35. Parent or Guardian Information Check the box below if the Beneficial Owner is a minor child and the information
provided is that of a parent or guardian:
42. Date of Birth Enter the date of birth of the Beneficial Owner in the format MM/DD/YYYY:
43. Street Address Enter in this field the street address of the Beneficial Owner, including suite or apartment
number, as applicable:
44. City Enter in this field the city of the Beneficial Owner:
45. Country The response to this question defaults to “United States”.
46. State Enter in this field the state of the Beneficial Owner. Use the state’s two-letter
abbreviation:
47. ZIP Code Enter in this field the ZIP code of the Beneficial Owner. Five-digit or nine-digit ZIP codes
are acceptable:
48. Type of Identification Document Utilized Check the box corresponding to the type of identification document utilized by the
Beneficial Owner:
Do you have another Benefitical Owner to add? 35.2 Parent or Guardian Information Check the box below if the Beneficial Owner is a minor child and the information
provided is that of a parent or guardian:
42.2 Date of Birth Enter the date of birth of the Beneficial Owner in the format MM/DD/YYYY:
43.2 Street Address Enter in this field the street address of the Beneficial Owner, including suite or apartment
number, as applicable:
44.2 City Enter in this field the city of the Beneficial Owner:
45.2 Country The response to this question defaults to “United States”.
46.2 State Enter in this field the state of the Beneficial Owner. Use the state’s two-letter
abbreviation:
47.2 ZIP Code Enter in this field the ZIP code of the Beneficial Owner. Five-digit or nine-digit ZIP codes
are acceptable:
48.2 Type of Identification Document Utilized Check the box corresponding to the type of identification document utilized by the
Beneficial Owner:
Do you have another Benefitical Owner to add? 35.3 Parent or Guardian Information Check the box below if the Beneficial Owner is a minor child and the information
provided is that of a parent or guardian:
42.3 Date of Birth Enter the date of birth of the Beneficial Owner in the format MM/DD/YYYY:
43.3 Street Address Enter in this field the street address of the Beneficial Owner, including suite or apartment
number, as applicable:
44.3 City Enter in this field the city of the Beneficial Owner:
45.3 Country The response to this question defaults to “United States”.
46.3 State Enter in this field the state of the Beneficial Owner. Use the state’s two-letter
abbreviation:
47.3 ZIP Code Enter in this field the ZIP code of the Beneficial Owner. Five-digit or nine-digit ZIP codes
are acceptable:
48.3 Type of Identification Document Utilized Check the box corresponding to the type of identification document utilized by the
Beneficial Owner:
Do you have another Benefitical Owner to add? 35.4 Parent or Guardian Information Check the box below if the Beneficial Owner is a minor child and the information
provided is that of a parent or guardian:
42.4 Date of Birth Enter the date of birth of the Beneficial Owner in the format MM/DD/YYYY:
43.4 Street Address Enter in this field the street address of the Beneficial Owner, including suite or apartment
number, as applicable:
44.4 City Enter in this field the city of the Beneficial Owner:
45.4 Country The response to this question defaults to “United States”.
46.4 State Enter in this field the state of the Beneficial Owner. Use the state’s two-letter
abbreviation:
47.4 ZIP Code Enter in this field the ZIP code of the Beneficial Owner. Five-digit or nine-digit ZIP codes
are acceptable:
48.4 Type of Identification Document Utilized Check the box corresponding to the type of identification document utilized by the
Beneficial Owner:
Do you have another Benefitical Owner to add? 35.5 Parent or Guardian Information Check the box below if the Beneficial Owner is a minor child and the information
provided is that of a parent or guardian:
42.5 Date of Birth Enter the date of birth of the Beneficial Owner in the format MM/DD/YYYY:
43.5 Street Address Enter in this field the street address of the Beneficial Owner, including suite or apartment
number, as applicable:
44.5 City Enter in this field the city of the Beneficial Owner:
45.5 Country The response to this question defaults to “United States”.
46.5 State Enter in this field the state of the Beneficial Owner. Use the state’s two-letter
abbreviation:
47.5 ZIP Code Enter in this field the ZIP code of the Beneficial Owner. Five-digit or nine-digit ZIP codes
are acceptable:
48.5 Type of Identification Document Utilized Check the box corresponding to the type of identification document utilized by the
Beneficial Owner:
Do you have another Benefitical Owner to add? 35.6 Parent or Guardian Information Check the box below if the Beneficial Owner is a minor child and the information
provided is that of a parent or guardian:
42.6 Date of Birth Enter the date of birth of the Beneficial Owner in the format MM/DD/YYYY:
43.6 Street Address Enter in this field the street address of the Beneficial Owner, including suite or apartment
number, as applicable:
44.6 City Enter in this field the city of the Beneficial Owner:
45.6 Country The response to this question defaults to “United States”.
46.6 State Enter in this field the state of the Beneficial Owner. Use the state’s two-letter
abbreviation:
47.6 ZIP Code Enter in this field the ZIP code of the Beneficial Owner. Five-digit or nine-digit ZIP codes
are acceptable:
48.6 Type of Identification Document Utilized Check the box corresponding to the type of identification document utilized by the
Beneficial Owner:
Do you have another Benefitical Owner to add? 35.7 Parent or Guardian Information Check the box below if the Beneficial Owner is a minor child and the information
provided is that of a parent or guardian:
42.7 Date of Birth Enter the date of birth of the Beneficial Owner in the format MM/DD/YYYY:
43.7 Street Address Enter in this field the street address of the Beneficial Owner, including suite or apartment
number, as applicable:
44.7 City Enter in this field the city of the Beneficial Owner:
45.7 Country The response to this question defaults to “United States”.
46.7 State Enter in this field the state of the Beneficial Owner. Use the state’s two-letter
abbreviation:
47.7 ZIP Code Enter in this field the ZIP code of the Beneficial Owner. Five-digit or nine-digit ZIP codes
are acceptable:
48.7 Type of Identification Document Utilized Check the box corresponding to the type of identification document utilized by the
Beneficial Owner:
Do you have another Benefitical Owner to add? 35.8 Parent or Guardian Information Check the box below if the Beneficial Owner is a minor child and the information
provided is that of a parent or guardian:
42.8 Date of Birth Enter the date of birth of the Beneficial Owner in the format MM/DD/YYYY:
43.8 Street Address Enter in this field the street address of the Beneficial Owner, including suite or apartment
number, as applicable:
44.8 City Enter in this field the city of the Beneficial Owner:
45.8 Country The response to this question defaults to “United States”.
46.8 State Enter in this field the state of the Beneficial Owner. Use the state’s two-letter
abbreviation:
47.8 ZIP Code Enter in this field the ZIP code of the Beneficial Owner. Five-digit or nine-digit ZIP codes
are acceptable:
48.8 Type of Identification Document Utilized Check the box corresponding to the type of identification document utilized by the
Beneficial Owner:
Do you have another Benefitical Owner to add? 35.9 Parent or Guardian Information Check the box below if the Beneficial Owner is a minor child and the information
provided is that of a parent or guardian:
42.9 Date of Birth Enter the date of birth of the Beneficial Owner in the format MM/DD/YYYY:
43.9 Street Address Enter in this field the street address of the Beneficial Owner, including suite or apartment
number, as applicable:
44.9 City Enter in this field the city of the Beneficial Owner:
45.9 Country The response to this question defaults to “United States”.
46.9 State Enter in this field the state of the Beneficial Owner. Use the state’s two-letter
abbreviation:
47.9 ZIP Code Enter in this field the ZIP code of the Beneficial Owner. Five-digit or nine-digit ZIP codes
are acceptable:
48.9 Type of Identification Document Utilized Check the box corresponding to the type of identification document utilized by the
Beneficial Owner:
Do you have another Benefitical Owner to add? 35.10 Parent or Guardian Information Check the box below if the Beneficial Owner is a minor child and the information
provided is that of a parent or guardian:
42.10 Date of Birth Enter the date of birth of the Beneficial Owner in the format MM/DD/YYYY:
43.10 Street Address Enter in this field the street address of the Beneficial Owner, including suite or apartment
number, as applicable:
44.10 City Enter in this field the city of the Beneficial Owner:
45.10 Country The response to this question defaults to “United States”.
46.10 State Enter in this field the state of the Beneficial Owner. Use the state’s two-letter
abbreviation:
47.10 ZIP Code Enter in this field the ZIP code of the Beneficial Owner. Five-digit or nine-digit ZIP codes
are acceptable:
48.10 Type of Identification Document Utilized Check the box corresponding to the type of identification document utilized by the
Beneficial Owner: