99969000-M0S-Wdr asetio uealooldr iIq paisanbael tuatuteau leituaPIJunD MOM TX3CINI AIS01099[ 010 tio [a5ed00:601l£P3Z/ZKOVIVEig IN1 kJ 11 -an Funds Transfer Request Meese Type instructions) Effective Date: 03112113 Please enter current a Mule date onty Select Appropiate Payment Type and Fields will be Displayed O JPMC Transfer O ACH O Check 0 Domestic Wire Income: Principal: Debit Account Title: Southern Trust Company, Inc. Debit Account Receiving Bank ABA: Receiving Bank Name: Beneficiary Account #: Beneficiary Name: $8.468.25 Citibank Address 1: David Tarlow & Co. CPA, PC Pay 'thrbugh/Intounediary Party (II Requtrod) Account Type: IntermIdiary Bank Account/Code: Intermediary Bank Name: O DDA O Swift O Other (US) Payment Details (Reference/ Advice Description/Addenda) O International Wire ..• Address 2: City: State: Zip Code: Invoices: 1000005013 & 1000005082 03/12/13 Date EFTA01580348