Text extracted via OCR from the original document. May contain errors from the scanning process.
For Natural/Individual Persons For Brokerage Accounts and/or retirement accounts with DBSI
This Authorization/Power of Attorney constitutes a non-durable limited power of attorney, designed to
give a person or persons designated by you either 1) limited authority over your Account(s) or (2) full
authority over your Account(s) as set forth below.
CAUTION TO THE PRINCIPAL: Your Power of Attorney is an important document. As the "Principal," you
give the person whom you choose (your "agent") authority to spend your money and senor dispose of your
property during your lifetime without telling you. You do not lose your authority to act even though you have
given your agent similar authority. When your agent exercises this authority, he or she must act according
to any instructions you have provided or, when there are no specific instructions, in your best interest
"Important Information for the Agent" at the end of this document describes your agent's responsibilities.
Your agent can act on your behalf only after signing the Power of Attorney before a notary public.
You can request information from your agent at any time. If you are revoking a prior Power of Attorney by
executing this Power of Attorney, you should provide written notice of tha revocation to your prior agent(s)
and to the financial institutions where your accounts are located. You can revoke or terminate your Power
of Attorney at any time for any reason as long as you are of sound mind. If you are no longer of sound mind,
a court can remove an agent for eating improperly. Your agent cannot make health care deeisions for you.
You may execute a "Health Cam Proxy" to do this. The law governing Powers of Attorney is contained in the
New York General Obligations Law, Article 5, Title 15. This law is available at a law library, or online through
the New York State Senate or Assembly websites, www.sonate:state.ny.us or www.assembly.state.ny.us.
If there is anything in this document that you do not understand, you should consult with your lawyer.
AUTHORITY
The u ersignel Principal (the "Undersigned" or "Principal") hereby appoints:
fir 0O; v-
or
,pis „e
as the Undersigned's agands) and attorneys)
in-fact (
ent(s)") to act INDIVIDUALLY with respect to any and all accounts, if applicable (see below) in the
Undersigned's name ("Account(s)"), held individually or jointly (provided that all joint account holders have
executed this font) with DBSI, as well as individual retirement accounts held for the benefit of the Undersigned
("IRAs"), with the authority to direct DBSI to buy, sell (including short sales) and otherwise transact in any
security, including but not limited to stocks, bonds, mutual fund shares, limited partnership interests, call and put
options (covered and uncovered), en margin or otherwise, and any instrument, agreement or contract relating
to same, on margin or otherwise, or enter into futures, options on futures and forward contracts, interest rate,
currency, equity or commodity swap transactions, deposit accounts at financial institutions and direct or indirect
interests in securities, deposit instruments or contracts where all or part of the return is calculated by reference
to changes in, among other things, the value of securities, commodities, currencies, interest rates, property of
any description or indices, in each case in accordance with ()BSI's terms and conditions for the Undersigned's
account, account type, and risk and in the Undersigned's names. or number(s) on DBSI's books. Agent(s) must
exercise the authority granted herein pursuant to the Undersigned's instructions, or otherwise for purposes
which the Agent(s) reasonably deems to be in the Undersigned's best interest. By giving this authority, the
Undersigned authorizes Agent(s) to make inquiries on the Account(s), including requesting information about
account transactions, balances and holdings.
1018aseacto
11PM/0985(01/121
009611-010512
CONFIDENTIAL — PURSUANT TO FED. R. CRIM. P. 6(e)
DB-SDNY-0001636
EFTA_000 15 I 10
EFTA00165888
Principal agrees that DBSI shall not be obligated to proceed with instructions that are inconsistent with
the terms of any agreements governing the Account(s), or that would violate any applicable laws, rules or
regulations, or that would be otherwise limited by the account type or documentation on file.
AND TRANSACTION CONFIRMATIONS UPON THE AGENT(S)'S REQUEST. DBSI RETAINS THE RIGHT
THE MAILING ADDRESS ASSIGNED TO THE UNDERSIGNED'S ACCOUNT(S) OR ANY BENEFICIARY
DESIGNATIONS.
NOTE: If you want to authorize your Agent(s) to make gifts of your money or assets or other property held in
the Account(s) during your lifetime, without restriction, to any one or more persons, including the Agent(s)
himself, herself or themselves, you will need to execute a Statutory Major Gifts Rider. Giving such a power to
your Agent(s) grants your Agent(s) authority to take actions whidh could significantly reduce your property
or change how your property is distributed at death. DRS' shall not be responsible to monitor whether any
payments or transfers are gifts and/or require the execution of a Statutory Major Gifts Rider.
O LIMITED TRADING AUTHORIZATION. In all such purchases, safes or trades, DBSI is
rnwp
authorized to follow the instructions of Agent(s) in every respect concerning the Account( s), add Agent(s)
is/are authorized to act for the Undersigned and on the Undersigned's behalf in the same manner and
with the same force and effect as the Undersigned might or could do with respect to such purchases,
sales or trades as well es with respect to all other things necessary or incidental to the furtherance or
conduct of such purchases, sales or trades.
Note: This Limited Authorization does not permit Agenffs) to withdraw or transfer assets from the
Account(s).
— OR —
L/
/ 7
f3 FULL AUTHORIZATION TO TRADE AND MOVE ASSETS. DBSI is authorized to follow the
/imam
instructions of Agent(s) in every respect concerning the Account(s), and to make deliveries or transfers
of assets (including cash), from the Account(s) and payment of moneys as directed by Agent(s), without
restriction froseludingicedureagent(ef; himself, herself or themselves except in connection with IRAsI
in accordance with DBSI's terms and conditions and account type. In all matters and things aforementioned,
as well as in another things necessary or incidental to the furtherance or conduct of the Accoura(s), Agenffs)
may act in the same manner and with the same force and effect as the Undersigned might or could do.
Note: This Full Authorization grants Agentls) unrestricted authority to trade in the Account(s) and to
withdraw or transfer assets from the Account(s).
For IRAs. Agent is authorized to elect whether to make tax withholding elections in connection with
distributions.
This Authorization/Power of Attorney shall remain in full force and effect until DBSI receives actual written
notice signed by the Undersigned of its revocation to be delivered to the Undersigned's DBSI Client Advisor or
his or her branch manager. However, the limited power of attorney granted hereunder is mg a durable power
of attorney and will cease to be effective upon actual receipt by DBSI of written notice of the occurrence of
either of the following events: (i) the Undersigned is judicially declared to be incompetent, or (ii) the death of
the Undersigned. Notwithstanding the foregoing, the Undersigned acknowledges that DBSI shell be entitled
to continue to rely upon this Authorization/Power of Attorney until such time as DBSI receives such actual
written notice.
2
1 I SVVIA.098.5 (0%/13)
0096I1-010b17
CONFIDENTIAL — PURSUANT TO FED. R. CRIM. P. 6(e)
DB-SDNY-0001637
EFTA_000 15 1 1 1
EFTA00165889
The Undersigned understands and agrees that DBSI has the right to require additional verification and
documentation from the Undersigned or the Undersigned's Agent(s) in certain transactions that DBSI, in its
sole discretion, deems necessary. In addition, DBSI has the right to request that either a new Authorization/
Power of Attorney be executed or that the Agent(s) verify in writing the validity of the current Authorization!
Power of Attorney.
Agent Name:
Sic
Le ct adritn
(1L Yft4~
11
I-1 y ice 7,1-
Address:
TIN of Agent:
Relationship
I
to Principal:
11-c.ct., ad"-,
Agent Name:
j
i IJA-C
1 2)i-eh A.4 /I
l/cc ,()&j 44*
Address:
57.
/OA f 5 , (icy/ coiktt.
TIN of Agent:
Relationship
to Principal: yr(
LINES BELOW.
INDEMNIFICATION
The Undersigned acknowledges and agrees that the Undersigned is responsible for all acts of the Agent(s). The
Undersigned hereby agrees, individually and on behalf of his/her heirs, executors, legal representatives, and
assigns to indemnify and hold harmless DBSI and its parents, affiliates, subsidiaries, officers, employees, and
agents (collectively, "DB") from all claims that may arise in connection herewith, and to pay DB promptly, on
demand, any and all losses and liabilities arising therefrom or from any action taken or not taken by DB in reliance
hereon, including without limitation, any debit balance due with respect to the Aocount(s). The Undersigned
further hereby ratifies and confirms any and all transactions (including any payments or transfers) made by the
Undersigned's Agent(s) in connection with the Account(s) prior or subsequent to the execution of this document
and holds harmless DB regarding same.
This Authorization/Power of Attorney shall inure to the benefit of DB and its successors and assigns irrespective
of any change or changes at any time in the personnel thereof for any cause whatsoever.
The Undersigned understands and agrees that the DBSI may require joint account holder(s) to sign all requests
for withdrawals from an account jointly with the Agent(s).
3
II PWM.0985101/I7)
033611.010612
CONFIDENTIAL — PURSUANT TO FED. R. CRIM. P. 6(e)
DB-SDNY-0001638
EFTA_000 15 1 12
EFTA00165890
• • The Undersigned by signing below confirms that he/the has read the contents of this Power of Attorney
and understands same, and has executed this Power of Attorney of his/her own free will and has received
. advice about the effect of this Power of Attorney from his/her advisers as he/she has deemed necessary or
advisable.
In witness whereof, the Undersigned has executed this Autheriz ion/Power of A owe
Signature:
Print Name:
(the "Cinders
In witness whereof, the Undersigned has executed this Authorization/Power of Attorney.
Date:
Signature:
Print Name:
(the "Undersigned")
This section intentionally left blank.
4
11SW1,40965 (0ll12)
CO9611-010512
CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e)
DB-SDNY-0001639
EFTA_000 15 1 I 3
EFTA00165891
ACKNOWLEDGEMENT OF PRINCIPAL'S SIGNATURE IN NEW YORK STATE
On
40 L3
/4
41, .11 0.
before me, /74/ty
personally
,
appeared kt-
tile im personally known to me 6r proved to me on the basis of satisfactory
evidence to
the ind idual s) whose name(s) is (are) subscribed to within the instrument and acknowledged
to me that he/she/they executed the same in his/herhheir capacity(ies), and that by his/her/their signature(s)
on the instrument, the individual(s), or the person upon beh
of whom thein v ual(s) acted, executed
the instrument.
Pe .41 yflie,k
as.:
Notary Public
HARRY I. SELLER
Notary Pudic, ;Mite of New York
No 31RE4853924
ACKNOWLEDGEMENT OF PRINCIPAL'S SIGNATURE OUTSIDE NEW YORMAT-E
Rack!and County jr
Commission Expires Feb. 17. 20 •
•
STATE OF
COUNTY OF
ss.:
On
before me,
personally
appeared
personally known to me or proved to me on the basis of
satisfactory evidence to be the individual(s) whose names) is (are) subscribed to within the instrument and
acknowledged to me that he/she/they executed the same in his/her/their capacity(ies), and that by his/her/
their signature(s) on the instrument, the individual(s), or the person upon behalf of whom the individual(s)
acted, executed the instrument, and that such individual(s) made such appearance before the Undersigned
in
(state/country).
(signature and office of the individual taking acknowledgement)
ACKNOWLEDGEMENT OF PRINCIPAL'S SIGNATURE IN NEW YORK STATE (for joint accounts)
ss.:
On
before me,
personally
appeared
personally known to me or proved to me on the basis of satisfactory
evidence to be the individual(s) whose name(s) is (are) subscribed to within the instrument and acknowledged
to me that he/shelthey executed the same in his/her/their capacity(ies), and that by his/her/their signature(s)
on the instrument, the individual(s), or the person upon behalf of whom the individuals) acted, executed
the instrument.
Notary Public
ACKNOWLEDGEMENT OF PRINCIPAL'S SIGNATURE OUTSIDE NEW YORK STATE (for joint accounts)
STATE OF
,
COUNTY OF
ss.:
On
before me,
personally
appeared
personally known to me or proved to me on the basis of
satisfactory evidence to be the individual(s) whose name(s) is (are) subscribed to within the instrument and
acknowledged to me that he/she/they executed the same in his/her/their capacity(ies), and that by his/her/
their signature(s) on the instrument, the individual(s), or the person upon behalf of whom the individual(s)
acted, executed the instrument, and that such individuafis) made such appearance before the Undersigned
in
(state/country).
(signature and office of the individual taking acknowledgement)
5
11.PlArMA985 MI/12)
CO9617-010512
CONFIDENTIAL — PURSUANT TO FED. R. CRIM. P. 6(e)
DB-SDNY-0001640
EFTA_00015114
EFTA00165892
.
• • • IMPORTANT INFORMATION FOR THE AGENT(S):
When you accept the authority granted under this Authorization/Power of Attorney, a special legal relationship
is created between you and the Principal. This relationship imposes on you legal responsibilities that continue
until you resign or the Authorization/Power of Attorney is terminated or revoked. You must:
1. act according to any instructions from the Principal, or. where there are no instructions, in the Principal's
best interest;
2. avoid conflicts that would impair your ability to act in the Principal's best interest;
3. keep the Principal's property separate and distinct from any assets you own or control, unless otherwise
permitted by law;
4. keep a record of all receipts, payments, and transactions conducted for the Principal;
5. disclose your identity as an Agent whenever you act for the Principal by writing or printing the Principal's
name and signing your own name as "Agent" in either of the following manner (Principal's Name) by
(Your Signature) as Agent, or (Your Signature) as Agent for (Principal's Name); and
6. agree that DBSI shall not be obligated to proceed with instructions that are inconsistent with the terms of
any agreements governing the Account(s) or that would violate any applicable laws, rules or regulations.
You may not use the Principal's assets to benefit yourself or give major gifts to yourself or anyone else
unless the Principal has specifically granted you that authority in this Authorization/Power of Attorney and in
a Statutory Major Gifts Rider which the Principal may attach to this Authorization/Power of Attorney. If you
have that authority, you must act according to any instructions of the Principal or, where there are no such
instructions, in the Principal's best interest. You may resign by giving written notice to the Principal and to
any co-agent, successor agent, or the Principal's guardian if one has been appointed. If there is anything
about this document or your responsibilities that you do not understand, you should seek legal advice.
Liability of Agent: The meaning of authority given to you is defined in New York's General Obligations Law,
Article 5, Title 15. If it is found that you have violated the law or acted outside the authority granted to you
in the Authorization/Power of Attorney, you may be liable under the law for your violation.
AGENT(S)' SIGNATURE AND ACKNOWLEDGEMENT OF APPOINTMENT:
It is not required that the Principal and the Agent(s) sign at the same time, nor that multiple Agents sign
at the same time.
I/we,
- 7 /22tav
have read the foregoing
(insert name(s) of Agenth)I
Authorization/Power of Attorney.
I am/we are
e person(s) identified therein as Agent(s) for
e Principalyr5me therein.
GA-C
m
Agent's signature
Agekit's sig ature r:/
/fig/IS
Dated:
6
Dated:
11.PWM-0.5.85 (01P 2)
CONFIDENTIAL — PURSUANT TO FED. R. CRIM. P. 6(e)
DB-SDNY-0001641
EFTA_000 15 1 15
EFTA00165893
ACKNOWLEDGEMENT OF AGENT(S)' SIGNATURE IN NEW YORK STATE
1...ri,..„. rrt i -
ss.:
On
/A/ 13
before me,
Rs r r7 /Vet,
personalty
appeared _...icer- r.. v.,
6 rb It "'I...-, personally known to me or proved to me on the basis of satisfactory
evidence to bethe individual(s) whose names) is (are) subscribed to within the instrument and acknowledged
to me that he/she/they executed the same in his/her/their ciipacity(ies), and that by is/her/their signature(s)
on the instrument, the individual(s), or the person upon bib f of torn the,
tvidual(s) acted, executed
the instrument.
HARRY I. REELER
Notary Public
Notary Public, Slate of New York
No 01624853924
ACKNOWLEDGEMENT OF AGENT(S)' SIGNATURE OUTSIDE NEW YORK STATgrn
omission Expires Feb. 17, 20
Ouslifiod in Poc:rland County",
STATE OF
COUNTY OF
ss.:
On
before me
personally
appeared
personally known to me or proved to me on the basis of
satisfactory evidence to be the individual(s) whose name(s) is (are) subscribed to within the instrument and
acknowledged to me that he/she/they executed the same in his/her/heir capacity(ies), and that by his/her/
their signature(s) on the instrument, the individual(s), or the person upon behalf of whom the individual(s)
acted, executed the instrument, and that such individual(s) made such appearance before the Undersigned
in
(state/country).
(signature and office of the individual taking acknowledgement)
ACKNOWLEDGEMENT OF AGENT(S)' SIGNATURE IN NEW YORK STATE (for joint accounts)
Ajcpv
\-/ O r
ss.:
On
ZC1/5
before me, bias , ri
personally
appeared
ter
personally known to me or proved to me on the basis of satisfactory
evidence to
the in tv ual(s) whose name(s) is (are) subscribed to within the instrument and acknowledged
to me that he/she/they executed the same in his/her/their capacity(ies), and that by his/her/their signature(s)
on the instrument, the individual(s), or the person upon behalf of whom the individual(s).acted, executed
the instrument.
Notary Public. Slate of New York
S-14_,VA
No O I /16053071
Qualified in Queens County
Notary Public
comntission Expires January 2. 20.15
ACKNOWLEDGEMENT OF AGENT(S)' SIGNATURE OUTSIDE NEW YORK STATE (for joint accounts)
STATE OF
COUNTY OF
ss.:
On
before me,
personally
appeared
personally known to me or proved to me on the basis of
satisfactory evidence to be the individual(s) whose name(s) is (are) subscribed to within the instrument and
acknowledged to me that he/she/they executed the same in his/her/their capacity(ies), and that by histher/
their signature(s) on the instrument, the individual(s), or the person upon behalf of whom the individual(s)
acted, executed the instrument, and that such individual(s) made such appearance before the Undersigned
in
(state/country).
(signature and office of the individual taking acknowledgement)
7
11-PWPA-0905(01/12)
03961 I -010512
CONFIDENTIAL — PURSUANT TO FED. R. CRIM. P. 6(e)
DB-SDNY-0001642
EFTA_00015116
EFTA00165894
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Endorsement;
Restrictions
•
CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e)
DB-SDNY-0001643
EFTA_00015117
EFTA00165895
rEATE:
`+
CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e)
DB-SDNY-0001644
EFFA_000 15 1 18
EFTA00165896