TUNISON AND CAMPBELL DENTISTRY, PLLC

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2005-01-01
Business code	621210
Sponsor’s telephone number	6077543903
Plan sponsor’s address	139 N JENSEN ROAD, VESTAL, NY, 13850

Signature of

Role	Plan administrator
Date	2024-08-16
Name of individual signing	MICHELLE K. TUNISON, D.D.S.

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2005-01-01
Business code	621210
Sponsor’s telephone number	6077543903
Plan sponsor’s address	139 N JENSEN ROAD, VESTAL, NY, 13850

Signature of

Role	Plan administrator
Date	2023-07-25
Name of individual signing	MICHELLE K. TUNISON, D.D.S.

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2005-01-01
Business code	621210
Sponsor’s telephone number	6077543903
Plan sponsor’s address	138 N JENSEN ROAD, VESTAL, NY, 13850

Signature of

Role	Plan administrator
Date	2022-09-20
Name of individual signing	MICHELLE K. TUNISON, D.D.S.

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2005-01-01
Business code	621210
Sponsor’s telephone number	6077543903
Plan sponsor’s address	139 JENSEN ROAD, VESTAL, NY, 13850

Signature of

Role	Plan administrator
Date	2021-08-31
Name of individual signing	MICHELLE K. TUNISON, D.D.S.

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2005-01-01
Business code	621210
Sponsor’s telephone number	6077543903
Plan sponsor’s address	139 JENSEN ROAD, VESTAL, NY, 13850

Signature of

Role	Plan administrator
Date	2020-10-06
Name of individual signing	MICHELLE K. TUNISON, D.D.S.

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2005-01-01
Business code	621210
Sponsor’s telephone number	6077543903
Plan sponsor’s address	139 JENSEN ROAD, VESTAL, NY, 13850

Signature of

Role	Plan administrator
Date	2019-09-30
Name of individual signing	MICHELLE K. TUNISON, D.D.S.