $ $ ____ $ _ _ _____________ _

____________ s ______ s s '---------------------------_____ s,__ ___ s s $. _____________ __ _


ltem 18.

Li$l·a11 &ancial statements t®t were prepared for tQt· cotpora~oq's last~ complete fiscal years and for the current fiscal year--to-date. Altach capies oj'rJJhtaJern~nt.r.p-ovulbtg aJJdited Jtatemrnt$ tf avmwblt.

~ BaJpnce Sheet Ptofit 8t. Loss Sfa!emebl Cash flow Statement CJw.lm in:Owner's.Eouitv _Audited?

-------------------------------~.~-~~--------~--------------·------

Ite,m lJ. FlnaDtfal Sum:mary

For each of the last tJmle .complete fiscal ;yem ·and for tbe·.cumni ti·scal yem·-t~ate !or whlr.h tbc· ~l)l]Joration bas not provided a profit and loss statem~nt in aeooroanct: with Item 18 a'Qove. provicfe·the'following swnmary f'~i.al infotmatioo.

C\mrlt Y~-to-Dp.te 1 Year AAA

omss Revejlue

gxptmses

s .$. ______ _

s....--___ _.__ $. ______ _

Net Prpflt After Iaxt~ $. __ --_ __._,__ '$

t>aylil?Je$ s~~---

s.e~~ables s·--...-----

Item 20. Casb, &.-k, and MoU,y·Ma~ .A(lto~JIW

3 YemAgg

$. _________ _ $. _____ _

s _____ _ $. ____ __,..

$ $

List cash and .an barik and money market account$, ;nc..hlding but not limited to, cb~ e~unt$, savings Jtccow.u,s_. ~~ c6ttl"tice.1es ·of deposit, 'beld by 'the ~ration. 1'be tctm "tl!$" ·includes. ~cy· and \it'el$hed cltee.le.

Cash on Hand$~-----~--Ca$Held for the COl'poration's Bensfit:s._· ~-------

Si&@.tor!sl on :Account Acctlunt No·

----------------------------------------------------------~-------$·~: --_____ _ ---------------------------------------------------------------------$--------------------------------~-----------------------~-----------$. ______ __ ---------------------------~~------------------------------s _____ __


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Item21. G.<Wer-ntnen.t. Oblfg-t.i~i .and Pnblidy :rrt:ded Securl~e$

List·aU U.S. Oovermn¢n~.op)jgati(ms, includmg but not Jimittd to, savints bQnds,, trea$u.ty bill~ or trea$11\j' not~ betd.by . tb~ eorpo.rati~n. Also list an pubticly Jraded securitie'l. it~luding but not Umited to. ~. stoek Opti¢rts, registem ~d beater b.oods. '$late Md municipa,l bonds, and tnutUal ~ds,ltetd by f.l:l~ c-oqx;ranon.

~uer _______ .........,.....---___ 1)tpe:QrSeCllrity/Obl\gation. ___ __, _______ _

No. of Units OWned __ __,._,_. 'Cl!a-r~nt Pair Mark~t Value$. ____ _.... __ Maturity Date_~"'"------

Iss11e.r -----'------..-----'----Type of seeurity/Oblig!rtion .. __,_ ____ ,__ _ _.... _ ___,__,.,...,.._

No. of Uft)ts Owned _ _,_.___._Curtent.F,alt Market Value $._"--______ Matuiity Date~-----

R.ul~te

'List .tl.ral estate~ ~cluding !easeboids-iu tl.{Cess of five y~r.s. held by the corponruon.

Tyv.e:ofProperty ________ ......-____ P.ropmy~s Location.;..... ____ .....,.... _____ _

Nam~s)nn 1"itl~ and Owner$hip Perc~mages._ ......... ___________________ _

Qln:~.nt Value$ ....... ------- L9'an ·pr Aceount No. __,. _ __.. ____ ...__ __

L~pders Natn.~andAddress:___ ______ ....,.... _______ _;,__..-...... ________ _

Curmit :S~anee On Fiest M()Ttgtge S. _____ Mortthly Payn1ent $. _____ _

Other Lo~1>) (&eseribe) __ __,,__ ___ ..__ _______ eur~nt Balarn.e 'S·---------Monthiy Paymcnt·$. _ __,_ _______ Rental Urut?......,..__,.,. ____ Momh]y Rent~eelv~ $._,..__. __ _

iype efPro~-------------Propetty's Loeation......_.,......,.,__ _ _,_-:--__ _.... __ __,

Nante(s)()n 'ritleand0wnersbip P~es~-------------------...---

G~ Value·$ _______ Loaner A.cc~t No._. -------~--"--

Lender's NameandAddt~~-----......... ---------....... -----.;_,..--------

Current'Balanee On First M()rtgage $. ____ __._. Mol!l1:bfy"Paymem $. _ _.....____,_

Otbel'l,.oail('S) (dese.ribe). ____________________ . ~~:SAlanC'e $ _____ _

Monthly Payment$-------~~ Unit'l ______ ~oiithly .R~tRtceived :$:..-..----

rage· 10 ImtiaJs __ _


It~rri.,2J:. Othet .Ass~ts

List aH. othet property. by categQry, with an e,stim~· vaiue o.f $2,500 or more. held by the eorpc;11'81ion. including but not ii.mited. to. inventory, snachin.ei'y _ equtp~llt, fur:nirur.e. vehi{:.l~s, .customer liSts, cOmputer softw~ patents. ·and other

·intell~ual property.

Property Catet9rt fro!?erty Loct.tiim ~~uisiti.on ~ ~ Value

$ $

$ s

$ s $ $

$ $

$ $

$ $

$ $,_,

$ $

Jtemi4.

Ljst all persons. and olher ~ti.ties holdin$ funds or other ~ets that are in e.serow or in tnlSt for the corporation.

]'rUstAA !Jt Escrow Agent's N.&Add!W

Descrjjltion and ~tiM ofAs$_et$ fles!entM!rket Value of A~sets

'$ --------------------------~------~------~~~------~-- ------------__________________________________________________________ $ __________ ~

--------~----------~--r---~-----~-----------------------$_· __________ __ $

~----------------~----~--------------------~----------- ----------------------------~-----------------------------------------$·--~-------------------------------------------------------------~-----$ ____________ _ -----------------------------~----------------------------~$ __________ __

Pi$e 11


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ltem25.

List all monetary JU{igm~nts and settlements. r.ec.otded and unreoorded. ow~d tq the corpor.ati.on.

Opposmg Party's N~We & Addr$·--..,..----~-----.,-----,-..------

Coul1,s Na,me·& Ad~s~--------.----------~ P<><:ketNo .. ____ _

Nature ofLawsuit._,_ ____ ~----- Date.()f Ndgment:..._----- AmountS:-------

Opposing PartY's ~e 8t, Addr-ess·-----.......-.-----.------..-,------~---

C~\llt's Name&. .._ddress. ___ _.__.....---.......----'--~----- Pocket No,, ____ _

NatU):e ofLawsuit:-.. -"'----~-------Dateof]Ud,glhent. ______ Arixc>unt$ ___ _

}tem 26. Monetary Judg~ct$ aud S.ettlemenu ()Wed By the Cg-rpo:ration

List at~ ..rnQh~ judgm~ and ~ettl~ents, recotde4 and unreoorrled, owe(! by ·the torpol<!lion.

OppGsing Party,1$ Na:ne& Address'. ____ .__ ____________ ~---..-------

Court"s :W~ & t.\d4!l.re$s. ____ ___.__~----------"-- Docket No •. __ .,_..__

NatureofLawsuiJ~-----------;.--.- Date.__ ___ __,_ Amount$._. ------

OppQ.SingPilrtY~s1~aote. &Add~.__,.-----~---------.,..._,......,._ _________ _

.Cout.f.s Namt4 Address~.· ---------...,...-------- :O~etNo. ____ _

Nature.ofU.wsmt:......----------_,_-P.ate "Of Judgment . ..,.._ __ __, __ AmoPDt'$.._. __ _

O:pJX)Slng PartY's Name.& Address. ______ __.._ ______ ,__ __ ~,___,_ ____ _

Court's Name &A{ldress._~---~---------"----~-..... Do~efN~.·-----.Nat\11'8<0fLawswt. _ _,_ _____________ -pate of ~~em.·_----- Amount$._. ___ _

Oppas~·iP.art)''·s N~e&.Aadress.·_ -...-----------------'-------=----CoUrt',; Name & Ad.c'iress. _______ ..:.:.-----..-----...._...=-.....,_ Da~ No .. ____ _

Naturo of Lawsua ..... _...._ _________ Da~ of Judpent:.- -----AmO\Illt $ _____ _

Opp.osillg Part)''sName 8t.Addr~·------,--,..-----------.,.-..---

Court'~:Name.& Addr.ess·-------------------·~· . '.bocket :No .. ~----

Nature of LawsUit. _____________ -Dtlle .. of Judgmen1.~-----·Amount $ . .,__,.. __ _

lniliaJs __ _

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1tem:2'l, Governtnent OrdeN-1ltld Seffit:mtmb

Name of A:g«u:~y ......... _.__,_ _ __,..._""-_________ c~tttact ·P~rsun -------------

Address _ __._ ____________________ Te~phQne No. __ __, __ _

Agr~ntem Dai( ___ -_,_Nature of Agreement ____ -=----~----------.-------

Ck'eCIJt Card.~.

~ist.a,ll of the e.oiJ10ration 's· credit ~s end store ch~e accounts end the indi¥1dUaJs .authoM.ed 1o U$e tbem.

}'lam-e ()f Credit Can:J or.§tore ;; - - . Names ofAWhorizM Users and Positions Held . ' .

Itt.m.19.

LiSt·aU C(llllpCMUion .$d other b~efits received frotn !1.\e e0rpoJ.atio~ by "tbe ·fi~e mo~ higt.W compensated etnploY.eel, itJdepetrdent .centtacto.rs, and c;onsilltants {other 1ban those ~vidu$.1i~~ in I~ 5. ·and 6 abov.e:). for the two previo.us ·&tal yc~ an4 <;Utront fist:al y.ear.t~&Lte. "Com.pe~on" iJlcl~. bm, ~not limtted to. S'al~ <;Oim'l)iisiou. eonswtiog .fees. bonu.~. di~1 . .C~tribu.tio~ %'Qyalti~. peasio.ns. and ptQ'flUbarin:g pliiJU . .,Other b~tus·• i®1ad~. bu~>~ not liln~ to.- lOAn$, loan paym.e~~ re~t. car pay.ments, and i:nsu~ce prtmbnn~. -wheth=- paid tt~cti'- te the mdi\'idual$, or paid to of:h«s oa their 'behali

Curteqlfi§Ql 1 Year Ago .2 Years.Ago Year-ttaDate.

--------------~· $----~~$--~~--$--------~-~--------~----~ --------------~------s _________ s. ________ s _________ ~------~------~---_____________________ s s.~------s~· ~------------------------~

------------------~-$.+-_______ $ ________ $ __________________________ __

------~--------~---$------~-$ $·--------------------~------


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Ittm.30. Com1>ens3tlon o!Boatd Members and Omcors

List all comp·ensatioo and other benefits ~ived from the CQtporatiOn by each person listed in !terns 5 and 6, for the curtent fiscal year·to-¢tte and the twO previoqs fi!;tal yean. '~omptusatlont• includes, bUt is notUtnited to. salaries. colllJTUSsions, COt\SUl~ fees. dividend$. d~buti011$, royalties, pensions, -an.d profit $1\aring plans. ~benefits" include, b\lt ato not limited to. loans, loan pa~n~ ~t, car pay~~u. and insurance premJUtns. whe~t paid directly to the mdh·iduals, or paid to others-on tbeit ·behalf.

r~m31~

Nameleosition ·Qm:rentEiscal t YeJr Ai2 2 Yeaa Agg Year-to;= Date.

$ $ $

$ s $

·s ·s $.

s $ s

$ $ $

$ s s

:$ s $

s $ s

Trausrers of Assm ln~n.dfng Cash and Proper-ty

Cornpegsmon or Iwt 6fBenefiis

List .U transf$ of as$ets.ovet $2,500 made ·by the c-otpot'littlotl. other than in 1he o~ course cf\lusiness, dUring the pte"-ious tl\ree yta~. by I!Wl, gift, sale, ()r Qther transfer,.

Aggregate Value· '

l'YJ;?t of'l'Jaosfer .(U •. 'Loan. Gift)

---------------------------------------s·----------------·--~~------

_______________________________________ $. ________ ~--------------------

_______________________________________ $. __________________________ __

---------------------------~------------s·------------~--------------

Page 14 loitials _...__ __


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Item32·. Doc'llments Attached to the F"Jnandal Statement

List aD documents that are being submitted -with the financial statement.

ltom No. Document Description of Document Relates To·

I am subJllitting thts finanaial statement with the underStanding that lt may .affect aaion ·by tbe Federal 'rr:ade Cotmnission or a~~~. I bave·used my btm efforts' to obtain the infOtrnaiion requested In th4~=t The. TCSJlOilSC.S I ha.ve provWea t9 the items. abov~ are ~ 8Dd contain all the requested tacts and info.rmltion ·of wbieli-1 have no~ or lcMwl~ge. l.ha~ ·provided .til requested document! in .m.y cust.®y, posseSsion. 01. control. I kno.w Qftbe pe®lties for false -s~ments under JB U.S-C. § 1001, l.S U.S.C: § 1~1~ and li U,S.C. § 1623· (five yws itilpri~ent and/« fi.J1~). 1 cenify und~ penalty of~ under the laws .pfthe tltilled ~.that the fo:r.egoing-f~ #Ue-~d totreet.

(Date)

COJpO~ePo¢tion


Attachment C

j

l :

1

I l


CONSENT TO.lU:LEASE OF FINANCIAL RECORDS

t,

-------~-~-· in the Cotmtty .of_......,... ___ ......__ _____ ~

-do beropy -direct any hank, f.J.tUmCiallnst1tution.. trust oompany, or person 'that bold$, .oorttrols or

maintains cUstody -of ass~. wberev~r lqca~d that a,re owned· or -contr~ed by .me or at whlcll I

b~vo an ~count of any lcind1 or at which a· ~orp9rafion has an acto~ of NlY' kind -upon 'Which l

am authorized 1o draw, ~md. it$ offic·ers, etnployeeS and agent~ to d{sclose au mfo.rmati-on and

cfeHver-:eopies of all :documents ofevery.n.fltUre in yc.ur possession .or control. 'Wblch ~late- to said

apc.<?UJl~. w ,any .attOrney of the F~derat Tr.ade C-omnifssio~ or of the· Consumer Proteetion

Div.isi9n of Jlw Office of the At.tamey Gener4ll -of the S~w of Florlda; and tQ give evide.n~

~levant 'thcm:to, in th~ m@tWr. of Federal Trade Comllif3.Jion and 'State of Florida· v, 7fJ51620

Cimtul~ Inc .• st al,, now-p~g P, the U~ ·~~s: D~et Court for tht So.uthem DiStri~ of

Florida. and this shall be mevocable authority for so doing. This di:rec.tfbn h~s: 'been ~e~

pursuant to. ·a certain order. of the. Un_ited' States District Comt for ~e Sou them Pisl;riQt of P.Iorida

in -cczillec;ticm with that-afo~Jl)entl'Q.{led rp~r. Tb1s·dfJ:e·etlo.n ~s intended· to epply tt>•the Laws of

·cotitl~s other than the Uni~ States- ·which :restrW.t or }'Nhibit the di®loSU¢ of bank

i:nfo.nn~ol\ witbo'Ut. the ·09~ent of 'the hol4ei: ~r beiieficfal <>'WD~ of the. aecQurt:4 ~d .shill be

oonsttuedllS c6nscut with respc~tiheteto, and ·tM. -siine:$hai:l apply to any -of the· b~ acto~

for Which I may h~ Jl. relevant prl.ttcl.J>al,

Dated:. 20'14· ·-------~