All redactions made pursuant to (b)(6),

(b)(7)(C), (b)(7)(F)

MR. RICHARD NEWCOMB

OFFICE OF FOREING ASSETS CONTROL
DEPARTMENT OF TREASURE OF UNITED STATES OF AMERICA.

Mi nombre es| Identificada con C&Jula

de Ciudadanfa Colombiana No.) expedida en Popaya"n y con reskJencia
en (a ciudad de Cali - Colombia. (Anexo 1}

Soy

Ml proposfto con esta carta es manifestarle mi deseo de INTERPONER EL

RECURSO DE APELACION por la inclusion de mi nombre en la Usta OFAQ
llamada y conodda publicamente como Usta Clinton, emrtfda por fa Agenda que
usted dignamente representa.

La inclusion de ml nombre en dicha lista trae como consecuencia muchas variables

que afectan la vlda de cualquier ciudadano del mundo, entre ellos nombro tres de
las mas importantes:

U Estar induida en la lista de los narcotraficantes y terroristas ma's importantes del

MUNDO sin serlo ni tener absolutamente nada que ver en esas adjvidades.
. r?
Bloqueo econdmico tales como en ios bancos, corporaciones de ahorro y vMenda,
corporaciones financferas, fidudas y en general todos los servitios bancarios.,
comerdal y dvfl en el mundo.
Congelamiento de bienes y activos personates; casa ubicada en

Como informaddn adjunto la definidon de Narcotrafico y Lavado de Activos; de

acuerdo con el Regimen Penal Cofombiano: ,

Narcotra'fico: El cul&'vo, proceso y comercio de sustandas sucesivamente

prohibidas. .;-:
7
Lavado de Activos: El que adquiera, resguarde, invierta, transporte, transforrr^,
custodie o administre bienes que tengan su origen mediato b inmediato en

000948
 All redactions made pursuant to exemptions (b)(6),
(b)(7)(C), (b)(7)(F)

actividades de t i f i c o de migrantes, trata de personas, extarskSn, enriquecimiento

ilfcito, secuestro, extorsi6n, rebelidn, trSflco de amnas, delitos contra el sistema
financiero, ia admlnistradon publica, o vinculados con el producto de tos delitos
objeto de un conderto para dellnquir, relacionada con el trafico de drogas toxicas,
estupefadentes o sustancias sicotrdpicas, o les de" a los bienes provenientes de
dichas actividades aparienda de legalldad o los legalice, oculte o encubra la
verdadera naturaleza, origen, ubicaddn, destino, movimiento o derecho sobre tales
bienes o realice cualquier otro ads para ocultar o encubrir su origen ilidto.

FUNDAMENTOS DEL RECURSO

Presento ante usted mi respetuoso pero completo desacuerdo por la inclusion de

mi nombre en esta lista. A continuation explico por que:

Nunca jamfe en m l s H H H d e vida he cometldo ningun acto delidwo o criminal

i*
en contra de ninguna persona nl mucho menos en contra de ninguna instltud6n ni
Colornbiana ni Americana. Mo he sido ni investlgada, ni juzgada ni condenada por
ningun delfto ni en Colombia ni en Estados Unidos de Norteamerica ni en ninguna
otra parte del mundo. Nunca he tenido el mas mfnimo contacto con lo que se
)rismo.
I (Anexo 5). Cree que,
siendo narcotraficante, el DEPARTAMENTO DE 2MMlGftAQ6N DE ESTADOS
UNlDOSmeh|jfo|ej3aprob^^
HHHHHHHRHHHHHHRI56 nizo
bSsfcamente con el objetivo de
lograr un mejor futuro, acosados por una grave sttuaci6n de inseguridad que
R6 la familla de mi esposo en ese momento,
: K
B buscando una mejor calidad de vida para mi y rriifamilia. Todos somos
conocedores de la critica situad6n economica, social y de inseguridad en la que se
encuentra sumerglda Colombia desde hace mudios anos. Todos los seres
i. humanos tenemos el derecho y la necesidad de labrar un mejor futuro.

Creo en ia justa apllcaddn de las leyes tanto Americanas como Colomblanas, asf
como tambien soy conocedora de el mas simple de los DERECHOS HUMANOS
INTERNACIONALES que dice: TODA PERSONA ES ZNOCENTE HASTA QUE
DEMUESTRE LO CONTRARIO.

En ei HHHHHRHHHHHHHHHHHicu^^ t o d o s yca(ia un°

de los requisites que debe cumplir un dudadano extranjero en su pals, por lo tanto
creo tambien tengo los derechos de cualquier residente. De acuerdo con la
Constituddn de los Estados Unidos, quisiera recordar algunas de las enmiendas:

000949
 ENMIENDAXV
El derecho de los habitants de que sus personas, domfcillos,
:
papeles y efectos se hallen a salvo de pesquisas y
P, aprehensiones arbitrarias, seri Inviolable, y no se expedirdn al
• efecto mandamientos que no se apoyen en un motivo
1
verosfmil, esten corroborados mediante juramento o protests y
descrfban con particularidad el lugar que deba ser registrado y
las personas o cosas que nan de ser detenidas o embargadas.

ENMIENDAV
Nadfe estara" obllgado a responder de un delito castigado con la
pena capital o con otra infamante si un gran jurado no lo
denunda o acusa, a exception de los casos que se presenter!
en las fuerzas de mar o tierra o en la milicla nacional cuando se
encuentre en serviclo efectfvo en tlempo de guerra o peligro
f publico; tampoco se prondra* a persona alguna dos veces en
;
peligro de perder la vida o algun miembro con motivo del
mismo delito; ni se le compelera a dedarar contra sf misma en
ningun juicio criminal; NI SE LE PRWARA DE LA VIDA, LA
LJBERTAD O LA PROPIEDAD SIN EL DEBIDO PROCESO LEGAL;
NI SE OCUPARA LA PROPIEDAD PRIVADA PARA USO PUBLICO
SIN UNA JUSTAINDEMNEACION.

ENMXENDAVI
t^
y En toda causa criminal, el acusado gozara del derecho de ser
' juzgado rapidamente y en publico por un jurado imparcial del
; i» distrito y Estado en que el delito se haya cometido, Dlstrito que
[•. debera" haber sido deterrninado previamente por la ley; asf
como de que se le haga saber la naturaleza y causa de la
• acusacidn, de que se le caree con los testigos que depongan
en 5U contra, de que se obligue a comparecer a los testigos
que le tavorezcan y de contar con la ayuda de un abogado que
to defienda.
ENM1ENDAIX
I \l No por el hecho de que la Constitucion enumera ctertos
I li derechos ha de entenderse que niega o menosprecia otros que
retiene el pueblo.
* ?>
En mi caso particular yo no tuve la oportynidad de adarar, ni explicar, ni mucho
menos presentar pruebas para comprobar mi ZNOCENCZA. Cree usted esto un

000950
 All redactions made pursuant to
exemptions (b)(6), (b)(7)(C), (b)(7)(F)

hecho justo basa"ndonos en los DERECHOS HUMANOS INTERNACIONALES?

Derechos que Estados Unidos cumple a cabalidad y no se cansa de predicar.

Cree la OFAC que es justo desbaratar la vida de una familia completa (incluyo hijo
menor de edad) solo porque algunas autoridades en Estados Unidos creen que
pertenezco a la red narcotraficante mas grande del Mundo? Yo creo que esta
acusaddn es muy grave y dolorosa, mas aun cuando lo unico que he hecho en ml
vida es reglrme por las leyes y trabajar limpiamente para tener algun b'po de
estabilidad econdmlca y social. Con el bloqueo economico, social, civil y comerdal
al cual soy sujeta en este momento, de que manera puedo ser una persona
productiva econdmicamente para el bien propio y de mi famliia?

Yo creo que la unica raz6n por la cual la OFAC Induye mi nombre en la lista es

Dicha empresa fue fundada en el afio 2.001 (Anexo 6) con el unico proposito de
comprar attfculos meclicos (Tenslometros) en USA y traerfos a Colombia para su
comerdalizacidn (Anexo 7). Esta transaccidn comercial se hizo solamente una vez
durante 2 anos, lo que llevo la compafiia a su derre en Didembre 31 del 2,002 por
fatta de objeto social y de acuerdo con las leyes de Estados Unidos (Anexo 8).
Esta transaction fu£ el unico movimiento comercial que tuvo ia compafiia; toda la
?;
contabilidad fue llevada de acuerdo con las normas americanas y presentadas ante
i:
iaentjdadcompetente en su momento (Anexo 9). En ningun momento YO, o H H
H H H H f o i m o s partidpes de ningun tipo de negocio de traTico de drogas o
lavado de activos. Adjunto contabilidad.

Apesar de q u e ^ ^ H H f u e C £ r r a d ^ n J H J H H H H | H , ml nombre fue

incluido en lei Ijstade la OFAC el H H H H H H H H > 3 S o a a y las companfas
con las cualesBBKUvorelacidncomerdal alguna, aparecen reglstradas en la lista
de la OFAC e n | ^ B H H B H H H e s d e c i r 2 rneses despues de quej
y es cerrada y mucho despues de haber hecho las transacciones.

r> Mi pregunta es: porque la OFAC reladona mi nombre en su lista, si todas la

reladones comerdales que existieron se dieron ANTES de que la OFAC nos
incluyera? Segun entjendo el Departamento del Tesoro de Estados Unidos prohibe

000951
 All redactions made pursuant to exemptions (b)(6), (b)(7)(C), (b)(7)(F)

realizar algun tipo de transaction comerdal con todas aquellas personas o

entidades una vez aparecen reladonadas en la llsta de fa OFAC.
Porque si todas Jas transacdones fueron legates y Ifdtas me bidan de
Narcotraficante perjudicandome moral y sodalmente?

El unico objeovo que motiv6 ml vinculaddrt con esta empresa, fue el tener la
H1
posibilldad en un futuro de que H H H H H H H H H H H i Para P°c'er
trabajar legalmente dentro de los Estados Unidos. Como profesional preparado,
mis deseos eran hacer empresa en los Estados Unidos y de esta manera lograr
algun desarrollo comerdal entre Colombia y Estados Unidos y l<5glcamente mi
desarrollo profesional y personal.

Ademas de todo el bloqueo economico, social y dvll con el cual cuento en este
momento, como consecuenda de figurar en la lista emitida por la OFAC^mi
residenda familiar ubicada en "'"
ha sido bloqueada por su departamento. Dejeme
que la cuota inldal y los pagos mensuales reallzados entre Febrero del
2,002 y Noviembre del 2,003 fueron el products del trabajo de mi esposo, limpio y
honesto, no es justo que en este momento no pueda disponer de ella porque la
OFAC la tiene bloqueada. Si ustedes mlran todas nuestras dedaradones de
impuestos que afio tras afio, durante los 4 afios de residenda en Estados Unidos
presentamos al IRS, se dara cuenta de que manera adquirimos esta propiedad.
NO ES FRUTO DE NXNGUN TRAFZCO DE DROGAS NZ MUCHO MENOS DE
LAVADO DE ACTEVOS. Es el unico activo con el que contamos ml famllla y yo
para labrarnos un mejor futuro.
Tambien nos fue bloqueada a mi esposo y a mi, una cuenta corriente conjunta, sin
notiflcacidn alguna y congelando todo ei dinero que aili habia H H H t s { n tener
en cuenta o ni slquiera pensar que ese dinero estaba destinado a cumpllr con
nuestras necesidades de alimentaddn mensuales.

personajes que pertecen a las cupulas militares de los grupos guerrilleros y

paramilitares de nuestro pais, reconoddos mundialmente, y que tanto dafio nos
han causado.

Al final de dicha lista esta la siguiente anotadon :

"are blocked pending investigation pursuant to Section 106 of the USA

PATRIOT Act of 2001, Pub.L. No. 107-56 (October 26,2001)."

• r* iMr. Richard Newcomb! Porque a unas personas con esta trayectoria tan
reconodda, si les cabe el derecho a la duda y a la investigadon? Tenga en cuenta
que yo no he podido nisiquiera opinar.

000952
 All redactions made pursuant to exemptions (b)(6), (b)(7)(C), (b)(7)(F)

Recibire comunicaciones en la siguiente direction

PETICION ESPECIAL

Les ruego Mr. Richard Newoomb y demfe ftincfonarios de OFFICE OF FOREING

ASSETS CONTROL, tengan como pruebas todos los anexos que he enunciado y
acepten este recurso de APELACION, haciendo la nota correctiva en la Ifsta OFAC
recurrida y descongelen nuestra unica vivienda y nuestra cuenta corrlente.

De ustedes atentamente,
r
" DILIGENC1A DE PRESENTACION PERSONAL
Y RECONOCMIENTO

En Santiago de Coll o: H-&MAR ?""*-

IEONOR AMPARO CAROONA M.. NoKHia Velntluita (EJ
ael ciiculo de Santiago da Coll. hoce contim: que «i
escrlto q-ia ™tar«rn» tue oreiafHodo penonolmenta

por.
Identltlcodo conlQCjCN'

! DeclO(6 que su contenido e» cleilo v veidodero V que to

tirma y la huello due en 61 apoiecen ton tuyoi
i y

fltmo Dectaia
_•>••> *

; t:
i U
1..

000953
r
i

ANEXO 1

y
n

000954
 Withheld in full pursuant to exemptions (b)(6), (b)(7)
(C), and (b)(7)(F)

000956
 ANEXO 2

y
i
t;

v
I
000957
Withheld in full pursuant to exemptions
(b)(6), (b)(7)(C), and (b)(7)(F)
All redactions made pursuant to
exemptions (b)(6), (b)(7)(C), and (b)
(7)(F)
p
i;
f'

y
1.1

ANEXO 3

G
n

000963
 Withheld in full pursuant to exemptions (b)(6),
(b)(7)(C), and (b)(7)(F)

r.
r •

b
n

000964
 p
i.
f'

r
i

ANEXO 4
• t z

u
n

:R
i U
n

000965
Withheld in full pursuant to exemptions (b)(6),
(b)(7)(C), and (b)(7)(F)

000966
r

ANEXO 5
12
u
n

rs
y.
n

000967
Withheld in full pursuant to exemptions
(b)(6), (b)(7)(C), and (b)(7)(F) r:ra CTX
i

ANEXO 6

n
v

000969
 l!>0>407-6013 00/10/01 07:51 Fl Dept OX State p2 II

All redactions made pursuant to

exemptions (b)(6), (b)(7)(C), and
(b)(7)(F)

FLORIDA DEPARTMENT OF STATE

Kathei-ine Harris
Secretary of State

August 10, 2001

Incorporation for| Jfiled on

and assigned document number Please refer
to this number whenever corresponding with this office.'
Enclosed is the certification requested. To be official, the
certification for a certified copy mu.st be attached to this original
document that was electronically submitted and filed under FAX audit
number HHHHHHIH1
A corporation annual report/uniform business report will lie due this
office between January 1 !.nd Ma}' 1 of the year following the calendar year
of the file date year. A Federal Employer Identification (PEI) number
will be required before this report can be filed. Please apply NOW with
the Internal Revenue Service by calli-.ig 1-800-829-367 6 and requesting form
SS-4.
p.
Please be aware if the corporate addr.sss changes, it is the responsibility
Li of the corporation to,notify this off.Ice.
P Should you have questions regarding corporations, please contact this
office at the address giv^n below.
V.
Corporate Specialist
New Filings Section
Division of Corporations Letter Number:

Division of Corporations - P.O. BOX 6327-Tallahassee, Florida 32314

000970
 All redactions made pursuant to
exemptions (b)(6), (b)(7)(C), and (b)
IIJO) 407-0013 00/10/01 07:bl Kl Dept or St (7)(F)

+e of jfr n
r*

Dpfrartmpnt o f &1ntp

I certify the attaohedisatrueatid correct copy of the Articles of

Incorporation of m m B H W B i , a Florida corporation, filed on
as shown by the records of this office.
I. further certify the Tdocument
his
was electronically received under FAX audit*
r number H H H H H H I certificate is issued in accordance with
section 15.16, Florida Statutes, and authenticated by the code noted belowj
t,.
The document number of this corporation is
Given under my hand and the
Great Seal of the State of Florida.,
at Tallahassee, the Capital, this the
Tenth day of Aiiguet, 2001
Authentication Code;

H
Li

li
farm?
 All redactions made pursuant to
exemptions (b)(6), (b)(7)(C), and
(b)(7)(F)

ARTICLES OF INCORPORATION

M The Undersigned incorparcitorfs), for the purpose o/Jbrming a corporation under the Florida
fiusiness Corporation Act, hereby adopifs) the fallowing Articles of Incorporation.

r-

ARTICLE 1 NAME

The name of the corporation shall be:I

ARTICLE II PRNCIPAL OFFICE

The principal place aCbusine shall be:

ARTICLE III SHARES

The number of shares of stock that this corporation is aulhorizctl to htivc milslamling m any one
lime is:
lOOSInircsof SI.00
P
I;

ARTICLE IV INITIAL REGISTERED AGENT AND STREET ADDRESS

The name and address of the initial registered agent is:

r?

000972
 All redactions made pursuant to
exemptions (b)(6), (b)(7)(C), and
(b)(7)(F)

ARTICLE V INCORPORATORfSl

The nnme(s) and street addresses) nl'the inco/poinro(s)to these Articles ofliK-oqwration is
{
(lire):
i .

ARTICLE VI PIRECTORfSl

The name(s) ami street adtlrosstts) of the <lircctor(s) to these Article of Incorporation is (me):

iTARY

The undcrsiiinetJ incwporaiols) h:i<(have) executed those Articles orineorporation this

H :o*ilayi>rjul\.20OI.
b

G
 Ail redactions made pursuant
to exemptions (b)(6), (b)(7)(C),
and (b)(7)(F)

CERTIFICATE OF DESIGNATION
KECISTERES ACiENT/REGISTERED OFFICE

r Pursuant 10 the provisions of seetions 607,0501 or 617.0501, Florida Sin I ul us, ihe uiulersiy.ni:d
corporation, nipmi/vd under the l:lw^ of the Slide ol" Florida, submits the fnllowing statement in
lifMgMiiling thu tujiisiered ijJTicc/rL'iii^lijreil agent,, in the Slate of Florida.

1. TheiKimcof ihc corporation is:l

2. The name nnd iicklrcss of the registered ngeni and olllce is:

r (NAME)

(P.O.UOX NOT ACCEPTABLE)

(CITY/STATE/ZIP)

I lAVINCJ OHF.N NAMF.I) AS RI-GISTfUir.D AGII"NT AND TO ACCEPT SERVICE OF

PROCESS I-'OR Tl II- ABOVI-: STAT1-I) CORPORATION AT THE PLACE DESIGNATED IN
Li I IMS CERTIFICATE. I HEREBY ACCEPT THE APPOINTMENT AS REGISTERED AGENT
AND AGRI.h I'O AC1 IN THIS CAPACITY. IITIIVI111-R AtlRKI- TO COMPLY WITH THE
PROVISIONS OF Al.l. STATUTliS RI-l.AUNG TO Till- PROPER ANDCOMI'LI-Ti:
PERFORMANCE OF MY DUTIES. AND I AM FAMILIAR WITH AND ACCEPT THE
OBLIGATIONS OF MY POSITKJN AS REGIS IEREO AGENT.

000974
 All redactions made pursuant to exemptions
(b)(6), (b)(7)(C), and (b)(7)(F)

form SS-4 Application for Employer Identification Number

(For use by employers, corporations, partnerships, trusts, estates, churches, EINI
'Pffi Apnl 2000) government agencies, certain individuals, ana others. See instructions.)
Oi-piMimiHoi iht T'ttuiry OMB No I M S 0003
t»t*rnal ft*vtr*i« SefVM • Keep a copy for your records.
1 N m of Applicanl (1«Q«I | » M ) («« nUWltllWl*)

2 Iradt Niwn of Buurwu (il drtiVtnl from rama on line I) 3 Eisuilor Trutrea Care of Nam«

N/A n/a
nl, Of w«t« number) 5 A Buumt Add/eti (it dtfttteni trout ftddr*» on bn*t *» and «b)
i
SAME AS 4A
5 buy Siilt Tu'ruk
SAME AS 4B

7 Hanw ol Principal Ollicw Gtiwal Partna Osmlor CMim « Troilor - SSN a 1TIN iniy b* i«t>»r»d (!•« nnlnicWm)

8a Type of entity (Check only one box) (see instructions)

Caution, II applicant is o limited liability company, see the instructions for line 8a
Sole proprietor (SSN) Estate (SSN ot decedent)
Partnership n Personal service corp Plan administrator (SSN)
PCMlC M National Guard Other corporation (specify) ••
State/local government |_J Farmers' cooperalive Trust
Church or church controlled organization Federal government/military
Oiher nonprolit organization (specify)*- (enter GEN il applicable)
Other (specify) *• NEW CORPORATION
SUIa Forc^ii CouAlry
8b H a corporation, name me state or loreign couitiy
(if applicable) where incorporated FLORIDA USA
9 BtDSon la jpplytng (Qiecli only orw boi.) (see insltuctioiis) Banking purpose (specify purpose) •
g ] Stated new business (specify type} •• IMPOST t EXPORT QonqpL type of uganizatioii (specify new type) s
Puicttased going business
P ) Hired einpkiyees (ChtcV the box ant sea line 12.) Cioled a liusl (specify type) •
i l freaied J ptnsion plan (specily type) »• _ n OttetawfyV
10 Date business started or acquired (month, day, year) (see instructions) 11 Closing month of accounting year (see instructions)
08/01/01 DECEMBER
12 First date wages or annuities were paid or will be paid (month, day, year) Note: II applicant is
_ IJ withholding agent enter dale income wilt first be paid /o nonresident alien (month day year) N/A
Noflftgriaillural Agricultural
r 13 i-trghfcM number ot employees expected in the next 12 monlhs Note: If the applicant
iioes not expect lo have ony einptoyaes diniiiQ me peimt enlei 0' (see mstnielions)
14 P)weia3ljiiint>(;eeinshuelnif>») • IMPORT & EXPORT

F 15 Is me principal business activity manufacturing?

lf_Vea. portapal product and raw mdlenai usi-ri • N/A
[JY« I No

16 •'. wiiun oro most ol the producl& ur burvii-uj M\dJ P\eaw cJicck unrj DOX siness (wholesale)
[~1 Public (retail) f~| Other (specify) *• HIA
17 a has fie applicant ever applied for an employer identification number for this or any other business7 LjYes I No
Note If Yes ' please complete lines 17b and 17c
17b U you checked 'Yes on line 17a, give applicant's legal name & trade name shown on prior application, if different from line 1 or Z above
Legal name • N/A Trade n a m e " N/A
17 c Appio/imata date when and city and $tate where thp application was filed Enter previous employer identification number if known
AE0r>*«in « D A M Whtn Ftted (inanUi day y«ar) City and Slali Wrmt Fled PrevKxitEIN

n N/A N/A
ilv o-rn«n*4 1' mriury I OKtti* nal I hav« oaiwml tm% aptlUamn and B »•* in\ ol niy knomUi)^ and b«lMl il.» Im* conui andcompkU
N/A
| a»«p«jli_ TtUpholji Niitnbil

n inn * a'wl Ii»t (Pi»atg iyp» w pfmL daariy) "

•« Mumb>r (indudi

'''•'jmtkir'r

.Note: Do nof wr/fe betow Ibis line For official use only
Co Ind Cl>u Siu Reason (or Applying
rl^ass leave
bisnf •
BAA For Privacy and Paperwork Reduction Act Notice, see separatelnstructions. fDizwoi M/IS/OO Form SS-4 (Rav 4 2000)

000975
 All redactions made pursuant to
exemptions (b)(6), (b)(7)(C), and
—-2O02 UNIFORM BUSINESS REPORT (UBR) (b)(7)(F)

p"

f •

r
8, TNI« ova named orally imtwmlB thin statraiwrn lor llui purpnra ol rivinfjinrj ur. rflijistimx) ofllcu or n>ulst«red agnnt, or bold, in IHB Solo of Barilla

SIGNATl RE
S^iwjilw. ytsml w ar*N«a nniM«l JvptMMtf I Q M I #ldw*tt-ia0ta3MMfc INOfE PHTtfiwUJMiam KrM**»f^OuiNMItthwrM««l«*rt|it

, This ijorporoiion It digibte 10 a t d y hi ImanoibU

10. Eteclion Campaign Flnancbig $5.l>"
U x fi ing rMgufrvneniiunclnl9r.lt
1 lo do 10.
Taiil Fund Contribution O Aildi.f!:
(See :rHoria on Sack)
a
OFFICERS AND DIRECTORS 13. AOOITIONS/CHAWGES TO QFHCERS AND QIREtyot i
D Dottle IlTlf P<««>-
NAME
U N S I AOCUIESS
PJIY-Sr-W

• Dd«ie lllLf
waif.
siniirNionfSS

P O IKWe
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tillEETUD *S5 MMXTMWIES5
OTT'ST-W

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srKn«>QjT!s KlIltflWIIHtSS
w-sr-w otvsi ?«•
nnr G nittic tniE OtiTl/
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I i si«t*nnff3s SM*(TA00r»S5
orr-sr-n CilY SI- *

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siittr Aootess SIMOADOnESS
cur-si-n cnv-sr-zip
13. I hoi iby iiertily thcl iho mlormsilon supplied with Irus libno ooai r u nunlify Im iht» oxemplion staled in Saclion 119.07|3)(l). FloridB iSlslules. I lurlhcr cen.iy :rio! p*- •
Indlc Had on nils report or supplement rnpeft is Irua ana socurats and Ilial my sianalura cfiall hove (he earns legal e'leci as If mads under oaUi: llut I sin m 1.,;.'.(
of Uv: crypocfilion or llw receivar or Irusloo enipnwered lo execulci Uih> laporl «s ruqulfsd by Chnptv 607, FkirirUi SlMules: tuxi that my namo BIHWIUE in I'M*:-.; 1.
; cl-wi port, of on a r t etiachmanl with an address, wffli an other Mts ampow/ariid.

SIGNATURE: OI|K)|03.
00007G
r •

ANEXO 7

000977
 omRon, tMlw
1
OMRON HEALTHCARE. INC.
300 Lakevlew Paritway Varnon Hills, Illinois 60061
PLEASE BltiT TO
OMRON HEALTHCARE. INC.
P.O. BOX 73496
Phone 847-680-6200 Fax 800-637-5763
CHICAGO IL60673-74S6

All redactions made pursuant to

exemptions (b)(6), (b)(7)(C), and (b)(7)(F)
INVOICE
Page HuHber-
Iivoice 40
Date
r CustoHer -
Droi Ship -
40
60
D H B T Hkr - 97 U
Soli Jo: Ship To:

United States

Tix ID*
Tax Cert: DEA Kunber: 240571 Pro. Ho: 0041478<404«2008?4«i
.- Request Date Custontr F.D. F.D.D. Skit: PLS SHIP flSAP!
03/11/02. 031402-CL PPO/DEST lust :
pLo/Rq Dt Description Iten Kunber Ult Sbip/Bictc/CiRce Price Extttieil Price
'"" BKIlftL THCRH - IKTCRKftTIDKftL HC-120 EA S 500 2.4800 1,240.00
DIGITAL THERIt - IHTERKATIDKftL Per Eft
SELF-TAKIHC DP KIT - IHTL HEH-18IK1 IH S 1300 11.5000 M.MO.OO
Per EA

f-2

Total Dr^er
-U

B" CREDIT CARD Net Due Date 04/07/02 Invoice - 404028) 16,1?0.00

n
4 By; 5*

CLAIMS FOR SH0RTAQE8 MUST 8 6 MADE WTTHW TEN DAYS FROM INVOICE DATE.
NO ME ACHANCXSE MAY BE SPURNED WITHOUT OUR PERMISSIOH.
WE HEfEBV CERTIFY THAT THESE GOODS WERE PRODUCED tH COMPLIANCE WITH ALL
APPLICABLE REOUIREMEmS OF OECTIOHfl.7 AND IS OF THE FAIR LAOOB STANDARDS ACT.
AS AMENOEO, AM> Of REOULATlONS AND OFIDER5 Of THE UNITED STATES DEFAHTUEHT OF
LABOR ISSUED UNDER SECTION U THEREOF. 000978 .,
 All redactions made pursuant to exemptions
(b)(6), (b)(7)(C), and (b)(7)(F)

P. 03
MR-29-02 FR1 O3:2B PH OttROH HEALTHCARE INC FAX MO. 84716806504

PACKING LIST
INTTEJftNA'nONAL

Picker Packer # LQ__ Company Name;

r Order# (b'7C>£p>2, j Date -ft / «3&/ <P £ t

CAHTOW TOTAC arr MODEL DIMENSIOWCTN WEIGHT TOTAI. "

UD. C7N UN/CTK No. UWxH LBS/CTM • WT.

1 /Vv/ox/o • /S J3 '
•
Me. -/ Q-n

NTJMIKiU 0 ^ SICiDS: . 9- TOTAL WEIGnT;• ^JOUCLLJZS:^

TOTAI. CARTONS: 5

>>< an \3dzfa
000979
J *^7Tp*lS\*i't\'r'*-**•• - *
 All redactions made pursuant to exemptions (b)
(6), (b)(7)(C), and (b)(7)(F)

Invoice
Date Invoice #
4/3/2002 10003

ri I Bill To •f "
i ;VICIOS1TDA

: A L I - WAI
'COLOMBIA

P.O. Number Terms Rep ; Ship Via FO.B. Project

PREPAID 4/5/2002 jABECARGO.

n Quantity Item Code Description Price Each Amount

1.300 TENSIOMETROS jHEM-18 11.99 ' 15,587.00
500 TERMOMETROS MC-I20 2.62 I U10.00

r
y

?•

Total $16,897.00

000980
r

ANEXO 8
L2
5:
U

000981
 I All redactions made pursuant to
exemptions (b)(6). (b)(7)(C), and (b)(7)(F)

Closing or Sale of Business or Change of Legal Entity,

I J- _. If you change your legal entity and ara continuing to do business In Florida, you muat
I D The legal entity changed on.
register on-line or complete and mall a new Application to Cdlaet and/or Report 76x In Florida (Form DR-1).
[ y i l w business was dosed permanently on \SL I.?} \ I O ^ • (The Department will cancel your sales tax corttficofe number as ol this dale.)
\{/\ Are you a corporaUon/psrtnerehlp required tofilecorporate Income tax or corporate Intangible tax returns? DNo
Sales and Use Tax I^B^B^B^B^B^B^B^B^B^B^B^B^B^B^B^B^B^B^B| pE
Certificate Number
TTiayMronly
I 1 *

D The business will close/was closw temporarily on I

Forwarding Address: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^
City: •! Stata:_
. . I plantoreopen or»_

.ZIP:.
The business was sold o n . 1 J . . The new owner Intormation IK
Name ol New Owner. Telephone Number of New Ownar: (_
Mailing Address of Nsw Owner
City: ' Stela: ZIP:

r Signature of Taxpayer (Required ..Telephone NumtierJ

:
\ mmm ^^fflJ^^^^JM
I 000982
I
I

I
I
I
I
I
I
I
I
I

CUT ALONG DOTTED LINE

Closing or Sale of Business or Change of Legal Entity

I Tno legal entity changed on . ^ _ _ _ _ . IF YOU CHANGE YOUR LEGAL ENTITY AND ARE CONTINUING TO DO BUSINESS IN FLORIDA AND THE
CORPORATION 15 REGISTERED FOR SALES AND U5E/TAX./OU MUST COMPLETE A NEW Application la Collect and Report Tax in Florida (FORM DR-1),

I The business was closed permanently on

obligation as of this date.)
(XJ'Jl/DZ. . (The Department will remove your corporate Income tax and corporate intangible la

Are you a corporation/partnership required to file sales and use tax returns?
Salos and Use Tax
I FEIN Certificate Number

I
D The business was sold on

Name of new owner:

. The new owner Information Is:

Telephone number of new owner

Mailing address of new owner:
City: County: State: ZIP:

I • • Signature of officer (REQUIRED) Date Telephone number

000983
I All redactions made pursuant to
exemptions (b)(6), (b)(7)(C), and
(b)(7)(F)

I 2003 FOR PROFIT CORPORATION

UNIFORM BUSINESS REPORT (UBR)
I
I
I
I
I
6. Name and Addr»a» ot Current Registered Agant 7. Nama and AddrenB of N«w Ragtatarad *gaot
Name

Street Address (P.O. Box Number hi Not Accsplable)

I C«y Zip Coda

FL
I 8. Tha above named antMy sutvnim this statement lor (he purpose of changing Us registered oHico or registered Bgenl. or both, in the Stale of Florida I am famaia! with, and ac
(he obligation* of raflitterad agent.

SIGNATURE .

I
S«nMm- hPMto'p^vtf «»n*»ngMamtf^Mttt arrtIH%II«p|ire«b4» INOTe Rftohlnrad A0(K4«*piMt*Mnqu<Mdw*«n»Mm9tfnU)

I m 10.
tnic
HIM.
•
\
^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^
OFFICERS AND DIRECTORS
DIM*
11.
Tmf
NAME.
9. Election Campaign Financing
Trust Fund Conlrtouiioo D

ADDITIONS/CHANGES TO OFFICERS AND DIRECTORS IN 11

$ 5 . 0 0 Way
Added to F «

I crur.sr-W

tnu '
J
SIKEFUXIMSS

imr

I SUS.HAIMBtTSS:

Cll> 51-?fr j
STHEET WORKS
cnv-Ei-ap

HUE _ 1• • ^ • • i " " DDe

e
tl mi —TT c? / i nt»»ng» D*

I fUMf
W t t l WKWSS
OK 5T-B» ,
NAME
EIBEfTAOOMSS
CttV-ST-W

DDtWe
I I D ChJime D A<
tmr TIItE
1

siwtiwiorss STMnMHACSS
DTY-SI-Zlf

I niu
IWJi
HIHEEIAROBErS
rnu
NAME
STREET ADDUCES
• Change Q*t

r.iry-5i BF CITY-St-ac

I mtF
HAUC
•
D DfWe TmE
NAME
• Chsnii! QM

•.inaiMxwrj STREFTAIXIIKSS 000984

I •IIY-Sl-Jlf CTY-5T-2IP
i
I
I
I
I
i
i
i
i
, ANEXO 9
I
I
I
I
I
I
I
I 000985

I
i All redactions made
pursuant to exemptions (b)

i (6), (b)(7)(C), and (b)(7)(F)

Balance Sheet

As of December 2001
4/18/2002
12:01:47 PM

Assets
i Current Assets
Cash On Hand
Checking Account $3,946.69

i total Cash On Hand

Merchandise Inventory
Total Current Assets
"$3,946.69
$930.56
"$4,877.25
Total Assets $4,877.25
t
Liabilities

i Long Term Labilities

Loan From Stockholder
Total Long Term Liabilities
$4,600.00
$4,600.00
Total Liabilities $4,600.00
i Equity
Owner/Shareholder's Equity

i Owner/Sharehidr Investment
Total Owner/Shareholder's Equity
Current Year Earnings
$480.00
$480.00
($202.75)
Total Equity $277.25
i Total Liability & Equity $4,877.25

i
i
i
i
i
i
i
i 000986
i
All redactions made
pursuant to exemptions
(b)(6), (b)(7)(C), and (b)(7)
(F)

!
_•
Profit & Loss Statement

1/1/2001 through 12/31/2001

i 4/18/2002
12:01:56 PM I

Income
i Cost of Sales

i Gross Profit

Expenses
$0.00

Genera) & Administrative Exp

i Bank Charges
Office Supplies
$30.00
$15.00
$152.75
Courier

i Corporation Taxes
Total General & Administrative Exp
TotaJ Expenses I
55.00
$202.75
_$202.75

i Operating Profit

Other Income j
($202.75)

i Other Expenses

Net Profit/(Loss) ($202.75)

i
i I

i I
e I
i

I
1
1
1
1 i

000987
1 I
_J
{ All redactions made pursuant to
exemptions (b)(6), (b)(7)(C), and
(b)(7)(F)

Detail Trial Balance

I
1/1/2001 To 12/31/2001
I 4/18/2002
12:02:03 PM
ID# ' Src Date | Memo Debit Credit Job Net Activity _
Page 1

Ending Balance

I 1-1110 Checking Account

Beginning Balancer
0991 CD 8/23/20O1
I
$0.00
Florida Department of Rev $5.00 $5 00 cr
GJ000001 GJ 8/31/2001 Deposits For August 2001 $480.00 $475.00

I GJ000002 GJ
GJ000003 GJ
GJ000004 GJ
8/31/2001
9/30/2001
10/31/2001
Chock Order
Service Charge
Deposits For October 2001 $4,600.00
$15.00
$15.00
$460.00
$445.00
$5,045.00
GJ000005 GJ 10/31/2001 Service Charge $15.00 $5,030.00

I 1041
1002
GJ000006 GJ
CD 11/6/2001
CD 11/20/2001
11/30/2001
ABE Cargo Express
ABE Cargo Express
Sportsman Guide Magazin $25.00
$85.25
$67.50
$4,944 75
$4,877.25
$4,902.25
GJ000007 GJ 11/30/2001 Sportsman Guide $160.36 $4,741.89

I GJ000008 GJ
GJ000009 GJ
11/30/2001
11/30/2001
The Sharper Image Purcha
Hammacher Schlemme
• $737.35
$57.85
$4,004.54
$3,946.69

Total: $5,105.00 $1,158.31 $3,946.69 $3,946.69

I 1-1200 Accounts Receivable

Beginning Balance: $0.00
GJ000010 GJ 11/30/2001 Sales $1,306.50 $1,306.50

I GJ000011 GJ 12/31/2001 RelbcateA/R

i Total: $1,306.50
$1,306.50

$1,306.50 $0.00
$0.00

$0.00

I 1-1300 Merchandise Inventory

Beginning Balance:
GJ000006 GJ 11/30/2001
$O.CJO
Sportsman Guide Magazin $25.00 $25.00 cr
•GJ000007 GJ 11/30/2001 Sportsman Guide $160.36 $135.36

I GJ0O0008 GJ
GJ0O0OOS GJ
11/30/2001
11/30/2001
The Sharper Image Purcha
Hammacher Schlemme
$737.35
$57.85
$B72.71
$930.56

Total: $955.56 $25.00 $930.56 $930.56

I 2-2300 Loan From Stockholder

Beginning Balance: S0.00
GJ000004' GJ 10/31/2001 Deposits For October 2001 $4,600.00 $4,600.00 cr

I Total: $0.00 $4,600.00 $4,600.00 cr $4,600.00 cr

3-1100 OwnerfSharehldr Investment

I Beginning Balance:
GJ000001 GJ
50.00
8/31/2001 Deposits For August 2001 $480.00 $480.00 cr

Total: $0.00 $480.00 $480.00 cr $480.00 cr

I 4-1000 Sales
Beginning Balance:
GJ000010 GJ
$0,00
11/3072001 Sales $1,306.50 $1,306 50 cr

P
GJ000011 GJ 12/31/2001 Relocate A/R $1,306.50 $0.00

Total: $1,306.50 $1,306.50 $0.00 $0.00

6-1200 Bank Charges

Beginning Balance: $0.00
GJ000003 GJ 9/30/2001 Service Charge $15.00 $15.00
GJ000005 GJ 10/31/2001 Service Charge $15.00 $30.00
000988
i All redactions made pursuant to
exemptions (b)(6), (b)(7)(C), and
(b)(7)(F)
1 Detail Trial Balance

1/1/2001 To 12/31/2001
4/18/2002 Page 2
12:02:03 PM

1 1D# Src Date

6-1200 Bank Charges

Memo Debit Credit Job Net Activity Ending Balance

Beginning Balance: $0,00

1 i Total: $30.00 $0.00 $30.00 $30.00

6-1500 Office Supplies

1 Beginning Balance:
GJ000002 GJ
$0.00 .
8/31/2001 Check prder $15.00 $15.00

i Total: $15.00 $0.00 $15.00 $15.00

1 6-1550 Courier
Beginning Balance: $0.00 |
1041 CD 11/6/2001 ABE Cargo Express $85.25 $85.25

1 1002 CD 11/20/2001 ABE Cargo Express

• Total:
$67.50

$152.75 $0.00 $152.75

$152.75

$152.75

1 6-1900 Corporation Taxes

Beginning Balance:
0991 CD
$0.00
8/23/2001 Florida Department of Rev $5.00 $5.00

1 Total:

Grand Total:
$5.00

$8,876.31
$0.00

$8,876.31
$5.00 $5.00

I
I
I
I
I
I
I
I 000989

I
 All redactions made pursuant to exemptions

i 1120
(b)(6), (b)(7)(C), and (b)(7)(F)
U.S. Corporation Income Tax Return OMB Ha T5<Mi;3

Department of the Trawury
I Internal Revtnue ^efvtea
A Check ir a:
1 Consolidated return
For calendar year 2001 or lax year beginning....... .ending _
2001
I I
• Instructions are separate. See page 20 for Paperwork Reduction Act Notice.
identification number

I 2

3
Personal holding co.
(attach Sch. PH) - •
Personal service corp.
•
D Total assets (see page 8
of'Instructions)
(see instructions)' I I

I E Check applicable boxes:

1a
(1)

Gross receipts or sales |

P i Rnnl return (31 ( _ ] Name change
I b Less returns I ol
(*) Q Addrsn change
c Balance
S 4,87

2 Cost of goods sold (Schedule A, line 8)

I 1
n
c
3
4
S
Gross profit Subtract line 2 from line 1c
Dividends (Schedule C, line 19)
Interest -
o 6 Gross rents

I m
e
7
8
9
Gross royalties
Capital gain net income (attach Schedule D (Form 1120))
Net gain or (loss) from Form 4797, Part II, line 18 (attach Form 4797)
10 Other income (see page 6 of instructions - attach schedule) . . . .

I 11
12
13
Total income. Add lines 3 through 10
Compensation of officers (Schedule E, line 4)
Salaries and wages (less employment credits)

I 14
15
16
Repairs and maintenance.
Bad debts
Rents '
17 Taxes and licenses . .•!

I 18
19
20
Interest
Charitable contributions (see page 10 of instructions for 10% limitation)
Depreciation (attach Form 4562)
,

21 Less depreciation claimed on Schedule A and elsewhere on return . .

I 22
23
24
Depletion
Advertising
:

Pension, profit-sharing, etc., plans

25 Employee benefit programs
I 26
27
Other deductions {attach schedule)
Total deductions. Add lines 12 through 26
28 Taxable income before NOL deduction and special deductions. Subtract line 27 from line 11

I 29 Less: a Net operating loss (NOL) deduction (see page 13 of instructions)

b Special deductions (Schedule C, line 20)
30 Taxable income] Subtract line 29c from line 28
31 Total tBX (Schedule J, line 11)

I 32. Payments:
a 2000 overpayment credited to 2001 . . .
b 2001 estimated tax payments
32a
32b HBttPi
I
c Less 2001 refund appliedifor on Form 4466 32c d Bal
ol
I e Tax deposited with Form 7004
f Credit for tax paid on undistributed capital gains (attach Form 2439)
g Credit for Federal tax on fuels (attach Form 4136). See instructions

I 33 Estimated tax penalty (see page 14 of instructions). Check if Form 2220 is attached
34 Tax due. If line 32h is smaller than the total of lines 31 and 33, enter amount owed
35 Overpayment. If line 32h Is larger than the total of lines 31 and 33, anter amount overpaid
36 Enter amount of line 35 you want: Credited to 2002 estimated tax • Refunded •
I
I
I LSP Associates Inc
12916 SW 133"1 Court, Ste B

I : Miami, FL 33186
Ph. (3P5) 251-2121 Fax. (305) 251-2H7
Form 1120 (20
 All redactions made pursuant to exemptions (b)(6), (b)(7)(C), and (b)(7)(F)

i Form 1120(2001)
Schedule A
1
Cost of Goods Sold
Inventory at beginning of year
(See page 1 4 o l Instructions.)
- 1
Page 2

i 2
3
4
Purchases
Cost a( labor
Additional section 263A costs (attach schedule)
2
3
4
931
0
0
S 0

I 5
6
7
Other costs (attach schedule)
Total. Add lihes'1 through 5
Inventory at.erid of year
• • 6
7
B
931
931
C
8 Cost of goods sold. Subtract line 7 from Jina 6. Enter here and on line 2, page 1

I 9a Check all methods used for valuing closing inventory:

(•ijQCost as described in Regulations section 1.471-3
$ ) Q Lower of cost or market as described in Regulations section 1.471-4

i b
$ ' ) • Other (Specify methodlused and attach explanation.)
Check if there was a writedown of subnormal goods as described in Regulations section 1.471 -2(c) . . .
•

c Check if the UFO inventory method was adopted this tax year for any goods (if checked, attach Form 970)

i d If the LIFO inventory method was used for this tax year, enter percentage (or amounts) of closing

•Yes
inventory computed under LIFO 9d
If property is produced or acquired for resale, do the rules of section 263A apply to the corporation? • NO
i Schedule C
Was there any change in determining quantities, cost, or valuations between opening and closing inventory?
If "Yes," attach explanation
Dividends and Special Deductions
. • | |YOS
(a) Dividends <b)%
• NO
(c) Special deduction

i 1
(See pane 15 of Instructions.)
Dividends from l e s * * a n - 2 0 % - o w n e d domestic corporations that are subject to
the 7 0 % deduction (other than debt-financed stock)
received

70%
(aUto)

I
2 Dividends from 20%-ONrnore-owned domestic corporations that are subject to

i 3
4
the 60% deduction {other than debt-financed stock)
Dividend* on d«bMinsncod»toclioC domestic and fcntign cwpotation* (section 24GA)
Dividend* on certain preferred stock lot !ess-than-20%-owned pubHc utilities
80%
see instruct.
42%
(
1
1

i 5
6
Dividends on certain preferred stock lof 20%-Of-more-owned public utilities
Dividends from less-than-20%-o«med foreign corporations and certain FSCs
that are subject to the 7 0 % deduction
48%

70%
1

7 Dividends from 20%-or-fnore-owned foreign corporations and certain FSCs

I 8
that are subject to the 6 0 % deduction
Dividends from wholly owned foreign wibsldtarle* subject lo tha 100% deduction (wtctkm 2«(b)>
9 Tola). Add lines 1 through 8. See page 16 of Instructions for limitation wimmmmmiiiiiimi
80%
100%^

t 10 Dividends from domestic corporations received by a small business Investment

11
12
company operating under the Small Business Investment Act of 1958
Dividend* from certain FSC» thai wa subject to Uw 100% deduction (section 245(c)(1)>
Dividends from uffffl*t»d group mambars iub|ecl lo the 100% deduction (ucjkm 243(a){3» . . . . 1
100%
100%
100%
—

i 13
14
15
Other dividends from foreign corporations not Included on Hnes 3 , 6 , 7 , 8 , or 11
income from controlled foreign corporations under subpartF (attach Form(s) 5471)
Foreign dividend gross-up (section 78)
. . .

i
16 IC-DISC and former D I S C dividends not Included on lines 1 , 2 . or 3 (section 246{d)) . ..
17 Other dividends . . . I
18 Deduction for dividends paid on certain preferred stock of public utilities
16 Total dividends Add lines 1 through 17. Enter here and on Rne 4 , page 1 •

I ' 20
Schedule E
Total SDecial deductions. Add lines 3 . 1 0 . 1 1 . 1 2 . and 16. Enter here and on line 29b. pane 1
Compensation of Officers (See Instructions for line 12, page 1.}
Note: Complete Schedule E only if total receipts (line l a phis lines 4 through 1 0 o n p a q e 1 , Form 1120 are $500,000 or more.
. . . . •

(c) Percent of Percent of corporation

i 1
(a) Name of officer (b) Social security number time devoted to
business
stock owned
(d) Common (e) Preferred
.
(f) Amount of compensation

i
i 2 Total compensation of officers
- 3 Compensation of office rs claimed on Schedule A and elsewhere on return
4 Subtract line 3 from llne 2. Enter the result here and on line 12. paqe 1

i uuusyi Form 1120(200

 All redactions made pursuant to exemptions (b)(6), (b)(7)(C), and (b)(7)

I (F)
Pa.
Form 1120(2001)

I SchedulB J Tax Computation (See page 16 of instructions.)

Check If the corporation is a fnember of a controlled group (see sections 1561 and 1563)
Important: Members of a controlled group, see instructions on page 16.
>•
2a If the box on line 1 is checked, enter the corporation's share of the $50,000, S25.000, and $9,825,000

I taxable income brackets (in that order):

(1)
b Enter the corporation's share of: (D
{2)
Additional 5% tax (not more than $11,750)
(3}

(2) Additional 3% tax (not more than $100,000)

I 3 Income tax. Check if a qualified personal service corporation under section 448(d)(2)
4 Alternative minimum tax (attach Form 4626)
*•
S Add lines 3 and 4 . , :

I 6a Foreign tax credit (attach Form 111B) . .

b Possessions tax credit (attach Form 5735)
C Check: QNonconventional source fuel credit P i QEV credit (attach Form 6834)
6a
6b
6c
d General business credit. Check box(es) and indicate which forms are attached. 6d
I QFomi3800 OForm(sS(specify) • ._ .
e Credit for prior year minimum tax (attach Form 8827)
f Qualified zone academy bo,nd credit (attach Form 6860)
•
. 6e
8f
7 Total credits. Add lines 6a through 6f
I 8 Subtract line 7 from line 5
g Personal holding companyjtax (attach Schedule PH (Form 1120))
10 Other taxes. Check if from: [ j F o r m 4 2 5 5 QR>rm8611 • F o r m 8697

f •Formeeee Q Other (attach schedule) . . .

11 Total tax. Add lines 8 through 10. Enter here and on line 31, page 1
Schedule K Other information (See p»flB 19 of Instructions.)
10
11

Yes No
I
1 Check method or accounting: » [XJCash
b • Accrual c • Other (specify) if this Is a consolidated return, answer here for the parent
corporation and on Form 851, Affiliations Schedule, for
2 See page 21 of the Instructions and enter the: each subsidiary.

I
4
a Business activity code no. ... 21990__
b Business activity . General Merchandj At any time during the tax year, did one foreign person
C Product or service ' .j=&ojVljnport own, directly or indirectly, at least 25% of (a) the total
3 At the end of the tax year, did the corporation voting power of ail classes of stock of the corporation

I own, directly or indirectly, 50% or more of the

voting stock of a domestic corboration? (For rules
of attribution, see section 267(c).)
I
If •Yes," attach a cclwduls ctiowipg: (a) r u m * and
employer Idantlflcalion number (EIN), (b) percentage
owned, and (c) laxabia Income or (Ion) before NOL
and special deduction* at cuch dwporalion tor the
entitled to vote or (b) the total value or all classes of stock
of the corporation?
ir "Yes," enter, (a) Percentage owned
and (b) Owner's country _ ___
C The corporation may have to file Form 5472, Information
Return of a 25% Foreign-Owned U.S. Corporation or a
Foreign Corporation Engaged in a U.S. Trade or Business.

I lax year ending with or within your tax year.

4 is the corporation a subsidiary in an affiliated
group or a parent-subsidiary controlled group?
i
mm
Enter number of Forms 5472 attached 1

B Check this box if the corporatton Issued pubUdy offered

H "V«a," enter mine and EIN ot Iho parent debt instruments with orlfiinal issue discount . . . ,f |

I corporation

5 At the end oHhe to year" did any Individual,

'„ ... If checked, the corporation may have to He Form B261,
Information Return for Publicly Offered Original Issue
Discount instruments.
partner- ship, corporation, estate, or trust

I own, directly or Indirectly, 50% or more of the

corporation's voting stock? (For rules of
attribution, see section 287(c).)
Enter the amount of tax-exempt Interest received or
accrued during the lax year $

10 Enter the number of shareholders at the end of the tax

I If "Yes," attach a schedule showing name and
Identifying number. (Do not indwla any liiluinuitian
alieady entered In 4 ebon.) EnWr percentage
year (If 75 or fewer)

owned 1CKJ;0p%_ 11 If the corporation has an NOL for the tax year and Is

I 6 During this tax year, did the' corporation

pay dividends (other than stock dividends
and distributions in exchange for stock)
electing to forego the carryback period, check here
If the corporation isfilinga consolidated return, the
statement required by Regulations section
j I

in excess of the corporation's current 1 .(502-21 (bM3)(() or (11) must be attached or the election

I and accumulated earnings land profits?

(See sections 301 and 31R)
If *Yes," file Form 5452, Corporate Report of
will not be valid.
12 Enter the available NOL carryover from prior tax years
(Do not reduce It by any deduction on line
NondMdend Distributions. 23a.) 1

I Note: If the corporation, at any time during the tax year,, had assets or operated a business In a foreign country or U.S. poss<fiBQ?8£ay be
required to attach Schedule N (form 1120V Foreign Operations of U.S. Corporations, to this return. See Schedule ^^"l-JrJb. 1
-—•—- '' .-^___^ ^000992
1
j Form 11
 All redactions made pursuant to exemptions (b)
(6), (b)(7)(C), and (b)(7)(F)

t Form 1120 (2001)

Schedule L Balance Sheets per Books
Assets

I 1
2a
Cash . •
Trade notes and accounts receivable .
b Less allowance for bad debts J . . .

I 3 Inventories .
4 U. S. government obligations . . . .
S Tax-exempt securities (see instructions)
. .

6 Other current assets (attach schedule) .

I 7 Loans to shareholders . . . . . . .
S Mortgage and real estate loans. . . .
s Other investments (attach schedule) .
I 10a Buildings and other depreciable assets
b Less accumulated depreciation . . .
11a Depletable assets
b Less accumulated depletion' . . . . ,

I 12 Land (net of any amortization) . . . .

13a Intangible assets (amortizable only) . .
b Less accumulated amprtization . . .

I 14 Other assets (attach schedule) . . .

15 Total assets
Liabilities and Shareholders' Equity

I
16 Accounts payable !
17 Mortgages, notes, bonds payable In less than 1 year
18 Other current liabilities (attach schedule) .
19 Loans from shareholders

I 20 Mortgages, notes, bonds payable in 1 lyear or more

21 Other liabilities (attach schedule) . . . .
22 Capital stock: a Preferred stock . . .

1 b Common stock . . .
23 Additional paid-in capital
24 Retained earnings - Appropriated (attach schedule)
25 Retained earnings - Unappropriated . . .

I 26 Adjustments to shareholders' equity (attach schedule)

27 Less cost of treasury stock
29 Total liabilities and shareholders' equity . .

1 Note: The corporation is not required to complete Schedules M-1 and M-2 H the total assets on line 15. col, (d) of Schedule L are less than $25.000.
Schedule M-1 Reconciliation of Income (Loss) per Books With Income per Return | X Ictw* i7
Net income (loss) per books Income recorded on books this year not
Federal income tax per books ^
I
included on this return (itemize):
Excess of capital losses over capital gains . . . . Tax-exempt Interest $
Income subject to tax not recorded on books this
year (itemize): RoypdiOS. .-?.

1 Expenses recorded on books trijs year not

deducted on this return (itemize):
Deductions on this return not charged
against book Income this year (itemize):
• Depreciation . . . . $ _

I
a Depreciation $ b Charitable contributions * 0
b Charitable contributions . . . . 5 0_ ""0
c Travel and entertainment . . . . 5 0 """"""""" "." "".9.
b" a
I 6 Add lines 1 through 5
9 Add lines 7 and B
-203110 Income (line 26, page 1)-llne 6 less line 9 -203
Schedule M-2 Analysis of Unappropriated Retained Earnings per Books (Line 25, Schedule L)

I 1 Balance at beginning of year

2 Net income (loss) per books
3 Other increases (itemize):
5 Distributions: a Cash . . . .
b Stock . . . .
c Property . . .

I 6 Other decreases (itemize):

7 Add'llnes*5a'rid"6"".".'"."."""."!
4 Add lines 1, 2, and 3 8 Balance at end of year [line 4 less flftOS9: -202

I 000993
-£pnall2Djt2{Kn)
 All redactions made pursuant to
exemptions (b)(6), (b)(7)(C), (b)(7)(F)
—
Una 26 {Form 1120) - Other Deductions
1 1
i
3
Bank charges
Delivery
Qffice tugplies and expense
1
2
3
30
153
15
4 Total other deductions 4 198
1
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
000994
I
 All redactions made pursuant to
A»H TRADING INC exemptions (b)(6), (b)(7)(C), (b)(7)(F) 65-H2B351

Line 6, Sch K (Form 1120) - Additional Information

If in Individual, partnership, corporation, estate or trust at the end of the tax year own, directly or Indirectly,
iOVt or more ol the corporation's voting stock, enter name and identifying number

i
NAME .IDENTIFYING NO.:

NAME: IDENTIFYING NO.:

i
i

I
i
i
i
i
i
i
i
i
i
i
i
i 000995
f
t
All redactions made pursuant to
exemptions (b)(6), (b)(7)(C), (b)
(7)(F)

Balance Sheet
I
As of December 2002
I 6/18/2003
11:41:51AM

Assets i
I Liabilities

I Equity
Owner/Shareholder's Equity
Owner/Sharehldr Investment $480.00
$480.00
I Total Owner/Shareholder's Equity
Retained Earnings
Current Year Earnings
($202.75)
($277.25)
Total Equity $0.00
I Total Liability & Equity $0.00

I
I
I
I
I
I
I
I
I
I
I 000996
All redactions made pursuant to
exemptions (b)(6), (b)(7)(C), (b)(7)
(F)

Profit & Loss Statement

1/1/2002 through 12/31/2002

6/18/2003
11:42:51 A M _

Income
Sales $18,203.50
total Income $18,203.50
l
Cost of Sales
Purchases $17,168.49
.I
Total Cost of Sales $17,168.49

Gross Profit $1,035.01

Expenses
General & Administrative Exp
Legal & Professional Fees S500.00
Bank Charges $64.64
Outside Services $380.63
Office Supplies $211.99
Renewal Corporation $150.00
License & Taxes $5.00
Total General & Administrative Exp $1,312.26.
Total Expenses "_$J ,312,26.

Operating Profit [$277,251

1

Other Income
j
Other Expenses'

Net Profit/(Loss) ($277.25)

000997
 All redactions made pursuant to
exemptions (b)(6), (b)(7)(C), (b)
(7)(F)
y
Detail Trial Balance
I-
1/1/2002 To 12/31/2002
f/18/2003 Pagei
11:44:11 AM
ID# Src Date Memo Debit Crejlit Job Net Activity Ending Balance

1-1110 Checking Account

beginning Balanca: $3.94889
QJ000012 GJ 1/7/2002 Deposit $1,306.50 $5,253.19
OJ000015 GJ 3/5/2002 Prestige Distributors $47.S3 $5,205 26
1003 CD 3/21/2002 Cash $200.00 $5,005.26
GJ000016 GJ 3/22/2002 OfficeMax $211.99 $4,793.27
GJ000017 GJ 3/28/2002 Omron Healthcare $16,190.00 $11,396.73 cr
GJ000014 GJ 3/29/2002 Bank Charges $1500 $11,411.73 cr
OJ000013 GJ 3/31/2002 Deposits March 2002 $12,900.00 $1,488.27
1004 CD 4/11/2002 Department of State $150.00 $1,338.27
OJ000018 GJ 4/30/?002 Bank Charges $1964 $1,318.63
1006 CD 5/13/2002 LSP Associates $500.00 $818.63
GJ000019 GJ 5/31/2002 Bank Charges $15.00 $803.63
1007 CD 6/27/2002 Florida Department of Rev $5.00 $798.63
GJ00O020 GJ 6/2672002 Bank Charges $15.00 $783 63
GJ000021 GJ 7/1/2002 Deposit $3,997.00 $4,78063
1008 CD 3/9/2002 ^ M W H H M M $1,700.00 $3,080.63
1008 CD $3,080.63 $000
9/16/2002 | | | ^ H ^ H | ^ H
I Total: $18,203.50 $22,150.19 $3,946.69 cr $000

1»1300 Merchandise Inventory I

Beginning Balanca: S930.56
GJ000022 GJ 12/31/2002 Relocate Inventory $930.56 $0.00

Total: $0.00 $930.56 $930.56 cr $0.00

3-2300 Loin Ftom Stockholder

Nglnning Balance: $4,600.00 cr
1003 CD 3/21/2002 Cash $200.00 $4,400.00 cr
1008 CD $1,700.00 $2,700.00 cr
1009 CD
3^2002 H | H H a H ^ H H $2,700.00 $0.00
9/16/2002 H I H H L H H
Total: $4,600.00 $0.00 $4,600.00 $0.00

M 0 0 0 Retained Earnings
Spinning Balanca: 50.00
OJ000000 G J 1/1/2002 End of Year Adjustment $202 75 $202.75

. Total: $202.75 $0.00 $202.75 $202.75

>-MO0 Current Year Earnings ]

tegltwlno Balanca: $20275,
OJ000000 G J 1/1/2002 End of Year Adjustment $202.75 $0.00

I Total: $0.00 $202.75 $202.75 cr $0.00

4.1600 Satot •
Itttjflntng Balance: $0.00
OJ000012 GJ 1/7/2002 Deposit $1,306.50 $1,306.50 cr
OJ000013 GJ 3/31/2002 Deposits March 2002 $12,900.00 $14,206.50 cr
OJ000021 GJ 7/1/2002 Deposit $3,997.00 $18,203.50 cr

Total: $0.00 $18,203.50 $18,203.50 cr $18,203.50 cr

ft. 1000 Purchase*

ivfmntng Balance $000 000998
OJ000018 GJ 3/6/2002 Prestige Distributors $47.93 $47.93
i All redactions made pursuant
to exemptions (b)(6), (b)(7)(C),
(b)(7)(F)
I Detail Trial Balance

I 8/18/2003
1/1/2002 To 12/31/2002
Page 2
11:44:12 AM

I ID# Src

5-1000 Purchases
Date Memo Debit Credit Job Net Activity Ending Balance

Beginning Balance: $0.00

I GJ000017 GJ
GJ000022 GJ
3/28/2002 Omron Healthcare
12/31/2002 Relocate Inventory
$16,190.00
$930.56
$16,237.93
$17,168.49

Total: $17,168.49 $0.00 $17,168.49 $17,168.49

I 6-1100 Legal & Professional Fees

Beginning Balance:
1005 CD
$0.00
5/13/2002 LSP Associates $500.00 $500.00

I ft-1200 Bank Charges

Total: $500.00 $0.00 $500,00 $500.00

I Beginning Balance:
GJ000014
GJ000018
GJ000019
GJ
GJ
GJ
3/29/2002
4/30/2002
5/31/2002
50.00
Bank
Bank
Bank
Charges
Charges
Charges
$15.00
$19.64
$15.00
$15.00
$34.64
$49.64

I GJ000020 GJ 6/28/2002 Bank Charges

Total:
$15.00

$64.64 $0.00 $64.64

$64.64

$64.64

I 8-1350 Outside Services

Beginning Balance:
1009 CD 9/16/20021 $380.63 $380.63

I 0-1500 Office Supplies

Bagtnmng Balance: SO.00
Total: $380.63 $0.00 $380.63 $380.63

GJ000016 GJ 3/22/2002 OfficeMax $211.99 $211.99

I Total: $211.99 $0,00 $211,99 $211.99

6-1010 Renewal Corporation

1 Beginning Balance:

1004 CD
$0.00

4/11/2002 Department of State

$150.00 $150.00

$150.00 $0.00 $150.00 $150.00

I 6' 1920 License & Taxes

((•pinning Balance: $0.00
Total:

$5.00 $5.00

I 1007 CD 6/27/2002 Florida Department of Rev

Total: $5.00 $0.00 $5.00 $5.00

I Grand Total: $41,487.00 $41,487.00

I
I
000999
 [All redactions made pursuant to exemptions (b)(6), (b)(7)(C), (b)(7)(F)

^,1120-A U.S. Corporation Short-Form Income Tax Return OMB No, 1545-OB9C
Ufli>nr<fnnnt of me Treasury For calendar year 2002, or tax year beginning __ , and ending
iniDrnil Revenue Service
See separata Instructions to make sure the corporation qualifies to file Form 1120-A. 2002
corp l> a personal
nitrvice corp (as
dttrmed *tn

i Hnuumlont section
1 <*\-31C)-SM
instructions)

a
E Check applicable boxes: (1)[^[] Initial return (2)LJ Name change (3)| j Address change
F Check method of accounting: (1)[x]Cash ^[^Accrual ( 3 ) n o ^ e r (specify) *•
a Gross receipts or sales { 18,2031 I b Less relums and allowances
_oL C Balance *• 1c 18,203
Cost of goods sold (see page 14 of Instructions) 17,168
Gfoss profit. Subtract line 2 from line 1c 1,035
Domestic corporation dividends subject to the 70% deduction . . .
Interest
Gross rents
Gross royalties
Capital gain net income (attach Schedule 0 {Form 1120))
Net gain or (loss) from Form 4797, Part II, line 18 (attach Form 4797)
Other income (see page 9 of instructions) 10
TOTAL INCOME. Add lines 3 through 10 11 1,035
12 Compensation of officers (see page 10 of Instructions) 12
13 Salaries and wages (less employment credits) . . . 13
14 Repairs and maintenance 14
15 Bad debts 15
1« Rents 16

I 17
18
19
20
Taxes and licenses
Interest
Charitable contributions (see page 11 of instructions for 10% limitation) . .
Depreciation (attach Form 4562) . . I 20
17
18
19
15(

21 Less depreciation claimed elsewhere on return J 21a 21b

22 Other deductions (attach schedule) 22 1,157

i 23
24
25
TOTAL DEDUCTIONS. Add lines 12 through 22
Taxable Income before net operating loss deduction and special deductions. Subtract line 23 from line 11
LESS: a Net operating loss deduction (see page 13 of instructions) 25a
23
24
1.31:
-277

b Special deductions (see page 13 of instructions) , . . . 25b 25c

28~ TAXABLE INCOME. Subtract line 25c from line 24 -277
27 TOTAL TAX (from page 2, Part I, line 6)
21 PAYMENTS:

< a
b
c
2001 overpayment credited to 2002 .
2002 estimated tax payments . . . .
Less 2002 refund applied for on Form 4466 28c
! • Tax deposited with Form 7004 . . .
I Credit for tax paid on undistributed capital gains (attach Form 2439)
g Credit for Federal tax on fuels (attach Form 4136). See instructions
h TOTAL PAYMENTS. Add lines 28d through 28g
29 Estimated tax penalty (see page 14 of Instructions). Check if Form 2220 is attached
30 TAX DUE. If line 28h is smaller than the total of lines 27 and 29, enter amount owed
31 OVERPAYMENT. If line 28h is larger than the total of lines 27 and 29, enter amount overpaid . . . .

t •ftlgn
XL. pntnr amount of line 31 you want CREDITED TO 2003 ESTIMATED TAX £ 0l REFUNDED •
Uwhr penalties of perjury, I declare lhat I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and
twlint, II It true, COTTBCI, and complete. Declaration ol preparer (other than taxpayer) Is based on all Information of which preparer has any knowledge

.f! May the IRS discuss thu return with

the preparer shown below (soe
Signature of officer Date Title Instructions)? •*«» | |H

Preparer"s
signature

f lrm'6 name (or ^ ___

Date
~3p^ Check if
self-employed [ |
| Prepared SSN or PTIN

iH« Only yours U sflH-employed), ^ ^ LSP Associates Inc

»d*eia, and ZIP code 12956 SW 133rd Court, Ste B
Miami, a 33186
f<i< ftfUiyurk Reduction Act Notice, see f (HTAJ
Ph. (305) 251-2121 Fax. (305) 251-ZH7
 All redactions made pursuant to exemptions (b)(6), (b)(7)(C), (b)(7)(F)
l-ormi120-A(2002) Page 2
Parti, Tax Computation (see page 17 o( Inslrucllons)
1
iL
Income tax. If the corporation is a qualified personal service corporation (see page 17). check here > Q
I 2 n General business credit. Check box(es) and indicate which forms are attached.
Q Form 3800 Q F o r m ( s ) (specify) *• 2a
b Credit for prior year minimum tax (attach Form 8827) 2b

I 4
3

5
TOTAL CREDITS. Add lines 2a and 2b
Subtract line 3 from line 1
Other taxes. Check if from: [ Z J Form 4255 Q F o r m 8611 Q F o m i 8697 I I Form 8866
Q Other (attach schedule)

I ft TOTAL TAX, Add lines 4- and 5. Enter here and on line 27, page 1
| P t r t l l ' I n ! Other Information (see page 19 o f instructions)
Soe page 21 and enter the: 5a II an amount is entered on line 2, page 1, enterfromwortisheet on D3oe 14 insir

I a Business activity code no. ••

b Business activity
c Product ot service
•
421990
IMPORT/EXPORT
* GENERAL MERCHANDISE
(1)
(2)
(3)
Purchases
Additional 263A costs (attach schedule)
Other costs (attach schedule) . . . .
16.237

If property is produced or acquired lor resale, do the rules of section

i At the end of the tax year, did any individual, partnership,

oslate, or trust own, directly or indirectly, 50% or more of the
corporation's voting stock? (For rules of attribution, see section
2B3A apply to the corporation? [Z]Yes
At any time during Ihe 2002 calendar year, did the corporation have
[E3No

an interest in or a signature or other authority over a financial account

Y
?r.7(c).) [Kl es dJNo (such as a bank account, securities account, or other financial

i It "Yos." atlach a schedule showing name and Identifying number.

I mei the amount of lax-exempt interest received or accrued

account) in a foreign country? Lj Y e s

If "Yes," the corporation may have to file Form TD F 90-22.1.

If "Yes," enter Ihe name of the foreign country • in
LHJNO

during Ihe tax year • 1$ |_ Are the corporation's lotal receipts (line 1a plus lines 4 through 10
4 I ninr total amount of cash distributions and ihe book value on page 1) for the tax year AND its lotal assets at the end of the tax
ni property distributions (other than cash) made during the tax year less than 5250,000? QTJYes Q N O »
H"U... . . MS "Yes.* the corporation is NOT required to complete Parts lit and IV below
|*»»rtj» Balance Sheets per Books (a) Beginning of tax year (b) End of lax year
1 Cash 3,947 0
2 a Trade notes and accounts receivable . . . .
b Less allowance for bad debts
3 Inventories 931
4 U.S. government obligations
5 Tax-exempt securities (see instructions) . .
8 Other current assets (attach schedule) . . . 01
7 Loans to shareholders
8 Mortgage and real estate loans
0 n Depreciable, depletable, and Intangible assets . .
b Less accumulated depredation, depletion, and amortization
10 Land (net of any amortization)
11 Other assets (attach schedule)
I? Total assets 4,878
Accounts payable
14 Other current liabilities (attach schedule) . . .
15 Loans from shareholders
16 Mortgages, notes, bonds payable . . . . . . 4,600
17 Other liabilities (attach schedule)
IB Capital stock (preferred and common stock) . . 480
10 Additional paid-in capital
70 Retained earnings -202
If > Adjustments to shareholders' equity (attach schedule)
72 l e s s cost of treasury stock
73 Total liabilities and shareholders' equity 4.87B
J Reconciliation of Income (Loss) per Books With Income per Return I Check to complete Part IV
h#t htM-iin |i(ifij) por books -277 6 Income recorded on books this year not included
'•% fort***! utenmn lux per books on this return (itemize)
I «Mt*« rt (miUfli losses over capital gains . 7 Deductions on this return not charged against
4 H t f i o »ili|nct It) lax not recorded on books book income this year (itemize)
pM t»#' (HB"«;r) oi
:.•'> • f.tt«iMk i*< ("iimi on books this year not
$ pit tin* return (ilemize)
wm 8 Income (line 24, page 1). Enter the sum of lines 1
through 5 less the sum of lines 6 and 7
001(Xb1m 1120-A (2002

1001001
 All redactions made pursuant to exemptions (b)(6),
(b)(7)(C), (b)(7)(F) 65-1128331

* ,Un?. 22.{Form.112.0-Ai - Other Deductions.

1 Bank charges. 1 65

I u
' .Q .'?'.d.6 J?fW?SS.
' .9!'i??.s.liPP!'?l.s.?Pit??PA1se __
- 2
3
380
212
500
* .^K'G.s.S'PIial.feJIs '. 4
I > Total other deductions

Line 2, Part II (Form 1120-A) - Additional Information

5_ 1.157

I II pn individual, partnership, corporation, estate or trust at the end of the tax year own, directly or indirectly,
50% or more of the corporation's voting stock, enter name and Identifying number.

NAME .IDENTIFYING NO.:

I NAME IDENTIFYING N O ;

i
i

001002
i All redactions made pursuant
to exemptions (b)(6), (b)(7)
Florida Corporate Short Form
ATX1
F-1120A

i Income Tax Return Ft 01/03

(C), (b)(7)(F)

i
i

Mah* checks payable and mail to:

n ORIDA DEPARTMENT OF REVENUE, 5050 W TENNESSEE STREET, TALLAHASSEE FL 32399-0135
. . . . , . , C u t along dptteaMJne . ... ...
FioffdaCorporateSKort l^ormTncome fax" Return "ATXVF-VI2OA
Umhw (wnollios ol penury. I declare that I have examined (his return and to the best of my knowledge and belief, it is true, correct, and com- R 01/03
i t t M . II pmHtrad bv a person other than the taxpayer, the declaration Is based on all Information of which the preoarer has any knowledge.
Date Phone

Htjjnotani <jn<v0tvKlual oi Firm Preparing Iho Return Dale Preparer1* SSN I J PTIN [ f o r FEIN J j(Check one) Phono

ft^Vri 120351 Taxable Year Beginning 01/01/2002 Taxable Year Ending 12/31/2002

DOR USE ONLY

/ /
t, b I 1 2 U \ b \ 0 o 0
800V0101 -27 1 700 0 0
SOO212J1 0 0 0
0 0 0 0
-377O0 0 0 0
• 3 noo 0 • 0 0
0 0 0 0
0 0 0
0

S3D1 0 50021231 DQ0200S0M3 3 3b530Ca§!$l 0000 3

(001003
i All redactions fnade pursuant to
exemptions (b)(6), (b)(7)(C), (b)
(7)(F)

Reconciliation Report
5/22/2003 Pagei
1:00:22 PM
ID# Date Payee Deposit Withdrawal

Checking Account: 1-1110 Checking Account

Dale of Bank Statement: 1/31/2002
Last Reconciled: 12/31/2001
Last Reconciled Balance: $3,946.69

Cleared OeposKs

GJ000012 1/7/2002 Deposit $1,306.50

Total: $1,306.50 $0.00

Reconciliation

MYOB Plus Balance on 1/31/2002: $5,253.19

Add: Outstanding Checks: $0.00

Subtotal: $5,253.19

Deduct Outstanding Deposits: 50.00

Expected Balance on Statement $5,253.19

m.

m..

001004
 All redactions made pursuant to exemptions (b)
(6), (b)(7)(C), (b)(7)(F)

SsiBS and USA Tsx iViturn DF^-15 R. 01/02

Florida I I . G r o s * Sales 2. Exsmpt Sales 3. Taxabta Amo.unt 4.T«xCo«acted
A. Satof . Q ^ °g . 20
B. "fittsirt PuichiHi H | | H | ^ H ^ | H i l
O .°? 21
C. SwvtaM 22
0. 1hnalenrR«ntBli 23

1 TVuulwt ftonau Ratt: .0600 SuttxRat*^ 0 0 0 0 1 Oatadton P«ted 5. Total Amount of Tax Collected Q » 24
25
H | 1 JUL-SEP a. Less Lawful Deductions
H^ 1 2002 7. Total Tax Due 26
O ."
a. Lets Eat Tax Prid/ DOR Memo 27
1 9. Plus EstTax Due Currart Month
10 Amount Due .
28

•••••••• 11. L « M Collectlen AHowanea 29

12.^Plus Penalty 30
j ^^ I
AltorUM 13. Phis Interest 31
20th, H *
kntnidfana,
LJnta 11-13 14. Amount Do* with Raturn HD
Duo: QCT 1 2002
Uta After. OCT 2 1 2002
I I Electronic Funds Transfer. Check here if I Do Not Write In This Space
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001005
J*mtn$e of Address or Business Name FEIN of Entity

-*—fete Hit* Inrm, sign it, and mail it with your tax return rt:
\ M M U H I I balow is not correct
i fta*t««i nome changes
• tha business location changes
within the same county
SSNOwrw
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I ntfrvt your business location to another county or you have a
f# ef Icpcl intlty, you must register online or complete and mall
SSN Spouts
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t Appttattlon to Collect and/or Report Tex In Florida (Form DR-1). Business location .
LouUsn
' tt»>. i e « Resources in the instructions, contact your local
[ ol Revenue Service Center, or call Taxpayer Services (see Cdy. _Sl»l«. .ZIP.
• (MM* cover) It you are closing or selling your business or have
i In l»p»l entity, complete the form on the reverse side. County .

AtJdlM*

OwrtriToKptiofn (. County .

All redactions made pursuant to

exemptions (b)(6), (b)(7)(C), (b)(7)(F)

20 21 22 23 24 25 26 27 28 29 30 31 HO
3. Taxable Amount 4. Tux Collected
-Cn* 3 ~cr&

Total Amount of Tax Collected

Less Lawful Deductions ( U M M >
Total Tax Due
Lees EstTax Paid/ DOR Memo
Plus Est. Tax Due Current Month
Amount Due
Less Collection Allowance
Plus Penalty
Plus Interest
14. Amount Due wttb Return
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J$ 50S
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Bank of America.

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