Self-declaration (checksum: b01a30985df37336173969e30a533000524ce19f77a3dd3f7ebfa1de1db232e3)
Proof of identity (checksum: 68ec5196be0e038f1a99026ba68bd7bf062286b561da9cfa8a47cfd050c641c0)
Physical Address: 13 Tokeneke Trail, Darien, CT 06820
Mailing Address: 206 Elm St, #200869, New Haven, CT 06520