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      <PreparerPersonNm>DENNIS HAYES</PreparerPersonNm>
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      <Organization501cInd organization501cTypeTxt="7">X</Organization501cInd>
      <TypeOfOrganizationCorpInd>X</TypeOfOrganizationCorpInd>
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      <GrossReceiptsForPublicUseAmt>0</GrossReceiptsForPublicUseAmt>
      <ProhibitedTaxShelterTransInd>0</ProhibitedTaxShelterTransInd>
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        <BusinessName>
          <BusinessNameLine1Txt>JILL SEIFERT</BusinessNameLine1Txt>
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        <USAddress>
          <AddressLine1Txt>52 PARK ST</AddressLine1Txt>
          <CityNm>PHELPS</CityNm>
          <StateAbbreviationCd>NY</StateAbbreviationCd>
          <ZIPCd>14532</ZIPCd>
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