543-764 (LM2) 12/31/2018

U.S. Department of Labor
Office of Labor-Management Standards
Washington, DC 20210

FORM LM-2 LABOR ORGANIZATION ANNUAL REPORT

Form Approved
Office of Management and Budget
No. 1245-0003
Expires: 09-30-2021

MUST BE USED BY LABOR ORGANIZATIONS WITH $250,000 OR MORE IN TOTAL ANNUAL RECEIPTS AND LABOR ORGANIZATIONS IN TRUSTEESHIP

This report is mandatory under P.L. 86-257, as amended. Failure to comply may result in criminal prosecution, fines, or civil penalties as provided by 29 U.S.C. 439 or 440.

READ THE INSTRUCTIONS CAREFULLY BEFORE PREPARING THIS REPORT.

For Official Use Only

1. FILE NUMBER
543-764

2. PERIOD COVERED
From	01/01/2018
Through	12/31/2018

3.	(a) AMENDED - Is this an amended report:	No
	(b) HARDSHIP - Filed under the hardship procedures:	No
	(c) TERMINAL - This is a terminal report:	No

4. AFFILIATION OR ORGANIZATION NAME AUTO WORKERS AFL-CIO
5. DESIGNATION (Local, Lodge, etc.) LOCAL UNION	6. DESIGNATION NBR 3058
7. UNIT NAME (if any)

8. MAILING ADDRESS (Type or print in capital letters)
First Name AMY	Last Name HUSBAND
P.O Box - Building and Room Number
Number and Street 12 LONE OAK DR
City EMINENCE
State KY	ZIP Code + 4 40019

9. Are your organization's records kept at its mailing address?

Yes

Each of the undersigned, duly authorized officers of the above labor organization, declares, under penalty of perjury and other applicable penalties of law, that all of the information submitted in this report (including information contained in any accompanying documents) has been examined by the signatory and is, to the best of the undersigned individual's knowledge and belief, true, correct and complete (See Section V on penalties in the instructions.)

70. SIGNED:

Thomas s Williams

PRESIDENT

71. SIGNED:

Amy Husband

TREASURER

Date:

Mar 30, 2019

Telephone Number:

502-294-0097

Date:

Mar 30, 2019

Telephone Number:

502-424-6911

Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)

ITEMS 10 THROUGH 21

FILE NUMBER: 543-764

10. During the reporting period did the labor organization create or participate in the administration of a trust or a fund or organization, as defined in the instructions, which provides benefits for members or beneficiaries?	No
11(a). During the reporting period did the labor organization have a political action committee (PAC) fund?	No
11(b). During the reporting period did the labor organization have a subsidiary organization as defined in Section X of these Instructions?	No
12. During the reporting period did the labor organization have an audit or review of its books and records by an outside accountant or by a parent body auditor/representative?	No
13. During the reporting period did the labor organization discover any loss or shortage of funds or other assets? (Answer "Yes" even if there has been repayment or recovery.)	No
14. What is the maximum amount recoverable under the labor organization's fidelity bond for a loss caused by any officer, employee or agent of the labor organization who handled union funds?	$110,000
15. During the reporting period did the labor organization acquire or dispose of any assets in a manner other than purchase or sale?	No
16. Were any of the labor organization's assets pledged as security or encumbered in any way at the end of the reporting period?	No
17. Did the labor organization have any contingent liabilities at the end of the reporting period?	No
18. During the reporting period did the labor organization have any changes in its constitution or bylaws, other than rates of dues and fees, or in practices/procedures listed in the instructions?	No
19. What is the date of the labor organization's next regular election of officers?	06/2019

20. How many members did the labor organization have at the end of the reporting period?

1,294

21. What are the labor organization's rates of dues and fees?

Rates of Dues and Fees
Dues/Fees	Amount		Unit	Minimum	Maximum
(a) Regular Dues/Fees	2.5 hours	per	month	0	0
(b) Working Dues/Fees	0	per	0	0	0
(c) Initiation Fees	20.00	per	one time	0	0
(d) Transfer Fees	0	per		0	0
(e) Work Permits	0	per		0	0

Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)

STATEMENT A - ASSETS AND LIABILITIES

FILE NUMBER: 543-764

ASSETS

ASSETS	Schedule Number	Start of Reporting Period (A)	End of Reporting Period (B)
22. Cash		$371,487	$539,819
23. Accounts Receivable	1	$0	$0
24. Loans Receivable	2	$0	$0
25. U.S. Treasury Securities		$0	$0
26. Investments	5	$0	$0
27. Fixed Assets	6	$4,196	$4,196
28. Other Assets	7	$0	$0
29. TOTAL ASSETS		$375,683	$544,015

LIABILITIES

LIABILITIES	Schedule Number	Start of Reporting Period (A)	End of Reporting Period (B)
30. Accounts Payable	8	$4,736	$98,098
31. Loans Payable	9	$0	$0
32. Mortgages Payable		$0	$0
33. Other Liabilities	10	$3,995	$908
34. TOTAL LIABILITIES		$8,731	$99,006

35. NET ASSETS

$366,952

$445,009

Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)

STATEMENT B - RECEIPTS AND DISBURSEMENTS

FILE NUMBER: 543-764

CASH RECEIPTS	SCH	AMOUNT
36. Dues and Agency Fees		$680,251
37. Per Capita Tax		$0
38. Fees, Fines, Assessments, Work Permits		$13,018
39. Sale of Supplies		$0
40. Interest		$0
41. Dividends		$0
42. Rents		$0
43. Sale of Investments and Fixed Assets	3	$0
44. Loans Obtained	9	$0
45. Repayments of Loans Made	2	$0
46. On Behalf of Affiliates for Transmittal to Them		$0
47. From Members for Disbursement on Their Behalf		$875
48. Other Receipts	14	$21,476
49. TOTAL RECEIPTS		$715,620

CASH DISBURSEMENTS		SCH	AMOUNT
50. Representational Activities		15	$72,657
51. Political Activities and Lobbying		16	$16,307
52. Contributions, Gifts, and Grants		17	$5,164
53. General Overhead		18	$54,371
54. Union Administration		19	$46,817
55. Benefits		20	$0
56. Per Capita Tax			$339,754
57. Strike Benefits			$0
58. Fees, Fines, Assessments, etc.			$0
59. Supplies for Resale			$0
60. Purchase of Investments and Fixed Assets		4	$318
61. Loans Made		2	$0
62. Repayment of Loans Obtained		9	$0
63. To Affiliates of Funds Collected on Their Behalf			$0
64. On Behalf of Individual Members			$575
65. Direct Taxes			$4,590

66. Subtotal			$540,553
67. Withholding Taxes and Payroll Deductions
67a. Total Withheld	$20,872
67b. Less Total Disbursed	$27,607
67c. Total Withheld But Not Disbursed			-$6,735
68. TOTAL DISBURSEMENTS			$547,288

Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)

SCHEDULE 1 - ACCOUNTS RECEIVABLE AGING SCHEDULE

FILE NUMBER: 543-764

Entity or Individual Name (A)	Total Account Receivable (B)	90-180 Days Past Due (C)	180+ Days Past Due (D)	Liquidated Account Receivable (E)
Total of all itemized accounts receivable	$0	$0	$0	$0
Totals from all other accounts receivable
Totals (Total of Column (B) will be automatically entered in Item 23, Column(B))	$0	$0	$0	$0

Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)

SCHEDULE 2 - LOANS RECEIVABLE

FILE NUMBER: 543-764

List below loans to officers, employees, or members which at any time during the reporting period exceeded $250 and list all loans to business enterprises regardless of amount.
(A)

Loans
Outstanding at
Start of Period
(B)

Loans Made
During Period
(C)

Repayments Received During Period
Cash (D)(1)	Other Than Cash (D)(2)

Loans
Outstanding at
End of Period
(E)

Total of loans not listed above

Total of all lines above

Totals will be automatically entered in...

Item 24
Column (A)

Item 61

Item 45

Item 69
with Explanation

Item 24
Column (B)

Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)

SCHEDULE 3 - SALE OF INVESTMENTS AND FIXED ASSETS

FILE NUMBER: 543-764

Description (if land or buildings, give location) (A)	Cost (B)	Book Value (C)	Gross Sales Price (D)	Amount Received (E)
Total of all lines above	$0	$0	$0	$0

				Less Reinvestments	$0
(The total from Net Sales Line will be automatically entered in Item 43)				Net Sales	$0

Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)

SCHEDULE 4 - PURCHASE OF INVESTMENTS AND FIXED ASSETS

FILE NUMBER: 543-764

Description (if land or buildings, give location) (A)	Cost (B)	Book Value (C)	Cash Paid (D)
Total of all lines above	$318	$318	$318
Shredders	$318	$318	$318

		Less Reinvestments	$0
(The total from Net Purchases Line will be automatically entered in Item 60.)		Net Purchases	$318

Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)

SCHEDULE 5 - INVESTMENTS

FILE NUMBER: 543-764

Description (A)	Amount (B)
Marketable Securities
A. Total Cost
B. Total Book Value
C. List each marketable security which has a book value over $5,000 and exceeds 5% of Line B.

Other Investments
D. Total Cost
E. Total Book Value
F. List each other investment which has a book value over $5,000 and exceeds 5% of Line E. Also, list each subsidiary for which separate reports are attached.

G. Total of Lines B and E (Total will be automatically entered in Item 26, Column(B))

Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)

SCHEDULE 6 - FIXED ASSETS

FILE NUMBER: 543-764

Description (A)	Cost or Other Basis (B)	Total Depreciation or Amount Expensed (C)	Book Value (D)	Value (E)
A. Land (give location)	$0		$0	$0

B. Buildings (give location)

C. Automobiles and Other Vehicles

D. Office Furniture and Equipment

$856

E. Other Fixed Assets

$3,340

F. Totals of Lines A through E (Column(D) Total will be automatically entered in Item 27, Column(B))

$4,196

Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)

SCHEDULE 7 - OTHER ASSETS

FILE NUMBER: 543-764

Description (A)	Book Value (B)
Total (Total will be automatically entered in Item 28, Column(B))	$0

Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)

SCHEDULE 8 - ACCOUNTS PAYABLE AGING SCHEDULE

FILE NUMBER: 543-764

Entity or Individual Name (A)	Total Account Payable (B)	90-180 Days Past Due (C)	180+ Days Past Due (D)	Liquidated Account Payable (E)
Total for all itemized accounts payable	$0	$0	$0	$0
Total from all other accounts payable	$98,098	$0	$0	$0
Totals (Total for Column(B) will be automatically entered in Item 30, Column(D))	$98,098	$0	$0	$0

Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)

SCHEDULE 9 - LOANS PAYABLE

FILE NUMBER: 543-764

Source of Loans Payable at Any Time During the Reporting Period (A)	Loans Owed at Start of Period (B)	Loans Obtained During Period (C)	Repayment During Period Cash (D)(1)	Repayment During Period Other Than Cash (D)(2)	Loans Owed at End of Period (E)
Total Loans Payable	$0	$0	$0	$0	$0
Totals will be automatically entered in...	Item 31 Column (C)	Item 44	Item 62	Item 69 with Explanation	Item 31 Column (D)

Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)

SCHEDULE 10 - OTHER LIABILITIES

FILE NUMBER: 543-764

Description (A)	Amount at End of Period (B)
Total Other Liabilities (Total will be automatically entered in Item 33, Column(D))	$908
Federal Income Taxes 941 Forwarded	$36
FICA employee OASDI and HI Forwarded	$93
State Income Taxes Forwarded	$82
County Taxes Forwarded	$64
State Unemployment	$140
FICA Employer OASDI and HI 941	$22
Federal Unemployment 940	$471

Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)

SCHEDULE 11 - ALL OFFICERS AND DISBURSEMENTS TO OFFICERS

FILE NUMBER: 543-764

(A)
Name

(B)
Title

(D)
Gross Salary
Disbursements
(before any
deductions)

(E)
Allowances
Disbursed

(F)
Disbursements for Official Business

(G)
Other
Disbursements not reported in
(D) through (F)

(H)
TOTAL

A
B
C

Baker , Dora
Trustee
N

$2,805

$577

$3,382

Schedule 15
Representational Activities

90 %

Schedule 16
Political Activities and Lobbying

10 %

Schedule 17
Contributions

0 %

Schedule 18
General Overhead

0 %

Schedule 19
Administration

0 %

A
B
C

Barker , Carla
Recording Secretary
C

$3,250

$706

$3,956

Schedule 15
Representational Activities

38 %

Schedule 16
Political Activities and Lobbying

30 %

Schedule 17
Contributions

0 %

Schedule 18
General Overhead

0 %

Schedule 19
Administration

32 %

A
B
C

Collins , Lee
Sgt at arms
C

Schedule 15
Representational Activities

100 %

Schedule 16
Political Activities and Lobbying

0 %

Schedule 17
Contributions

0 %

Schedule 18
General Overhead

0 %

Schedule 19
Administration

0 %

A
B
C

Dumas , Chad
trustee
C

Schedule 15
Representational Activities

100 %

Schedule 16
Political Activities and Lobbying

0 %

Schedule 17
Contributions

0 %

Schedule 18
General Overhead

0 %

Schedule 19
Administration

0 %

A
B
C

Felty , Bruce
Sgt at arms
N

$2,590

$557

$3,147

Schedule 15
Representational Activities

100 %

Schedule 16
Political Activities and Lobbying

0 %

Schedule 17
Contributions

0 %

Schedule 18
General Overhead

0 %

Schedule 19
Administration

0 %

A
B
C

Harman , Danny
Vice President
C

$3,884

$1,465

$5,349

Schedule 15
Representational Activities

68 %

Schedule 16
Political Activities and Lobbying

32 %

Schedule 17
Contributions

0 %

Schedule 18
General Overhead

0 %

Schedule 19
Administration

0 %

A
B
C

Husband , Amy L
Financial Secretary
C

$8,625

$3,109

$11,734

Schedule 15
Representational Activities

15 %

Schedule 16
Political Activities and Lobbying

20 %

Schedule 17
Contributions

0 %

Schedule 18
General Overhead

0 %

Schedule 19
Administration

65 %

A
B
C

Newman , John
Trustee
C

$2,176

$541

$2,717

Schedule 15
Representational Activities

0 %

Schedule 16
Political Activities and Lobbying

0 %

Schedule 17
Contributions

0 %

Schedule 18
General Overhead

0 %

Schedule 19
Administration

100 %

A
B
C

Osaumkpe , Clayton
Guide
C

$2,056

$965

$3,021

Schedule 15
Representational Activities

91 %

Schedule 16
Political Activities and Lobbying

9 %

Schedule 17
Contributions

0 %

Schedule 18
General Overhead

0 %

Schedule 19
Administration

0 %

A
B
C

Williams , Thomas
President
C

$5,735

$2,534

$8,269

Schedule 15
Representational Activities

46 %

Schedule 16
Political Activities and Lobbying

36 %

Schedule 17
Contributions

0 %

Schedule 18
General Overhead

0 %

Schedule 19
Administration

18 %

A
B
C

Wise , Kayla
Trustee
C

$1,801

$297

$2,098

Schedule 15
Representational Activities

0 %

Schedule 16
Political Activities and Lobbying

0 %

Schedule 17
Contributions

0 %

Schedule 18
General Overhead

0 %

Schedule 19
Administration

100 %

Total Officer Disbursements	$32,922	$0	$10,751	$0	$43,673
Less Deductions					$8,523
Net Disbursements					$35,150

Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)

SCHEDULE 12 - DISBURSEMENTS TO EMPLOYEES

FILE NUMBER: 543-764

	(A) Name	(B) Title	(C) Other Payer	(D) Gross Salary Disbursements (before any deductions)	(E) Allowances Disbursed	(F) Disbursements for Official Business	(G) Other Disbursements not reported in (D) through (F)	(H) TOTAL

TOTALS RECEIVED BY EMPLOYEES MAKING $10,000 OR LESS

$47,284

$12,649

$59,933

Schedule 15
Representational Activities

66 %

Schedule 16
Political Activities and Lobbying

11 %

Schedule 17
Contributions

0 %

Schedule 18
General Overhead

3 %

Schedule 19
Administration

20 %

Total Employee Disbursements	$47,284	$0	$12,649	$0	$59,933
Less Deductions					$12,349
Net Disbursements					$47,584

Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)

SCHEDULE 13 - MEMBERSHIP STATUS

FILE NUMBER: 543-764

Category of Membership (A)	Number (B)	Voting Eligibility (C)
Members (Total of all lines above)	1,294
Agency Fee Payers*
Total Members/Fee Payers	1,294
*Agency Fee Payers are not considered members of the labor organization.
Regular members	1,294	Yes

Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)

DETAILED SUMMARY PAGE - SCHEDULES 14 THROUGH 19

FILE NUMBER: 543-764

SCHEDULE 14 OTHER RECEIPTS
1. Named Payer Itemized Receipts	$8,302
2. Named Payer Non-itemized Receipts	$11,753
3. All Other Receipts	$1,421
4. Total Receipts	$21,476

SCHEDULE 17 CONTRIBUTIONS, GIFTS & GRANTS
1. Named Payee Itemized Disbursements	$0
2. Named Payee Non-itemized Disbursements	$0
3. To Officers	$0
4. To Employees	$0
5. All Other Disbursements	$5,164
6. Total Disbursements	$5,164

SCHEDULE 15 REPRESENTATIONAL ACTIVITIES
1. Named Payee Itemized Disbursements	$0
2. Named Payee Non-itemized Disbursements	$0
3. To Officers	$19,644
4. To Employees	$39,556
5. All Other Disbursements	$13,457
6. Total Disbursements	$72,657

SCHEDULE 18 GENERAL OVERHEAD
1. Named Payee Itemized Disbursements	$6,441
2. Named Payee Non-itemized Disbursements	$14,373
3. To Officers	$0
4. To Employees	$1,798
5. All Other Disbursements	$31,759
6. Total Disbursements	$54,371

SCHEDULE 16 POLITICAL ACTIVITIES AND LOBBYING
1. Named Payee Itemized Disbursements	$0
2. Named Payee Non-itemized Disbursements	$0
3. To Officers	$8,833
4. To Employees	$6,593
5. All Other Disbursements	$881
6. Total Disbursements	$16,307

SCHEDULE 19 UNION ADMINISTRATION
1. Named Payee Itemized Disbursements	$6,400
2. Named Payee Non-itemized Disbursements	$8,953
3. To Officers	$15,196
4. To Employees	$11,987
5. All Other Disbursements	$4,281
6. Total Disbursements	$46,817

Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)

SCHEDULE 14 - OTHER RECEIPTS

FILE NUMBER: 543-764

Name and Address
(A)

International Uaw
8000 East Jefferson Ave

Detriot
MI
48214

Type or Classification
(B)

Union

Purpose (C)	Date (D)	Amount (E)
Total Itemized Transactions with this Payee/Payer		$8,302
Total Non-Itemized Transactions with this Payee/Payer		$6,066
Total of All Transactions with this Payee/Payer for This Schedule		$14,368
strike rebate	04/27/2018	$8,302

Name and Address
(A)

Ube
2000 Maxon Rd

Onaway
MI
49765

Type or Classification
(B)

labor travel

Purpose (C)	Date (D)	Amount (E)
Total Itemized Transactions with this Payee/Payer		$0
Total Non-Itemized Transactions with this Payee/Payer		$5,687
Total of All Transactions with this Payee/Payer for This Schedule		$5,687

Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)

SCHEDULE 15 - REPRESENTATIONAL ACTIVITIES

FILE NUMBER: 543-764

Name and Address
(A)

-1

Type or Classification
(B)

Purpose (C)	Date (D)	Amount (E)
Total Itemized Transactions with this Payee/Payer
Total Non-Itemized Transactions with this Payee/Payer
Total of All Transactions with this Payee/Payer for This Schedule		$0

Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)

SCHEDULE 16 - POLITICAL ACTIVITIES AND LOBBYING

FILE NUMBER 543-764

Name and Address
(A)

-1

Type or Classification
(B)

Purpose (C)	Date (D)	Amount (E)
Total Itemized Transactions with this Payee/Payer
Total Non-Itemized Transactions with this Payee/Payer
Total of All Transactions with this Payee/Payer for This Schedule		$0

Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)

SCHEDULE 17 - CONTRIBUTIONS, GIFTS & GRANTS

FILE NUMBER: 543-764

Name and Address
(A)

-1

Type or Classification
(B)

Purpose (C)	Date (D)	Amount (E)
Total Itemized Transactions with this Payee/Payer
Total Non-Itemized Transactions with this Payee/Payer
Total of All Transactions with this Payee/Payer for This Schedule		$0

Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)

SCHEDULE 18 - GENERAL OVERHEAD

FILE NUMBER: 543-764

Name and Address
(A)

renaissance hotels Florida
6677 Sea harbor Dr

Orlando
FL
32821

Type or Classification
(B)

hotel

Purpose (C)	Date (D)	Amount (E)
Total Itemized Transactions with this Payee/Payer		$6,441
Total Non-Itemized Transactions with this Payee/Payer		$0
Total of All Transactions with this Payee/Payer for This Schedule		$6,441
hotel stay	09/04/2018	$6,441

Name and Address
(A)

Region 8 Cap Council
151 Maddox-Simpson Pkwy

Lebanon
TN
37090

Type or Classification
(B)

Union Cap

Purpose (C)	Date (D)	Amount (E)
Total Itemized Transactions with this Payee/Payer
Total Non-Itemized Transactions with this Payee/Payer		$8,275
Total of All Transactions with this Payee/Payer for This Schedule		$8,275

Name and Address
(A)

Southwest
2702 Love Field Dr

Dallas
TX
75235

Type or Classification
(B)

travel

Purpose (C)	Date (D)	Amount (E)
Total Itemized Transactions with this Payee/Payer		$0
Total Non-Itemized Transactions with this Payee/Payer		$6,098
Total of All Transactions with this Payee/Payer for This Schedule		$6,098

Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)

SCHEDULE 19 - UNION ADMINISTRATION

FILE NUMBER: 543-764

Name and Address
(A)

International Uaw
8000 East Jefferson Ave

Detriot
MI
48214

Type or Classification
(B)

Union

Purpose (C)	Date (D)	Amount (E)
Total Itemized Transactions with this Payee/Payer
Total Non-Itemized Transactions with this Payee/Payer		$5,078
Total of All Transactions with this Payee/Payer for This Schedule		$5,078

Name and Address
(A)

Region 8 Cap Council
151 Maddox-Simpson Pkwy

Lebanon
TN
37090

Type or Classification
(B)

Union Cap

Purpose (C)	Date (D)	Amount (E)
Total Itemized Transactions with this Payee/Payer		$6,400
Total Non-Itemized Transactions with this Payee/Payer		$3,875
Total of All Transactions with this Payee/Payer for This Schedule		$10,275
registration fees	06/24/2018	$6,400

Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)

SCHEDULE 20 - BENEFITS

FILE NUMBER: 543-764

Description (A)	To Whom Paid (B)	Amount (C)
Total of all lines above (Total will be automatically entered in Item 55.)		$0

Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)

69. ADDITIONAL INFORMATION SUMMARY

FILE NUMBER: 543-764

Schedule 13, Row1:

Schedule 13, Row1:Anyone who has applied and been accepted for membership is a regular member. Regular members pay full dues.

Schedule 13, Row1:

Schedule 13, Row1:



Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)