Profesor

Consultant Genealogy Form

Please fill out for each transaction and return. This information will help expedite the process. Each transaction must have a separate form.Transaction Code: (CODE)

Owner Information:

|Name of Owner |Type of Bond |Location of Bond(s) ||Juán Mario Comparán Noriega |Two headed President Bond a Historic Bond issued by the |México |
| |Unites States ofMéxico and the States of Tamaulipas and San | |
| |Luis Potosi, a Bond of July 4, 1865, Series “d”, sheet number||
| |7286 of 100 Dollars. | |


TransactionIntermediaries:

List of working seller side consultants pertaining to this transaction (referrals will be paid by each broker or in mutual agreement, list in groups or in one line). FOR THE LEADCONSULTANT LIST THE DATE OF ISSUE AND EXPIRATION OF THE PASSPORT

|Name |Nationality/ Passport |Phone # |Email address|
|José Ramírez Muñoz |Mex. G09578555 | | |
||Issued: 04/06/2012 | | |
| |Expires: 04/06/2022| | |
|Rafael Padilla González |Mex. G05781199 | |...