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3. A. Present Residential Address: B. Length of time at this address: UL months C. Home telephone lll D. List all residential addresses (including street and number, city and state) for the last five (5) years and dates you resided at each address: Addresses Dates 4. A. Present Place of Employment: Law O*Sice o More Fernich I. Name of immediate supervisor: March Fernich | Sonata Sa\e lla II. Employer’s business address: Blo Seve Sté £26 tw Yor 061 III. Employer’s telephone number: 212 -446- Pee {IIL Dates of Employment: = 2008 —_ Present B. List all previous employers for the past five (5) years, including employers’ addresses and dates of your employment with each employer: EMPLOYER ADDRESS DATES OF EMPLOYMENT 5. A. List all schools, universities, or other educational institutions attended from grade Page 4 of 10 Revised 2/01/08 DOJ-OGR-00023877