EFTA01344421.pdf

Account # IV. PARTIAL TRANSFERS, DIRECT MUTUAL FUNDS AND LIQUIDATIONS (If there are more than eight assets, attach a signed list to this form) clunscire ASSET DESCMPTON CUSIPISYMEDI: ILI\,...:irezri fliACCGki'.7 TRANSFER INSTRUCTIONS' DIVIDEND CAPITAL GAIN ESTIMATED s OPTIOAF VALUE US Dollar OUSDPRAA7 illTransfer in lend U Liquidate CI Cash 0 Reinvest J Cash LI Reinvest 28366.12 CI Transfer in Kind 0 Liquidate 0 Cash 0 Reinvest ..I Cash U Reinvest O Transfer in lend CI Liquidate 0 Cash 0 Renver U Cash LI Reinvest CI Transfer in *net 0 Liquidate CI Cash CI Reinvest J Cash U Reinvest O Transfer in Kind CI Liquidate CI Cash 0 Reinvest U Cash LI Reinvest 0 Transfer in Kind 0 Liquidate 0 Cash CI Reinvest J Cash U Reinvest O Transfer in Kind 0 Liquidate CI Cash 0 Reinvest U Cash 0 Reinvest 0 Transfer in *rid 0 Liquidate 0 Cash CI Reinvest LI Cash U Reinvest II you have requested a iguidellon, your market price is not guaranteed. YOu will receive the current market price after your transfer request is received. reviewed, and determined to be In good order by the delivering firm. Pershing is not responsible for markel fluctuations or delays n the review process. DRS items cannot be liquidated. 2 It this is a mutual fund transfer and there is no dividend or Capital gain option checked in the section above. Pershing will PrOOOSS this request as reinvest. (FOR OFFICE USE ONLY: All transfers must be added to Pershing's transfer systems) V. RETIREMENT PLAN RESTRICTIONS AND CERTIFICATIONS ni Age 70" restrictions. It you are at :era the age of 70 this year and you are transferring or rolling over assets from an IRA. qualilied plan or 40300 account. you may be required to take a minimum dstribubon (FWD) from your qualified plan or 40310) account before rolling over your assets. la Rollover Certification of Employee: I understand the Mee and conditions and I have met the requirements for making a rollover. Due to the important tax consequences of rolling over lunds or property. I have been advised to see a tax prolossional. All information provided by rne is true and correct and may be [eked on by Pershing LLC. I assume full responsibility for this transaction and will not hold Pershing LLC liable for any adverse consequences that may result I hereby irrevocably designate this contribution in lunds or other property as a transfer or rollover contribution. TO THE PRIOR TRUSTEE: J Pershing LLC accepts appointment as successor custodian. J Please be advised that does hereby accept appointment as successor custodian (linen Firm Name) SUCCESSOR CUSTODIAN'S SIGNATURE: DAT E VI . PARTICIPANT SIGNATURE AND CERTIFICATION To the Delivering f rim Named Abon• the trustee tided above. Unless writP., A Irir...ond reor.:oymen :fin er ni t .1C.COnn: :0 irnannO W,Inf:U1 st(r my be transferred within the time frames required by NYSt Rule 412 or smiler ruie of the NASD or other deugnated examining authority. Unless otherwise indicated in the instructions above, I authorize you to liquidate any nontransferable propnelary money market fund assets that we pert of my account and transfer the revelling credit balance to the succosscf custodian I authorize you to deduct any ouislandng lees due to you from the credit balance in my account. II my account does not contain a credit balance. or if the credit balance in the account is insufficient to satisfy any outstanding lees due to you. I authorize you 10 liquidate the assets ri my account to the extent necessary lo steely that obligation. II centhcates or other instruments n my account are in Wit physic-al possession. I instruct you to transfer them in good deliverable then inducing affixing any necessary tax wavers. to enable the successor custodian to transfer them in es name la the purpose of the sale, when. and as directed to me. I understand that upon receiving a copy of the transfer information, you nil cancel all open orders for my account on your books. I affirm that I have destroyed or returned to you credit/debit cards and/or unused checks issued tome n Connection with my brokerage aCCOun I understand that sOu will Contact me vnth respect to the disposition of any assets in my brokerage account that are nontransferable. SIGNATURE GUARANTEED BY: CLIENT'S SIGNATURE: DATE: JOINT CLIENT'S SIGNATURE: DATE. Please attach your most recent brokerage account statement to process this account transfer INVESTMENT PROFESSIONAL'S NAME: INVESTMENT PROFESSIONAL'S PHONE NUMBER: CUSIP' belongs to as respective owner 09 P1k0A 059/ IIOW) Page 3 of 3 CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e) DB-SDNY-0029844 CONFIDENTIAL SDNY_GM_00176028 EFTA01344421