rom DO Notice Concerning Fiduciary Relationship ‘OMB No, 1545-0019 ee > Goto mnie gov/Fomt6 for erste andthe toe information Prey (hier Revenue Code sstons 6056 end 003) Identification i gg a OWN MkaK DOG aE Bar ee iret, ar rm ose Fa) 41D VO BOX iz ‘Gaye toun stead 7 cope a forecn acess, See nawuriona) MY TOWN , OHIO DiI4SZ Fiioarystare STEVEN T.MNUCHIN “TBOG PENNSYLVANIN ANENUE NW Bata emma aR WAoHIN ETON DL Z0Z20 aici Section A. Authority 1 Authority for fiduciary relationship. Check applicable box CJ Court appointment of testate estate (valid will exists) Gi Court appointment of intestate estate (no vai will exists) Gi Court appointment as guardian or conservator G) Valid trust instrument and amendments Gy Bankruptcy or assignment for the benefit or creditors ad Bone. dosorbor Pwdolyc. Commerciad ust Adoumsttahen 2a ifbor aor tbie check enter the Sale of death 'b If box te—ifis checked, enter the date of appointment, taking office, or assigniment or transfer of assets > _ seaoge Section B. Nature of Liability and Tax Notices 3” Type of taxes Check all that app): L] Income LJ Git] Estate L] Genevation-skipping wansfer —C] Employment Di Bxcise — L] Other (describe) > 4 Federal tax form number (check all that apply): a 3706 series bB709 c¢f]940 [1] 941,943,944 © C1 1040, 1040-4, or 1040-2 fC] 1041 gL11120 h Other is Ail focen: 5 IFyour authority as a fiduciary does not cover all years or tax periods, check here... {and list the specific years or periods For Paperwork Reduction Act and Privacy Act Notice, see separate insiuctions. ‘oat Ne 708751 Form 56 (Rov 112017)for fv. 1-207 oe 2 Revocation or Termination of Notice ‘Section A—Total Revocation oF Termination Check this box if you are revoking or terminating al prior notices concerning fclary relationships on fle withthe internal Revenue Service for the same tax maters and years or petiods covered by this notice concerning fiduciary relationship > C1] Reason for termination of flucary relationship. Check applicable box: a LJ Court order revoking fiduciary authority 1] Cortfcate of dissolution or termination of abusiness entity © Bi Other, Describe ec. aa ‘Section B—Partial Revocation 7a Check this box if you are revoking earlier notices concerning fiduciary relationships on file with the Internal Revenue Service for the same tax matters and years or periods covered by this notice concerning fiduciary relationship... >oO 1b Specify to whom granted, date, and address, including ZIP code. > Section C— Substitute Fiduciary Check is box anew Sculary Salaries have senor wl be eubetued for he revoking or trang fcay and ‘specty the name(s) and address(es), including ZIP code(s}, of the new fiduciaries)... . >o > Court and Administrative Proceedings Tgp east tha 8 ar se SER Ws ee aT a TASS) ae aoa TT DIME CF OUI0, OFFILE OF VITAL STATISTICS _| APR\L 4, 19SO. Bizet Ceska oe ober Pe BOX (3D IS-\9S0W6e Geyer tg. nea ote ie Tina — BE am. | Pa oT aCe PACS Ore 12345 2 Bi Bd0o em | UWS Signature Ta ata tayo cote co erring ein ln on tha tay Please Hoe | Ba» Jodn Mark Dec pushoriegh Rpnsentakve _\-H-Z079 mack aes “Title. if applicable Fom 56 (Rov. 112017 1 wish +o be indemnitied inst clams ec lossea under Hor sovereran Use Prvale Res istev eck (ndemavty Bond AMG) OOOOC\ RABID4EZTLHOUS