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          <StateAbbreviationCd>NY</StateAbbreviationCd>
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      <ForeignOfficeInd>false</ForeignOfficeInd>
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        <FormAndLineReferenceDesc>PAGE 1, LINE 16</FormAndLineReferenceDesc>
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        <ExplanationTxt>DONATIONS $300</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PAGE 1 LINE 16</FormAndLineReferenceDesc>
        <ExplanationTxt>FEE REFUNDS $412</ExplanationTxt>
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