Apple Store, Fifth Avenue
767 Fifth Avenue
New York, NY 10153
fifthavenue@apple.com
212-336-1440
DCA License 11226523 & 1226517

www.apple.com/retail/fifthavenue

December 12, 2012 05:22 PM

<table><tr><th></th><th></th></tr><tr><td>iPad mini Smart Cover Pink</td><td>$39.00</td></tr><tr><td>Part Number: MD968LL/A</td><td></td></tr><tr><td>Return Date: Dec. 26, 2012</td><td></td></tr><tr><td>For Support, Visit: www.apple.com/support</td><td></td></tr><tr><td>iPad mini Wi-Fi Cellular 64GB White</td><td>$ 659.00</td></tr><tr><td>Part Number: MD539LL/A</td><td></td></tr><tr><td>Serial Number: F4KJT356F19H</td><td></td></tr><tr><td>Return Date: Dec. 26, 2012</td><td></td></tr><tr><td>For Support, Visit: www.apple.com/support</td><td></td></tr></table>

<table><tr><th>Sub-Total</th><th>$698.00</th></tr><tr><td>Tax@8.875%</td><td>$61.95</td></tr><tr><td>Total</td><td>$759.95</td></tr><tr><td>Amount Paid Via AmEx (A)</td><td>$759.95</td></tr><tr><td>XXXXXXXXXXXXXXXX2037</td><td></td></tr><tr><td>608346</td><td></td></tr></table>



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