Case File
efta-01343945DOJ Data Set 10OtherEFTA01343945
Date
Unknown
Source
DOJ Data Set 10
Reference
efta-01343945
Pages
1
Persons
0
Integrity
Extracted Text (OCR)
Text extracted via OCR from the original document. May contain errors from the scanning process.
Account Transfer Form
I. RECEIVING FIRM INFORMATION (Only one per form)
RECEIVING FIRM CLEARING NUMBER.
ACCOUNT NUMBER:
SOCIAL SECURITY
NUMBER
SECONDARY SOCIAL
SECURITY NUMBER:
- FF1-
ACCOUNT TYPE: (Enter the two character code)
R
or TAXPAYER
IDENTIFICATION
NUMBER:
or TAXPAYER
IDENTIFICATION
NUMBER:
Nonratuemeni.
SN—(Singiei JT—IJoint) TR —(Twen CT-1Coirustee) CO-(Corporate) CU—(Custodian) ES —IEstate)
BC —(Bank Custody) AG—(Agency)
Retirement.
IR —I Iraditional IRA' RI-(Roth IRA, DR —(Direct Rollover) RI —IBeneliciary) BR —(Beneliciary Roth IRA)
4K —(401k) El—(Education Savings Account) SI —ISIMPLE IRA) QP—(Qualified Plan) 4B—(403b)
78—(457 Plan) HS-114eallh Savings Account) 5P-(529 Plan)
OT — !Other)
Other.
II. DELIVERING ACCOUNT INFORMATION
CLEARING NUMBER:
ACCOUNT NUMBER:
FIRM NAME JPMorgan Chase Bank, N.A.
ACCOUNT TITLE: (As it appears on your statement)
The Haze Trust
NOTE: A complete copy of yet.
DELIVERING FIRM CONTACT INFORMATION
(MANDATORY WHEN CLEARING NUMBER IS NOT PROVIDED)
CONTACT NAME:
FIRM ADDRESS. (No PO Box)
CITY:
STATE:
ZIP.
TELEPHONE NUMBER:
- 1 statement is necessary to process this form.
III. TRANSFER TYPE (Choose only one)
A ACCOUNT TRANSFER
U FULL 'Check one below)
K TRANSFER ALL ASSETS IN KIND (Skip to Seclion VII
U LIQUIDAI E ALL ASSETS LISTED IN SECTION IV (Lquicielions are not for brokerage accounts)
U TRANSFER ALL ASSE IS IN KIND EXCEPT FOR THE ASSETS USTED IN SECTION N. WHICH REQUIRE LIQUIDATION
U PARTIAL (Complete Section M
B. DRS/DRIP
U FULL (Check one below)
U SELL FRACTIONS AND CLOSE ACCOUNT
0 TRANSFER ALL FULL SHARES ONLY
U PARI IAL (List assets in Section NI
NOTE: For transfer agents. electronically send positions Of issue a certificate for whole shares and redeem fractional shares.
C. DIRECT MUTUAL FUND
LI TRANSFER MUTUAL FUNDS FROM THE ACCOUNT HELD DIRECILY AI THE FUND COMPANY 'See list in Section IV for exact
instructions)
NOTE: Only one fund family per form.
D. BANK RETIREMENT PLAN ACCOUNTS (Select only one)
K LIQUIDATE iMMEGiAt ELY AND TRANSFER CASH I am aware of and acknowledge any penalty I will incur from an early withdraws.
O LIQUIDATE Af MATURITY AND TRANSFER CASH Sootily maturity dale (submit two to litree weeks before maturity date).
NOTE: Liquidations involving bank CDs. checking accounts, or savings accounts can only be processed Irorn retirement accounts.
SIGNATURE
SIGNATURE
DATE
DATE
BPD
ul
111
150 ACAT
u9 WiTA-0697 NOM Page 2 of 3
CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e)
DB-SDNY-0028930
CONFIDENTIAL
SONY GM_00175114
EFTA01343945
Technical Artifacts (11)
View in Artifacts BrowserEmail addresses, URLs, phone numbers, and other technical indicators extracted from this document.
SWIFT/BIC
ACCOUNTSSWIFT/BIC
CLEARINGSWIFT/BIC
DIRECILYSWIFT/BIC
INFORMATIONSWIFT/BIC
LIQUIDAISWIFT/BIC
LIQUIDATIONSWIFT/BIC
MATURITYSWIFT/BIC
SECURITYSWIFT/BIC
TAXPAYERWire Ref
TRANSFER MUTUALWire Ref
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