EPSTEIN
page 3 / 693 . OCR, unverified
W60975005
JP Morgan
Jeepers Inc.
or TAXPAYER
IDENTIFICATION
NUMBER:
or TAXPAYER
IDENTIFICATION
NUMBER:
06 29 1
3
DELIVERING FIRM CONTACT INFORMATION
(MANDATORY WHEN CLEARING NUMBER IS NOT PROVIDED)
CONTACT NAME:
FIRM ADDRESS: (No. P.O. Box)
CITY:
EFTA01464662
--- PAGE 4 ---
STATE:
TELEPHONE NUMBER:
NOTE: A complete copy of your most
this form.
III. TRANSFER TYPE (Choose
A. ACCOUNT TRANSFER
u FULL (Check one below)
u TRANSFER ALL ASSETS IN KIND
u LIQUIDATE ALL ASSETS LISTED
brokerage accounts)
u TRANSFER ALL ASSETS IN KIND
WHICH REQUIRE LIQUIDATION
u PARTIAL (Complete Section IV)
B. DRS/DRIP
u FULL (Check one below)
u SELL FRACTIONS AND CLOSE ACCOUNT
u TRANSFER ALL FULL SHARES ONLY
u PARTIAL (List assets in Section IV)
NOTE: For transfer agents, electronically send positions or issue a
certificate for whole shares and redeem fractional shares.
C. DIRECT MUTUAL FUND
u TRANSFER MUTUAL FUNDS FROM THE ACCOUNT HELD DIRECTLY AT 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)
u LIQUIDATE IMMEDIATELY AND TRANSFER CASH I am aware of and acknowledge any
penalty I will incur from an early withdrawal.
u LIQUIDATE AT MATURITY AND TRANSFER CASH Specify maturity date: (submit two
to three weeks before maturity date).
NOTE: Liquidations involving bank CDs, checking accounts, or savings
accounts can only be processed from retirement accounts.
ZIP:
IV. PARTIAL TRANSFERS, DIRECT MUTUAL FUNDS AND LIQUIDATIONS
SIGNATURE
DATE
SIGNATURE
DATE
09-PWM-0597 (10/09) Page 2 of 3
recent statement is necessary to process
only one)
(Skip to Section VI)
IN SECTION IV (Liquidations are not for
EXCEPT FOR THE ASSETS LISTED IN SECTION IV,
EFTA01464663
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Account # N4G-024935
IV. PARTIAL TRANSFERS, DIRECT MUTUAL FUNDS AND LIQUIDATIONS
(If there are more than eight assets, attach a signed list to this form)
QUANTITY
ASSET DESCRIPTION
CUSIP®/SYMBOL
FUND ACCOUNT
NUMBER
TRANSFER INSTRUCTIONS1
DIVIDEND OPTION2
CAPITAL GAIN
OPTION2
u Transfer in Kind J Liquidate J Cash u Reinvest J Cash u Reinvest
u Transfer in Kind J Liquidate u Cash u Reinvest J Cash u Reinvest
u Transfer in Kind J Liquidate u Cash u Reinvest J Cash u Reinvest
u Transfer in Kind u Liquidate u Cash u Reinvest J Cash u Reinvest
u Transfer in Kind u Liquidate u Cash u Reinvest J Cash u Reinvest
u Transfer in Kind u Liquidate u Cash u Reinvest J Cash u Reinvest
u Transfer in Kind u Liquidate u Cash u Reinvest J Cash u Reinvest
u Transfer in Kind u Liquidate u Cash u Reinvest J Cash u Reinvest
If you have requested a 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
firm. Pershing is not responsible for market fluctuations or delays
in the review process. DRS items cannot be liquidated.
If 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
■ Age 701/2
restrictions: If you are at least the age of 701/2
ESTIMATED S
VALUE
this year and you are transferring or rolling over assets from an IRA,
qualified plan or 403(b)
account, you may be required to take a minimum distribution (RMD) from your
qualified plan or 403(b) account before rolling over your assets.
■ Rollover Certification of Employee: I understand the rules and conditions
and I have met the requirements for making a rollover. Due to the important
tax consequences of rolling over funds or property, I have been advised to
see a tax professional. All information provided by me is true and correct
and may be relied 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 funds or other property as a transfer or rollover
contribution.
TO THE PRIOR TRUSTEE:
u Pershing LLC accepts appointment as successor custodian.
u Please be advised that
EFTA01464664
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(Insert Firm Name)
SUCCESSOR CUSTODIAN'S SIGNATURE:
VI. PARTICIPANT SIGNATURE AND CERTIFICATION
To the Delivering Firm Named Above: If this account is a qualified
retirement account, I have amended the applicable plan so that it names as
successor custodian
the trustee listed above. Unless otherwise indicated in the instruction
above, please transfer all assets in my account to Pershing without
penalties, such assets
may be transferred within the time frames required by NYSE Rule 412 or
similar rule of the NASD or other designated examining authority. Unless
otherwise
indicated in the instructions above, I authorize you to liquidate any