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Personal Information:

Purchases and Sales:

Use the fields below to indicate dates and amounts for stock purchases or sales. If you have more than 3 purchases or sales to disclose, please indicate additional transactions in the additional information section.

By clicking the submit button, I acknowledge that this form is not intended to and does not establish an attorney-client relationship between myself and Cohen Milstein Sellers & Toll PLLC, and that the submission or receipt of information to the Firm or one of its attorneys via this form, website, e-mail or telephone does not create an attorney-client relationship.*

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Contact Information:

Contact Name, Title - test@test.test
Cohen Milstein Sellers & Toll PLLC
1100 New York Avenue, N.W.
Suite 500, West Tower
Washington, D.C. 20005
Tel: (888) 240-0775 or (202) 408-4600
Fax: (202) 408-4699