EFTA00617044.pdf

'LAC COPY TD F 90-22.1 REPORT OF FOREIGN BANK OMB No. 1146.10111 1 The ROOM k ler Cilder pee mint 2011) AND FINANCIAL ACCOUNTS Yew Ended 12131 Ociessmort et dm Maw? Do NOT Me with your Federal Tax Return 2010 Do nol see meadow Salons •I liken Arnended ❑ ilnetal Filer Information 2 Type OFIler • pleat 1 O Parewhip c Derscrahhe a DCasotaild • D Macy a Oar —Fides We U.s. Taper" Malatalen IMMO 4Fotemn cloadcation (Comae/ °rag I Pea 3 6 4•I ollfdidahlt) S Iminded' Dam el etc, MSAttlefert a Tam OPsesmal Danes a Mee hears US. IdemiSralkm Number complete MOM 4. bee*. • Ccemtry &Inn 1/20/1953 I Last Parr* et Otteerendion Noose 7 Free Pew I mace esism EPSTEIN JEFFREY E. Address (tiatet.Streel. ad Isenneel of Set Nece310 6100 Red Rook Qtr Ste 38 16 City 11 State 12 ZIPIPostal Cods 13 Osunfry St Thomas VT 00802 OS 14 Ohm he At hew • enema/ Ithemel el 2521se kwids awes? Eke e Yee' Anus lees number olicdmad• Qr k chocked. do not complete Parlor Part Illamt ma maids of Ns Somme]on) No - J Information on Financial Account(s) Owned Separately IS Mamman rain ol mann °woo seem year reports Type el acetate • I Li Setulas • LI Ott'— ESr type OS. /13M" 17 Num.:111.ra, Iralikemn k vole it, waxed is held IS Accowe Rumba or ohm detonatan 12 111-4 Meese dtsenhor. Street solo tewnbel) N Iledesesal haft:Wertheim mowed is held 20 City 21 Slobe Mom 11 im/Pollel Co& 1 1•11•31 ..--1 22 Cavalry M Plet 41 reef ma, e Mremateroa neat eat Osie gaIDIWoren Sts FIN this form *By U.S. Department of the Treasury, P.O. Box 32621, Detroit, PM 482324621 This form should be used to report a financial interest in, signature authority or other authority over one a more financial accounts n foreign countries, as required by the Department of the Treasury Regulations 31 OFFt 1010.350 (Formerly 31 CFR 103.24). No report is required If It aggregate value of the accounts did not exceed 110,000. See Instructions For Dellonions. PRIVACY ACT AND PAPERWORK REDUCTION ACT NOTICE Pursuant to tree requirements of Pitt Law 93-579 (Privacy AM of 1974), notice is hereby oven t rat the authority la collect information on TD F 90.22.1 in accordance with 5 USC 552a (e) is Public Law 91.501 31 USC 5314; 5 USC 301; 31 CFR 1010.350 (formerly 31 CFR 103.24). The principal purpose for collecting the information is lo assure maintenance of reports where such reports or records have a high degree of usefulness in criminal, tax, or regulatory invesbgaliOns or proceedings. The information corseted may be provided to those officers arid employees of any constituent unit of the Department of the Treasury who have a need for the records in the performance of their dotes. The records may be, referred to any other deparbnerM a agency of the United States upon the request of tne head of such department or agency or use in a criminal, lax, or regulatory investigation or proceeding. The information cc lected may also be provided to appropriate slate, local, and foreign law enforcement and regulatory personnel in the perWmanee of the r official duties. Disclosure of this information is mandatory. Civil and criminal penalties, including in certain circumstances a fine of not more than $500,000 and imprisonment of not more than free years, are provided for to fie a report, information, and for ling a raise or fraudulent report. Disclosure of Social Secur is mandatary. The authority to collect issupply failure 37 0FR 1010.350 (formerlyfr31 CFR 103.24). The Social Security number will thebe used as a ity means nurnaer to identify the individual who files the report. The estimated average burden associated with this collection of information is 20 minutes per respondent or record temper, depending on individual circumstances. Comments regarcfing the accuracy of this burden estimate. and suggestions for reducing the burden should be directed to the Intern.S Revenue Service, Bank Secrecy Ad Pruicy, 5000 Elln Road C.3.242, Lanham MD 20706. FOC2)101t 0335/II APPRV e053 Form TD F 80.721 (Rev 3.2011) EFTA00617044  PbOlbCont/nued--InformationonFIrwncWIAccount4)0wmedSepandMy Form TO F 9042.1 Complete a Separate Block for Each Account Owned Separately Papa Number This side can be copied as many times as necessary in order to provide information on all accounts. 2 at 1 Fang tot 3-4 tea precorate nenthastran tear 6 Last Ptak cat 0rpnizalen Name Sarre, X Mown* Idensrsceurn Nana. 2010 _ Ratko Identifealen tinter EPSTEIN neuter Nat Is Iftelinue rake el eat ihniq abaft is., repertO 16 Tane at awn' 'Bank b USectairks Wither — Enter WS bib. 990,733. 17 Need Firendalbelibkp in Pilch acsamt HSBC Private Bank SA la Aomori pease/0Pd Openekn 19 /Pip Ada Paw, *Pt fan Plantat) etlinetkal Irtslilutan b OA =Mid k MIp PO Box 3580 20 ay 21 Ste. If loom, n by ass Code, Pape to Camp Geneva 3 CH-1211 Switzerland IS Wasinten ware ell all dare oar pie spay $ Tkiendatesai . r (Bank I StarilieS e I IOMr - rota pc. 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Want APPRV #053 Form TO F 90-22.1 (Rev 3-2011) EFTA00617045  tgaatIllaitinformation on Financial Account(s) Owned Jointly Form TD F 90421 Complete a Separate Block for Each Account Owned Jointly Pace Number This side can be copied as many limes as necessary in order to rovide information on all accounts. 3 of 1 Pas Ice anal par 34 Clasklaraclail larrallan tear s Lsol Nita or Ocipalaban Nam Tian kfralfeatiro tants 2010 rap Ichinitallon ants EPSTEIN Ins thaikedon ream Mgt 15 Maximo vats." of mcountat 16 la• el lama • Ulan% U Lscarlan c L00 - ErrIsehg• lobo • tans of Petal Irritate A Will accent a tea Acosta ends or slur Owatalio 19 Medi% Address amber, aut. ate Nanbes) a Mara essban hetet accord k Ma Ca I 21 Salo 4 known 22 ZoPostal Cafe. Mao V County 24 Nurnw of pot avow for Ills asaisia 25 Teccont Idanliforasten Noma or on gal sloopcol Moors Se• atirocaos. 26 cau sena or Oroanuata lane it aceirce lea Omar ✓ ant awns a puralpallilt craw, it leoon 1 26 awls Inea, 4 kross 29 Sea auntor. 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X mown 30 Ca, d Worm I it 3240, X lawn 32 Zaeostal pace, a Yawn a Coma. amass 20129101. 0321111 APPRV 3053 Form TD F 90.22.1 (flay 3-2011) EFTA00617046  fRattlartiInformation on Financial Account(s) Where Filer has Signature Authority Fern 1D F 30.2M but No Financial Interest in the Account(s) Page Number Complete a Separate Block for Each Account 4 of 4 This side can be copied ia many tones as necessary in order to ?rovide information on all accounts. 1 Farb for calendar par 34 Chat appropriate knintallon Parnber i last Naves Organization Mame Topa Idenalcaban Muer 2010 rap laniacaane babe EPSTEIN • r hart IS Araboun atm al acoart Sunny canner yaw raprbil I a TYPO al maul . Li bmw b Sarin e UOliim — Sabi bpi bins 17 Mama al nand" tineeitan am *Nth Kona k hob IS Aoccant lanais et caw danassaan IS Maim Pant (Taear, SYN. Sob Numtan) al tad ISIS= le atdcli Ural aIWI a Ca St L.r Ilanm a Organdzatea Marne a Pard Ora RI SU; I Mop -r 21paosial Coda. 0 I X 35 OM*/ T.q... IdamecaSse Mater S Accrual Owe a Fpm Nom 37 NM& Mt Adana abater. Snob and Aprerral a smga Pb) I 40 19 Clk Slels I 71piroatal Cork 41 Qounby 43 Faaa ille war Pe Owner IS Mairnan yam of amen Omens eater yew mportD1 11 Two al =an • U Sank a LI Samba a U Ober — Este lea Slam 17 Srn MFWa aal Ireaullan int Mach bomb i had I Ia Aezona nate at PM' durprnaton 19 Malls Abbas Paenbet. brat bila Numb.) al Imancibl entrap', In Mich ancaml k hale X coy 21 MM, if krona LOPosal Cols II bran Crated 31 LOU Name a °banana Nana et Aamal Owner 95 Ta Karr Iterldr.alon Mater ed Atzsal Oar a FhlNr 37 Mat Ideal a Amiss Criernbee. sate. and Mariesel or ScalaNa..) 39 Cry I 40 Stab apiabLal Cada 42 Canny 43 bla oat be Omer IS Ilbaran van et appal tag °Wake par ortparkal 14 Ina t acteui a UN'S SUN:pa= el !Mee — Enbr tan below 17 bow s Finannal banning ma t account a;Mid 14 AOMMII aunty 01 GAM creignalien 19 Warn Adana (Nteriaer, SInra. IS. rhatart) of ammo asbarlien a wank acceram n raw a coy 21 Silk 4 51 a ZorPoelal Ca d baba II Canby 14 Lay Elm or Onberlation Marna aI Ilgorad Omer a TriMmer IdairficaM None ol AMoorlOoMe a FA Maw 37 MS MSS 3I MTh's 414arkee. 5treet rob Amine ar Sao IX) a ca 41 712Pos441Cc* 1 47 can, 43 fetes T4e wan nes Caper Memo. 03/22/11 APPRV 4053 Fo'rn TD F 90.22.1 (Rev 3-2011) EFTA00617047