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High Risk Media - Callback Verification
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Client Instructions: jati;tisluie Ve.iiied
ETVeiified Account has sufficient c.:
^Transaction consistent w/enpH tr.
Deutsche Bank
Private Wealth Management
^JenaluicVctiiicd
- 10"alU'r A j;,Vr'l.c.;:r'd
6 VcMfied Actoimt/.--uf,i.Mi/Recipicni
Approver/
Callback
Authorization for Asset Movement
For Non-Retirement Accounts
Alo*. Brown" or "OBABfllo loUow the bolciw assot
Icrtl^nt/Autli SlEnatopiSjTirirft0 I pyjt
Phone#: t2>Z) ^ ,
movement Instruon ms.
The undersigned hereby authorites and directs Deutsche Bank Alex. Brown
("Deutsche Bary
II you wish to request multiple wires, checks, journals or free deliveries,
please use the long
DBAS Account Name; Southftrn Trust Company Inc.
Account #: 44129244
>1^ 5-
n»te-
Name j^rinp:
( ,
JOU Hi
Wire
leclpi(!nt Signatuie
Q Nmwnal Ftimis In Ihn nmniinLol S
Aj'F>ovjifci5??sii;natu.e
Q Wire Isderel funds in the amount of S 91.119.85
To Bank Name; Banco Popular
City / State:
ABA#:
Q Journal Holflmgs:
Otv/Symboi/Security
Oiv/Symboli'Secunly _
Li Journal All Holdings
To DBAS Account #.
021502011
Further credit to Inteimediary Financial Institution (Optional)
EFTA01405300
Account t:
Name:
Account Name;
Ultimate Beneficery Inibnnation:
Benaikinv Mama: Terrence E Rabsatt
ccount
AddnkjnaHnstnjcwms: Final Payment
Floe Dellveriee
Q Please deliver the securitiae indicated below to:
DTCCIi:
Nari'.e o( Receiving Firm:
Check
Q Issue a check in the amount of $
Rectpieni'sNanie;
Reapianrs Malmg Address:
Aodouni Name:
ptbahbto;
at Rocoiving Firm
Account Numbei.
QlV/Symbol/Sociirity:
Oiy/Syn iboUSecurity:
Standing Authorization
Q The undersigned hereby requests that this authorization act as a standing
authoiizaiion. the undeteigned undarslands and agrees that this
aulhorizallon will
remain in ellect until Deutsche Bank Alex Brown requests a new
aotiiorization. The undersigned authorizes Deutsche Bank Alex. Brown lo
issue the wire.
check or journal on the
.1%
Q The undersigned luither authorizes Deutsche Bank Alex. Brown to accept
verbal instruclions horn the undersigned to wire funds, issue cheeks or
journal
funds to/from the above listed accounts. The undersigned will (iruvtile
verbal iitsuuctions as lo the date and the amount of lha wire, check or
journal. If the
undersigned decides io vary either the date or the amount of the wire, check
or lournal, the undersigned hereby auihorizes Dauischa Bank Alex Brown to
accept the verbal inslruclions from the undersigned regarding the change or
changes The undersigned lurther understands and agrees to comply with the
procedures of Deutsche Bank Atex. Brown to verify the authorization and
accuracy of verbal instructions.
day of
for a leuii of
The unao'signed hereby acknowledges that (i) the information contained in
this form is complete and accurate to the best knowledge of the undersigned;
and (S) the
undersigned is io5pons>bie for the method of transmission 01 any insuuctions
issued pursuant to this eulhotization. If the undersigned elects to transmit
any such
EFTA01405301
Instructions via tax (including desktop lax), via email Or as an mage
attachment to email le.g., as a PDF. TIP or other irrwge ol such
instructions), the undarsignod
understands and ogteas that the unders.gnod bears the risk ol loss ansuig
Irom such method of transmission In the event of transmission errors,
misunderslendings.
impersonauons, transmission by utvaulhonzed persons, forgery of .i.tui.
v,... i u tiosla or other enlilios, lha undersigned lurther acknowledges
that the undersignod Is
authoiizod ID issue tha above asset movement instructions under ilie terms
ol the governing documents and any applicabts laws. The undersigned hereby
rofeasas and
holds harmless Deulscha Bank Alex. Brown from and agsmsi loss I'-m nnvaci-
on, claim or demand of any parson as a result 01 Oeuiseho Bank Alex Brown's
receipt of
or compliance with this aulhorizaticn and/or any Inslruotions that m.., bo
rsnoii lo Deulscha Bank Alex, Brown pursuant to this authorization
(including any standing
aulhorizaiicni.
Tite undetsigned understands lliai Doutsclie Bank Alex. Brown may. but is
nol requnad to. seek vaiilication of the undersigned's instructions by call
back and that
Douischa Bank Alex Brown may in its sole discrollon refuse to axnoiin iixh
inslruclions (including standing instructions) given pursuant to this
authorization, wilhoul
incuirirtg any liabllily. it (Jeulsche Bank Alex. Brown has reason to
tx'i'Cvo such inslioctions lot standing instructions) have nol bean provided
by the undersigned. The
undersigned further understands that Deutsche Bank Alex. Brown ii-ljins t'lu
tight to refuse lo execute any Instructions lo Vansfoi funds or socuriiles
lo any Bccount(s)
B505uani lo this authorization wil(i(oql written ip^iuclyfljes bearing
onginal signature(s) of the undersigned.
Darren Indyke
1-23-2015
Signatum
Print Name
Signature
•'11
1B.PWM-01775 (12/10)
EFTA01405302