EFTA00237759.pdf

UBS UBS Financial Services Inc. Account Number ❑ Check here if this document applies to multiple accounts Letter of Authorization for Duplicate Recipient of Tax Records This letter authorizes 1)85 Financial Services Inc. to send a copy of your tax form for the below account(s) to the following interested paity(ies) Such authorization will continue for ten years unless terminated by UBS Financial Services Inc. or until you notify UBS Financial Services Inc in veiling of your decision to terminate the mailing of your tax reports to the parties below. Be advised that the service only pertains to your form 1099, )099R or 1099Q. If you are eligible to receive a different tax report, this will not be sent to the below parties Also be aware that if 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 four) INTERESTED PARTY Alan Blether Fist Name Middle Name Last Name Address Line 1 Address tine 2 City State Zip Email Address Phone islaine Account Owner First Name 0159495149 AC-DPT (Rev 10(1I) O2011 UBS Financial Services Inc. A I rights reserved. Member SIPC. Page if'', CONFIDENTIAL UBSTERRAMAR00002180 EFTA00237759