Certification of Beneficial Owners, 2020 April 17

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DocuSign Envelope ID: 21A42985-5121-40AE-B366-2C729A62FC6E

CERTIFICATION OF BENEFICIAL OWNER(S)

Principal Loan Date | Maturity Loan No _ Call / Coll
$21,562.50 04-17-2020 [04-17-2022 | 200009103 afd

References in the boxes above are for use only and do not limit the applicability of this document to any particular loan or item.

Any item above containing ">" has been omitted due to text length

Persons opening an account on behalf of a legal entity must provide the following information:
a. Name and Title of Natural Person Opening Account:
Michael E. Stone, Executive Director of Virginians for Alternatives to the Death Penalty, Inc.
b. Name, Type, and Address of Legal Entity for Which the Account is Being Opened:
Virginians for Alternatives to the Death Penalty, Inc., Corporation; 2007 Semmes Ave; Richmond, VA 23225

c. The following information for each individual, if any, who, directly or indirectly, through any contract, arrangement, understanding,
relationship or otherwise, owns 25 percent or more of the equity interests of the legal entity listed above:

Not Applicable

d. The following information for one individual with significant responsibility for managing the legal entity listed above, such as:
O1An executive officer or senior manager (e.g., Chief Executive Officer, Chief Financial Officer, Chief Operating Officer, Managing
Member, General Partner, President, Vice President, Treasurer); or
Any other individual who regularly performs similar functions.

(If appropriate, an individual listed under section (c) above may also be listed in this section (d)).

Name/Title Date of Birth |Address (Res. or Bus. Street Address) For U.S. Persons! _[For Non-U.S. Persons”
Michael E. Stone, Executive 07-15-1955 |2507 Semmes Ave, Richmond, VA 23225, 494-62-4021
Director USA

I, Michael E. Stone (name of natural person opening account), hereby certify, to the best of my knowledge, that the information provided above
is complete and correct, and on behalf of Virginians for Alternatives to the Death Penalty, Inc., | agree to notify the financial institution of any
change in such information.

ay! al €. Stone 4/17/2020
Michael E. Stone, Executive Director of Virginians Date

for Alternatives to the Death Penalty, Inc.

1U.S. Persons must provide a Social Security Number.

2Non-U.S. Persons must provide a Social Security Number, passport number and country of issuance, or similar identification number. In lieu of
a passport number, Non-U.S. Persons may also provide a Social Security Number, an alien identification card number, or number and country of
issuance of any other government-issued document evidencing nationality or residence and bearing a photograph or similar safeguard.

Legal Entity Identifier: 04061289

ase, Ver 20.,0.038 Copr Fiaiva USA Comporaton 1997, 2020, AIRighs Reseved. VA CACFILPOCOBOFE TRAZS PRI

Metadata

Resource Type:: Document
Rights:: CC BY-NC-SA 4.0
Date Uploaded:: December 23, 2025

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