EFTA00238622.pdf

UBS Financial Services Inc. UBS Account Number 21 Check here if this document applies to multiple accounts- Letter of Authorization for Duplicate Recipient of Tax Records This letter authorizes UBS Financial Services Inc. to send a copy of your tax form for the below accountfs) to the following Account Number Account Number Account Number interested party(ies). Such authorization will continue for ten years unless terminated by UBS Financial Services Inc. or until you notify UBS Financial Services Inc. in writing of your decision to terminate the mailing of your tax reports to the parties below Account Number Account Number Account Number Be advised that the service only pertain to your form 1099, 1099R or 1099O. If you are eligible to receive a different tax Account Number Account !timber Account Number report, this will not be sent to the below parties. Also be aware that it you are a beneficiary on an account or a participant of a qualified plan, you are not eligible to enroll the account to send duplicate tax information to a third party. Interested Party Information (may select up to fax) INTERESTED PARTY Laura Barooshian First Name Middle Name Last Name Address Lire 1 Address Line 2 City State Zip Email Address Phone SI(7M -hislaine Maxwell X -bikr Account Owner First Name Last Name Ar.(9:011 OM SRIid:We Date 0206602695 ;Rev ion 11 titingENEENI O2011 UBS F nanoal Services Inc. A I tights r sent d Memver s'" P 90 1/1 CONFIDENTIAL UBSTERRAMAR00003243 EFTA00238622