SDO Manda PROPERTY-NUMBER-TAG-STICKER (1)

ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN ACCOUNTABLE OFFICE: ________________________________________ ASSET CLASSIFICATION: ________________________________________ DESCRIPTION: ________________________________________________ ____________________________________________________________ PROPERTY NUMBER: ___________________________________________ SOURCE OF FUND: ____________________________________________ ACQUISITION COST: ___________________________________________ ACQUISITION DATE: ___________________________________________ ACCOUNTABLE PERSON: ________________________________________ SIGNATURE: __________________________________________________ ________________________________________ NAME AND SIGNATURE OF CUSTODIAN

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