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DOJ EFTA Data Set 10 document EFTA01344423

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DOJ EFTA Data Set 10 document EFTA01344423

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EFTA Disclosure
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Account # IV. PARTIAL TRANSFERS. DIRECT MUTUAL FUNDS AND LIQUIDATIONS (If there are more than eight assets, attach a signed list to this form) GuANTIFY ASSET DESCRIPTION CUSIPISYMBOL VND ACCOUNT NUMBER TRANSFER INSTRUCTIONS' CAPITAL GAIN DIVIDEND OPTION' ORTIOhF ESTIMATED r VALUE lnunh'Iws"/'"elbel n fli 870994928 S Transfer in Kind 0 Liquidate U Cash 0 Reinvest U Cash 0 Reinvest 5001766.64 'in. /Iv .1/ -Rn MIRIOSS”‘ 4812C0803 S Transfer in Kind U Liquidate U Cash U Reinvest j Cash u Reinvest 2704385.15 Mad? two (ire Sr we said 704549AE4 S Transfer in and 0 Liquidate 0 Cash 0 Reinvest U Cash 0 Reinvest 1363500 l arall TR I ries Pau he re Feld 48121L510 a Transfer in Kind 0 Liquidate CI Cash 0 Reinvest J Cash U Reinvest 2057601.37 I ranarril te iii yearn) i sent 46262EAE5 S Transfer in Kind 0 Liquidate 0 Cash 0 Reinvest j Cash 0 Reinvest 445000 Ilea Chase& Co 7.9% Pit 4662511HA 1 a Transfer in Kind 0 Liquidate U Cash 0 Reinvest J Cash U Reinvest 333795833 IBOFA Corp 81/8% 060505DT8 a Transfer in and U tiquidaa U Cash U Reinvest U Cash U Reinvest 331062023 Kleelmtlleateiesre lee s I/4 I 494580AB9 !aTransfer in Kind U Liquidate U Cash U Reinvest ; U Cash U Reinvest 996250 I II you have requested j liquidation, 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 form. Pershing is not responsible for market fluctuations or delays in the review process. DRS items cannot be liquidated. 2 II this is a mutual fund transfer and there is no dividend or capital gain option checked in the section above. Pershing will process this request as reinvest. (FOR OFFICE USE ONLY: All transfers must be added to Pershing's transfer systems) V. RETIREMENT PLAN RESTRICTIONS AND CERTIFICATIONS hi Age 70" restrictions. If you are at the age of 70 this year and you are transferring or rolling over assets from an IRA. qualilied plan or 4030) account. you may be required to lake a minimum distribution (FWD) from your qualified plan or 40310) account before rolling over your assets. II Rollover Certification of Employee: I understand the rube 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 prolenional. All information provided by me 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: CI Pershing LLC accepts appointment as successor custodian. U Please be advised that does hereby accept appointment as successor custodian (Inert Firm Nanw) SUCCESSOR CUSTODIAN'S SIGNATURE: RAI f VI PARTICIPANT SIGNATURE AND CERTIFICATION To the Delivering f am Nonwd Abian• the trustee listed above. unless ointl I': ire :fin er 411 AS: ,1:2, :11 iic.ccu. Ore :rincl ,U(.I' may be transferred within the time frames required by NYSt Rule 412 or smiler rule of the NASD or other deugnared exonning authority. Unless otherwise indicated in the instructions above, I authorise you to liquidate any nontransferable propnelary money market fund assets that we part of my account and transfer the retailing credit balance to the SUCCenn4 Custodian I authorize you to deduct any outstanding 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 in my account to the extent necessary le satoly that Obligation. II oertilicates or other instruments n my account are in you physcal possession. I instruct you to Render them in good deliverable form, including affixing any necessary fax waivers, to enable the successor custodian to transfer them in es rase la the purpose of the sale, when. and as directed to me. I understand that upon receiving a copy of ars karst (sr informalton. 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 CalnettiOn With my brokerage annuli I understand dial yOU will contact MO With respect to the disposition of any assets in my brokerage account that are nontranslerable. 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 tons respective owner 09 MIA 059/ I illare Page 3 of 3 CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e) DB-SDNY-0029847 CONFIDENTIAL SDNY GM_00178031 EFTA01344423

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Phone2704385
Phone3795833
Phone5001766
SWIFT/BICDESCRIPTION
SWIFT/BICDIVIDEND
Wire RefTRANSFER INSTRUCTIONS
Wire Reftransfer INVESTMENT
Wire Reftransfer request
Wire Reftransfer systems

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