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Deposit Sample Documents

ComplianceOne® Solution

ii Deposit Sample Documents

This publication was written for ComplianceOne®.

Publication Information / Version

Deposit Administration Training Workbook

Revision: April 24, 2011

Distributed Subject to Terms of a License or other Agreement

The contents of this publication, including its appendices, exhibits, and other attachments, as updated or revised, are highly confidential and proprietary to Wolters Kluwer Financial Services, Inc. or its subsidiaries or affiliates (“Wolters Kluwer Financial Services”). This publication is distributed pursuant to a Non-Disclosure Agreement, Evaluation Agreement, License Agreement and/or other similar agreement(s) with Wolters Kluwer Financial Services, Inc. or its subsidiary or affiliate. Unless otherwise specifically provided in such agreement(s), the reproduction of this publication is strictly prohibited. Use and distribution of this publication are also subject to the responsibilities and obligations of such agreement(s), which require confidential treatment of this publication and its contents.

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This publication is intended to provide accurate and authoritative information about the subject matter covered based upon information available at the time of publication. Examples given in this publication are for illustrative purposes only.

Development of this publication and the software (including forms, disclosures, reports, and other documents generated by the software) or other products that it describes was based on Wolters Kluwer Financial Services' understanding of various laws, regulations and commentaries. Wolters Kluwer Financial Services cannot and does not guarantee that its understanding is correct.

This publication is not intended, and should not be used, as a substitute for legal, accounting, or other professional advice. Wolters Kluwer Financial Services is not engaged in providing legal, accounting or other professional services. If legal or other professional assistance is required, you should seek the services of a competent professional. We encourage you to seek the advice of your own attorney concerning all legal issues involving the use of this publication and any products described in this publication. If your interpretations or your counsel’s interpretations are contrary to those expressed in this publication, you should of course, follow your/your counsel’s interpretations.

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Copyright Information

© 2011 Wolters Kluwer Financial Services, St. Cloud, Minnesota

This publication is the confidential information of Wolters Kluwer Financial Services. Distribution of this publication is subject to restrictions in the license or agreement under which this publication is provided to authorized Wolters Kluwer Financial Institution customers.

All rights reserved.

Deposit Sample Documents iii

Table of Contents

Signature Instruments/Identification/Account Terms ................................... 1

Multi Purpose Multi-Party Signature Card (MPMP-LAZ-MN) ..................................................... 3

Multipurpose Signature Card (MP-SC-C1) .......................................................................... 5

Party Identification Information Report-Individual (MP-CIP-C1 ................................................ 6

Multipurpose Addendum/Amendment Form (SIG-ADD-DEP) .................................................... 7

Terms & Conditions (TC-MN) ........................................................................................ 8

Disclosures and Notices ....................................................................... 11

Combined Disclosure................................................................................................. 12

Business Debit Card Agreement .................................................................................... 33

Overdraft Services Notice and Opt-In (ODOPTINNOT-S) ....................................................... 37

Overdraft Services Opt-in Confirmation (CON-CONSENT) ...................................................... 38

Certificates of Deposit ........................................................................ 39

Certificate of Deposit (CD-GEN-LAZ) .............................................................................. 41

Variable/Fixed Rate Time Certificate of Deposit (VRFCD-LAZ) ............................................... 42

7/31 Certificate of Deposit (7/31-CD-LAZ) ...................................................................... 43

Certificate of Deposit Receipt-Bank (CDREC-BK-LAZ) .......................................................... 46

Term Share Certificate (CD-DIV-LAZ .............................................................................. 47

Multipurpose Certificate/Signature Card (MP-CDSC-C1) ....................................................... 48

Multipurpose Receipt/Signature Card (MP-RCSC-C1) ........................................................... 52

IRA Documents .................................................................................. 55

IRA Age 70 ½ Election Form for Traditional and SIMPLE IRAs (IRA-6-LAZ) .................................. 57

IRA Contribution Instructions for Traditional, Roth, and SIMPLE IRAs (IRACMBCONLAZ).................. 59

IRA Distribution Form for Traditional, Roth, and SIMPLE IRAs (IRACMBDISLAZ) ............................ 62

IRA Election of Payment by Beneficiary for Traditional, Roth, and SIMPLE IRAs (IRACMBEPBLAZ) ...... 66

IRA Recharacterization Notice (IRA-RCHT-LAZ) ................................................................. 70

Request for Transfer or Conversion to IRA for Traditional, Roth, and SIMPLE IRAs (IRACMBTRCVLZ) .. 73

IRA Rollover or Conversion Review for Traditional, Roth, and SIMPLE IRAs (IRACMBROLLAZ) ........... 75

Traditional IRA Organizer-Custodial (IRA-49-LAZ) .............................................................. 78

iv Deposit Sample Documents

Roth IRA Organizer-Custodial (IRACUSROTHLZ) ................................................................. 93

Request for Direct Rollover to a Traditional IRA (IRA-DIRROLLZ) .......................................... 107

Resolutions and Authorizations ........................................................... 109

Entity Authorization (AUTH-ENTITY) ............................................................................ 111

Government Documents .................................................................... 113

Cert of Foreign Stat. of Ben. Owner for US Tax Withholding (W-8BEN) ................................... 115

Request for Taxpayer ID Number and Certification (W-9) ................................................... 116

Application for Individual Taxpayer ID Number-IRS Form (W-7) ............................................ 120

Suspicious Activity Report (SAR-LAZ) ........................................................................... 121

Direct Deposit Sign-Up Form (1200) ............................................................................. 124

Currency Transaction Report (CTR) ............................................................................. 126

Application and Support Documents ..................................................... 131

Card Application (CARD-APP)..................................................................................... 133

Business Purpose Account Service Application (CARD-APP-B) ............................................... 134

Automatic Transfer Authorization (ATA-PL) ................................................................... 135

Authorization for Preauthorized Payments (ACH-PW) ........................................................ 137

Funds Transfer Agreement and Authorization (FTAA-LAZ) .................................................. 138

ACH Origination Agreement (ACHORIGAGRLZ) ................................................................ 140

Power of Attorney (POA-MN) ..................................................................................... 145

Night Depository Agreement (NDA-COMB) ...................................................................... 147

Credit Report Authorization (FCRA-CRA) ....................................................................... 149

Notice of Action Taken (DN-FCRA-D) (all purpose) ........................................................... 150

Notice of Action Taken (DNFCRA-D-CRA) (Consumer Reporting Agency) .................................. 151

Fair Credit Reporting Act-Notice of Reporting Address (FCRA-NRA) ....................................... 152

Federal Sale of Insurance Disclosure (INS-WARN) ............................................................. 153

Notice of Delayed Availability (FFAD-NDA-CBC) (case-by-case delay) ..................................... 154

Notice of Delayed Availability (FFAD-NDA-SE) (safeguard exception hold) ............................... 155

Notice of Delayed Availability (FFAD-NDA-LD) (large deposit/redeposited items blanket notice) .... 156

Notice of Delayed Availability (FFAD-NDA-RO) (repeated overdrafts) ..................................... 157

Notice of Delayed Availability (FFAD-NRI-NDA) (notice of returned item) ................................ 158

Deposit Sample Documents v

Check Order Forms .......................................................................... 159

Deluxe Check Order Form-Personal Check Order Form (DELUXE-PER) .................................... 161

Deluxe Check Order Form-Business Products Order Form (DELUXE-BUS) ................................. 162

Harland Check/Deposit/Savings Order Form (HAR-31G-COMB) ............................................. 163

Clarke American Personal Check Order Form (CLRK-EB1-PER) ............................................. 164

Clarke American Commercial Check Order Form (CLRK-COMM) ............................................ 165

Liberty Check Order Form ........................................................................................ 166

Miscellaneous ................................................................................. 167

Rate Sheet ........................................................................................................... 169

Deposit Certificate (CD) Report.................................................................................. 170

Deposit Account Summary Report .............................................................................. 171

vi Deposit Sample Documents

Deposit Sample Documents vii

Alphabetical List 7/31 Certificate of Deposit (7/31-CD-LAZ) ...................................................................... 43

ACH Origination Agreement (ACHORIGAGRLZ) ................................................................ 140

Application for Individual Taxpayer ID Number-IRS Form (W-7) ............................................ 120

Authorization for Preauthorized Payments (ACH-PW) ........................................................ 137

Automatic Transfer Authorization (ATA-PL) ................................................................... 135

Business Debit Card Agreement .................................................................................... 33

Business Purpose Account Service Application (CARD-APP-B) ............................................... 134

Card Application (CARD-APP)..................................................................................... 133

Cert of Foreign Stat. of Ben. Owner for US Tax Withholding (W-8BEN) ................................... 115

Certificate of Deposit (CD-GEN-LAZ) .............................................................................. 41

Certificate of Deposit Receipt-Bank (CDREC-BK-LAZ) .......................................................... 46

Clarke American Commercial Check Order Form (CLRK-COMM) ............................................ 165

Clarke American Personal Check Order Form (CLRK-EB1-PER) ............................................. 164

Combined Disclosure................................................................................................. 12

Credit Report Authorization (FCRA-CRA) ....................................................................... 149

Currency Transaction Report (CTR) ............................................................................. 126

Deluxe Check Order Form-Business Products Order Form (DELUXE-BUS) ................................. 162

Deluxe Check Order Form-Personal Check Order Form (DELUXE-PER) .................................... 161

Deposit Account Summary Report ............................................................................... 171

Deposit Certificate (CD) Report.................................................................................. 170

Direct Deposit Sign-Up Form (1200) ............................................................................. 124

Entity Authorization (AUTH-ENTITY) ............................................................................ 111

Fair Credit Reporting Act-Notice of Reporting Address (FCRA-NRA) ....................................... 152

Federal Sale of Insurance Disclosure (INS-WARN) ............................................................. 153

Funds Transfer Agreement and Authorization (FTAA-LAZ) .................................................. 138

Harland Check/Deposit/Savings Order Form (HAR-31G-COMB) ............................................. 163

IRA Age 70 ½ Election Form for Traditional and SIMPLE IRAs (IRA-6-LAZ) .................................. 57

IRA Contribution Instructions for Traditional, Roth, and SIMPLE IRAs (IRACMBCONLAZ).................. 59

IRA Distribution Form for Traditional, Roth, and SIMPLE IRAs (IRACMBDISLAZ) ............................ 62

IRA Election of Payment by Beneficiary for Traditional, Roth, and SIMPLE IRAs (IRACMBEPBLAZ) ...... 66

viii Deposit Sample Documents

IRA Recharacterization Notice (IRA-RCHT-LAZ) ................................................................. 70

IRA Rollover or Conversion Review for Traditional, Roth, and SIMPLE IRAs (IRACMBROLLAZ) ........... 75

Liberty Check Order Form ........................................................................................ 166

Multi Purpose Multi-Party Signature Card (MPMP-LAZ-MN) ..................................................... 3

Multipurpose Addendum/Amendment Form (SIG-ADD-DEP) .................................................... 7

Multipurpose Certificate/Signature Card (MP-CDSC-C1) ....................................................... 48

Multipurpose Receipt/Signature Card (MP-RCSC-C1) ........................................................... 52

Multipurpose Signature Card (MP-SC-C1) .......................................................................... 5

Night Depository Agreement (NDA-COMB) ...................................................................... 147

Notice of Action Taken (DN-FCRA-D) (all purpose) ........................................................... 150

Notice of Action Taken (DNFCRA-D-CRA) (Consumer Reporting Agency) .................................. 151

Notice of Delayed Availability (FFAD-NDA-CBC) (case-by-case delay) ..................................... 154

Notice of Delayed Availability (FFAD-NDA-LD) (large deposit/redeposited items blanket notice) .... 156

Notice of Delayed Availability (FFAD-NDA-RO) (repeated overdrafts) ..................................... 157

Notice of Delayed Availability (FFAD-NDA-SE) (safeguard exception hold) ............................... 155

Notice of Delayed Availability (FFAD-NRI-NDA) (notice of returned item) ................................ 158

Overdraft Services Notice and Opt-In (ODOPTINNOT-S) ....................................................... 37

Overdraft Services Opt-in Confirmation (CON-CONSENT) ...................................................... 38

Party Identification Information Report-Individual (MP-CIP-C1 ................................................ 6

Power of Attorney (POA-MN) ..................................................................................... 145

Rate Sheet ........................................................................................................... 169

Request for Direct Rollover to a Traditional IRA (IRA-DIRROLLZ) .......................................... 107

Request for Taxpayer ID Number and Certification (W-9) ................................................... 116

Request for Transfer or Conversion to IRA for Traditional, Roth, and SIMPLE IRAs (IRACMBTRCVLZ) .. 73

Roth IRA Organizer-Custodial (IRACUSROTHLZ) ................................................................. 93

Suspicious Activity Report (SAR-LAZ) ........................................................................... 121

Term Share Certificate (CD-DIV-LAZ .............................................................................. 47

Terms & Conditions (TC-MN) ........................................................................................ 8

Traditional IRA Organizer-Custodial (IRA-49-LAZ) .............................................................. 78

Variable/Fixed Rate Time Certificate of Deposit (VRFCD-LAZ) ............................................... 42

Signature Instruments Identification Account/Terms

This section includes the following sample documents:

Multi Purpose Multi-Party Signature Card (MPMP-LAZ-MN)

Multipurpose Signature Card (MP-SC-C1)

Party Identification Information Report-Individual

Multipurpose Addendum/Amendment Form (SIG-ADD-DEP)

Terms & Conditions (TC-MN)

1

2

Sample

Institution Name & Address

]

l Authorized Signer (See Owner/Signer Information for AuthorizedSigner designation(s).)

[

Account Agreement Date:

The undersigned authorize the financial institution to investigate creditand employment history and obtain reports from consumer reportingagency(ies) on them as individuals. Except as otherwise provided by lawor other documents, each of the undersigned is authorized to makewithdrawals from the account(s), provided the required number ofsignatures indicated above is satisfied. The undersigned personally andas, or on behalf of, the account owner(s) agree to the terms of, andacknowledge receipt of copy(ies) of, this document and the following:

l Terms and Conditions l Privacyl Electronic Fund Transfers l Truth in Savingsl Substitute Checks l Funds Availabilityl Common Features l

Signature(s)

]

Name

Employer

Enter Non-Individual Owner Information on page 2. There is additionalOwner/Signer Information space on page 2.

X

Name

Employer

Mailing Address(if different)

Address

Relationship

Birth Date


PreviousFinancial Inst.

Address

Relationship

Other ID(Description, Details)

SSN/TIN

(Check appropriate beneficiary designation above.)

X

Account Title & Address

Home Phone

Birth Date



Work Phone

SSN/TIN

Home Phone

Work Phone

Mobile Phone

E-Mail

Mobile Phone

Owner/Signer Information 2

4


Internal Use

Beneficiary Designation

l If checked, this is a temporary account agreement.Number of signatures required for withdrawal: .

Beneficiary Name(s), Address(es), and SSN(s)

(Check appropriate ownership above.)

E-Mail

X

[X

[

IMPORTANT ACCOUNT OPENING INFORMATION: Federal law requiresus to obtain sufficient information to verify your identity. You may beasked several questions and to provide one or more forms ofidentification to fulfill this requirement. In some instances we may useoutside sources to confirm the information. The information you provideis protected by our privacy policy and federal law.

(not as tenants in common)

(as tenants in common)

Ownership of AccountThe specified ownership will remain the same for all accounts.l Individual l Corporation - For Profitl Joint with Survivorship l Corporation - Nonprofit

l Partnershipl Joint with No Survivorship l Sole Proprietorship

l Limited Liability Companyl Trust-Separate Agreement Dated:l

l Revocable Trust l Pay-On-Death (POD)l

Gov't Issued Photo ID(Type, Number, State,Issue Date, Exp. Date)


[ ]]

1

2

3

-

Signature Card-MNBankers SystemsWolters Kluwer Financial Services 2003, 2006

*MPMP-LAZ-MN 5/2/2007

Page 1 of 2Initials:

3

Sample


Type of Entity

State/Country & Dateof Organization

Mobile Phone

E-Mail

Non-Individual Owner Information

EIN

Name

Nature ofBusiness

Authorization/Resolution Date

Other Terms/Information

Account Description Account #$

l Cash l Check

l

$

l Cash l Check

l

$

l Cash l Check

l

Initial Deposit/Source

l ATM l Debit/Check Cards (No. Requested: )l ll l


Services Requested

(If not a "U.S. Person," certify foreign status separately.)

l Taxpayer I.D. Number (TIN) - The number shown above is mycorrect taxpayer identification number.l Backup Withholding - I am not subject to backup withholdingeither because I have not been notified that I am subject to backupwithholding as a result of a failure to report all interest or dividends,or the Internal Revenue Service has notified me that I am no longersubject to backup withholding.l Exempt Recipients - I am an exempt recipient under the InternalRevenue Service Regulations.I certify under penalties of perjury the statements checked inthis section and that I am a U.S. person (including a U.S.resident alien).

X (Date)

TIN:

Name

Employer


Address

Relationship

Name

Employer


Address

Relationship

Backup Withholding Certifications


Phone


Birth Date



SSN/TIN

Home Phone

Work Phone

Mobile Phone

E-Mail

Birth Date



SSN/TIN

Home Phone

Work Phone

Mobile Phone

E-Mail



Address

-

Signature Card-MNBankers SystemsWolters Kluwer Financial Services 2003, 2006

*MPMP-LAZ-MN 5/2/2007

Page 2 of 2Initials:

4

Sample

Financial InstitutionAccount Agreement Date:


Account Number, Type, Initial Amount, SourceOwnership of Account(s)

Required number of signatures for withdrawal:

Account Title & Address

Beneficiary InformationAdditional Services Requested

MP-SC-C1 12/25/2010

Page 1 of 1

Signature(s)

Other Terms

By:

Signer Designation (Non-Owner)

l The number shown above is my correct TIN.l I am not subject to backup withholding either because Ihave not been notified that I am subject to backupwithholding as a result of failure to report all interest ordividends, or the Internal Revenue Service has notified methat I am no longer subject to backup withholding.l EXEMPT: I am an exempt recipient under the InternalRevenue Service Regulations.

The undersigned certify the accuracy of the information provided. The undersigned also authorize financial institution toinvestigate credit and employment history and to obtain reports from consumer reporting agencies on them as individuals.Except as otherwise provided by law or other documents, each of the undersigned is authorized to make withdrawals,provided the required number of signatures is satisfied. The undersigned personally, and as or on behalf of the accountowner(s), agree to the terms, and acknowledge receiving copies, of this document and the following:

Taxpayer Identification Number (TIN):

I certify under penalties of perjury the statementschecked above and that I am a U.S. person (includesU.S. resident aliens).

Date

Date

l New Agreement l Replaces Previous Agreement(s)

(Date)

Date

Date


Multipurpose Signature CardBankers Systems*

-Wolters Kluwer Financial Services 2010

03/15/2011

Oklahoma Bank 123 This Street This City, OK 12345 222-555-1212

JOE OFFICER / sskroch

X

Joint Account - With Survivorship (And Not As Tenants InCommon) (The terms of various ownership options are described in theaccount Terms and Conditions.)

This section is Not Applicable.

Bob Smith Sara Smith 217 Dogwood Lane Metropolis, OK 80202

Checking(MP-SC-C1); Consumer Checking Account (MP-SC-C1Format); $850.00; Cash - New Money

Debit card(s) requested.

XX

Bob Smith Account Owner

Sara Smith Account Owner

000-00-0023

1

Account Disclosure (Truth In Savings), Privacy, Common Features (fees, etc), Terms & Conditions (including ElectronicDisclosures and Notices), Electronic Fund Transfers, Funds Availability, Substitute Checks

5

Sample

Identification InformationDate:

MP-CIP-C1 12/25/2010

Page 1 of 1

Additional Information (Verification, Discrepancy Resolution, Etc.)

Account Context

Multipurpose Party Identification InformationBankers Systems*Wolters Kluwer Financial Services 2010-

03/15/2011 Customer No. 123-1

Bob Smith

U.S. PERSON SSN/ITIN: 000-00-0023 DOB: 01/01/1980 RESIDENCE/LOCATION ADDRESS: 217 Dogwood Lane,Metropolis, OK 80202 MAILING ADDRESS: 217 Dogwood Lane, Metropolis, OK80202 HOME PHONE: 555-555-1111 MOBILE PHONE: 555-555-2222 EMAIL: [email protected] OK DL# 123456789789; Issued 01/01/2010; Oklahoma; Expires01/01/2014 SPOUSE: Sara Smith MOTHER'S MAIDEN NAME: Johnson PREV.FINANCIAL INST.: Last National Bank, 656 BenjaminBlvd., Metropolis, OK 55555

EMPLOYER-Current: ABC Company, 123 Letter Lane,Metropolis, OK 80202 CONTACT: Bob; 555-555-6666 DETAIL: Manager (Current Position/Title) - employed since09/28/2005 - employed 60 months - $5,000.00 income/mo. YRS IN PROFESSION: 5

RELATIONSHIP TO ACCOUNT: Owner ACCT NO. Checking(MPMP) ACCT TYPE: Consumer Checking Account (MPMP Format) NAMES ASSOC. W/ ACCT.: Sara Smith SOURCE OF FUNDS: $650.00 by Cash - New Money

OFFICER/OPEN BY: Joe Officer/SSKROCH OFFICE: 1

RELATIONSHIP: Existing

6

Sample

ADDENDUM Date:Account Title & Address

ADDENDUM - This Addendum is incorporated into and made a part of the document described as follows (the"Agreement"): (for example, "Account Agreement")dated: , relating to account number(s): .

l Amendment Signatures - This Addendum amends the Agreement. The undersigned agree to the additional terms orinformation above. This Addendum overrides any conflicting terms of the Agreement.

Date

Date

Date

Date

Date

Page 1 of 1

SIG-ADD-DEP 12/25/2010

l Signature Addendum - The following signatures are added to and supplement the signatures provided on the Agreement.The undersigned agree to the terms of the Agreement, and all terms and disclosures acknowledged on the Agreement.

Financial Institution

l Beneficiary Information and/or l Additional Terms

Date

Signature/Terms AddendumBankers Systems*Wolters Kluwer Financial Services 2007, 2010-

7

Sample

TERMS AND CONDITIONS OF YOUR ACCOUNT

summarize some laws that apply to common transactions;establish rules to cover transactions or events which the lawdoes not regulate;establish rules for certain transactions or events which the lawregulates but permits variation by agreement; andgive you disclosures of some of our policies to which you may beentitled or in which you may be interested.

AGREEMENT - This document, along with any other documents wegive you pertaining to your account(s), is a contract that establishesrules which control your account(s) with us. Please read thiscarefully. If you sign the signature card or open or continue to usethe account, you agree to these rules. You will receive a separateschedule of rates, qualifying balances, and fees if they are notincluded in this document. If you have any questions, please call us.

This agreement is subject to applicable federal laws and the lawsof the state of New Mexico (except to the extent that this agreementcan and does vary such rules or laws). The body of state and federallaw that governs our relationship with you, however, is too large andcomplex to be reproduced here. The purpose of this document is to:(1)(2)

(3)

(4)

If any provision of this document is found to be unenforceableaccording to its terms, all remaining provisions will continue in fullforce and effect. We may permit some variations from our standardagreement, but we must agree to any variation in writing either onthe signature card for your account or in some other document.

As used in this document the words "we," "our," and "us" meanthe financial institution and the words "you" and "your" mean theaccount holder(s) and anyone else with the authority to deposit,withdraw, or exercise control over the funds in the account. Theheadings in this document are for convenience or reference only andwill not govern the interpretation of the provisions. Unless it wouldbe inconsistent to do so, words and phrases used in this documentshould be construed so the singular includes the plural and the pluralincludes the singular. "Party" means a person who, by the terms ofan account, has a present right, subject to request, to payment fromthe account other than as a beneficiary or agent.LIABILITY - You agree, for yourself (and the person or entity yourepresent if you sign as a representative of another) to the terms ofthis account and the schedule of charges. You authorize us todeduct these charges directly from the account balance as accrued.You will pay any additional reasonable charges for services yourequest which are not covered by this agreement.

Each of you also agrees to be jointly and severally (individually)liable for any account shortage resulting from charges or overdrafts,whether caused by you or another with access to this account. Thisliability is due immediately, and can be deducted directly from theaccount balance whenever sufficient funds are available. You haveno right to defer payment of this liability, and you are liableregardless of whether you signed the item or benefited from thecharge or overdraft. You will also be liable for our costs to collectthe deficit as well as for our reasonable attorneys' fees, to theextent permitted by law, whether incurred as a result of collection orin any other dispute involving your account including, but not limitedto, disputes between you and another joint owner; you and anauthorized signer or similar party; or a third party claiming an interestin your account.DEPOSITS - We will give only provisional credit until collection isfinal for any items, other than cash, we accept for deposit (includingitems drawn "on us"). Actual credit for deposits of, or payable in,foreign currency will be at the exchange rate in effect on finalcollection in U.S. dollars. We are not responsible for transactions bymail or outside depository until we actually record them. We willtreat and record all transactions received after our "daily cutoff time"on a business day we are open, or received on a day we are notopen for business, as if initiated on the next business day that weare open. Time or savings account deposits will be repaid todepositors under regulations adopted by our board of directors fromtime to time. These regulations will be available for inspection by youupon your request.

-

Terms and Conditions-NMBankers SystemsWolters Kluwer Financial Services 1983, 2009

TC-NM 1/15/2009

Page 1 of 3*

OWNERSHIP OF ACCOUNT AND BENEFICIARY DESIGNATION -These rules apply to this account depending on the form ofownership and beneficiary designation, if any, specified on theaccount records. We make no representations as to theappropriateness or effect of the ownership and beneficiarydesignations, except as they determine to whom we pay the accountfunds. Single-Party Account - Such an account is owned by one party.Multiple-Party Account - Parties own account in proportion to netcontributions unless there is clear and convincing evidence of adifferent intent.RIGHTS AT DEATH - Single-Party Account - At the death of a party,ownership passes as part of the party's estate. Multiple-Party Account With Right of Survivorship - At death ofparty, ownership passes to surviving parties. If two or more partiessurvive and one is the surviving spouse of the deceased party, theamount to which the deceased party, immediately before death, wasbeneficially entitled by law belongs to the surviving spouse. If two ormore parties survive and none is the spouse of the decedent, theamount to which the deceased party, immediately before death, wasbeneficially entitled by law belongs to the surviving parties in equalshares, and augments the proportion to which each surviving party,immediately before the deceased party's death, was beneficiallyentitled under law, and the right of survivorship continues betweenthe surviving parties.

WITHDRAWALS - Unless clearly indicated otherwise on the accountrecords, any of you, acting alone, who signs to open the account orhas authority to make withdrawals may withdraw or transfer all orany part of the account balance at any time. Each of you (until wereceive written notice to the contrary) authorizes each other personwho signs or has authority to make withdrawals to indorse any itempayable to you or your order for deposit to this account or any othertransaction with us. You agree that, as to any item that we have noopportunity to examine the signatures, such as an electronic checkconversion transaction where a check or similar item is convertedinto an electronic fund transfer as defined in the Electronic FundTransfers regulation, you waive any requirement of multiplesignatures for withdrawal. We may charge your account for a checkeven though payment was made before the date of the check,unless we have received written notice of the postdating in time tohave a reasonable opportunity to act. We may refuse any withdrawalor transfer request which you attempt on forms not approved by us,by any method we do not specifically permit, which is greater innumber than the frequency permitted, or which is for an amountgreater or less than any withdrawal limitations. Even if we honor anonconforming request, we may treat continued abuse of the statedlimitations (if any) as your act of closing the account. We will usethe date the transaction is completed by us (as opposed to the dateyou initiate it) to apply the frequency limitations. The fact that wemay honor withdrawal requests that overdraw the available accountbalance does not obligate us to do so later. You agree that we maycharge fees for overdrafts and use subsequent deposits, includingdirect deposits of social security or other government benefits, tocover such overdrafts and overdraft fees. If we are presented withan item drawn against your account that would be a "substitutecheck," as defined by law, but for an error or defect in the itemintroduced in the substitute check creation process, you agree thatwe may pay such item. See the funds availability policy disclosurefor information about when you can withdraw funds you deposit. Forthose accounts for which our funds availability policy disclosure doesnot apply, you can ask us when you make a deposit when thosefunds will be available for withdrawal.

We may require not less than 7 days' notice in writing beforeeach withdrawal from an interest-bearing account other than a timedeposit, or from any other savings account as defined by RegulationD. Withdrawals from a time account prior to maturity or prior to anynotice period may be restricted and may be subject to penalty. Seeyour notice of penalty for early withdrawal.

8

Sample

You further agree that if you fail to report any unauthorizedsignatures, alterations or forgeries in your account within 60 days ofwhen we first send or make the statement available, you cannotassert a claim against us on any items in that statement, and asbetween you and us the loss will be entirely yours. This 60-daylimitation is without regard to whether we used ordinary care. Thelimitation in this paragraph is in addition to that contained in the firstparagraph of this section.Your Duty to Report Other Errors - In addition to your duty to reviewyour statements for unauthorized signatures, alterations andforgeries, you agree to examine your statement with reasonablepromptness for any other error - such as an encoding error. Youagree that the time you have to examine your statement and reportto us will depend on the circumstances. However, such time periodshall not exceed 60 days. Failure to examine your statement andreport any such errors to us within 60 days of when we first send ormake the statement available precludes you from asserting a claimagainst us for any such errors on items identified in that statementand as between you and us the loss will be entirely yours. Errors Relating to Electronic Fund Transfers or Substitute Checks(For consumer accounts only) - For information on errors relating toelectronic fund transfers (e.g., computer, debit card or ATMtransactions) refer to your Electronic Fund Transfers disclosure andthe sections on consumer liability and error resolution. Forinformation on errors relating to a substitute check you received,refer to your disclosure entitled Substitute Checks and Your Rights.

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Multiple-Party Account Without Right of Survivorship - At death ofparty, deceased party's ownership passes as part of deceasedparty's estate. Single-Party Account With Pay-on-Death Designation - At death ofthe party, ownership passes to the designated pay-on-deathbeneficiaries and is not part of the party's estate. Multiple-Party Account With Right of Survivorship and Pay-on-DeathDesignation - At death of last surviving party, ownership passes tothe designated pay-on-death beneficiaries and is not part of the lastsurviving party's estate. BUSINESS, ORGANIZATION AND ASSOCIATION ACCOUNTS -Earnings in the form of interest, dividends, or credits will be paidonly on collected funds, unless otherwise provided by law or ourpolicy. We may require the governing body of the entity opening theaccount to give us a separate authorization telling us who isauthorized to act on its behalf. We will honor the authorization untilwe actually receive written notice of a change from the governingbody of the entity.STOP PAYMENTS - You must make any stop-payment order in themanner required by law and we must receive it in time to give us areasonable opportunity to act on it before our stop-payment cutofftime. To be effective, your stop-payment order must preciselyidentify the number, date and amount of the item, and the payee.

You may stop payment on any item drawn on your accountwhether you sign the item or not, if you have an equal or greaterright to withdraw from this account than the person who signed theitem. A release of the stop-payment request may be made only bythe person who initiated the stop-payment order.

Our stop-payment cutoff time is one hour after the opening of thenext banking day after the banking day on which we receive theitem. Additional limitations on our obligation to stop payment areprovided by law (e.g., we paid the item in cash or we certified theitem).TELEPHONE TRANSFERS - A telephone transfer of funds from thisaccount to another account with us, if otherwise arranged for orpermitted, may be made by the same persons and under the sameconditions generally applicable to withdrawals made in writing.Unless a different limitation is disclosed in writing, we restrict thenumber of transfers from a savings account to another account or tothird parties, to a maximum of six per month (less the number of"preauthorized transfers" during the month). Other account transferrestrictions may be described elsewhere.AMENDMENTS AND TERMINATION - We may change any term ofthis agreement. Rules governing changes in interest rates areprovided separately. For other changes, we will give you reasonablenotice in writing or by any other method permitted by law. We mayalso close this account at any time upon reasonable notice to youand tender of the account balance personally or by mail. Notice fromus to any one of you is notice to all of you.

ACCOUNT TRANSFER - This account may not be transferred orassigned without our prior written consent. DIRECT DEPOSITS - If, in connection with a direct deposit plan, wedeposit any amount in an account which should have been returnedto the Federal Government for any reason, you authorize us todeduct the amount of our liability to the Federal Government fromthe account or from any other account you have with us, withoutprior notice and at any time, except as prohibited by law. We mayalso use any other legal remedy to recover the amount of ourliability.TEMPORARY ACCOUNT AGREEMENT - If this option is selected,this is a temporary account agreement. Each person who signs toopen the account or has authority to make withdrawals (except asindicated to the contrary) may transact business on this account.However, we may at some time in the future restrict or prohibitfurther use of this account if you fail to comply with therequirements we have imposed within a reasonable time.SETOFF - We may (without prior notice and when permitted by law)set off the funds in this account against any due and payable debtyou owe us now or in the future, by any of you having the right ofwithdrawal, to the extent of such persons' or legal entity's right towithdraw. If the debt arises from a note, "any due and payable debt"includes the total amount of which we are entitled to demandpayment under the terms of the note at the time we set off,including any balance the due date for which we properly accelerateunder the note.

This right of setoff does not apply to this account if prohibited bylaw. For example, the right of setoff does not apply to this accountif: (a) it is an Individual Retirement Account or similar tax-deferredaccount, or (b) the debt is created by a consumer credit transactionunder a credit card plan (but this does not affect our rights under anyconsensual security interest), or (c) the debtor's right of withdrawalonly arises in a representative capacity. We will not be liable for thedishonor of any check when the dishonor occurs because we set offa debt against this account. You agree to hold us harmless from anyclaim arising as a result of our exercise of our right of setoff.

STATEMENTS - Your Duty to Report Unauthorized Signatures,Alterations and Forgeries - You must examine your statement ofaccount with "reasonable promptness." If you discover (orreasonably should have discovered) any unauthorized signatures oralterations, you must promptly notify us of the relevant facts. Asbetween you and us, if you fail to do either of these duties, you willhave to either share the loss with us, or bear the loss entirelyyourself (depending on whether we used ordinary care and, if not,whether we substantially contributed to the loss). The loss could benot only with respect to items on the statement but other items withunauthorized signatures or alterations by the same wrongdoer.

You agree that the time you have to examine your statement andreport to us will depend on the circumstances, but will not, in anycircumstance, exceed a total of 30 days from when the statement isfirst sent or made available to you.

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however, a remotely created check is not issued by the paying bankand does not contain the signature of the account owner (or asignature purported to be the signature of the account owner). Inplace of a signature, the check usually has a statement that theowner authorized the check or has the owner's name typed orprinted on the signature line. For example, if a person provides anaccount number in response to a telephone solicitation, thetelephone solicitor can use the account number to issue a remotelycreated check to withdraw money from that account.

You warrant and agree to the following for every remotelycreated check we receive from you for deposit or collection: (1) youhave received express and verifiable authorization to create thecheck in the amount and to the payee that appears on the check;(2) you will maintain proof of the authorization for at least 2 yearsfrom the date of the authorization, and supply us the proof if we ask;and (3) if a check is returned you owe us the amount of the check,regardless of when the check is returned. We may take funds fromyour account to pay the amount you owe us, and if there areinsufficient funds in your account, you still owe us the remainingbalance.UNLAWFUL INTERNET GAMBLING NOTICE - Restricted transactionsas defined in Federal Reserve Regulation GG are prohibited frombeing processed through this account or relationship. Restrictedtransactions generally include, but are not limited to, those in whichcredit, electronic fund transfers, checks, or drafts are knowinglyaccepted by gambling businesses in connection with theparticipation by others in unlawful Internet gambling.

AGENCY (Power of Attorney) DESIGNATION (Single-Party Accountsonly) - A single individual is the owner. The agent is merelydesignated to conduct transactions on the owner's behalf. Weundertake no obligation to monitor transactions to determine thatthey are on the owner's behalf.RESTRICTIVE LEGENDS - We are not required to honor anyrestrictive legend on checks you write unless we have agreed inwriting to the restriction. Examples of restrictive legends are "mustbe presented within 90 days" or "not valid for more than$1,000.00."CHECK PROCESSING - We may process items mechanically byrelying on the information encoded along the bottom of the items.This means that we may not individually examine all of your items todetermine if the item is properly completed, signed and indorsed.You agree that we have not failed to exercise ordinary care solelybecause we use an automated system to process items and do notinspect all items processed in such a manner. We reserve the rightnot to inspect each item because using an automated process helpsus keep costs down for you and all account holders. We maydetermine the amount of available funds in your account for thepurpose of deciding whether to return an item for insufficient fundsat any time between the time we receive the item and when wereturn the item or send a notice in lieu of return. We need only makeone determination, but if we choose to make a subsequentdetermination, the account balance at the subsequent time willdetermine whether there are insufficient available funds.CHECK CASHING - We may charge a fee for anyone that does nothave an account with us who is cashing a check, draft or otherinstrument written on your account. We may also require reasonableidentification to cash such a check, draft or other instrument. Wecan decide what identification is reasonable under the circumstancesand such identification may be documentary or physical and mayinclude collecting a thumbprint or fingerprint. TRUNCATION, SUBSTITUTE CHECKS, AND OTHER CHECK IMAGES -If you truncate an original check and create a substitute check, orother paper or electronic image of the original check, you warrantthat no one will be asked to make payment on the original check, asubstitute check or any other electronic or paper image, if thepayment obligation relating to the original check has already beenpaid. You also warrant that any substitute check you createconforms to the legal requirements and generally acceptedspecifications for substitute checks. You agree to retain the originalcheck in conformance with our internal policy for retaining originalchecks. You agree to indemnify us for any loss we may incur as aresult of any truncated check transaction you initiate. We can refuseto accept substitute checks that have not previously been warrantedby a bank or other financial institution in conformance with theCheck 21 Act. Unless specifically stated in a separate agreementbetween you and us, we do not have to accept any other electronicor paper image of an original check.REMOTELY CREATED CHECKS - Like any standard check or draft, aremotely created check (sometimes called a telecheck, preauthorizeddraft or demand draft) is a check or draft that can be used towithdraw money from an account. Unlike a typical check or draft,

ACH AND WIRE TRANSFERS - This agreement is subject to Article4A of the Uniform Commercial Code - Fund Transfers as adopted inthe state in which you have your account with us. If you originate afund transfer for which Fedwire is used, and you identify by nameand number a beneficiary financial institution, an intermediaryfinancial institution or a beneficiary, we and every receiving orbeneficiary financial institution may rely on the identifying number tomake payment. We may rely on the number even if it identifies afinancial institution, person or account other than the one named.You agree to be bound by automated clearing house associationrules. These rules provide, among other things, that payments madeto you, or originated by you, are provisional until final settlement ismade through a Federal Reserve Bank or payment is otherwise madeas provided in Article 4A-403(a) of the Uniform Commercial Code. Ifwe do not receive such payment, we are entitled to a refund fromyou in the amount credited to your account and the party originatingsuch payment will not be considered to have paid the amount socredited. If we receive a payment order to credit an account youhave with us by wire or ACH, we are not required to give you anynotice of the payment order or credit.FACSIMILE SIGNATURES - You authorize us, at any time, to chargeyou for all checks, drafts, or other orders, for the payment of money,that are drawn on us regardless of by whom or by what means thefacsimile signature(s) may have been affixed so long as theyresemble the facsimile signature specimen filed with us, and containthe required number of signatures for this purpose.

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Disclosures and Notices


Combined Disclosure

Business Debit Card Agreement

Overdraft Services Notice and Opt-In (ODOPTINNOT-S)

Overdraft Services Opt-in Confirmation (CON-CONSENT)

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COMBINATION DISCLOSURE

XX/1 21.021.04225 Wolters Kluwer Financial Services -2000, 2011 Bankers Systems* Page 1

IMPORTANT ACCOUNT INFORMATION FOR OUR CUSTOMERS

from

Demo Organization123 This Street

This City, MN 12345(222)555-1212

12 MONTH CERTIFICATE OF DEPOSIT

Rate information - The interest rate on this account is 1.250% with an annual percentage yield of 1.26%.

You will be paid this rate until next maturity.

Additional Rate Information - Additional rate information can be entered here.

Compounding frequency - Interest will be compounded monthly.

Crediting frequency - Our general policy is to credit interest out of this account monthly, but you have chosen to credit interestinto this account monthly.

Effect of closing an account - If you close your account before interest is credited, you will not receive the accrued interest.

Time requirements - Your account will mature on April 12, 2012.

Callable account - We may call (terminate) this account, at our option with a 30 day notice.

Early withdrawal penalties (a penalty may be imposed for withdrawals before maturity) - The penalty will equal three monthsinterest on the amount withdrawn subject to penalty. In certain circumstances, such as the death or incompetence of anaccount owner, the law permits, or in some cases requires, the waiver of the early withdrawal penalty. Other exceptions mayalso apply, for example, if this is part of an IRA or other tax-deferred savings plan.

Automatically renewable account - Your account will automatically renew at maturity. Each renewal term will be the same asthe original term, beginning on the maturity date. Unless we tell you otherwise in writing, the interest rate will be the same weoffer on new certificate of deposit accounts on the maturity date which have the same term, minimum balance (if any) andother features as the renewed certificate of deposit account. You will have a grace period of ten calendar day(s) after maturityto withdraw the funds without being charged an early withdrawal penalty. You may prevent renewal if you withdraw thefunds in the account at maturity (or within the grace period, if any) or we receive written or telephone notice from you beforematurity of your intention not to renew.

Final maturity - At final maturity, if your account is not renewed, the funds will accrue earnings for 10 calendar days, afterwhich the funds will remain in the account without accruing any earnings.

Daily balance computation method - Interest is calculated by the daily balance method which applies a daily periodic rate to thebalance in the account each day.

Accrual of interest on noncash deposits - Interest will begin to accrue on the business day you deposit noncash items (forexample, checks) into your account.

Minimum balance to open - The minimum balance required to open this account is $500.00.

Minimum balance to obtain the disclosed annual percentage yield - You must maintain a minimum daily balance of $500.00 inyour account each day to obtain the disclosed annual percentage yield.

Deposit limitations - After the account is opened, you may not make any deposits.

Withdrawal limitations - You may not make withdrawals of principal from your account before maturity. You can onlywithdraw interest credited in the term before maturity of that term, subject to penalty. You can withdraw interest only on thecrediting dates.

NOTICE OF NEGATIVE INFORMATION

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Federal law requires us to provide the following notice to customers before any "negative information" may be furnished to anationwide consumer reporting agency. "Negative information" means information concerning delinquencies, late payments,insolvency, or any form of default.

This notice does not mean that we will be reporting such information about you, only that we may report such informationabout customers that have not done what they are required to do under our agreement.

After providing this notice, additional negative information may be submitted without providing another notice.

We may report information about your account to credit bureaus. Late payments, missed payments, or other defaults on youraccount may be reflected in your credit report.

YOUR ABILITY TO WITHDRAW FUNDS

This policy statement applies to 'transaction accounts.' Transaction accounts, in general, are accounts that permit an unlimitednumber of payments to third persons and an unlimited number of telephone and preauthorized transfers to your other accountswith us. Checking accounts are the most common transaction accounts. Feel free to ask us whether any of your otheraccounts might also be under this policy.

Our policy is to make funds from your cash and check deposits available to you on the first business day after the day wereceive your deposit. Electronic direct deposits will be available on the day we receive the deposit. Once the funds areavailable, you can withdraw them in cash and we will use the funds to pay checks that you have written.

Please remember that even after we have made funds available to you and you have withdrawn the funds, you are stillresponsible for checks you deposit that are returned to us unpaid and for any other problems involving your deposit.

For determining the availability of your deposits, every day is a business day, except Saturdays, Sundays, and federal holidays.If you make a deposit before 2:00 p.m. on a business day that we are open, we will consider that day to be the day of yourdeposit. However, if you make a deposit after 2:00 p.m. or on a day we are not open, we will consider that the deposit wasmade on the next business day we are open. If you make a deposit at an ATM before 2:00 p.m. on a business day that we areopen, we will consider that day to be the day of your deposit. However, if you make a deposit at an ATM after 2:00 p.m. oron a day we are not open, we will consider that the deposit was made on the next business day we are open.

If we cash a check for you that is drawn on another bank, we may withhold the availability of a corresponding amount offunds that are already in your accounts. Those funds will be available at the time funds from the check we cashed would havebeen available if you had deposited it.

If we accept for deposit a check that is drawn on another bank, we may make funds from the deposit available for withdrawalimmediately but delay your availability to withdraw a corresponding amount of funds that you have on deposit in anotheraccount with us. The funds in the other account would then not be available for withdrawal until the time periods that aredescribed elsewhere in this disclosure for the type of check that you deposited.

Longer Delays May Apply

Case-By-Case Delays - In some cases, we will not make all of the funds that you deposit by check available to you on the firstbusiness day after the day of your deposit. Depending on the type of check that you deposit, funds may not be available untilthe fifth business day after the day of your deposit. The first $200 of your deposits, however, will be available on the firstbusiness day.

If we are not going to make all of the funds from your deposit available on the first business day after we receive your deposit,we will notify you at the time you make your deposit. We will also tell you when the funds will be available. If your deposit isnot made directly to one of our employees, or if we decide to take this action after you have left the premises, we will mail youthe notice by the day after we receive your deposit.

If you will need the funds from a deposit right away, you should ask us when the funds will be available.

Safeguard Exceptions - In addition, funds you deposit by check may be delayed for a longer period under the followingcircumstances:

· We believe a check you deposit will not be paid.

· You deposit checks totaling more than $5,000 on any one day.

· You redeposit a check that has been returned unpaid.

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We will notify you if we delay your ability to withdraw funds for any of these reasons, and we will tell you when the funds willbe available. They will generally be available no later than the eleventh business day after the day of your deposit.

Deposits at Automated Teller Machines Funds from any deposits (cash or checks) made at automated teller machines (ATMs) we own or operate will be madeavailable immediately after deposit.

Funds from any deposits (cash or checks) made at automated teller machines (ATMs) we do not own or operate will not beavailable until the third business day after the day of your deposit. This rule does not apply at ATMs that we own or operate.

All ATMs that we own or operate are identified as our machines.

Special Rules for New Accounts If you are a new customer, the following special rules will apply during the first 30 days your account is open.

Funds from electronic direct deposits to your account will be available on the day we receive the deposit. Funds from depositsof cash, wire transfers, and the first $5,000 of a day's total deposits of cashier's, certified, teller's, traveler's, and federal,state and local government checks will be available on the first business day after the day of your deposit, if the deposit meetscertain conditions. For example, the checks must be payable to you (and you may have to use a special deposit slip). Theexcess over $5,000 will be available on the ninth business day after the day of your deposit. If your deposit of these checks(other than a U.S. Treasury check) is not made in person to one of our employees, the first $5,000 will not be available untilthe second business day after the day of your deposit.

Funds from all other check deposits will be available on the eleventh business day after the day of your deposit.

SUBSTITUTE CHECKS AND YOUR RIGHTS

As an account holder, you may see substitute checks from time to time, such as when you receive your account statementwith copies of your checks, when you view your account information online, or when you request a copy of your originalcheck for proof of payment. The following substitute check disclosure provides information about substitute checks and yourrights. So you will recognize a substitute check when you receive one, we have also included an illustration of the front side ofa substitute check along with an explanation of the substitute check's components.

What is a substitute check?

To make check processing faster, federal law permits banks to replace original checks with "substitute checks." These checksare similar in size to original checks with a slightly reduced image of the front and back of the original check. The front of asubstitute check states: "This is a legal copy of your check. You can use it the same way you would use the original check."You may use a substitute check as proof of payment just like the original check.

Some or all of the checks that you receive back from us may be substitute checks. This notice describes rights you have whenyou receive substitute checks from us. The rights in this notice do not apply to original checks or to electronic debits to youraccount. However, you have rights under other law with respect to those transactions.

What are my rights regarding substitute checks?

In certain cases, federal law provides a special procedure that allows you to request a refund for losses you suffer if asubstitute check is posted to your account (for example, if you think that we withdrew the wrong amount from your accountor that we withdrew money from your account more than once for the same check). The losses you may attempt to recoverunder this procedure may include the amount that was withdrawn from your account and fees that were charged as a result ofthe withdrawal (for example, bounced check fees).

· You have overdrawn your account repeatedly in the last six months.

· There is an emergency, such as failure of computer or communications equipment.

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The amount of your refund under this procedure is limited to the amount of your loss or the amount of the substitute check,whichever is less. You also are entitled to interest on the amount of your refund if your account is an interest-bearing account.If your loss exceeds the amount of the substitute check, you may be able to recover additional amounts under other law.

If you use this procedure, you may receive up to $2,500.00 of your refund (plus interest if your account earns interest) within10 business day(s) after we received your claim and the remainder of your refund (plus interest if your account earns interest)not later than 45 calendar day(s) after we received your claim.

We may reverse the refund (including any interest on the refund) if we later are able to demonstrate that the substitute checkwas correctly posted to your account.

How do I make a claim for a refund?

If you believe that you have suffered a loss relating to a substitute check that you received and that was posted to youraccount, please contact us at:

My Organization Name123 This StreetThis City, MN 33333

Phone: (800)000-0000

E-Mail: [email protected]

You must contact us within 40 calendar days of the date that we mailed (or otherwise delivered by a means to which youagreed) the substitute check in question or the account statement showing that the substitute check was posted to youraccount, whichever is later. We will extend this time period if you were not able to make a timely claim because ofextraordinary circumstances.

number, the amount of the check, the name of the person to whom you wrote the check and date of check.

Substitute check image:

Your claim must include--

· A description of why you have suffered a loss (for example, you think the amount withdrawn was incorrect);

· An estimate of the amount of your loss;

· An explanation of why the substitute check you received is insufficient to confirm that you suffered a loss; and

· A copy of the substitute check and/or the following information to help us identify the substitute check: the check

1. An image of the original check appears in the upper right-hand corner of the substitute check.

2. A substitute check is the same size as a standard business check.

3. The information in asterisks relates to the "reconverting bank" - the financial institution that created the substitutecheck.

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ELECTRONIC FUND TRANSFERS

YOUR RIGHTS AND RESPONSIBILITIES

Indicated below are types of Electronic Fund Transfers we are capable of handling, some of which may not apply to youraccount. Please read this disclosure carefully because it tells you your rights and obligations for the transactions listed. Youshould keep this notice for future reference.

Health Savings Accounts (HSA) - Health Savings Accounts (HSA). We permit you (as described below) to access your HSAwith a card. This service is offered for the convenience of managing your HSA. However, electronically accessing your HSA -for example, getting additional cash back on an HSA debit card transaction - can raise a variety of tax concerns. As a result,before electronically accessing your HSA make sure you are using the correct card. Also, it is your responsibility to ensure thecontributions, distributions, and other actions related to your HSA, comply with the law, including federal tax law. As always,we recommend consulting a legal or tax professional if you have any questions about managing your HSA. The terms of thisdisclosure are intended to work in conjunction with the HSA Agreement provided to you earlier. In the event of a conflict, theterms of the HSA Agreement control. You understand that your HSA is intended to be used for payment of qualified medicalexpenses. It is your responsibility to satisfy any tax liability resulting from use of your HSA for any purpose other than paymentor reimbursement of qualified medical expenses. We do not monitor the purpose of any transaction to or from your HSA. Norare we responsible for ensuring your eligibility for making contributions or ensuring withdrawals are used for payment orreimbursement of qualified medical expenses. Refer to your HSA Agreement for more information relating to the use of yourHSA.Electronic Fund Transfers Initiated By Third Parties - You may authorize a third party to initiate electronic fund transfersbetween your account and the third party's account. These transfers to make or receive payment may be one-timeoccurrences or may recur as directed by you. These transfers may use the Automated Clearing House (ACH) or otherpayments network. Your authorization to the third party to make these transfers can occur in a number of ways. Forexample, your authorization to convert a check to an electronic fund transfer or to electronically pay a returned check chargecan occur when a merchant provides you with notice and you go forward with the transaction (typically, at the point ofpurchase, a merchant will post a sign and print the notice on a receipt). In all cases, these third party transfers will require youto provide the third party with your account number and financial institution information. This information can be found onyour check as well as on a deposit or withdrawal slip. Thus, you should only provide your financial institution and accountinformation (whether over the phone, the Internet, or via some other method) to trusted third parties whom you haveauthorized to initiate these electronic fund transfers. Examples of these transfers include, but are not limited to:

Company) to be accepted into your checking or savings.

your checking account using information from your check to pay for purchases or pay bills.

collect a charge in the event a check is returned for insufficient funds.

TeleBanking transactions - types of transactions - You may access your account by telephone using your account number(s),personal identification number (PIN) and touch tone phone to:

4. The information in brackets (appears sideways facing check image) relates to the "truncating bank" - the financialinstitution that took the original check out of the check processing system.

5. The Legal Legend states: This is a legal copy of your check. You may use it the same way you would use the originalcheck.

6. The MICR lines at the bottom of the image of the original and at the bottom of the substitute check are the same exceptfor the "4" at the beginning of the substitute check number, which indicates that it is a substitute check being movedforward for collection purposes. It is also possible for a substitute check number to begin with a "5" if the item is beingreturned. The rest of the MICR line is the same as the original check to ensure that it is processed as though it were theoriginal.

· Preauthorized credits - You may make arrangements for certain direct deposits (for example, from: U.S. Treasury, ABC

· Preauthorized payments - You may make arrangements to pay certain recurring bills from your checking or savings.

· Electronic check conversion - You may authorize a merchant or other payee to make a one-time electronic payment from

· Electronic returned check charge - You may authorize a merchant or other payee to initiate an electronic funds transfer to

· transfer funds from checking or savings to checking or savings

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You may access your account for telephone transactions at the following number(s) and during the following hours:

ATM Card transactions - types of transactions - You may access your account(s) by ATM using your ATM Card and youraccount number and personal identification number (PIN) to:

Some of these services may not be available at all terminals.

Debit Card ATM transactions - types of transactions - You may access your account(s) by ATM using your Debit Card and youraccount number and personal identification number (PIN) (as applicable) to:

Some of these services may not be available at all terminals.

Debit Card point-of-sale transactions - types of transactions - You may access your checking account(s) using your Debit Cardto do transactions that participating merchants will accept, including:

Currency Conversion and International Transactions - When you use your VISA(R) debit card at a merchant that settles incurrency other than US dollars, the charge will be converted into the US dollar amount. The currency conversion rate used todetermine the transaction amount in US dollars is either a rate selected by Visa from the range of rates available in wholesalecurrency markets for the applicable central processing date, which rate may vary from the rate Visa itself receives, or thegovernment-mandated rate in effect for the applicable central processing date. The conversion rate in effect on the processingdate may differ from the rate in effect on the transaction date or posting date.

Visa USA charges us a .8% International Service Assessment on all international transactions, regardless of whether there is acurrency conversion. If there is a currency conversion, the International Service Assessment is 1% of the transaction. The feewe charge you for international transactions/currency conversions is disclosed separately. An international transaction is atransaction where the country of the merchant is outside the USA.Advisory Against Illegal Use - You agree not to use your Debit Card for illegal gambling or other illegal purposes. Display of apayment card logo by, for example, an online merchant does not necessarily mean that transactions are lawful in thejurisdiction in which you may be located.

Non-Visa Debit Transaction Processing - We have enabled non-Visa debit transaction processing. This means you may use yourDebit Card on a PIN-Debit Network* (a non-Visa network) without using a PIN.

The non-Visa debit network(s) for which such transactions are enabled are: NETWORK NAME HERE.

· make payments from checking or savings to loans

· get balance information about checking or savings

· get withdrawal history about checking or savings

· get deposit history about checking or savings

· get transaction history about checking or savings

· (800)000-0000 (24 Hours)

· withdraw cash from checking or savings


· make payments from checking or savings to loan

(representative payees include ??????????)


· withdraw cash from checking or savings


· make payments from checking or savings to loan

(representative payees include ??????????)


· purchase goods in person, by phone, or online

· pay for services in person, by phone, or online

· get cash from a participating merchant or financial institution

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Examples of the types of actions that you may be required to make to initiate a Visa transaction on your Debit Card includesigning a receipt, providing a card number over the phone or via the Internet, or swiping the card through a point-of-saleterminal.

Examples of the types of actions you may be required to make to initiate a transaction on a PIN-Debit Network include initiatinga payment directly with the biller (possibly via telephone, Internet, or kiosk locations), responding to a logo displayed at apayment site and choosing to direct payment through that network, and having your identity verified using known informationderived from an existing relationship with you instead of through use of a PIN.

The provisions of your agreement with us relating only to Visa transactions are not applicable to non-Visa transactions. Forexample, the additional limits on liability (sometimes referred to as Visa's zero-liability program) and the streamlined errorresolution procedures offered on Visa debit card transactions are not applicable to transactions processed on a PIN-DebitNetwork.

*Visa Rules generally define "PIN-Debit Network" as a non-Visa debit network that typically authenticates transactions by useof a personal identification number (PIN) but that is not generally known for having a card program.

OnLine Banking - types of transfers - You may access your accounts at www.myorganization.com and using your User Nameand Password to:

OnLine BillPay - types of transfers -

Limits and fees - Please refer to our fee disclosure for information about fees and limitations that may apply to these electronicfund transfers.

ATM Operator/Network Fees - When you use an ATM not owned by us, you may be charged a fee by the ATM operator or anynetwork used (and you may be charged a fee for a balance inquiry even if you do not complete a fund transfer).

Limitations on frequency of transfers - In addition to those limitations on transfers elsewhere described, if any, the followinglimitations apply to your savings account(s):

During any calendar month or statement cycle of at least four weeks, you may not make more than six withdrawals ortransfers to another account of yours or to a third party by means of a preauthorized or automatic transfer or telephone orderor instruction. No more than three of the six transfers may be made by check, draft, debit card (if applicable) or similar order toa third party. If you exceed the transfer limitations set forth above in any statement period, your account will be subject toclosure by the financial institution.

Security limitations - For security reasons, there are other limits on the number of transfers you can make using our terminals,telephone bill-payments service, point-of-sale transfer service and computer transaction service.

Termination - You may terminate the electronic fund transfer agreement by giving us written notice. For transfers youpreauthorize with a third party, you should revoke authorization by appropriate notice to the third party. We may terminate theelectronic fund transfer agreement by giving you written notice.

Documentation


· make payments from checking or savings to loans

(Some payments made by paper check will not be subject to this Electronic Fund Transfers disclosure, as disclosedseparately. Additional limitations can be disclosed here.)

· get balance information about checking, savings, certificate of deposit or line of credit

· get withdrawal history about checking, savings, certificate of deposit or line of credit

· get deposit history about checking, savings, certificate of deposit or line of credit

· get transaction history about checking, savings, certificate of deposit or line of credit

You may access this service by computer at www.mybank.com and using your user name and password.

You may access this service to:

· make payments from your checking account(s) to Third Parties

(Some payments made by paper check will not be subject to this Electronic Fund Transfers disclosure, as disclosedseparately.)

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Terminal transfers - You can get a receipt at the time you make a transfer to or from your account using an automated tellermachine or point-of-sale terminal. However, you may not get a receipt if the amount of the transfer is $15 or less.

Preauthorized credits - If you have arranged to have direct deposits made to your account at least once every 60 days from thesame person or company:

· the person or company making the deposit will tell you every time they send us the money.· you can call us at (800)000-0000 to find out whether or not the deposit has been made.

· we will let you know if the deposit is made.

· we will let you know if the deposit is not made.

Periodic statements - You will get a monthly account statement from us for your checking account(s).

You will get a monthly account statement from us for your savings account(s), unless there are no transfers in a particularmonth. In any case, you will get a statement at least quarterly.

Preauthorized Payments Right to stop payment and procedure for doing so - If you have told us in advance to make regular payments out of youraccount, you can stop any of these payments. Here is how:

Call or write us at the telephone number or address listed in this disclosure in time for us to receive your request three businessdays or more before the payment is scheduled to be made. If you call, we may also require you to put your request in writingand get it to us within 14 days after you call.

Notice of varying amounts - If these regular payments may vary in amount, the person you are going to pay will tell you, 10days before each payment, when it will be made and how much it will be. (You may choose instead to get this notice onlywhen the payment would differ by more than a certain amount from the previous payment, or when the amount would falloutside certain limits that you set.)

Liability for failure to stop payment of preauthorized transfer - If you order us to stop one of these payments three businessdays or more before the transfer is scheduled, and we do not do so, we will be liable for your losses or damages.

Financial Institution's Liability

Liability for failure to make transfers - If we do not complete a transfer to or from your account on time or in the correctamount according to our agreement with you, we will be liable for your losses or damages. However, there are someexceptions. We will not be liable, for instance:

Confidentiality

We will disclose information to third parties about your account or the transfers you make:

Unauthorized Transfers (a) Consumer liability. (1) Generally. Tell us AT ONCE if you believe your card and/or code has been lost or stolen or if youbelieve that an electronic fund transfer has been made without your permission using information from your check.

(1) If, through no fault of ours, you do not have enough money in your account to make the transfer.

(2) If you have an overdraft line and the transfer would go over the credit limit.

(3) If the automated teller machine where you are making the transfer does not have enough cash.

(4) If the terminal or system was not working properly and you knew about the breakdown when you started the transfer.

(5) If circumstances beyond our control (such as fire or flood) prevent the transfer, despite reasonable precautions that wehave taken.

(6) There may be other exceptions stated in our agreement with you.

(1) where it is necessary for completing transfers; or

(2) in order to verify the existence and condition of your account for a third party, such as a credit bureau or merchant; or

(3) in order to comply with government agency or court orders; or

(4) if you give us written permission.

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Telephoning is the best way of keeping your possible losses down. You could lose all of the money in your account (plus yourmaximum overdraft line of credit). We will be liable for all unauthorized transfers unless the unauthorized transfer was due tothe loss or theft of your card and/or code. If due to the loss or theft of your card and/or code, and you notify us within 60 daysof when the unauthorized transfer appears on the statement you can lose no more than $50 if someone used your card and/orcode without permission.

If you do NOT notify us within 60 days after the unauthorized transfer appears on your statement, and we prove that we couldhave stopped someone from using your card and/or code without your permission if you had told us within 2 days of when youdiscover the loss or theft of your card and/or code, you could lose as much as $500 for unauthorized transfers that appear onthe statement.

Also, if your statement shows transfers that you did not make, including those made by card, code or other means, tell us atonce. If you do not tell us within 60 days after the statement was mailed to you, you may not get back any money you lostafter the 60 days if we can prove that we could have stopped someone from taking the money if you had told us in time.

If a good reason (such as a long trip or a hospital stay) kept you from telling us, we will extend the time period.

(2) Additional Limit on Liability for VISA(R) card. Unless you have been grossly negligent or have engaged in fraud, you willnot be liable for any unauthorized transactions using your lost or stolen VISA card. This additional limit on liability does notapply to ATM transactions or to transactions using your Personal Identification Number which are not processed by VISA.

(b) Contact in event of unauthorized transfer. If you believe your card and/or code has been lost or stolen, call or write us atthe telephone number or address listed in this disclosure. You should also call the number or write to the address listed in thisdisclosure if you believe a transfer has been made using the information from your check without your permission.

Right to Bring Civil Action You may bring a civil action against any person violating any provision of Minnesota Statutes section 47.69 (governingconsumer privacy and unauthorized withdrawals). If you prevail in such an action, you may recover the greater of your actualdamages or $500. You may also be entitled to recover punitive damages, your court costs and reasonable attorney's fees.

Point-Of-Sale Transactions Payment for goods or services made in this manner shall not affect any of the rights, protections or liabilities in existing lawconcerning a cash or credit sale by means other than through the use of a terminal.

You can reverse a point-of-sale transaction by giving us written notice that allows us a reasonable opportunity to act on thetransfer before final payment has been made.

Error Resolution Notice

In Case of Errors or Questions About Your Electronic Transfers, Call or Write us at the telephone number or address listed inthis disclosure, as soon as you can, if you think your statement or receipt is wrong or if you need more information about atransfer listed on the statement or receipt. We must hear from you no later than 60 days after we sent the FIRST statementon which the problem or error appeared.

(1) Tell us your name and account number (if any).

(2) Describe the error or the transfer you are unsure about, and explain as clearly as you can why you believe it is an error orwhy you need more information.

(3) Tell us the dollar amount of the suspected error.

If you tell us orally, we may require that you send us your complaint or question in writing within 10 business days.

We will determine whether an error occurred within 10 business days (5 business days if the transfer involved a point-of-saletransaction and 20 business days if the transfer involved a new account) after we hear from you and will correct any errorpromptly. If we need more time, however, we may take up to 45 days (90 days if the transfer involved a new account, apoint-of-sale transaction, or a foreign-initiated transfer) to investigate your complaint or question. If we decide to do this, we

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will credit your account within 10 business days (5 business days if the transfer involved a point-of-sale transaction and 20business days if the transfer involved a new account) for the amount you think is in error, so that you will have the use of themoney during the time it takes us to complete our investigation. If we ask you to put your complaint or question in writing andwe do not receive it within 10 business days, we may not credit your account. Your account is considered a new account forthe first 30 days after the first deposit is made, unless each of you already has an established account with us before theaccount is opened.

We will tell you the results within three business days after completing our investigation. If we decide that there was no error,we will send you a written explanation.

You may ask for copies of the documents that we used in our investigation.

If you have inquiries regarding your account, please contact us at:

Notice Of ATM/Night Deposit Facility User Precautions

As with all financial transactions, please exercise discretion when using an automated teller machine (ATM) or night depositfacility. For your own safety, be careful. The following suggestions may be helpful.

Organization Name

Jane Doe

123 Any Street

Any City, MN 33333

BUSINESS DAYS: Monday, Tuesday, Wednesday, Thursday, Friday and Saturday

Holidays are not included.

PHONE: (800)000-0000

1. Prepare for your transactions at home (for instance, by filling out a deposit slip) to minimize your time at the ATM ornight deposit facility.

2. Mark each transaction in your account record, but not while at the ATM or night deposit facility. Always save yourATM receipts. Don't leave them at the ATM or night deposit facility because they may contain important accountinformation.

3. Compare your records with the account statements you receive.

4. Don't lend your ATM card to anyone.

5. Remember, do not leave your card at the ATM. Do not leave any documents at a night deposit facility.

6. Protect the secrecy of your Personal Identification Number (PIN). Protect your ATM card as though it were cash. Don'ttell anyone your PIN. Don't give anyone information regarding your ATM card or PIN over the telephone. Never enteryour PIN in any ATM that does not look genuine, has been modified, has a suspicious device attached, or is operating ina suspicious manner. Don't write your PIN where it can be discovered. For example, don't keep a note of your PIN inyour wallet or purse.

7. Prevent others from seeing you enter your PIN by using your body to shield their view.

8. If you lose your ATM card or if it is stolen, promptly notify us. You should consult the other disclosures you havereceived about electronic fund transfers for additional information about what to do if your card is lost or stolen.

9. When you make a transaction, be aware of your surroundings. Look out for suspicious activity near the ATM or nightdeposit facility, particularly if it is after sunset. At night, be sure that the facility (including the parking area andwalkways) is well lighted. Consider having someone accompany you when you use the facility, especially after sunset.If you observe any problem, go to another ATM or night deposit facility.

10. Don't accept assistance from anyone you don't know when using an ATM or night deposit facility.

11. If you notice anything suspicious or if any other problem arises after you have begun an ATM transaction, you maywant to cancel the transaction, pocket your card and leave. You might consider using another ATM or coming backlater.

12. Don't display your cash; pocket it as soon as the ATM transaction is completed and count the cash later when you arein the safety of your own car, home, or other secure surrounding.

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MORE DETAILED INFORMATION IS AVAILABLE ON REQUEST

COMMON FEATURES

Limits and fees - The following fees may be assessed against your account and the following transaction limitations, if any,apply to your account:

$5.00

$2.00

$2.00

1.00

$1.00 per $100.00

$25.00

$15.00

$20.00

$20.00

$10.00

$10.00

13. At a drive-up facility, make sure all the car doors are locked and all of the windows are rolled up, except the driver'swindow. Keep the engine running and remain alert to your surroundings.

14. We want the ATM and night deposit facility to be safe and convenient for you. Therefore, please tell us if you know ofany problem with a facility. For instance, let us know if a light is not working or there is any damage to a facility.Please report any suspicious activity or crimes to both the operator of the facility and the local law enforcement officialsimmediately.

We reserve the right to at any time require not less than seven days notice in writing before each withdrawalfrom an interest-bearing account other than a time deposit, or from any other savings account.

ATM/Debit Card Withdrawal Limitations - per day

$200.00 ATM$500.00 POS

ATM/Debit Card Replacement

Check Printing - Fee depends on style of check ordered

Chashier's Check

Money Order

Check Copy Fee

Travelers Cheques

Joint travelers cheques also available for $1.10 per $100.00

Garnishments/Levies

Stop Payment Fee - all items

Overdraft Charge - per item

NSF Return Fee Charge - per item

Wire Transfer - Domestic Incoming

Wire Transfer - Domestic Outgoing

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$35.00

Varies

$50.00

$20.00

TERMS AND CONDITIONS OF YOUR ACCOUNT

IMPORTANT INFORMATION ABOUT PROCEDURES FOR OPENING A NEW ACCOUNT - To help the government fight thefunding of terrorism and money laundering activities, Federal law requires all financial institutions to obtain, verify, and recordinformation that identifies each person who opens an account. What this means for you: When you open an account, we willask for your name, address, date of birth (for individuals), and other information that will allow us to identify you. We may alsoask to see your driver's license (for individuals) or other identifying documents.

AGREEMENT - This document, along with any other documents we give you pertaining to your account(s), is a contract thatestablishes rules which control your account(s) with us. Please read this carefully. If you sign the signature card or continue touse the account, you agree to these rules. You will receive a separate schedule of rates, qualifying balances, and fees if theyare not included in this document. If you have any questions, please call us.

This agreement is subject to applicable federal laws and the laws of the state of MN (except to the extent that this agreementcan and does vary such rules or laws). The body of state and federal law that governs our relationship with you, however, istoo large and complex to be reproduced here. The purpose of this document is to:

(1) summarize some laws that apply to common transactions;

(2) establish rules to cover transactions or events which the law does not regulate;

(3) establish rules for certain transactions or events which the law regulates but permits variation by agreement; and

(4) give you disclosures of some of our policies to which you may be entitled or in which you may be interested.

If any provision of this document is found to be unenforceable according to its terms, all remaining provisions will continue infull force and effect. We may permit some variations from our standard agreement, but we must agree to any variation inwriting either on the signature card for your account or in some other document.

As used in this document the words "we," "our," and "us" mean the financial institution and the words "you" and "your"mean the account holder(s) and anyone else with the authority to deposit, withdraw, or exercise control over the funds in theaccount. The headings in this document are for convenience or reference only and will not govern the interpretation of theprovisions. Unless it would be inconsistent to do so, words and phrases used in this document should be construed so thesingular includes the plural and the plural includes the singular.

LIABILITY - You agree, for yourself (and the person or entity you represent if you sign as a representative of another) to theterms of this account and the schedule of charges. You authorize us to deduct these charges directly from the account balanceas accrued. You will pay any additional reasonable charges for services you request which are not covered by this agreement.

Each of you also agrees to be jointly and severally (individually) liable for any account shortage resulting from charges oroverdrafts, whether caused by you or another with access to this account. This liability is due immediately, and can bededucted directly from the account balance whenever sufficient funds are available. You have no right to defer payment of thisliability, and you are liable regardless of whether you signed the item or benefited from the charge or overdraft. You will alsobe liable for our costs to collect the deficit as well as for our reasonable attorneys' fees, to the extent permitted by law,whether incurred as a result of collection or in any other dispute involving your account including, but not limited to, disputesbetween you and another joint owner; you and an authorized signer or similar party; or a third party claiming an interest in youraccount.

DEPOSITS - We will give only provisional credit until collection is final for any items, other than cash, we accept for deposit(including items drawn "on us"). Actual credit for deposits of, or payable in, foreign currency will be at the exchange rate ineffect on final collection in U.S. dollars. We are not responsible for transactions by mail or outside depository until we actually

Wire Transfer - Foreign Incoming/Outgoing

Safe Deposit Box Annual Rent

Fee amount varies depending on box size.

Safe Deposit Box Drilling

Night Deposit Lock Bags

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record them. We will treat and record all transactions received after our "daily cutoff time" on a business day we are open, orreceived on a day we are not open for business, as if initiated on the next business day that we are open.

WITHDRAWALS - Unless clearly indicated otherwise on the account records, any of you, acting alone, who signs to open theaccount or has authority to make withdrawals may withdraw or transfer all or any part of the account balance at any time.Each of you (until we receive written notice to the contrary) authorizes each other person who signs or has authority to makewithdrawals to indorse any item payable to you or your order for deposit to this account or any other transaction with us. Youagree that, as to any item that we have no opportunity to examine the signatures, such as an electronic check conversiontransaction where a check or similar item is converted into an electronic fund transfer as defined in the Electronic FundTransfers regulation, you waive any requirement of multiple signatures for withdrawal. We may charge your account for acheck even though payment was made before the date of the check, unless we have received written notice of the postdatingin time to have a reasonable opportunity to act. We may refuse any withdrawal or transfer request which you attempt onforms not approved by us, by any method we do not specifically permit, which is greater in number than the frequencypermitted, or which is for an amount greater or less than any withdrawal limitations. Even if we honor a nonconformingrequest, we may treat continued abuse of the stated limitations (if any) as your act of closing the account. We will use thedate the transaction is completed by us (as opposed to the date you initiate it) to apply the frequency limitations. The fact thatwe may honor withdrawal requests that overdraw the available account balance does not obligate us to do so later. You agreethat we may charge fees for overdrafts and use subsequent deposits, including direct deposits of social security or othergovernment benefits, to cover such overdrafts and overdraft fees. If we are presented with an item drawn against youraccount that would be a "substitute check," as defined by law, but for an error or defect in the item introduced in thesubstitute check creation process, you agree that we may pay such item. See the funds availability policy disclosure forinformation about when you can withdraw funds you deposit. For those accounts for which our funds availability policydisclosure does not apply, you can ask us when you make a deposit when those funds will be available for withdrawal.We may require not less than 7 days' notice in writing before each withdrawal from an interest-bearing account other than atime deposit, or from any other savings account as defined by Regulation D. Withdrawals from a time account prior to maturityor prior to any notice period may be restricted and may be subject to penalty. See your notice of penalty for early withdrawal.

OWNERSHIP OF ACCOUNT AND BENEFICIARY DESIGNATION - These rules apply to this account depending on the form ofownership and beneficiary designation, if any, specified on the account records. We make no representations as to theappropriateness or effect of the ownership and beneficiary designations, except as they determine to whom we pay theaccount funds. INDIVIDUAL ACCOUNT - is an account in the name of one person. JOINT ACCOUNT - WITH SURVIVORSHIP(AND NOT AS TENANTS IN COMMON) - is an account in the name of two or more persons. Each of you intend that when youdie the balance in the account (subject to any previous pledge to which we have agreed) will belong to the survivor(s). If twoor more of you survive, you will own the balance in the account as joint tenants with survivorship and not as tenants incommon. JOINT ACCOUNT - NO SURVIVORSHIP (AS TENANTS IN COMMON) - is owned by two or more persons, but noneof you intend (merely by opening this account) to create any right of survivorship in any other person. We encourage you toagree and tell us in writing of the percentage of the deposit contributed by each of you. This information will not, however,affect the "number of signatures" necessary for withdrawal. REVOCABLE TRUST OR PAY-ON-DEATH ACCOUNT - If two ormore of you create this type of account, you own the account jointly with survivorship. Beneficiaries cannot withdraw unless:(1) all persons creating the account die, and (2) the beneficiary is then living, and (3) we have not been given written notice ofa claim under a will. If two or more beneficiaries are named and survive the death of all persons creating the account,beneficiaries will own this account in equal shares, without right of survivorship. The person(s) creating either of these accounttypes may: (1) change beneficiaries, (2) change account types, and (3) withdraw all or part of the account funds at any time.BUSINESS, ORGANIZATION AND ASSOCIATION ACCOUNTS - Earnings in the form of interest, dividends, or credits will bepaid only on collected funds, unless otherwise provided by law or our policy. We may require the governing body of the entityopening the account to give us a separate authorization telling us who is authorized to act on its behalf. We will honor theauthorization until we actually receive written notice of a change from the governing body of the entity.

STOP PAYMENTS - You must make any stop-payment order in the manner required by law and we must receive it in time togive us a reasonable opportunity to act on it before our stop-payment cutoff time. To be effective, your stop-payment ordermust precisely identify the number, date and amount of the item, and the payee.

You may stop payment on any item drawn on your account whether you sign the item or not, if you have an equal or greaterright to withdraw from this account than the person who signed the item. A release of the stop-payment request may be madeonly by the person who initiated the stop-payment order.

Our stop-payment cutoff time is one hour after the opening of the next banking day after the banking day on which we receivethe item. Additional limitations on our obligation to stop payment are provided by law (e.g., we paid the item in cash or wecertified the item).

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TELEPHONE TRANSFERS - A telephone transfer of funds from this account to another account with us, if otherwise arrangedfor or permitted, may be made by the same persons and under the same conditions generally applicable to withdrawals made inwriting. Unless a different limitation is disclosed in writing, we restrict the number of transfers from a savings account toanother account or to third parties, to a maximum of six per month (less the number of "preauthorized transfers" during themonth). Other account transfer restrictions may be described elsewhere.

AMENDMENTS AND TERMINATION - We may change any term of this agreement. Rules governing changes in interest ratesare provided separately. For other changes, we will give you reasonable notice in writing or by any other method permitted bylaw. We may also close this account at any time upon reasonable notice to you and tender of the account balance personallyor by mail. Notice from us to any one of you is notice to all of you.

STATEMENTS - YOUR DUTY TO REPORT UNAUTHORIZED SIGNATURES, ALTERATIONS AND FORGERIES - You mustexamine your statement of account with "reasonable promptness." If you discover (or reasonably should have discovered) anyunauthorized signatures or alterations, you must promptly notify us of the relevant facts. As between you and us, if you fail todo either of these duties, you will have to either share the loss with us, or bear the loss entirely yourself (depending onwhether we used ordinary care and, if not, whether we substantially contributed to the loss). The loss could be not only withrespect to items on the statement but other items with unauthorized signatures or alterations by the same wrongdoer.

You agree that the time you have to examine your statement and report to us will depend on the circumstances, but will not,in any circumstance, exceed a total of 30 days from when the statement is first sent or made available to you.

You further agree that if you fail to report any unauthorized signatures, alterations, or forgeries in your account within 60 daysof when we first send or make the statement available, you cannot assert a claim against us on any items in that statement,and as between you and us the loss will be entirely yours. This 60-day limitation is without regard to whether we usedordinary care. The limitation in this paragraph is in addition to that contained in the first paragraph of this section.

YOUR DUTY TO REPORT OTHER ERRORS - In addition to your duty to review your statements for unauthorized signatures,alterations and forgeries, you agree to examine your statement with reasonable promptness for any other error - such as anencoding error. You agree that the time you have to examine your statement and report to us will depend on thecircumstances. However, such time period shall not exceed 60 days. Failure to examine your statement and report any sucherrors to us within 60 days of when we first send or make the statement available precludes you from asserting a claim againstus for any such errors on items identified in that statement and as between you and us the loss will be entirely yours.

ERRORS RELATING TO ELECTRONIC FUND TRANSFERS OR SUBSTITUTE CHECKS - For information on errors relating toelectronic fund transfers (e.g., computer, debit card or ATM transactions) refer to your Electronic Fund Transfers disclosureand the sections on consumer liability and error resolution. For information on errors relating to a substitute check youreceived, refer to your disclosure entitled Substitute Checks and Your Rights.

ACCOUNT TRANSFER - This account may not be transferred or assigned without our prior written consent.

DIRECT DEPOSITS - If, in connection with a direct deposit plan, we deposit any amount in an account which should have beenreturned to the Federal Government for any reason, you authorize us to deduct the amount of our liability to the FederalGovernment from the account or from any other account you have with us, without prior notice and at any time, except asprohibited by law. We may also use any other legal remedy to recover the amount of our liability.

TEMPORARY ACCOUNT AGREEMENT - If this option is selected, this is a temporary account agreement. Each person whosigns to open the account or has authority to make withdrawals (except as indicated to the contrary) may transact business onthis account. However, we may at some time in the future restrict or prohibit further use of this account if you fail to complywith the requirements we have imposed within a reasonable time.

SETOFF - We may (without prior notice and when permitted by law) set off the funds in this account against any due andpayable debt you owe us now or in the future, by any of you having the right of withdrawal, to the extent of such persons' orlegal entity's right to withdraw. If the debt arises from a note, "any due and payable debt" includes the total amount of whichwe are entitled to demand payment under the terms of the note at the time we set off, including any balance the due date forwhich we properly accelerate under the note.

This right of setoff does not apply to this account if prohibited by law. For example, the right of setoff does not apply to thisaccount if: (a) it is an Individual Retirement Account or similar tax-deferred account, or (b) the debt is created by a consumercredit transaction under a credit card plan (but this does not affect our rights under any consensual security interest), or (c) thedebtor's right of withdrawal only arises in a representative capacity. We will not be liable for the dishonor of any check whenthe dishonor occurs because we set off a debt against this account. You agree to hold us harmless from any claim arising as aresult of our exercise of our right of setoff.

AUTHORIZED SIGNER - A single individual is the owner. The authorized signer is merely designated to conduct transactions onthe owner's behalf. We undertake no obligation to monitor transactions to determine that they are on the owner's behalf.

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RESTRICTIVE LEGENDS - We are not required to honor any restrictive legend on checks you write unless we have agreed inwriting to the restriction. Examples of restrictive legends are "must be presented within 90 days" or "not valid for more than$1,000.00."

PAYMENT ORDER OF ITEMS - The law permits us to pay items drawn on your account in any order (for purposes of thissection "items" means checks, orders and electronic transactions). To assist you in handling your account with us, we areproviding you with the following information regarding how we process those items.

When processing items drawn on your account, our policy is to pay them in the order that they are received. The order inwhich items are paid is important if there is not enough money in your account to pay all of the items that are presented. Thereis no policy that is favorable in every instance. If the smallest items are paid first, you may have fewer NSF or overdraft fees,but the largest, and perhaps more important items (such as rent or mortgage payments) might not be paid. However, if thelargest items are paid first, your most important items might be paid but it may increase the overdraft or NSF fees if funds arenot available to pay all of the items. By paying items in the order that we receive them, we think our policy attains areasonable balance between minimizing additional cost to you and paying your more important items.

If an item is presented without sufficient funds in your account to pay it, we may, at our discretion, pay the item (creating anoverdraft) or return the item (NSF). The amounts of the overdraft and NSF fees are disclosed elsewhere. We encourage you tomake careful records and practice good account management. This will help you to avoid creating items without sufficientfunds and incurring the resulting fees.

FACSIMILE SIGNATURES - You authorize us, at any time, to charge you for all checks, drafts, or other orders, for the paymentof money, that are drawn on us regardless of by whom or by what means the facsimile signature(s) may have been affixed solong as they resemble the facsimile signature specimen filed with us, and contain the required number of signatures for thispurpose.

PLEDGES - Unless we agree otherwise in writing, each owner of this account may pledge all or any part of the funds in it forany purpose to which we agree. Any pledge of this account must first be satisfied before the rights of any surviving accountowner or account beneficiary become effective.

FICTITIOUS BUSINESS NAME ACCOUNTS - If the name in which the account is held is fictitious, each account holderrepresents that one or more of the account holders have the right to use that name and have fulfilled all legal requirements forusing and or doing business under that name.

POWER OF ATTORNEY - You may wish to appoint an agent to conduct transactions on your behalf. (We, however, have noduty or agreement whatsoever to monitor or insure that the acts of the agent are for your benefit.) This may be done byallowing your agent to sign in that capacity on the signature card or by separate form, such as a power of attorney. A powerof attorney continues until your death or the death of the person given the power. If the power of attorney is not "durable," itis revoked when you become incompetent. We may continue to honor the transactions of the agent until: (a) we have receivedwritten notice or have actual knowledge of the termination of the authority or the death of an owner, and (b) we have had areasonable opportunity to act on that notice or knowledge. You agree not to hold us responsible for any loss or damage youmay incur as a result of our following instructions given by an agent acting under a valid power of attorney.

STALE-DATED CHECKS - We are not obligated to, but may at our option, pay a check, other than a certified check, presentedfor payment more than six months after its date. If you do not want us to pay a stale-dated check, you must place astop-payment order on the check in the manner we have described elsewhere.

FDIC INSURANCE - Funds in your account(s) with us are insured by the Federal Deposit Insurance Corporation (FDIC) andbacked by the full faith and credit of the United States. The amount of insurance coverage you have depends on the number ofaccounts you have with us that are of different "ownership." An individual account is one unique form of "ownership"; a jointaccount, a pay-on-death account, and a self directed qualified retirement account (e.g., an IRA) are examples of some of theothers. Deposit insurance for a person's self directed qualified retirement account is up to $250,000. (An IRA is a self directedqualified retirement account as is any account where the owner decides where and how to invest the balance.) Depositinsurance for the other ownerships is at least $250,000 per interest of the owner. If you want a more detailed explanation oradditional information, you may ask us or contact the FDIC. You can also visit the FDIC website at www.fdic.gov and click onthe Deposit Insurance link. The link includes detailed contact information as well as a deposit insurance estimator.INDORSEMENTS - We may accept for deposit any item payable to you or your order, even if they are not indorsed by you. Wemay give cash back to any one of you. We may supply any missing indorsement(s) for any item we accept for deposit orcollection, and you warrant that all indorsements are genuine.

UNCLAIMED PROPERTY - The law establishes procedures under which unclaimed property must be surrendered to the state.(We may have our own rules regarding dormant accounts, and if we charge a fee for dormant accounts it will be disclosed toyou elsewhere.) Generally, the funds in your account are considered unclaimed if you have not had any activity orcommunication with us regarding your account over a period of years. Ask us if you want further information about the period

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of time or type of activity that will prevent your account from being unclaimed. If your funds are surrendered to the state, youmay be able to reclaim them, but your claim must be presented to the state. Once your funds are surrendered, we no longerhave any liability or responsibility with respect to the funds.

DEATH OR INCOMPETENCE - You agree to notify us promptly if any person with a right to withdraw funds from youraccount(s) dies or becomes legally incompetent. We may continue to honor your checks, items, and instructions until: (a) weknow of your death or incompetence, and (b) we have had a reasonable opportunity to act on that knowledge. You agree thatwe may pay or certify checks drawn on or before the date of death or legal incompetence for up to ten (10) days after yourdeath or legal incompetence unless ordered to stop payment by someone claiming an interest in the account.

UTMA ACCOUNTS - Under the Uniform Transfers to Minors Act, the funds in the account are owned by the child who hasunconditional use of the account when he or she reaches the age of majority. Before that time, the account may be accessedonly by the custodian (or successor custodian), and the funds must be used for the benefit of the child. We, however, have noduty or agreement whatsoever to monitor or insure that the acts of the custodian (or successor custodian) are for the child'sbenefit. For this type of account, the child's SSN/TIN is used for the Backup Withholding Certification.

FIDUCIARY ACCOUNTS - Accounts may be opened by a person acting in a fiduciary capacity. This account may be openedand maintained by a person or persons named as a trustee under a written trust agreement, or as executors, administrators, orconservators under court orders. You understand that by merely opening such an account, we are not acting in the capacity ofa trustee in connection with the trust nor do we undertake any obligation to monitor or enforce the terms of the trust orletters.

CASH TRANSACTION REPORTING - To help law enforcement agencies detect illegal activities, the law requires all financialinstitutions to gather and report information on some types of cash transactions. If the information we need to complete thereport is not provided, we are required to refuse to handle the transaction. If you have any questions regarding these rules,please contact your local Internal Revenue Service office.

BACKUP WITHHOLDING/TIN CERTIFICATION - Federal tax law requires us to report interest payments we make to you of $10or more in a year, and to include your taxpayer identification number (TIN) on the report (the taxpayer identification number isyour social security number if you are an individual). Interest includes dividends, interest and bonus payments for purposes ofthis rule. Therefore, we require you to provide us with your TIN and to certify that it is correct. In some circumstances, federallaw requires us to withhold and pay to the IRS a percentage of the interest that is earned on funds in your accounts. This isknown as backup withholding. We will not have to withhold interest payments when you open your account if you certify yourTIN and certify that you are not subject to backup withholding due to underreporting of interest. (There are special rules if youdo not have a TIN but have applied for one, if you are a foreign person, or if you are exempt from the reporting requirements.)We may subsequently be required to begin backup withholding if the IRS informs us that you supplied an incorrect TIN or thatyou underreported your interest income.CREDIT VERIFICATION - You agree that we may verify credit and employment history by any necessary means, includingpreparation of a credit report by a credit reporting agency.

LOST, DESTROYED, OR STOLEN CERTIFIED, CASHIER'S OR TELLER'S CHECKS - Under some circumstances you may be ableto assert a claim for the amount of a lost, destroyed, or stolen certified, cashier's or teller's check. To assert the claim: (a) youmust be the remitter (or drawer of a certified check) or payee of the check, (b) we must receive notice from you describing thecheck with reasonable certainty and asking for payment of the amount of the check, (c) we must receive the notice in time forus to have a reasonable opportunity to act on it, and (d) you must give us a declaration (in a form we require) of your loss withrespect to the check. You can ask us for a declaration form. Even if all of these conditions are met, your claim may not beimmediately enforceable. We may pay the check until the ninetieth day after the date of the check (or date of acceptance of acertified check). Therefore, your claim is not enforceable until the ninetieth day after the date of the check or date ofacceptance, and the conditions listed above have been met. If we have not already paid the check, on the day your claim isenforceable we become obligated to pay you the amount of the check. We will pay you in cash or issue another certifiedcheck.At our option, we may pay you the amount of the check before your claim becomes enforceable. However, we will require youto agree to indemnify us for any losses we might suffer. This means that if the check is presented after we pay your claim, andwe pay the check, you are responsible to cover our losses. We may require you to provide a surety bond to assure that youcan pay us if we suffer a loss.

CHANGING ACCOUNT PRODUCTS - We may change your account to another product offered by us at any time by giving younotice that your account will be changed to another product on a specified date. If your account is a time account, the changewill not occur before the next maturity date of your account. If you do not close your account before the date specified in thenotice, we may change your account to that other product on the date specified in the notice.

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TRANSACTIONS BY MAIL - You may deposit checks by mail. You should indorse the check being sent through the mail withthe words "For Deposit Only" and should include your correct account number underneath to ensure the check is credited tothe correct account. You should use the pre-encoded checking deposit slips found behind your checks in your checkbook. Ifyou do not use your deposit slip or provide us with instructions indicating how or where the check should be credited, we mayapply it to any account or any loan balance you have with us or we may return the check to you. Receipts for suchtransactions will be mailed to you only if a self-addressed stamped envelope is provided. Following your deposit, examine yourstatement carefully or call us to ensure that we received the item. Do not send cash through the mail for deposit.

FOREIGN ACCOUNTS - Unless we agree in writing to the contrary, funds held in accounts at our offices located outside of theStates of the United States and the District of Columbia (termed "foreign accounts" in this section) are payable solely in thecountry in which your account was opened and is maintained. Payment from foreign accounts may not be demanded from ouroffices in the United States. Funds are payable only in the currency of the country in which the foreign account is held. Officeslocated in the United States do not accept responsibility for any loss or damages incurred by any owner or payee of a foreignaccount resulting from government orders, laws, or from any other cause beyond our control. Owners of foreign accountsassume whatever risk may exist that the foreign country in which an office is located might impose restrictions onwithdrawals.

LEGAL ACTIONS AFFECTING YOUR ACCOUNT - If we are served with a subpoena, restraining order, writ of attachment orexecution, levy, garnishment, search warrant, or similar order relating to your account (termed "legal action" in this section),we will comply with that legal action. Or, in our discretion, we may freeze the assets in the account and not allow anypayments out of the account until a final court determination regarding the legal action. We may do these things even if thelegal action involves less than all of you. In these cases, we will not have any liability to you if there are insufficient funds topay your items because we have withdrawn funds from your account or in any way restricted access to your funds inaccordance with the legal action. Any fees or expenses we incur in responding to any legal action (including, withoutlimitation, attorneys' fees and our internal expenses) may be charged against your account. The list of fees applicable to youraccount(s) provided elsewhere may specify additional fees that we may charge for certain legal actions.CHECK PROCESSING - We may process items mechanically by relying on the information encoded along the bottom of theitems. This means that we may not individually examine all of your items to determine if the item is properly completed, signedand indorsed. You agree that we have not failed to exercise ordinary care solely because we use an automated system toprocess items and do not inspect all items processed in such a manner. We reserve the right not to inspect each item becauseusing an automated process helps us keep costs down for you and all account holders. We may determine the amount ofavailable funds in your account for the purpose of deciding whether to return an item for insufficient funds at any timebetween the time we receive the item and when we return the item or send a notice in lieu of return. We need only make onedetermination, but if we choose to make a subsequent determination, the account balance at the subsequent time willdetermine whether there are insufficient available funds.CHECK STORAGE AND COPIES - You agree that you will not receive your canceled checks. We will store your canceledchecks or copies of them for a reasonable retention period. You may request copies from us in the manner we require.

CHECK CASHING - We may charge a fee for anyone that does not have an account with us who is cashing a check, draft orother instrument written on your account. We may also require reasonable identification to cash such a check, draft or otherinstrument. We can decide what identification is reasonable under the circumstances and such identification may bedocumentary or physical and may include collecting a thumbprint or fingerprint.

TRUNCATION, SUBSTITUTE CHECKS, AND OTHER CHECK IMAGES - If you truncate an original check and create a substitutecheck, or other paper or electronic image of the original check, you warrant that no one will be asked to make payment on theoriginal check, a substitute check or any other electronic or paper image, if the payment obligation relating to the original checkhas already been paid. You also warrant that any substitute check you create conforms to the legal requirements and generallyaccepted specifications for substitute checks. You agree to retain the original check in conformance with our internal policy forretaining original checks. You agree to indemnify us for any loss we may incur as a result of any truncated check transactionyou initiate. We can refuse to accept substitute checks that have not previously been warranted by a bank or other financialinstitution in conformance with the Check 21 Act. Unless specifically stated in a separate agreement between you and us, wedo not have to accept any other electronic or paper image of an original check.SECURITY - It is your responsibility to protect the account numbers and electronic access devices (e.g., an ATM card) weprovide you for your account(s). Do not discuss, compare, or share information about your account number(s) with anyoneunless you are willing to give them full use of your money. An account number can be used by thieves to encode your numberon a false demand draft which looks like and functions like an authorized check. If you furnish your access device and grantactual authority to make transfers to another person (a family member or coworker, for example) who then exceeds thatauthority, you are liable for the transfers unless we have been notified that transfers by that person are no longer authorized.

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Your account number can also be used to electronically remove money from your account. If you provide your account numberin response to a telephone solicitation for the purpose of making a transfer (to purchase a service or merchandise, forexample), payment can be made from your account even though you did not contact us directly and order the payment.

You must also take precaution in safeguarding your blank checks. Notify us at once if you believe your checks have been lostor stolen. As between you and us, if you are negligent in safeguarding your checks, you must bear the loss entirely yourself orshare the loss with us (we may have to share some of the loss if we failed to use ordinary care and if we substantiallycontributed to the loss).

DEPOSIT OF REMOTELY CREATED CHECKS - Like any standard check or draft, a remotely created check (sometimes called atelecheck, preauthorized draft or demand draft) is a check or draft that can be used to withdraw money from an account.Unlike a typical check or draft, however, a remotely created check is not issued by the paying bank and does not contain thesignature of the account owner (or a signature purported to be the signature of the account owner). In place of a signature, thecheck usually has a statement that the owner authorized the check or has the owner's name typed or printed on the signatureline. For example, if a person provides an account number in response to a telephone solicitation, the telephone solicitor canuse the account number to issue a remotely created check to withdraw money from that account.

You warrant and agree to the following for every remotely created check we receive from you for deposit or collection: (1) youhave received express and verifiable authorization to create the check in the amount and to the payee that appears on thecheck; (2) you will maintain proof of the authorization for at least 2 years from the date of the authorization, and supply us theproof if we ask; and (3) if a check is returned you owe us the amount of the check, regardless of when the check is returned.We may take funds from your account to pay the amount you owe us, and if there are insufficient funds in your account, youstill owe us the remaining balance.

MONITORING AND RECORDING TELEPHONE CALLS - We may monitor or record phone calls for security reasons and toensure that you receive courteous and efficient service. You consent in advance to any such recording. We need not remindyou of our recording before each phone conversation.

TELEPHONIC INSTRUCTIONS - Unless we have agreed otherwise in writing, we are not required to act upon instructions yougive us via facsimile transmission or leave by voice mail or on a telephone answering machine.

CLAIM OF LOSS - If you claim a credit or refund because of a forgery, alteration, or any other unauthorized withdrawal, youagree to cooperate with us in the investigation of the loss, including giving us an affidavit containing whatever reasonableinformation we require concerning your account, the transaction, and the circumstances surrounding the loss. You will notifylaw enforcement authorities of any criminal act related to the claim of lost, missing, or stolen checks or unauthorizedwithdrawals. We will have a reasonable period of time to investigate the facts and circumstances surrounding any claim ofloss. Unless we have acted in bad faith, we will not be liable for special or consequential damages, including loss of profits oropportunity, or for attorneys' fees incurred by you.

You agree that you will not waive any rights you have to recover your loss against anyone who is obligated to repay, insure, orotherwise reimburse you for your loss. You will pursue your rights or, at our option, assign them to us so that we may pursuethem. Our liability will be reduced by the amount you recover or are entitled to recover from these other sources.

EARLY WITHDRAWAL PENALTIES (and involuntary withdrawals) - We may impose early withdrawal penalties on a withdrawalfrom a time account even if you don't initiate the withdrawal. For instance, the early withdrawal penalty may be imposed if thewithdrawal is caused by our setoff against funds in the account or as a result of an attachment or other legal process. We mayclose your account and impose the early withdrawal penalty on the entire account balance in the event of a partial earlywithdrawal. See your notice of penalty for early withdrawals for additional information.

ADDRESS OR NAME CHANGES - You are responsible for notifying us of any change in your address or your name. Unless weagree otherwise, change of address or name must be made in writing by at least one of the account holders. Informing us ofyour address or name change on a check reorder form is not sufficient. We will attempt to communicate with you only by useof the most recent address you have provided to us. If provided elsewhere, we may impose a service fee if we attempt tolocate you.

RESOLVING ACCOUNT DISPUTES - We may place an administrative hold on the funds in your account (refuse payment orwithdrawal of the funds) if it becomes subject to a claim adverse to (1) your own interest; (2) others claiming an interest assurvivors or beneficiaries of your account; or (3) a claim arising by operation of law. The hold may be placed for such period oftime as we believe reasonably necessary to allow a legal proceeding to determine the merits of the claim or until we receiveevidence satisfactory to us that the dispute has been resolved. We will not be liable for any items that are dishonored as aconsequence of placing a hold on funds in your account for these reasons.

NOW ACCOUNT ORGANIZATION - We have organized your NOW account in a nontraditional way. Your NOW accountconsists of two subaccounts. One of these accounts is a transaction subaccount (e.g., a checking subaccount). You willtransact business on this subaccount. The other is a nontransaction subaccount (e.g., a savings account). You cannot directly

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access the nontransaction subaccount, but you agree that we may automatically, and without a specific request from you,initiate individual transfers of funds between subaccounts from time to time at no cost to you. This account organization willnot change the amount of federal deposit insurance available to you, your available balance, the information on your periodicstatements, or the interest calculation, if this is an interest-bearing account. You will not see any difference between the wayyour NOW account operates and the way a traditionally organized NOW account operates, but this organization makes us moreefficient and helps to keep costs down.

HEALTH SAVINGS ACCOUNTS (HSA) - For your convenience, we permit you to take distributions from your HSA by check.This feature can raise a variety of tax concerns - for example getting additional cash back on an HSA checking transaction. Asa result, if you have more than one account with us, it is a good practice to make sure you are using the appropriatecheckbook for the transaction. Also, it is your responsibility to ensure your distributions and other actions related to the HSAcomply with the law, including federal tax law. As always, we recommend consulting a legal or tax professional if you haveany questions about managing your HSA. The terms of this agreement are intended to work in conjunction with the HSAAgreement provided to you earlier. In the event of a conflict, the terms of the HSA Agreement control. You understand thatyour HSA is intended to be used for payment of qualified medical expenses. It is your responsibility to satisfy any tax liabilityresulting from use of your HSA for any purpose other than payment or reimbursement of qualified medical expenses. We donot monitor the purpose of any transaction to or from your HSA. Nor are we responsible for ensuring your eligibility for makingcontributions or ensuring withdrawals are used for payment or reimbursement of qualified medical expenses. Refer to your HSAAgreement for more information relating to the use of your HSA.UNLAWFUL INTERNET GAMBLING NOTICE - Restricted transactions as defined in Federal Reserve Regulation GG areprohibited from being processed through this account or relationship. Restricted transactions generally include, but are notlimited to, those in which credit, electronic fund transfers, checks, or drafts are knowingly accepted by gambling businesses inconnection with the participation by others in unlawful Internet gambling.

ACH AND WIRE TRANSFERS - This agreement is subject to Article 4A of the Uniform Commercial Code - Fund Transfers asadopted in the state in which you have your account with us. If you originate a fund transfer for which Fedwire is used, andyou identify by name and number a beneficiary financial institution, an intermediary financial institution or a beneficiary, weand every receiving or beneficiary financial institution may rely on the identifying number to make payment. We may rely onthe number even if it identifies a financial institution, person or account other than the one named. You agree to be bound byautomated clearing house association rules. These rules provide, among other things, that payments made to you, or originatedby you, are provisional until final settlement is made through a Federal Reserve Bank or payment is otherwise made as providedin Article 4A-403(a) of the Uniform Commercial Code. If we do not receive such payment, we are entitled to a refund from youin the amount credited to your account and the party originating such payment will not be considered to have paid the amountso credited. If we receive a payment order to credit an account you have with us by wire or ACH, we are not required to giveyou any notice of the payment order or credit.INTERNATIONAL ACH TRANSACTIONS - Financial institutions are required by law to scrutinize or verify any international ACHtransaction (IAT) that they receive against the Specially Designated Nationals (SDN) list of the Office of Foreign Assets Control(OFAC). This action may, from time to time, cause us to temporarily suspend processing of an IAT and potentially affect thesettlement and/or availability of such payments.

QUESTIONS AND ANSWERS ABOUT CHECKING ACCOUNTS - Q. CAN YOUR CHECKING ACCOUNT BE CLOSED FORMISUSE?

A. Yes. There is a provision in Minnesota law that permits financial institutions to close accounts due to overdrafts or NSFchecks. Policies vary among financial institutions as to when an account will be closed for misuse. Closure usually requires 30days written notice. However, when an account is in an overdraft position or the financial institution has reason to believefunds will not be collectible, immediate closing may take place.

Should your account be closed for NSF activity, Minnesota law prohibits any financial institution from opening a checkingaccount for you for one year. Many financial institutions have set internal policies that expand the period of time to 5 years. Allfinancial institutions are required to verify whether or not you have had an account closed in the last year every time you applyfor a new account.

Protect your checking account privileges. Always make sure that there are funds available in your account when you write acheck and reconcile your account monthly. Maintaining an existing checking account is a lot easier than trying to go withoutan account.

Q. SHOULD YOU GIVE OUT YOUR CHECKING ACCOUNT NUMBER?

A. No. In the financial institution industry, there is an instrument called a "sight draft." A sight draft looks like a check but doesnot require a signature. It is payable immediately. Sight drafts have become one of the most common forms of fraud involvingconsumers. Once a criminal has your account number, they prepare a sight draft and run it through the clearing system for

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checks. The funds are out of your account before you are even aware of it and if you don't balance your account on a regularbasis, you won't be aware of it. If you furnish the account number to a telemarketer, the case can be made that it was anauthorized transaction. Never give your account number out over the telephone.

Q. WHEN CAN YOUR FINANCIAL INSTITUTION GIVE INFORMATION ABOUT YOUR ACCOUNT TO OTHERS?

A. From time to time, your financial institution may release the information necessary to inform you of new products orservices. Other times, the financial institution may be legally required to release information. If your account is closed due tomisuse on your part, the financial institution may be required to report that to a credit bureau. Other examples include:

- When verifying a check you wrote or authorizing an electronic withdrawal.

- When required by law or regulation or upon receipt of a court order, subpoena or search warrant.

- When your financial institution has an arrangement with another company to market its products or services to you.

USER DEFINED SECTION ONE - Information for the user defined section will print here.

ELECTRONIC DISCLOSURES AND NOTICES

This disclosure describes the process that must occur before we can provide you with electronic disclosures and notices (suchas by email or website). It also describes your rights in the event you consent to receiving electronic disclosures and notices.First we must inform you as to the computer hardware and software requirements to receive and keep the electronicdisclosures and notices. Then we must make an electronic request for your consent. Finally, you must give your consentelectronically in response to our request. You understand prior to giving your consent that:

(1) Your consent applies only to disclosures and notices regarding your deposit accounts, including your periodic accountstatements;

(2) Unless you consent, you have the right to receive all required disclosures in paper or non-electronic form;

(3) Even after consent, if you want to receive a paper copy of the disclosure in addition to the electronic disclosure you canobtain one free of charge by calling us;

(4) You can withdraw your consent at any time by calling us; and

(5) You must promptly provide us with the information (such as an email address) needed to communicate with youelectronically and update us as to any changes in such information by calling us.

We reserve the right to provide any disclosures or notices in writing, rather than electronically. Except as otherwise provided inthis or other agreements, by law, or on our website, you cannot give us notices electronically, and all notices from you mustbe in writing.

NOTICE REGARDING INACCURATE INFORMATION

As a participant in the consumer reporting system, we furnish information about our experience with you to consumerreporting agencies. These consumer reports allow us to make credit and other opportunities available to you. If you believe thatwe have furnished information to a consumer reporting agency that is inaccurate please notify us at the following address andidentify the specific information that is inaccurate:

Demo Organization, Customer Service, 123 My Address, Anytown, Minnesota 00000

Telephone: (800)000-0000

NOTICE OF NEGATIVE INFORMATION

Federal law requires us to provide the following notice to customers before any "negative information" may be furnished to anationwide consumer reporting agency. "Negative information" includes information concerning delinquencies, overdrafts orany form of default. This notice does not mean that we will be reporting such information about you, only that we may reportsuch information about customers that have not done what they are required to do under our agreement.

After providing this notice, additional negative information may be submitted without providing another notice.

We may report information about your account to credit bureaus. Late payments, missed payments or other defaults on youraccount may be reflected in your credit report.

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BUSINESS DEBIT CARD AGREEMENT

___________________________________________________________________________________________________________________________________________________________NAME ON ACCOUNT:

_________________________________________________________________________________________________________________________________________________________________________ACCOUNT NO:

______ day ofThis Business Debit Card Agreement ("Agreement") is made and entered into on this___________________________________________________________________________________________________________________________by and between_____________________________________________,

("Bank") and the company whose name appears on the signatory page hereof ("Company").

Company desires to have Bank issue certain debit cards ("Cards") in the name of the Company forWHEREAS,the use by Company's officers, employees or other agents ("Employees"), as more particularly designated in Exhibit A;and

Bank is willing to issue such Cards pursuant to the terms of this Agreement.WHEREAS,

the parties agree as follows:NOW, THEREFORE,

Business Debit Card Agreement contains contract terms and other importantTheIntroduction.1.information relating to Company's Card(s). These terms govern the operation of this account unless varied orsupplemented in writing. This Agreement also incorporates any other terms and conditions provided separately withCompany's Deposit Account agreement as well as the terms of any disclosures Company may have received. To theextent of any inconsistent terms between this Agreement and any other agreement or disclosures, the terms of thisAgreement shall control. Company should read this Agreement carefully and keep a copy for Company's records.

inconsistent, words and phrases used in this document shall be construed soUnlessDefinitions.2.that the singular includes the plural and the plural includes the singular. The words "we," "our," and "us" refer to Bank.The words "you" and "your" refer to Company. The word "Deposit Account" refers to the deposit account listed aboveagainst which Card transactions governed by this Agreement will be applied.

the Company and inBank will issue, or cause to be issued, Cards in the name of Issuance of Cards.3.the names of the Employees as designated in Exhibit A attached hereto and made a part hereof. Usage of the Cards willbe limited to debits only. No electronic (ATM) deposits may be made using the Cards. All Cards must be signedimmediately upon receipt by the Employees, but all Cards remain the property of Bank and must be surrendered to Bankupon demand. Company acknowledges that Bank is providing such service to Company as an accommodation toCompany only and, except as otherwise provided by law, Bank is not responsible in any way for the manner in which theCards are utilized.

Company agrees to be unconditionally and without limitationCompany Liability and Promise to Pay.4.liable for all debits effectuated by use of the Cards, whether authorized or unauthorized, whether utilized by an Employeeor some other person, and whether arising from lost or stolen Cards. All Employees who are granted use of the Cardsshall be deemed third party beneficiaries of the accommodation extended hereunder and of the terms and conditions ofthis Agreement. Accordingly, such Employees shall be jointly and severally liable with Company for any debiteffectuated under the Card issued to the respective Employee, whether authorized or unauthorized, and whether arisingfrom lost or stolen Cards and Company agrees to so advise each such Employee. Acceptance and use of a Card issuedhereunder constitutes Employee's agreement to be bound hereby. Immediately upon discovery of unauthorized use of a

or writing Bank at___________________________________________Card, Bank should be notified by either calling_______________________________________________________________________________________________________________________________________________________________________________________________________and Customer should initiate cancellation of the Cards and closing of the Deposit Account. The services described in thisAgreement will be available to Company only as long as Company maintains a Deposit Account with Bank. The DepositAccount may not be transferred or assigned without Bank's prior written consent.

Notwithstanding the terms contained in paragraph 4 of thisBusiness Debit Card(s) Liability Limits.5.Agreement, Card holders may have zero liability for unauthorized transactions in accordance with Card sponsor's ZeroLiability Policy as governed by the Card sponsor's Operating Regulations, if (1) Company can demonstrate that Companyand all Employees have exercised reasonable care in safeguarding Company's Card(s) from the risk of loss or theft, (2)Company has not reported to Bank two or more incidents of unauthorized use of the Card(s) within the prior twelve (12)month period and (3) Company's Account is in good standing. Upon notification from Company of an unauthorizedtransaction for which zero liability applies, Bank will limit Company's liability for those transactions to zero. Companymust notify Bank within thirty (30) calendar days of the mailing date of the first statement showing any unauthorizedtransactions. Bank may increase this limit and hold Company liable for all unauthorized transactions if it is reasonablydetermined that the Employee or the Company was negligent or fraudulent in handling the Card or Deposit Account, orotherwise does not qualify for such liability limits. If Company qualifies for such liability limits, Bank will provideCompany with provisional credit for unauthorized transactions within five business days from receipt of notification of anunauthorized transaction. Additionally, Bank may ask for written confirmation of the unauthorized transactions beforeproviding provisional credit. If Bank asks for and does not receive such written confirmation by the time Bank wouldotherwise provide Company with provisional credit, Bank may not credit Company's Deposit Account.

accountThe Card allows Cardholders to directly access the business checking Security Measures.6.specified above. In an effort to better protect Company and Employees from lost Cards or unauthorized use of the Cards,Bank requires that each Employee have a Personal Identification Number (PIN) and use the PIN to process a debittransaction. Company and Employees acknowledge that use of a PIN provides them a commercially reasonable degree ofprotection in light of their particular needs and circumstances, and represent that each PIN shall be afforded the highestlevel of security by Company and Employees and shall be known only to those persons who are on a "need to know"basis. Bank assumes no duty to discover any breach of security by Company or Employees or the unauthorizeddisclosures or use of a PIN. On occasion, due to merchant equipment limitations it may be necessary to complete a debittransaction using a Card by means of the user signing his or her name to the evidence of the transaction (as is the case ina credit card transaction) and both Company and Employees acknowledge that this procedure also provides them acommercially reasonable degree of protection in light of their particular needs and circumstances. Once a card has beenissued it cannot be transferred to another person. Company agrees to immediately notify Bank when Customer terminatesa Cardholder's rights and to promptly return the Card to Bank.

GP - ALL Rev (7/26/06) Page 1 of 433

Sample

IMPORTANT: The security of Company's Business Debit Card(s) is especially important sincestores, restaurants, hotels, gas stations, mail order companies, and other merchants will allowpurchases and other transactions to be performed with its Business Debit Card(s) just as if it was acredit card (i.e. without requiring a PIN).

Bank will make available each month to Company an account statementStatements and Errors.7.("Monthly Statement") showing, among other things, all debits made by use of the Cards. Errors regarding any Carddebits shall be communicated in writing to Bank at the address indicated below. Communications shall include theCardholder and Company's names, the dollar amount of any suspected error, the reference number and description of theerror. Any communication regarding a suspected error must be received by Bank within sixty (60) days of the date of theMonthly Statement on which the incorrect debit first appeared. Company shall bring no action and the Bank will not beliable for any loss, demand, or expenses sustained by Company as the result of an error unless Company so notify theBank within the sixty (60) day period.

Except with respect to notices relating to the lost or stolen Cards, allNotice and Communication.8.notices, requests and other communications provided for hereunder must be directed to the other party at the respectiveaddresses indicated below and, unless otherwise specified herein, must be in writing, postage prepaid or hand-deliveredor delivered by telecopy. Either party may, by written notice to the other, change its address indicated below.

If to Bank:If to Customer:

Attention:________________________________________________________________________________________________________________________Attention:_________________________________________________________Telephone:_________________________________________________________Telephone:

_______________________________________________Telecopier (fax):_______________________________________________Telecopier (fax):

Bank agrees that it will maintain all data relative to Company'sInformation Deemed Confidential.9.Deposit Account as confidential information and will exercise the same standard of care and security to protect suchinformation as Bank uses to protect its own confidential information. Bank agrees to use such data exclusively for theproviding of services to Company and Employees hereunder and not to release such information to any other party,except as may be required by law.

A Monthly Debit Card Fee may be charged to Company's Deposit AccountMonthly Debit Card Fee.10.for the privilege of having the Cards. The Monthly Debit Card Fee is payable whether or not any of the Cards are used.Refer to Paragraph 22 of this Agreement.

Company represents and warrants, on behalf of itself and its Employees, that the CardsUse of Cards.11.will only be used for business purposes. Company acknowledge and understand that the Card shall not be treated as aconsumer card under the provisions of state and federal laws and regulations including but not limited to Federal ReserveBoard Regulation E and The Electronic Funds Transfer Act. Bank may establish maximum limits on the dollar amount ofPoint of Sale purchases, ATM withdrawals and other transactions Company may make using the Card in any one calendarday. The amounts of these maximum limits will be based on the defaults in Bank's system. Company may contact Bank toreview these limits unless otherwise requested by Company on Company's Card application and agreed to by Bank.

Immediately upon discovery that a Card is lost or stolen, Company shouldLost or Stolen Cards.12._________________________________________________________________________________________________________________________________ or notify Bank ateither call

and Customer should initiate cancellation of the Card(s) and closing of the account.

Bank shall have the right, at its sole discretion, and upon three (3) days notice toTermination.13.Company, to terminate Company's privileges hereunder.

All Cards shall be deemed canceled effective upon termination of this Agreement andReturn of Cards.14.Company shall instruct the Employees to cut in half all Cards, and return them to Bank. Company shall remain liable forall debits or other charges incurred or arising by virtue of the use of a Card prior to or following the termination date.

Bank may from time to time amend the terms of this AgreementAmendments and Change in Terms.15.to the extent allowed by applicable federal and state law. Bank will notify Company by mail of such amendments, andsubject to the requirements of applicable law, any amendment to this Agreement will become effective at the time statedin such notice. Notice will be given to Company if Bank changes the terms of this Agreement at any time by mailingnotice to the Company address shown on Bank's records, by including a notice with or on the Deposit Account statement,by posting a notice of any such changes at Bank's main office, or by whatever notice requirements that may be requiredby law. Use of the Card(s) after the effective date of a change indicates Company's acceptance of the changes.

Bank is not responsible for the refusal of anyone to honor the Cards.Refusal to Honor Cards.16.

Bank may charge Company a reasonable charge for research, photocopies and reprintsService Fees.17.which Company or any Employee may request and for other special services as allowed by law.

If any provision of the Agreement is determined to be unlawful or unenforceable for anySeverability.18.reason, the remainder of the Agreement will remain enforceable.

This agreement and all transactions hereunder shall be construed as contracts subjectGoverning Law.19._______________________________________________________________________________________.to applicable federal law and the laws of the

Any dispute regarding the terms of this agreement, and any transaction hereunder orArbitration.20.subject hereto, is governed by the Arbitration Agreement relating to the Account(s) to which this agreement relates.

If Bank hires an attorney to assist in collecting any amount due hereunder, or toCollection of Costs.21.enforce any right or remedy hereunder, Company agrees to pay Bank's reasonable attorney's fees and expenses, and anyother as permitted by law.

Rev (7/26/06) Page 2 of 434

Sample

Charges may be assessed against Company by Bank for the privileges beingDisclosure of Charges.22._____________ for each withdrawal or transfer made at an ATM orafforded hereunder. Bank will charge Company $

______________ for each balance inquiry made at an ATM orterminal not owned by Bank. Bank will charge Company $terminal not owned by Bank. The character, type and amount of charges and fees are subject to change from time to timein the same manner as other fees and charges.

Other Provisions.23.

BANK

___________________________________________________________________________________By:

___________________________________________________________________Typed Name:

_________________________________________________________________________________Title:

Rev (7/26/06) Page 3 of 4

Date

Date

Date

Date

Date

Date

35

Sample

EXHIBIT A

having entered into the_______________________________________________________________________________________________________________________________________________________________,Business Debit Card Agreement by and between Company and Bank, hereby directs Bank to issue Cards in the followingnames:

Dollar LimitsEmployee Printed NameDollar LimitsEmployee Printed Name






Rev (7/26/06) Page 4 of 436

Sample

What You Need to Know About Overdrafts and Overdraft Fees

-

Overdraft Services and Opt-In (S)Bankers SystemsWolters Kluwer Financial Services 2010 Page 1 of 1

*ODOPTINNOT-S 4/2/2010

ELECTION FORM

An overdraft occurs when you do not have enough money in your account to cover a transaction, but we pay itanyway. We can cover your overdrafts in two different ways.

1. We have standard overdraft practices that come with your account.2. We also offer one or more overdraft protection plans, such as

This notice explains our standard overdraft practices.} What are the standard overdraft practices that come with my account?

We DO authorize and pay overdrafts for the following types of transactions:}}}

} ATM transactions} Everyday debit card transactions

We pay overdrafts at our discretion, which means we do not guarantee that we will always authorize and pay any typeof transaction.If we do not authorize and pay an overdraft, your transaction will be declined.} What fees will I be charged if

pays my overdraft?Under our standard overdraft practices:}

$}

$}

} What if I wantto authorize and pay overdrafts on my ATM and everyday debit card transactions?

I wantto authorize and pay overdrafts on my ATM and everyday debit card transactions for the account identified below.

Account Number(s):Printed Name:

37

Sample

Confirmation of Consent

-

Confirmation of ConsentBankers SystemsWolters Kluwer Financial Services 2010 Page 1 of 1

*CONF-CONSENT 3/12/2010

This notice is confirmation that you (the above named Account Owner) consented to our (the above named Institution) authorizingand paying overdrafts on your ATM and everyday debit card transactions with respect to the following account:

Account number

You have the right to revoke such consent at any time.

Institution Name and Address Account Owner Name and Address Date

.

38

Certificates of Deposit


Certificate of Deposit (CD-GEN-LAZ)

Variable/Fixed Rate Time Certificate of Deposit (VRFCD-LAZ)

7/31 Certificate of Deposit (7/31-CD-LAZ)

Certificate of Deposit Receipt-Bank (CDREC-BK-LAZ)

Term Share Certificate

Multipurpose Certificate/Signature Card (MP-CDSC-C1)

Multipurpose Receipt/Signature Card (MP-RCSC-C1)

39

40

Sample

Amount ofDeposit: $This Certificate is Issued to: Issuer:

By

Certificate of Deposit Certificate Number:Account Number:

SSN/TIN Number:

Not Negotiable - Not Transferable.

This account is subject to all the terms and conditions stated in the Certificate of Deposit Disclosures, as they may beamended from time to time, and incorporates the Certificate of Deposit Disclosures by reference into this agreement.

This certificate may be redeemed on only upon presentation of the certificate to the Financial Institution.The initial term of this certificate of deposit is . The interest rate of this certificate of deposit is % with an annual percentage yield of %.The rate on this certificate is l fixed l variable. The interest will be:l added to principall paid to account (No. )l mailed to the owner(s)l .

DateOpened:

Endorsements - Sign only when you request withdrawal.

X

X

-

Certificate of DepositBankers SystemsWolters Kluwer Financial Services 1994, 2008 Page 1 of 1Initials:

*CD-GEN-LAZ 4/8/2008

41

Sample

This CertificateEvidences ADeposit In TheName(s) Of:

Certificate Number

Account Number

SSN/TIN

Date

In The Amount Of

dollars $

ll

ll

Single Maturity l Automatically Renewable

Additions permitted in a minimum amount of $

Rate Structure: l Single Rate l Tiered Rate l Stepped Rate

Fixed Rate: Your deposit will earn interest at the initial interest rate(s) until first maturity.

Variable Rate: Initial Index Rate % Maximum Rate %

Minimum Rate % First Adjustment

Adjustment Frequency

Rate Formula

BY

within days after the maturity date; or

Endorsements (Sign only when requesting withdrawal):

x

x

AUTOMATIC RENEWALS: If the automatically renewable box is checked, theterms of this section apply, except as otherwise disclosed in writing. Thiscertificate will be automatically renewed after the stated maturity date stated forsuccessive terms, each equal to the original term. The interest rate will be thesame we offer on new certificates on the maturity date which have the same term,minimum balance (if any) and other features as this original certificate. You maycall us on or shortly before the maturity date and we will tell you what theinterest rate will be for the next renewal term.

The automatic renewal of this certificate may be prevented if one of thefollowing things happens:

(1) This certificate is personally presented for payment on a maturity date or

(2) We receive written notice from you before a maturity date of yourintention to cash in this certificate.

l At our option, we may accelerate the maturity, or call this account,

.

Upon final maturity, if any funds remain in the account, your deposit

l will l will not earn interest after final maturity, except as otherwise

disclosed in writing.

NUMBER OF ENDORSEMENTS REQUIRED:

Interest l will l will not accrue after maturity, except as otherwise


be made within days of the final maturity date.

-

Certificate of DepositBankers SystemsWolters Kluwer Financial Services 1982, 2010

VFRCD-LAZ 6/28/2010

Page 1 of 2*

SINGLE MATURITY: If the single maturity box is checked, you should presentthis certificate promptly at maturity for payment.

GENERALLY: "We" and "us" means the financial institution. "You" and"your" means the depositor(s). "Certificate" means both this original instrumentas well as the deposit it shows. This certificate (and the account it represents)may not be transferred or assigned without our prior written consent and is notnegotiable.

VARIABLE INTEREST RATE: The interest rate(s) may change during theterm, subject to the terms of the account. The interest rate we will pay on thiscertificate will not, however, be greater than the stated maximum rate (if any) orbe less than the stated minimum rate (if any).

COMPOUNDING: The compounding frequency and interest calculation methodwill not change during the term of the certificate, regardless of adjustments to theinterest rate, until we give reasonable notice to you of such change.

ADDITIONS: If we permit you to make any additions, they will only bepermitted in an amount equal to, or greater than, the minimum amount indicated.Except as otherwise disclosed in writing, the making of additions to this certificatewill not extend the maturity of all, or any portion, of the funds on deposit, andadditions will mature at the same time as the first deposit. No additions may

ACCOUNT TYPE AND TERMS - Only the boxes that are checked and the lines that are filled in apply. Any "*" means "See your account disclosure for details."

Account Type

Term (Initial)

Maturity Date (First)

Interest Rate (Initial) %

Annual Percentage Yield %

Compounded

Interest Calculated /

Interest Paid

(a) l By

(b) l By Deposit To Acct. No.

Bob Smith Sara Smith POD John Smith 217 Dogwood Lane, Metropolis, OK 80202

LongFormatCDLongFormatCD

000-00-0023 Customer No. 123-1

03/15/2011Two Thousand Five Hundred and 00/100 X X X X X X X X X X X X X X X

X X X X X X X X X X X X X X X X X X X X X X X X $2,500.00

Consumer 12 Month CD (Long Format CD)12 mth(s)

03/15/20122.5002.53

Monthly Actual 365

MonthlyX adding it to the account balance.

X

XX

Oklahoma Bank 123 This Street, This City, OK 12345 222-555-1212

*

10

X

1

*123-1%LongFormatCD%922%03/15/2011*42

Sample

-


VFRCD-LAZ 6/28/2010

Page 2 of 2*

ADDITIONAL TERMS:

CALCULATION OF INTEREST PENALTIES: For any fixed, single rate timedeposit we will use the nominal (simple interest) rate in effect to calculate theamount of the applicable penalty.

EXCEPTIONS: In certain circumstances, such as the death or incompetenceof an account owner, the law permits, or in some cases requires, the waiverof the early withdrawal penalty. Other exceptions may also apply, forexample, if this is part of an IRA or other tax-deferred savings plan.

NOTICE OF PENALTY FOR EARLY WITHDRAWAL

l

l

l

l

l

the average (weighted for time) of the simple interest rates earned during the

term up to the date of withdrawal;

the simple interest rate in effect at the beginning of the term;

the simple interest rate in effect at the time of early withdrawal;

the highest of the simple interest rates in effect during the term; or

l

l

l

l

the greater of all interest earned on the amount withdrawn or seven days'

interest on the amount withdrawn.

one month's interest on the amount withdrawn.

three months' interest on the amount withdrawn.

For any time deposit which earns a rate that may vary from time to time duringthe term, or for which multiple rates apply during the term, the interest rate wewill use to calculate the interest forfeiture will be:

Except as otherwise disclosed in writing, any early withdrawal we permit issubject to penalty. The penalty will be in an amount equal to:

We will charge the penalty first against any interest then in the account, and anyexcess will be deducted from the amount you withdraw.

X

*123-1%LongFormatCD%922%03/15/2011*43

Sample

This CertificateEvidences ADeposit In TheName(s) Of:

Certificate Number

Account Number

SSN/TIN

Date

ACCOUNT TYPE AND TERMS - Only the boxes that are checked and the lines that are filled in apply. Any "*" means "See your account disclosure for details."

Account Type

Term (Initial)

Maturity Date (First)

Interest Rate (Initial) %

Annual Percentage Yield %

Compounded

Interest Calculated /

Interest Paid

(a) l By

(b) l By Deposit To Acct. No.

Endorsements (Sign only when requesting withdrawal):

x

x

lRate Structure: l Single Rate l Tiered Rate l Stepped Rate

ll

Day Minimum Notice l Single Maturity l Automatically Renewable

Fixed Rate: Your deposit will earn interest at the initial interest rate(s) until first maturity.

Variable Rate: Initial Index Rate % Maximum Rate %

Minimum Rate % First Adjustment Date

Adjustment Frequency

Rate Formula

BY

AUTOMATIC RENEWALS: If the automatically renewable box is checked, theterms of this section apply, except as otherwise disclosed in writing. Thiscertificate will be automatically renewed after the stated maturity date stated forsuccessive terms, each equal to the original term. The interest rate will be thesame we offer on new certificates on the maturity date which have the same term,minimum balance (if any) and other features as this original certificate. You maycall us on or shortly before the maturity date and we will tell you what theinterest rate will be for the next renewal term.

The automatic renewal of this certificate may be prevented if one of thefollowing things happens:

(1) This certificate is personally presented for payment on a maturity date or

GENERALLY: "We" and "us" means the financial institution. "You" and"your" means the depositor(s). "Certificate" means both this original instrumentas well as the deposit it shows. This certificate (and the account it represents) orminimum notice account may not be transferred or assigned without our priorwritten consent and is not negotiable.

In The Amount Of

dollars $

*-

l At our option, we may accelerate the maturity, or call this account,

.

within days after the maturity date; or(2) We receive written notice from the depositor before a maturity date of

their intention to cash in this certificate.



7/31-CD-LAZ 8/30/2010

Page 1 of 2

VARIABLE INTEREST RATE: The interest rate(s) may change during theterm, subject to the terms of the account. The interest rate we will pay on thiscertificate will not, however, be greater than the stated maximum rate (if any) orbe less than the stated minimum rate (if any).COMPOUNDING: The compounding frequency and interest calculation methodwill not change during the term of the certificate, regardless of adjustments to theinterest rate, until we give reasonable notice to you of such change.DEFINED DAY MINIMUM NOTICE ACCOUNT: If we have specified anumber of days and checked the minimum notice box, then this account has nodefinite maturity date. To withdraw all or any portion of the account balancewithout penalty, you must give us (and we must actually receive) notice of yourintention to withdraw funds from this account. This notice period must be equalto the minimum number of days stated above. Your notice may be in writing orby such other means as we may permit, and must specify the amount and date ofintended withdrawal.

this certificate promptly at maturity for payment. Interest l will l will notaccrue after maturity, except as otherwise disclosed in writing.

SINGLE MATURITY: If the single maturity box is checked, you should present

NUMBER OF ENDORSEMENTS REQUIRED:

Upon final maturity, if any funds remain in the account, your deposit

l will l will not earn interest after final maturity, except as otherwise

44

Sample

Additions: If checked, you may make additions in an amount equal to or

greater than $ at any time.

Additions To Minimum Notice Accounts: An addition to a minimum notice

Your addition must remain on deposit for a period of time not less thanthe original term of this certificate. This means that your next maturitydate for all funds will be reset to the date that follows the date of theaddition by a period of time equal to the original term of this account.

Your addition must remain on deposit for a period of time not less thanthe original term of this certificate, plus the amount of time remaining onthe term at the time of the addition. This means that the first maturitydate for the addition will be the second regularly scheduled maturity datefollowing the date of the addition. Thereafter, all funds will have thesame maturity date(s).

l

Your addition will not extend the maturity of the funds on deposit.Additions will earn interest from the date of deposit, and will mature atthe same time as the existing deposit.

l

Additions to Single Maturity and Automatically Renewable Accounts(check one):

l

account will not be permitted if at the time of the proposed addition, arequest for withdrawal is pending which would, within the minimum noticeperiod following the proposed addition, reduce the account balance belowthe minimum balance required. If this account has a minimum notice of at

seven and not more than days, additional deposits must remain inthis account for a period equal to at least the notice period before such fundsmay be withdrawn without the imposition of an early withdrawal penalty.

l

l

*-


7/31-CD-LAZ 8/30/2010

Page 2 of 2

ADDITIONAL TERMS:

CALCULATION OF INTEREST PENALTIES: For any fixed, single rate timedeposit we will use the nominal (simple interest) rate in effect to calculate theamount of the applicable penalty.

EXCEPTIONS: In certain circumstances, such as the death or incompetenceof an account owner, the law permits, or in some cases requires, the waiverof the early withdrawal penalty. Other exceptions may also apply, forexample, if this is part of an IRA or other tax-deferred savings plan.

NOTICE OF PENALTY FOR EARLY WITHDRAWAL

l

l

l

l

l

the average (weighted for time) of the simple interest rates earned during the

term up to the date of withdrawal;

the simple interest rate in effect at the beginning of the term;

the simple interest rate in effect at the time of early withdrawal;

the highest of the simple interest rates in effect during the term; or

l

l

l

l

the greater of all interest earned on the amount withdrawn or seven

days' interest on the amount withdrawn.

one month's interest on the amount withdrawn.

three months' interest on the amount withdrawn.

l

For any time deposit which earns a rate that may vary from time to time duringthe term, or for which multiple rates apply during the term, the interest rate wewill use to calculate the interest forfeiture will be:

Except as otherwise disclosed in writing, any early withdrawal we permit issubject to penalty. The penalty will be in an amount equal to:

We will charge the penalty first against any interest then in the account, and anyexcess will be deducted from the amount you withdraw.

l

45

Sample- 1994 Bankers Systems, Inc., St. Cloud, MN Form CDREC-BK-LAZ 8/7/2002 (page 1 of 1)

This receipt is issued to:

Certificate of Deposit Receipt

The account evidenced by this receipt is subject to and further explained in the terms and conditions contained in the accountagreement and account disclosures. The account is Not Negotiable and Not Transferable. Only the items checked apply.

Account Number:IRA Number:

Amount $Date OpenedTermMaturity DateInterest Rate %Annual Percentage Yield %

l Fixed Interest Rate l Variable Interest Ratel Additions Permittedl Automatically Renewable l Single Maturity (not automatically renewable) l Callable l Notice Account

Interest will be:l mailed to the owner(s).l added to principal (compounded).l paid to account No.l

.

.


Oklahoma Bank 123 This Street, This City, OK 12345 222-555-1212

GeneralPurposeReceipt

1,000.0003/15/2011

12 mth(s)03/15/2012

2.5002.53

X

X

X

*123-1%GeneralPurposeReceipt%922%03/15/2011*46

SampleNot Negotiable - Not Transferable.

By

DateOpened:

-

This Certificate is Issued to: Issuer:

Term Share CertificateThis CertificateEvidences an Account in theOriginal Amount of

ENDORSEMENTS - SIGN ONLY WHEN YOU REQUEST A WITHDRAWAL.

X Date Notes

X Date Notes

X Date Notes

X Date Notes

This account is subject to all terms and conditions stated in the Certificate Account Disclosures, as they may be amended from time totime, and incorporates the same by reference into this agreement.

Certificate Number:Member Number:Account Number:

$

This certificate may be redeemed on only upon presentation of the certificate to the Credit Union. Thedividend rate of this certificate account is % with an annual percentage yield of %. The rate onthis certificate is l fixed l variable. Dividends will be:l added to principall paid to account (No. )l mailed to the owner(s)l

Additional Terms and Conditions:

Term Share CertificateBankers SystemsWolters Kluwer Financial Services 2001, 2008 Page 1 of 1Initials:

*CD-DIV-LAZ 3/3/2008

03/15/2011TermShareCD123-1TermShareCD

Two Thousand Five Hundred and 00/100 2,500.00


Oklahoma Credit Union 123 This Street, This City, OK 12345 222-555-1212

*See Certificate Account Disclosures for details.03/15/2012

2.500 2.53X

X

47

Sample

*

MP-CDSC-C1 (1) 12/25/2010

Page 1 of 2*

Date Opened:

(Date)

(Date)

(Date)

(Date)

Initial Amount of:dollars $

Account Holder: Financial Institution:

BY

Signatures for Withdrawal

Ownership of Account

Account Features


Following are the basic features of the account. The separate

Account No.:

ENDORSEMENTSSign only when requesting withdrawal.

X

X

X

X

account disclosure contains more detailed information.

Multipurpose Certificate/Signature Card (1)Bankers Systems*Wolters Kluwer Financial Services 2010-

04/12/2011 00000001

Five Hundred and 00/100 500.00

Josephine Nestegg123 Somewhere StreetThis City, MN 12345

Demo Organization123 This StreetThis City, MN 12345222-555-1212

RATE: The interest rate is 1.250% with disclosed annual percentageyield (APY) of 1.26%. The rate applies until the first maturity. Additional conditions apply. See the disclosure. CREDITING, COMPOUNDING: Earnings are typically creditedout of this account monthly, but you have arranged crediting intothis account monthly. Compounding will occur monthly.AUTOMATIC RENEWAL: The account automatically renews atmaturity. Each renewal term will be the same as the original term.The interest rate upon renewal will be the rate we offer at the timeof renewal on new accounts with the same features as the accountbeing renewed. The account has a grace period of 10 calendar day(s)after maturity for withdrawal without penalty. You may preventrenewal by withdrawing the funds at maturity or by advance writtenor telephone notice.

EARLY WITHDRAWAL PENALTY: The penalty will equalthree months' interest on the amount withdrawn subject topenalty. Some exceptions may apply. CALL FEATURE: We may terminate this account, at ouroption, with a 30 day notice.EARNINGS COMPUTATION: Earnings will be calculatedusing the daily balance method. NO ADDITIONS: Additions are not permitted prior tomaturity. WITHDRAWAL LIMITS: Early withdrawals of principal arenot allowed before maturity. Credited interest can bewithdrawn during the term, subject to penalty. Earnings canonly be withdrawn on the crediting dates.

Individual Account(The terms of various ownership options are described in theaccount Terms and Conditions.)

1

CERTIFICATE OF DEPOSIT12 Month Certificate of Deposit

Term: 12 month(s)Number: 00000001

Customer No.:Maturity Date:

11104/12/2012

This Certificate Evidences a Deposit in the

Not Negotiable - Not Transferable - Additional terms are below.

48

Sample

MP-CDSC-C1 (1) 12/25/2010

Page 2 of 2

Other Terms

Account holder signed a copy of this document that included aU.S. Taxpayer Identification Number certification and statementscertifying the accuracy of information provided and agreeing tothe terms of this account and the terms of the following (copies ofwhich were delivered separately):


"We," "us," and "our" mean the Financial Institution and issuerof this certificate, and "you" and "your" mean the account holder."Account" means the certificate as well as the account it evidences. You must present this certificate when you request withdrawal ortransfer. Keep this document in a safe place. If the certificate is lost,stolen or destroyed, additional conditions for withdrawal may apply.For example, you may be required to indemnify us for any losses wemight suffer in the event of future disputes, and you may have toprovide a surety bond. A fee may also apply, if disclosed separately. You have agreed to keep your funds in this account until thematurity date. (Automatically renewable accounts mature at regularintervals.) You cannot transfer the account without obtaining ourwritten consent. "Transfers" include any change in ownership,withdrawal, or survivorship rights, or any pledge or assignment ofthis account as collateral. Any pledge, and any right we have torepayment of indebtedness, must first be satisfied before the rightsof any survivor or beneficiary are effective. "Required number of signatures for withdrawal" means thenumber of you who can request withdrawal or transfer. Forexample, if two or more of you sign the signature card but only onesignature is required for withdrawal, then any one of you mayrequest withdrawal of the entire account. Except as agreed inwriting, only one signature is required. You must notify us in writing of any change of name, address orother circumstances relating to this account. The account is subjectto any "Terms and Conditions" you have received, as they maychange from time to time, under their terms. The account is void iffunded by any method requiring collection (such as a check) and thefunds are not promptly collected in full. If the account is funded ormade payable in a foreign currency, the amount will be adjusted toreflect final exchange into U.S. dollars.

Account Disclosure (Truth In Savings), Privacy, Common Features (fees,etc), Terms & Conditions (including Electronic Disclosures and Notices),Electronic Fund Transfers, Funds Availability, Substitute Checks

49

Sample

MP-CDSC-C1 (2) 12/25/2010

Page 1 of 2

Date Opened:



BY

Account Features

Following are the basic features of the account. The separateaccount disclosure contains more detailed information.

Account No.:


l I am an EXEMPT recipient under the Internal Revenue ServiceRegulations.I certify under penalties of perjury the statements checked aboveand that I am a U.S. person (includes U.S. resident aliens).


(Date)X


l The number shown above is my correct TIN.

l I am NOT subject to backup withholding either because I have notbeen notified that I am subject to backup withholding as a result of failureto report all interest or dividends, or the Internal Revenue Service hasnotified me that I am no longer subject to backup withholding.


Taxpayer Identification Number (TIN):


[Authorized Signature Appears on Certificate]


Individual Account(The terms of various ownership options are described in theaccount Terms and Conditions.) X

X

000-00-0001

RATE: The interest rate is 1.250% with disclosed annual percentageyield (APY) of 1.26%. The rate applies until the first maturity. Additional conditions apply. See the disclosure. CREDITING, COMPOUNDING: Earnings are typically credited outof this account monthly, but you have arranged crediting into thisaccount monthly. Compounding will occur monthly.AUTOMATIC RENEWAL: The account automatically renews atmaturity. Each renewal term will be the same as the original term.The interest rate upon renewal will be the rate we offer at the time ofrenewal on new accounts with the same features as the account beingrenewed. The account has a grace period of 10 calendar day(s) aftermaturity for withdrawal without penalty. You may prevent renewalby withdrawing the funds at maturity or by advance written ortelephone notice.

EARLY WITHDRAWAL PENALTY: The penalty will equalthree months' interest on the amount withdrawn subject topenalty. Some exceptions may apply. CALL FEATURE: We may terminate this account, at ouroption, with a 30 day notice.EARNINGS COMPUTATION: Earnings will be calculatedusing the daily balance method. NO ADDITIONS: Additions are not permitted prior tomaturity. WITHDRAWAL LIMITS: Early withdrawals of principal arenot allowed before maturity. Credited interest can bewithdrawn during the term, subject to penalty. Earnings canonly be withdrawn on the crediting dates.

Term: 12 month(s)

04/12/2011Customer No.:Maturity Date:

Number: 000000010000000111104/12/2012500.00

Demo Organization123 This StreetThis City, MN 12345222-555-1212


Josephine Nestegg123 Somewhere StreetThis City, MN 12345

Five Hundred and 00/100

The Certificate Evidences a Deposit in the

12 Month Certificate of Deposit

Signature Card & Copy of Certificate of Deposit

1

50

Sample

MP-CDSC-C1 (2) 12/25/2010

Page 2 of 2

Signature(s)

DateDate

DateDate

DateDate

DateDate

The undersigned certify the accuracy of the information provided. The undersigned personally, and as or on behalf of theaccount owner(s), agree to the terms, and acknowledge receiving copy(ies), of this document and the following:

Other Terms


Josephine NesteggAccount Owner

"We," "us," and "our" mean the Financial Institution and issuerof this certificate, and "you" and "your" mean the account holder."Account" means the certificate as well as the account it evidences. You must present this certificate when you request withdrawal ortransfer. Keep this document in a safe place. If the certificate is lost,stolen or destroyed, additional conditions for withdrawal may apply.For example, you may be required to indemnify us for any losses wemight suffer in the event of future disputes, and you may have toprovide a surety bond. A fee may also apply, if disclosed separately. You have agreed to keep your funds in this account until thematurity date. (Automatically renewable accounts mature at regularintervals.) You cannot transfer the account without obtaining ourwritten consent. "Transfers" include any change in ownership,withdrawal, or survivorship rights, or any pledge or assignment ofthis account as collateral. Any pledge, and any right we have torepayment of indebtedness, must first be satisfied before the rightsof any survivor or beneficiary are effective. "Required number of signatures for withdrawal" means thenumber of you who can request withdrawal or transfer. Forexample, if two or more of you sign the signature card but only onesignature is required for withdrawal, then any one of you mayrequest withdrawal of the entire account. Except as agreed inwriting, only one signature is required. You must notify us in writing of any change of name, address orother circumstances relating to this account. The account is subjectto any "Terms and Conditions" you have received, as they maychange from time to time, under their terms. The account is void iffunded by any method requiring collection (such as a check) and thefunds are not promptly collected in full. If the account is funded ormade payable in a foreign currency, the amount will be adjusted toreflect final exchange into U.S. dollars.

Account Disclosure (Truth In Savings), Privacy, Common Features (fees, etc), Terms & Conditions (including ElectronicDisclosures and Notices), Electronic Fund Transfers, Funds Availability, Substitute Checks

51

Sample

MP-RCSC-C1 12/25/2010

Page 1 of 2

Date Opened:



By:

Account Features

Account No.:


l I am an EXEMPT recipient under the Internal Revenue ServiceRegulations.I certify under penalties of perjury the statements checked aboveand that I am a U.S. person (includes U.S. resident aliens).


(Date)X



l The number shown above is my correct TIN.l I am NOT subject to backup withholding either because I have notbeen notified that I am subject to backup withholding as a result of failureto report all interest or dividends, or the Internal Revenue Service hasnotified me that I am no longer subject to backup withholding.

(If not a "U.S. Person," certify foreign status separately.)Taxpayer Identification Number (TIN):

Following are the basic features of the account. The separateaccount disclosure contains more detailed information.

Multipurpose Receipt/Signature Card

Wolters Kluwer Financial Services 2010-*Bankers Systems

03/15/2011

Joint Account - With Survivorship (And Not As Tenants InCommon) with Pay On Death Beneficiary(ies) (The terms of various ownership options are described in theaccount Terms and Conditions.)

XX

SIGNATURE CARD & RECEIPT OF DEPOSITConsumer 12 Month CD (Receipt/Sig Card Combo)

This Receipt Evidences a Deposit in the

Two Thousand Five Hundred and 00/100

Bob Smith Sara Smith POD John Smith 217 Dogwood Lane Metropolis, OK 80202

Oklahoma Bank 123 This Street This City, OK 12345 222-555-1212


Term: 12 month(s)

RATE: The interest rate is 2.500% with disclosed annualpercentage yield (APY) of 2.53%. The rate applies until the firstmaturity. CREDITING, COMPOUNDING: Earnings will be credited intothe account monthly. Compounding will occur monthly. AUTOMATIC RENEWAL: The account automatically renews atmaturity. Each renewal term will be the same as the original term.The interest rate upon renewal will be the rate we offer at the timeof renewal on new accounts with the same features as the accountbeing renewed. The account has a grace period of 10 calendarday(s) after maturity for withdrawal without penalty. You mayprevent renewal by withdrawing the funds at maturity or byadvance written or telephone notice.

EARLY WITHDRAWAL PENALTY: The penalty will equalthree months' interest on the amount withdrawn subject to penalty.Some exceptions may apply. EARNINGS COMPUTATION: Earnings will be calculated usingthe daily balance method. NO ADDITIONS: Additions are not permitted prior to maturity. WITHDRAWAL LIMITS: Early withdrawals of principal areallowed, only if we agree, subject to penalty. Credited interest canbe withdrawn during the term, subject to penalty. Creditedearnings may be withdrawn any time during the term.

1

Receipt/CDSigCard123-103/15/20122,500.00

Customer No.:Maturity Date:

000-00-0023

JOE OFFICER / sskroch

52

SampleSignature(s)

Date

Date

Date

Date

The undersigned certify the accuracy of the information provided. The undersigned personally, and as or on behalf of theaccount owner(s), agree to the terms, and acknowledge receiving copy(ies), of this document and the following:

Other Terms

Date

Date

Date

Date

MP-RCSC-C1 12/25/2010

Page 2 of 2Multipurpose Receipt/Signature CardBankers Systems

-Wolters Kluwer Financial Services 2010*

Bob Smith Account Owner

Sara Smith Account Owner

Account Disclosure (Truth In Savings), Privacy, Common Features (fees, etc), Terms & Conditions

"We," "us," and "our" mean the Financial Institution and issuerof this receipt, and "you" and "your" mean the account holder. This receipt and signature card evidences this account in theinitial amount indicated. This receipt is NOT a certificate or othersimilar legal instrument. It does not need to be presented orendorsed to withdraw funds. However, this receipt, along with anyother documentation provided to you, does contain importantinformation about your account and should be kept in a safe place. You have agreed to keep your funds in the account until thematurity date. (Automatically renewable accounts mature at regularintervals.) You cannot transfer the account without obtaining ourwritten consent. "Transfers" include any change in ownership,withdrawal, or survivorship rights, or any pledge or assignment ofthe account as collateral. Any pledge, and any right we have torepayment of indebtedness, must first be satisfied before the rightsof any survivor or beneficiary become effective. "Required number of signatures for withdrawal" means thenumber of you who can request withdrawal or transfer. Forexample, if two or more of you sign the signature card but only onesignature is required for withdrawal, then any one of you mayrequest withdrawal of the entire account. Except as specified inwriting, only one signature is required. You must notify us in writing of any change of name, address orother circumstances relating to the account. The account is subject toany "Terms and Conditions" you have received, as they may changefrom time to time, under their terms. The account is void if fundedby any method requiring collection (such as a check) and the fundsare not promptly collected in full. If the account is funded or madepayable in a foreign currency, the amount will be adjusted to reflectfinal exchange into U.S. dollars.

SOURCE OF FUNDS: Non Cash - New Money BENEFICIARY INFORMATION: John Smith; TIN: 000-00-0025; DOB 02/02/2001; ADDR: 217Dogwood Ave, Metropolis, OK 80202

53

54

IRA Documents


IRA Age 70 ½ Election Form for Traditional and SIMPLE IRAs (IRA-6-LAZ)

IRA Contribution Instructions for Traditional, Roth, and SIMPLE IRAs (IRACMBCONLAZ)

IRA Distribution Form for Traditional, Roth, and SIMPLE IRAs (IRACMBDISLAZ)

IRA Election of Payment by Beneficiary for Traditional, Roth, and SIMPLE IRAs (IRACMBEPBLAZ)

IRA Recharacterization Notice (IRA-RCHT-LAZ)

Request for Transfer or Conversion to IRA for Traditional, Roth, and SIMPLE IRAs (IRACMBTRCVLZ)

IRA Rollover or Conversion Review for Traditional, Roth, and SIMPLE IRAs (IRACMBROLLAZ)

Traditional IRA Organizer-Custodial (IRA-49-LAZ)

Roth IRA Organizer-Custodial (IRACUSROTHLZ)

Request for Direct Rollover to a Traditional IRA (IRA-DIRROLLZ)

55

56

Sample

4

IRA Age 70½ Election Formfor Traditional and SIMPLE IRAs

WITHHOLDING ELECTION (See IRS Form W-8BEN if you are a foreign person.)

Signature of IRA Owner Date

3PAYMENT INSTRUCTIONS

5SIGNATURES

2AGE 70½ REQUIRED MINIMUM DISTRIBUTION METHOD

-

I hereby accept the elections I made above, and I agree with the terms of this form. I acknowledge that the custodian/trustee cannot provide mewith legal advice, and I agree to consult with my own tax or legal professional when I need advice. I understand that I am responsible for myprovision of accurate information, my required minimum distributions, and the consequences of my actions. I acknowledge that thecustodian/trustee is not responsible for my actions, and I agree to indemnify and hold the custodian/trustee harmless from any liabilities whichare a result of my actions.

The instructions to Form W-4P (Withholding Certificate) are included in the Additional Information section of this form.

l I elect not to have Federal income tax withheld from my IRA distribution.l I elect to have 10 percent Federal income tax withheld from my IRA distribution.

I want the following additional dollar amount ($ ), or additional percentage ( %) withheld from each IRA distribution.l I elect to have $ or % State income tax withheld from my IRA distribution (if applicable).

Form W-4PDepartment of the Treasury

Internal Revenue ServiceOMB No. 1545-0074

l Immediate distribution of my RMDamount of $ fortax year .

l Periodic DistributionI authorize automatic distributions of$ on al monthly l annuall quarterly l otherbasis, starting ondetermined by my RMD calculation.Continue periodic distributions until Inotify you in writing otherwise.

l I waive my RMD from this IRA andwill take it from another traditionalor SIMPLE IRA for all years untilI notify you in writing otherwise.

l Other (including transfers)

Upon reaching your age 70½ year, a required minimum distribution (RMD) must be calculated for you each year using one of two methods,depending upon the age and relationship of your primary beneficiary. Please check the box(es) that applies:

My spouse is the sole primary beneficiary on January 1 of the first distribution year.Is your spouse more than 10 years younger than you?l No - Use Uniform Lifetime Table.l Yes - Use Joint and Last Survivor Table. Spouse's Date of BirthMy spouse is not the sole primary beneficiary on January 1 of the first distribution year - Use Uniform Lifetime Table.I am not married - Use Uniform Lifetime Table.

(page 1 of 2)1975 Wolters Kluwer Financial Services - Bankers Systems* Form IRA-6-LAZ Rev. 2/1/2006

IRA OWNER INFORMATION

DATE OF BIRTH

1

I elect my required minimum distributions tobe paid in the following manner (select one):

l

ll

Signature of Custodian/Trustee Date

C. PAYMENT DETAIL (completed by financial organization)B. PAYMENT METHOD

E-MAIL (OPTIONAL)SOCIAL SECURITY NUMBER

TYPE OF IRA (SELECT ONE):NAME, ADDRESS, CITY, STATE AND ZIP

A. PAYMENT ELECTION

(1)

(2)

(3)

(4)

DAYTIME PHONE NUMBER

l Traditional IRA l SIMPLE IRAIRA ACCOUNT NUMBER

l Mail check to me.

l Deposited into myaccount at thisfinancial organization.Account Type

Account Number

l Other

(1)

(2)

(3)

Date of Distribution

Amount Requested $Penalties Charged (-)Administrative Fees (-)Subtotal (amount subject to withholding) $Federal Income Tax Withheld (-)State Income Tax Withheld (if applicable) (-)Local Tax Withheld (-)Net Amount Paid $

Earnings paid to date not already reported to IRAAdministration Provider (optional). Include thisfigure in the Amount Requested.$

Does this distribution close the IRA? l Yes l No

57

Sample

(page 2 of 2)-1975 Wolters Kluwer Financial Services - Bankers Systems* Form IRA-6-LAZ Rev. 2/1/2006

election each year. You can change the amount to be withheld by usingIRS Form W-4P or an appropriate substitute form.

State Withholding. Your state may allow or require state income taxwithholding on any taxable distribution.

Local Withholding. Your local governing authority may allow or requirelocal income tax withholding on any taxable distribution.

Required Beginning Date (RBD). Your RBD for your requiredminimum distributions is April 1 of the year following the year inwhich you attained age 70½. You have until this date to take the firstrequired distribution. All subsequent distributions must be received byDecember 31 of each distribution year.

Required Minimum Distribution (RMD). The rules and regulationsgoverning your IRA require that distributions must begin when youreach your age 70½ year. Generally, the balance in your IRA at theend of each year will be divided by a life expectancy factor todetermine your required minimum distribution for the following year.

Life Expectancy Factor. Most IRA owners will calculate theirrequired minimum distributions using the Uniform Lifetime Table.This table is indexed to the age of an IRA owner as of the end of ayear and automatically provides a joint and last survivor expectancyfactor assuming a beneficiary ten years younger than the IRA owner.You will use this table each year, and your age at the end of the year,to determine your life expectancy factor.

However, if on January 1 of any distribution year only beneficiary isyour spouse who is more than ten years younger than you, your RMDfor that year will be calculated from the Joint and Last Survivor Tableusing your and your spouse's ages at the end of that year. Your RMDfor that year will not change if your spouse dies or you becomedivorced during that year. Any other change will require a newcalculation using the Uniform Lifetime Table.

Previous Year-End Balance. The account balance used in thecalculation is the fair market value of the IRA on the previousDecember 31. Several adjustments may be necessary to the previousyear-end balance before you can calculate your required minimumdistribution for the year.

Waivers. The law permits you to waive your required minimumdistribution from one of your traditional IRAs if you take it from adifferent traditional IRA. For this purpose, you must calculate therequired minimum distribution for each traditional IRA you own andadd the individual required minimums together. This aggregate totalcan be distributed from any one or more of your traditional IRAs. Youshould provide a written notice of waiver to any custodian/trusteeaffected by your election to distribute elsewhere. You can only use thisaggregation and waiver for the traditional IRAs you actually own.IRAs, including Roth IRAs, that you have a right to as beneficiarycannot be aggregated with your personal traditional IRAs.

Purpose. The IRA Age 70½ Election Form for Traditional and SIMPLEIRAs is designed to document your calculation method for your requiredminimum distributions upon reaching your age 70½ year. It will alsoallow you to choose how you will receive these distributions.

For Additional Guidance. It is in your best interest to seek the guidanceof your tax or legal professional before completing this document. Formore information refer to Internal Revenue Service (IRS) Publication590f Individual Retirement Arrangements, IRS Publication 505fTaxWithholding and Estimated Tax, instructions to your federal income taxreturn, your local IRS office, or the IRS's web site at www.irs.gov.

Failure to Distribute. The penalty for failing to take your requiredminimum distribution in any taxable year is a 50 percent excise tax forthat year on the amount not distributed as required. IRS Form 5329 isused to report the tax on excess accumulations.

Terms. A general understanding of the following terms may be helpful incompleting your transactions.

Withholding of Federal Income Tax. Generally, federal income taxwithholding applies to your IRA distributions. The method and rate ofwithholding depends on (a) the type of distribution you receive, (b)whether the distribution is delivered outside the United States or itspossessions, and (c) whether you (or your beneficiary after your death)are a nonresident alien individual, a nonresident alien beneficiary, or aforeign estate. Qualified distributions from a Roth IRA are nontaxableand, therefore, not subject to withholding. Because your tax situation maychange from year to year, you may want to change your withholding

ADDITIONAL INFORMATION

Nonperiodic Paymentsf10% Withholding. Distributions from anIRA that are payable on demand are treated as nonperiodic payments.Your IRA custodian/trustee must withhold at a flat 10% rate from yourIRA distributions unless you choose not to have federal income taxwithheld. You can choose not to have income tax withheld from anonperiodic payment by using IRS Form W-4P or an appropriatesubstitute form and providing your correct tax identification number(TIN). Generally, your choice to have income tax withheld or not willapply to any later distribution from your IRA. You may also specify anadditional amount that you want withheld.

Caution. If you do not provide your correct TIN, your IRAcustodian/trustee cannot honor your request not to have income taxwithheld and must withhold 10% of the payment for federal incometax.

Choosing Not to Have Income Tax Withheld. You (or in the event ofdeath, your beneficiary or estate) can choose not to have income taxwithheld from your payments by using Form W-4P or an appropriatesubstitute form. For an estate, the election to have no income taxwithheld may be made by the executor or personal representative ofthe decedent. The executor/representative must provide the estate'sTIN/employer identification number (EIN).

Caution. There are penalties for not paying enough federal income taxduring the year, either through withholding or estimated tax payments.New retirees, especially, should see IRS Publication 505, TaxWithholding and Estimated Tax. It explains the estimated taxrequirements and describes penalties in detail. You may be able toavoid quarterly estimated tax payments by having enough tax withheldfrom your IRA using Form W-4P or an appropriate substitute form.

Changing Your "No Withholding" Choice. If you previously chosenot to have income tax withheld and you now want 10% withholding,write "Revoked" next to the checkbox on line 1 of IRS Form W-4Pand provide a copy to your IRA custodian/trustee. To the extent youwant a greater amount withheld, complete a new Form W-4P or anappropriate substitute form for your IRA custodian/trustee.

Payments to Foreign Persons and Payments Outside the UnitedStates. Unless you are a nonresident alien, withholding (in the mannerdescribed above) is required on any nonperiodic payments that aredelivered to you outside the United States or its possessions. Youcannot choose not to have income tax withheld on Form W-4P. SeeIRS Publication 505, Tax Withholding and Estimated Tax for additionaldetails.

In the absence of a tax treaty exemption, nonresident aliens,nonresident alien beneficiaries, and foreign estates generally aresubject to a 30% withholding tax under IRC Section 1441 on thetaxable portion of a nonperiodic pension or annuity payment that isfrom U.S. sources. However, most tax treaties provide that privatepensions and annuities are exempt from withholding and tax. Also,payments from certain pension plans are exempt from withholdingeven if no tax treaty applies. See IRS Publication 515, Withholding ofTax on Nonresident Aliens and Foreign Entities, and IRS Publication519, U.S. Tax Guide for Aliens, for details. A foreign person shouldsubmit IRS Form W-8BEN, Certificate of Foreign Status of BeneficialOwner for United States Tax Withholding, to the IRA custodian/trusteebefore receiving any payments. The Form W-8BEN must contain theforeign person's TIN.

If you are a foreign person who has provided an IRA custodian/trusteewith IRS W-8BEN, the IRA custodian/trustee will furnish a statementto you on IRS Form 1042-S, Foreign Person's U.S. Source IncomeSubject to Withholding, by March 15 of next year.

58

Sample

IRA Contribution Instructionsfor Traditional, Roth, and SIMPLE IRAs

2TRADITIONAL IRA CONTRIBUTION (See Additional Information included with this form.)

Regular (including Catch-Up) Rollover/Direct Rollover from an Eligible Retirement PlanSimplified Employee Pension (SEP) Plan Qualified Reservist/Designated Disaster Distribution Repayment*Recharacterization Disaster/Combat Zone Postponed Contribution*Rollover *Reason Code (if applicable)Transfer

1 IRA OWNER INFORMATION

6SIGNATURESI certify that I am the IRA owner, employer, or individual legally authorized to complete this form. I certify the accuracy of the information setforth in this form, and I authorize this transaction. I certify that this contribution is eligible for deposit, and I assume full responsibility fordetermining my eligibility and for ensuring the eligibility of the contribution. My designation of the tax year for the contribution, and any electionto treat a contribution as a rollover or recharacterization, is irrevocable. I indemnify and agree to hold the custodian/trustee harmless from anyresulting liabilities. I acknowledge that the custodian/trustee cannot provide, and has not provided, me with tax or legal advice. I have beenadvised to seek the guidance of a tax or legal professional.

ROTH IRA CONTRIBUTION (See Additional Information included with this form.)

TAX YEARINVESTMENT NUMBERTAX YEAR OF FIRST ROTH IRACONTRIBUTION/CONVERSION

INVESTMENT NUMBER

AMOUNT

AMOUNT CONTRIBUTION DATE

$3

SIMPLE IRA CONTRIBUTION (See Additional Information included with this form.)

Regular (including Catch-Up) Rollover/Direct Rollover from an Eligible Retirement PlanRollover Rollover/Direct Rollover from a Designated Roth AccountTransfer Qualified Reservist/Designated Disaster Distribution Repayment*Recharacterization Disaster/Combat Zone Postponed Contribution*Conversion *Reason Code (if applicable)

CONTRIBUTION TYPE: l Employer Contribution l Rollover from a SIMPLE IRAl Recharacterization l Transfer from a SIMPLE IRA

-

INVESTMENT NUMBER AMOUNT CONTRIBUTION DATE INITIAL CONTRIBUTION DATE4 $

Signature of Custodian/Trustee DateSignature of IRA Owner/Employer Date

TAX YEAR

5EMPLOYER INFORMATION (For SEP or SIMPLE contributions.)TAXPAYER IDENTIFICATION NUMBER


NAME, ADDRESS, CITY, STATE, AND ZIP

NAME, ADDRESS, CITY, STATE, AND ZIP

DATE OF BIRTH DAYTIME PHONE NUMBERSOCIAL SECURITY NUMBERIRA ACCOUNT (PLAN) NUMBER

$

TAX YEAR

CONTRIBUTION DATE

IRA Contribution Instructions for Traditional, Roth, and SIMPLE IRAsBankers SystemsWolters Kluwer Financial Services 1998, 2011 Page 1 of 3

*IRACMBCONLAZ 1/1/2011

CONTRIBUTION TYPE: l ll ll ll ll

CONTRIBUTION TYPE: l ll ll lll

59

Sample

Purpose. The IRA Contribution Instructions for Traditional, Roth, andSIMPLE IRAs form is used to document an individual retirement account(IRA) contribution transaction.

Additional Documents. Applicable law or policies of the IRAcustodian/trustee may require additional documentation. For arecharacterization, the Internal Revenue Service (IRS) requires you toprovide a written notice of recharacterization.

For Additional Guidance. It is in your best interest to seek the guidanceof a tax or legal professional before completing this document. Youshould also reference the IRA agreement and disclosure statement and/oramendments provided by the custodian/trustee. For more informationrefer to IRS Publication 590, Individual Retirement Arrangements (IRAs),IRS Publication 560, Retirement Plans for Small Business, IRS Form5498, IRA Contribution Information, your local IRS office, or the IRS'sweb site at www.irs.gov.


allowed three years after the date of receipt to roll over all or part ofthe qualified distribution without being subject to the one rollover per12-month rule or the 60-day requirement. Certain first-time homebuyeror hardship distributions may be eligible for rollover within aprescribed time period. Indicate the reason code as provided by thereporting instructions for IRS Form 5498 (e.g., DD for repayment of afederally designated disaster distribution).

Reason Code. The reporting instructions for IRS Form 5498 provide acode for use with designated IRA contribution types. Enter the code, ifapplicable, to indicate the reason for the contribution.

Recharacterization. A recharacterization is the method by which anIRA owner can redesignate the type of IRA contribution made for theyear. The deadline to recharacterize a contribution, plus earnings forany tax year, is the IRA owner's tax-filing due date, includingextensions. The IRS also requires you to provide a written notice ofrecharacterization.

Rollover or Direct Rollover from a Designated Roth Account. Ifyou have assets in a designated Roth account, these assets can berolled over or directly rolled over to a Roth IRA.

Rollover or Direct Rollover from an Eligible Retirement Plan. Youmay roll over or directly roll over any eligible assets from an employerplan to a Roth IRA. The taxable portion of the direct rollover amountis subject to federal income tax.

SIMPLE IRA Contribution. Employer contributions includeemployee deferrals, employer matching contributions, and employernonelective contributions.

Tax Year of First Roth Contribution/Conversion. Roth IRA ownerscan avoid paying tax on earnings if they do not remove earningsduring the five-year period that begins with the tax year the firstcontribution was made, regardless of contribution type.


Spouse as Beneficiary. A spouse beneficiary may roll over inheritedeligible retirement plan assets. This is not available to a nonspousebeneficiary.

SIMPLE IRA Restrictions. You are not allowed to transfer or roll overassets from an eligible retirement plan to a SIMPLE IRA. A rollover ortransfer from a SIMPLE IRA to a traditional IRA, or a conversion ofSIMPLE IRA assets to a Roth IRA, is not allowed within a two-yearperiod that begins on the date of the initial contribution to your SIMPLEIRA. You may, however, roll over or transfer a SIMPLE IRA to aSIMPLE IRA within the two-year period.

SEP or SIMPLE Employer Contributions. All SEP or SIMPLEcontributions should be made by the employer sponsoring the SEP plan orSIMPLE.

Traditional and Roth IRA Contributions. An annual contribution,commonly referred to as a regular contribution, is your contribution forthe tax year, and is based on your and/or your spouse's compensation.Your designation of the tax year for your contribution is irrevocable. Youmay direct all or a portion of any tax refund directly to an IRA.

Conversions. A conversion is a reportable movement of assets from atraditional IRA or SIMPLE IRA to a Roth IRA.

Designated Roth Account. A designated Roth account is an accountthat is part of an IRC Section 401(a) or 403(b) plan that accepts salarydeferrals designated as Roth contributions. Common names for theseplans include Roth 401(k) and Roth 403(b) plans.

Disaster/Combat Zone Postponed Contribution. IRA owners servingin a combat zone or hazardous duty area, or affected by a federallydeclared disaster area, have an additional period after the normalcontribution due date of April 15 to make annual IRA contributions fora prior year. Indicate the reason code as provided by the reportinginstructions for IRS Form 5498 (e.g., FD for a postponed contributiondue to an extension of the contribution due date because of a federallydesignated disaster). Eligible Retirement Plan. Eligible retirement plans include qualifiedtrusts under IRC Section 401(a), annuity plans under IRC Section403(a), annuity contracts under IRC Section 403(b), and certaingovernmental IRC Section 457(b) plans. Common names for theseplans include 401(k), profit sharing, pension, money purchase, federalthrift savings, and tax-sheltered annuity plans.

Qualified Reservist/Designated Disaster Distribution Repayment.If you are a qualified reservist ordered or called to active duty afterSeptember 11, 2001 for more than 179 days (or for an indefiniteperiod), and take an IRA distribution or take certain elective deferralsfrom an eligible retirement plan after September 11, 2001, and beforethe end of your active duty, you may make one or more contributionsof these assets to your IRA within two years of the end of your activeduty.

Individuals in certain federally declared disaster areas may be giventhe opportunity to take qualified distributions (subject to applicabletime periods defined by law) in aggregation from IRAs and othereligible retirement plans up to the prescribed limit (e.g., $100,000 forMidwestern Disaster and Hurricane Katrina). An individual may be

-



60

Sample

-



Maximum Contribution Limits. Your regular and catch-up IRAcontributions are limited to the lesser of 100 percent of your and/or yourspouse's compensation or the dollar amount announced each year. TheIRS announces the maximum contribution limits each year providingcost-of-living adjustments, if any, as required under the IRC. Refer to IRSPublication 590 or your tax or legal professional to determine the amountyou are eligible to contribute for a tax year.

Contribution By Your Spouse. If you are married, file a joint federalincome tax return, and are younger than age 70 1/2 (traditional IRA only)during the entire tax year, you and/or your spouse may make acontribution on your behalf for that tax year if you and/or your spousehave compensation. This contribution must be made into your IRA, and itcannot exceed the contribution limits applicable to regular IRAcontributions. Catch-Up Contributions. Catch-up contributions are IRA contributionsmade in addition to any other regular IRA contributions. You are eligibleto make catch-up contributions if you meet the eligibility requirements forregular contributions and you attain age 50 by the end of the taxable yearfor which a catch-up contribution is being made.

61

Sample

IRA Distribution Formfor Traditional, Roth, and SIMPLE IRAs

SOCIAL SECURITY NUMBER (SSN)

Tax Year of First Roth IRA Contribution/Conversion:


2DISTRIBUTION REASON Select One. (For further information, see Additional Information included with this form.)

l Mail check to me.


Account Number

l Other

PAYMENT ELECTION

TYPE OF IRA (SELECT ONE)

3PAYMENT INSTRUCTIONSPAYMENT DETAIL (completed by financial organization)PAYMENT METHOD

IRA ACCOUNT (PLAN) NUMBER

(1)

(2)

(3)

I elect distributions to be paid in thefollowing manner (select one):


l Conversion. I am l age 59½ or older l younger than age 59½.l Direct Rollover to an employer-sponsored Eligible Retirement Planl SIMPLE IRA Distribution in Two-Year Period (if less than age 59½)

l Traditional IRAl SIMPLE IRAl Roth IRA

Amount Requested $Penalties Charged (-)Administrative Fees (-)Subtotal (amount subject to withholding) $Federal Income Tax Withheld (-)State Income Tax Withheld (if applicable) (-)Local Tax Withheld (-)Net Amount Paid $Earnings paid to date not already reported to IRAAdministration Provider (optional). Include this figurein the Amount Requested. $Does this distribution close the IRA? l Yes l No

NAME, ADDRESS, CITY, STATE AND ZIP

Continue periodic distributions until Inotify you in writing otherwise.

Recipient Information (Complete for IRS Levy, Death, Transfer, Recharacterization, Direct Rollover, and QHSAFD transactions.)

BENEFICIARY DATE OF BIRTH (IF APPLICABLE)

IRA ACCOUNT (PLAN) NUMBER (IF APPLICABLE)


DAYTIME PHONE NUMBERDATE OF BIRTH DATE OF DEATH (IF APPLICABLE)


TAXPAYER IDENTIFICATION NUMBER (TIN)/SSN (IF APPLICABLE)

(1)l Immediate Distribution of$ .

(2)l Periodic DistributionI authorize automatic distributions of$ on al monthly l annuall quarterly l otherbasis, starting on .

(3)l Other (including transfers)

For Traditional and SIMPLE IRAs Onlyl Early Distribution, no known exceptionl Early Distribution, exception applies

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IRA Distribution Form for Traditional, Roth and SIMPLE IRAsBankers SystemsWolters Kluwer Financial Services 1998, 2009 Page 1 of 4

*IRACMBDISLAZ 7/1/2009

For Traditional, Roth, and SIMPLE IRAsl Early Distribution from a Roth IRAl Age 59½ or Older (Normal for Traditional IRAs)l Deathl Disabilityl Revocationl Transfer to another IRAl Prohibited Transactionl IRS Levy

l Recharacterization of Contribution/Conversion for Tax Yearl Correction of Excess Contribution for Tax Year

Amount of excess $Earnings attributable to excess (if applicable) $l On or before my tax-filing due date, including extensionsl In same year as excess contributionl In year after excess contribution

l After my tax-filing due date, including extensionsl Qualified Health Savings Account Funding Distribution (QHSAFD)

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Sample

l I elect not to have Federal income tax withheld from my IRA distribution.l I elect to have 10 percent Federal income tax withheld from my IRA distribution.

I want the following additional dollar amount ($ ), or additional percentage ( %)withheld from each IRA distribution.l I elect to have $ or %State income tax withheld from my IRA distribution (if applicable).

Form W-4PDepartment of the TreasuryInternal Revenue Service

OMB No. 1545-0074

SIGNATURESI certify that I am the IRA owner, the beneficiary, or individual legally authorized to complete this form. I certify the accuracy of the informationset forth in this form, and I authorize this transaction. I understand the custodian/trustee may require me to provide and/or complete additionaldocuments before processing any distributions. I assume full responsibility for any consequences associated with my distribution including anytaxes and penalties owed. I indemnify and agree to hold the custodian/trustee harmless from any resulting liabilities. I acknowledge that thecustodian/trustee cannot provide, and has not provided, me with tax or legal advice. I have been advised to seek the guidance of a tax or legalprofessional.

Signature of Custodian/Trustee DateSignature of IRA Owner/Beneficiary Date

5

(Not Applicable to Roth IRAs. See IRS Form W-8BEN if you are a foreign person.)WITHHOLDING ELECTION The instructions to Form W-4P (Withholding Certificate) are included in the Additional Information section of this form.4

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63

SampleTransfer. A transfer is the non-reportable movement of assetsbetween IRAs of the same type.Two-Year Rule. SIMPLE IRA funds cannot be rolled or transferred toa traditional IRA or converted to a Roth IRA within a two-year periodthat begins on the date of the initial contribution to your SIMPLE IRA.SIMPLE IRA funds transferred or distributed during the two-yearperiod are subject to an additional 25 percent excise tax.

Nonperiodic Paymentsf10% Withholding. Distributions from anIRA that are payable on demand are treated as nonperiodic payments.Your IRA custodian/trustee must withhold at a flat 10% rate from yourIRA distributions unless you choose not to have federal income taxwithheld. You can choose not to have income tax withheld from anonperiodic payment by using IRS Form W-4P or an appropriatesubstitute form and providing your correct tax identification number(TIN). Generally, your choice to have income tax withheld or not willapply to any later distribution from your IRA. You may also specify anadditional amount that you want withheld.Caution. If you do not provide your correct TIN, your IRA custodian/trustee cannot honor your request not to have income tax withheld andmust withhold 10% of the payment for federal income tax.

extent it is contributed to your health savings account. The election tomake this distribution is irrevocable.Recharacterization. A recharacterization is the method by which anIRA owner can redesignate the type of IRA contribution made for theyear. Revocation. You may revoke your IRA on or before seven (7) daysafter the date of establishment. For traditional and SIMPLE IRAs only,if you revoke a regular contribution, the distribution is reported to theIRS as a correction of excess contribution in the same year. If yourevoke a rollover or transfer contribution, the distribution is reportedto the IRS as a normal distribution if you are age 59½ or older, or asan early distributionfno known exception, if you are younger thanage 59½.Separate Accounting. Under Treasury Regulation Section1.409(a)(9)-8, Q&A-3, a separate account in an IRA would be aseparate portion of the IRA that reflects a beneficiary's separateinterest in the IRA as of the date of the owner's death. If separateaccounting is not immediate upon an IRA owner's death, an IRAcustodian/trustee should allocate the post-death investment gains andlosses for the period prior to the establishment of separate accounts ona reasonable and consistent pro rata basis among the separatebeneficiary accounts.Tax Year of First Roth IRA Contribution/Conversion. Distributionof earnings in a Roth IRA may be tax free and penalty free whenwithdrawn if five years have passed since the tax year of the Roth IRAowner's first contribution/conversion.

Purpose. The IRA Distribution Form for Traditional, Roth, and SIMPLEIRAs is designed to assist you in selecting your individual retirementaccount (IRA) distribution reason and method. This form does not allowfor cost- and penalty-free SIMPLE IRA transfers from a designatedfinancial institution (DFI). Your DFI will require additionaldocumentation, such as an election form.Additional Documents. Applicable law or policies of the IRAcustodian/trustee may require additional documentation. A separatedistribution form must be completed for each distribution reason. For Additional Guidance. It is in your best interest to seek the guidanceof a tax or legal professional before completing this document. Youshould also reference the IRA agreement and disclosure statement and/oramendments provided by the custodian/trustee. For more information,refer to Internal Revenue Service (IRS) Publication 590, IndividualRetirement Arrangements (IRAs), IRS Publication 505, Tax Withholdingand Estimated Tax, instructions to your federal income tax return, yourlocal IRS office, or the IRS's web site at www.irs.gov.Terms. A general understanding of the following terms may be helpful incompleting your transactions.


A distribution made to satisfy an IRS levy.Distributions based on an election to receive substantially equalperiodic payments for the greater of a five-year period or untilyou attain age 59½.

Higher Education ExpenseFirst-Time Home PurchaseMedical ExpenseHealth Insurance PremiumQualified Reservist Distribution

Recipient Information. The Recipient Information section must becompleted for a distribution due to IRS levy, a death distribution, atransfer to another IRA, a transfer to a former spouse's IRA due todivorce or legal separation, a transfer to a spouse's IRA due to death (ifsole beneficiary), a recharacterization, a direct rollover to an eligibleretirement plan, or a qualified health savings account funding distribution.Provide complete information regarding the individual or entity receivingthe assets. Withholding of Federal Income Tax. Generally, federal income taxwithholding applies to your IRA distributions. The method and rate ofwithholding depends on (a) the type of distribution you receive, (b)whether the distribution is delivered outside the United States or itspossessions, and (c) whether you (or your beneficiary after your death)are a nonresident alien individual, a nonresident alien beneficiary, or aforeign estate. Qualified distributions from a Roth IRA are nontaxableand, therefore, not subject to withholding. Because your tax situation maychange from year to year, you may want to change your withholdingelection each year. You can change the amount to be withheld by usingIRS Form W-4P or an appropriate substitute form.

Age 59½ or Older (Normal). If you are age 59½ or older, you arenot subject to a 10 percent early distribution penalty tax.Conversion. This is a distribution taken from a traditional or SIMPLEIRA that is exempt from the 10 percent early distribution penalty taxand deposited into a Roth IRA as a conversion contribution. Death. This is a distribution taken by a beneficiary(ies) of a deceasedIRA owner that is exempt from the early distribution penalty tax.Disability. A distribution for a disability can avoid the 10 percent earlydistribution penalty tax if you are younger than age 59½ and meet thedefinition of disability under Internal Revenue Code (IRC) Section72(m)(7).Early Distribution from a Roth IRA. Follows the same guidelines asEarly Distribution, no known exception with an additional exception ofSubstantially Equal Periodic Payments.Eligible Retirement Plan. Eligible retirement plans include qualifiedtrusts under IRC Section 401(a), annuity plans under IRC Section403(a), annuity contacts under IRC Section 403(b), and certaingovernmental IRC Section 457 plans. Excess Contribution. An excess contribution occurs when thecontribution amount exceeds allowable limits or when an ineligibleindividual makes a contribution. For correction purposes, an IRAowner can treat an unwanted contribution as an excess.Early Distribution, exception applies. The following types ofdistributions are automatically exempt from the 10 percent earlydistribution penalty tax:

}}

Early Distribution, no known exception. If you are younger than age59½, you may be subject to a 10 percent early distribution penalty taxunless you properly roll over the assets within 60 days (or 120 days inthe case of the return of a first-time homebuyer distribution), or unlessyou meet an exception. The exceptions are for distributions used topay for a:

}}}}}

Prohibited Transaction. Violations of IRC Section 4975 due toimproper investment or use of IRA assets could result in the IRAassets becoming fully taxable and subject to penalty tax.Qualified Health Savings Account Funding Distribution. This is adistribution from an IRA, not including a SEP or SIMPLE IRA, to the

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64

Sample

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In the absence of a tax treaty exemption, nonresident aliens,nonresident alien beneficiaries, and foreign estates generally aresubject to a 30% withholding tax under IRC Section 1441 on thetaxable portion of a nonperiodic pension or annuity payment that isfrom U.S. sources. However, most tax treaties provide that privatepensions and annuities are exempt from withholding and tax. Also,payments from certain pension plans are exempt from withholdingeven if no tax treaty applies. See IRS Publication 515, Withholding ofTax on Nonresident Aliens and Foreign Entities, and IRS Publication519, U.S. Tax Guide for Aliens, for details. A foreign person shouldsubmit IRS Form W-8BEN, Certificate of Foreign Status of BeneficialOwner for United States Tax Withholding, to the IRA custodian/trusteebefore receiving any payments. The Form W-8BEN must contain theforeign person's TIN.If you are a foreign person who has provided an IRA custodian/trusteewith IRS W-8BEN, the IRA custodian/trustee will furnish a statementto you on IRS Form 1042-S, Foreign Person's U.S. Source IncomeSubject to Withholding, by March 15 of next year.

State Withholding. Your state may allow or require state income taxwithholding on any taxable distribution.Local Withholding. Your local governing authority may allow or requirelocal income tax withholding on any taxable distribution.

Choosing Not to Have Income Tax Withheld. You (or in the event ofdeath, your beneficiary or estate) can choose not to have income taxwithheld from your payments by using Form W-4P or an appropriatesubstitute form. For an estate, the election to have no income taxwithheld may be made by the executor or personal representative ofthe decedent. The executor/representative must provide the estate'sTIN/employer identification number (EIN). Caution. There are penalties for not paying enough federal income taxduring the year, either through withholding or estimated tax payments.New retirees, especially, should see IRS Publication 505, TaxWithholding and Estimated Tax. It explains the estimated taxrequirements and describes penalties in detail. You may be able toavoid quarterly estimated tax payments by having enough tax withheldfrom your IRA using Form W-4P or an appropriate substitute form.Changing Your "No Withholding" Choice. If you previously chosenot to have income tax withheld and you now want 10% withholding,write "Revoked" next to the checkbox on line 1 of IRS Form W-4Pand provide a copy to your IRA custodian/trustee. To the extent youwant a greater amount withheld, complete a new Form W-4P or anappropriate substitute form for your IRA custodian/trustee.Payments to Foreign Persons and Payments Outside the UnitedStates. Unless you are a nonresident alien, withholding (in the mannerdescribed above) is required on any nonperiodic payments that aredelivered to you outside the United States or its possessions. Youcannot choose not to have income tax withheld on Form W-4P. SeeIRS Publication 505, Tax Withholding and Estimated Tax for additionaldetails.

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Sample

5

IRA Election of Payment by Beneficiaryfor Traditional, Roth, and SIMPLE IRAs

WITHHOLDING ELECTION (Not applicable to Roth IRAs. See IRS Form W-8BEN if you are a foreign person.)

(if applicable)


OMB No. 1545-0074

l Immediate Distributionof $ .

l Periodic DistributionI authorize automatic distributions of$ on al monthly l annuall quarterly l otherbasis, starting ondetermined by my election.Continue periodic distributions until Inotify you in writing otherwise.

l Other (including transfers)

I elect my required minimum distributions tobe paid in the following manner (select one):

l Mail check to me.


Account Number

l Other

l Traditional IRAl SIMPLE IRAl Roth IRA

DATE OF BIRTH


2 BENEFICIARY INFORMATION

TYPE OF IRA (SELECT ONE):

TAXPAYER IDENTIFICATION NUMBER/SSN

IRA ACCOUNT (PLAN) NUMBER



SOCIAL SECURITY NUMBER (SSN)IRA ACCOUNT (PLAN) NUMBER


4 PAYMENT INSTRUCTIONS

BENEFICIARY ELECTION (Complete A, and either B, C, or D. See Additional Information included with this form.)3

DATE OF DEATH

C. PAYMENT DETAIL (completed by financial organization)B. PAYMENT METHODA. PAYMENT ELECTION

(1)

(2)

(3)

(1)

(2)

(3)

DATE OF BIRTH E-MAIL (OPTIONAL)


Amount RequestedPenalties ChargedAdministrative FeesSubtotal (amount subject to withholding)

Federal Income Tax WithheldState Income Tax WithheldLocal Tax WithheldNet Amount PaidEarnings paid to date not already reported to IRAadministration provider (optional). Includethis figure in the Amount Requested.$Does this distribution close the IRA? l Yes l No

The instructions to Form W-4P (Withholding Certificate) are included in the Additional Information section of this form.l I elect not to have Federal income tax withheld from my IRA distribution.l I elect to have 10 percent Federal income tax withheld from my IRA distribution.


A. Death Occurred: l Before Required Beginning Date (RBD)l On or After RBD (Roth IRA owners are treated as having died before the RBD.)

B. Total Distribution of Beneficiary's Share lC. Designated Beneficiary [Elect one option under (1) or (2)]:

(1) Spouse as Sole Beneficiary (2) Other Individuals (Includes spouse who is not sole beneficiary.)

l Single Life Expectancy* (Attained Age Method) l Single Life Expectancy* (Reduction Method)l Five-Year Rule (Only if death occurred before RBD.) l Five-Year Rule (Only if death occurred before RBD.)

l Treat as Own*If death occurred on or after RBD, the longer of the IRA owner's single life expectancy or the beneficiary's single life expectancy is used.

D. No Designated Beneficiary (Applies to all beneficiaries if any non-individual has assets remaining on the determination date.)

l Five-Year Rule (Only if death occurred before RBD.)

l IRA Owner's Single Life ExpectancyfReduction Method (Only if death occurred on or after RBD.) Not Applicable to Roth IRAs.

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IRA Election of Payment by Beneficiary for Traditional, Roth, and SIMPLE IRAsBankers SystemsWolters Kluwer Financial Services 1998, 2008 Page 1 of 4Initials:

*IRACMBEPBLAZ 6/1/2008

$(-)(-)$

(-)(-)(-)$

66

Sample


I certify that I am the beneficiary or individual legally authorized to complete this form. I accept the elections I made above. I understand that Imust provide the custodian/trustee with a copy of the IRA owner's death certificate and any other applicable documents before thecustodian/trustee will process any distributions. I understand that I am responsible for any consequences based upon the elections made above,and I agree to indemnify and to hold the custodian/trustee harmless from any resulting liabilities. I acknowledge that the custodian/trustee cannotprovide me with legal advice. I have been advised to seek the guidance of a tax or legal professional.

Signature of Beneficiary Date

SIGNATURES6

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Sample

Purpose. The IRA Election of Payment by Beneficiary for Traditional,Roth, and SIMPLE IRAs form is designed to assist you in selecting yourIRA distribution method and payment elections. This form is notdesigned for us by beneficiaries of deceased plan participants ofemployer-sponsored retirement plans.

For Additional Guidance. It is in your best interest to seek the guidanceof your tax or legal professional before completing this document. Yourfirst reference should be the IRA agreement and disclosure statement youreceived upon establishing your IRA or amendments provided by thecustodian/trustee. For more information refer to Internal Revenue Service(IRS) Publication 590fIndividual Retirement Arrangements (IRAs), IRSPublication 505fTax Withholding and Estimated Tax, instructions to yourfederal income tax return, your local IRS office, or the IRS's web site atwww.irs.gov.

Caution. If you are one of multiple beneficiaries you may find that yourpossible methods of distribution are restricted by the other beneficiarytypes and/or the timing of the IRA owner's death. The IRA agreementand disclosure statement in effect at the later of the time the IRA wasestablished or amended, provide valuable information concerningbeneficiary options. Custodian/trustee policies, such as a separateaccounting policy, should be reviewed to determine their effect onbeneficiary options.



Spouse Beneficiary Rollovers. Any spouse beneficiary can take adistribution of his/her share of a deceased spouse's IRA and roll it over tohis/her own IRA.

Withholding of Federal Income Tax. Generally, federal income taxwithholding applies to your IRA distributions. The method and rate ofwithholding depends on (a) the type of distribution you receive, (b)whether the distribution is delivered outside the United States or itspossessions, and (c) whether you (or your beneficiary after your death)are a nonresident alien individual, a nonresident alien beneficiary, or aforeign estate. Qualified distributions from a Roth IRA are nontaxableand, therefore, not subject to withholding. Because your tax situation maychange from year to year, you may want to change your withholdingelection each year. You can change the amount to be withheld by usingIRS Form W-4P or an appropriate substitute form.

Spouse as Sole Designated Beneficiary. Special rules apply to asurviving spouse who is the only beneficiary on the determinationdate. If the IRA owner died before his/her RBD, such spouse canpostpone receipt of required distributions until the year the deceasedIRA owner would have reached age 70½. Finally, such spouse canelect to treat the IRA as his/her own IRA and, if the surviving spouseis under age 70½, not be required to distribute until he/she attains age70½.

Single Life Expectancy. The single life expectancy is the number ofyears an individual is expected to live based on various statistical andactuarial variables. The IRS provides a single life expectancy table inits regulations and in IRS Publication 590. A factor from the single lifeexpectancy table will be divided into an IRA beneficiary's share of anIRA's previous year-end balance to calculate a required minimumdistribution for the year for that beneficiary.

There are two ways to determine the appropriate single life expectancyfactor each year a distribution to a beneficiary is requiredf the attainedage method and the reduction method.

Five-Year Rule. The five-year rule requires the beneficiary's interestin the IRA to be fully distributed by the end of the fifth year followingthe IRA owner's death year.

Nonperiodic Paymentsf10% Withholding. Distributions from anIRA that are payable on demand are treated as nonperiodic payments.Your IRA custodian/trustee must withhold at a flat 10% rate from yourIRA distributions unless you choose not to have federal income taxwithheld. You can choose not to have income tax withheld from anonperiodic payment by using IRS Form W-4P or an appropriatesubstitute form and providing your correct tax identification number(TIN). Generally, your choice to have income tax withheld or not willapply to any later distribution from your IRA. You may also specify anadditional amount that you want withheld.

Caution. If you do not provide your correct TIN, your IRA custodian/trustee cannot honor your request not to have income tax withheld andmust withhold 10% of the payment for federal income tax.

Choosing Not to Have Income Tax Withheld. You (or in the event ofdeath, your beneficiary or estate) can choose not to have income taxwithheld from your payments by using Form W-4P or an appropriatesubstitute form. For an estate, the election to have no income taxwithheld may be made by the executor or personal representative ofthe decedent. The executor/representative must provide the estate'sTIN/employer identification number (EIN).

-



Required Beginning Date (RBD). The RBD is April 1 of the yearfollowing the year in which an IRA owner attains age 70½.

Determination Date. The determination date is September 30 of theyear following the IRA owner's death year.

Designated Beneficiary. A designated beneficiary is an individualwho has a remaining interest in the IRA on the determination date.Though an individual named as a beneficiary by the IRA owner andhas a right to all or a portion of the IRA assets, he/she is notnecessarily a designated beneficiary under the law. A namedbeneficiary who takes his/her entire interest in the IRA or disclaims,under Internal Revenue Code (IRC) Section 2518, his/her interest inthe IRA before the determination date will be eliminated from thedesignated beneficiary(ies) determination.

A beneficiary who dies before the determination date will still beconsidered for designated beneficiary status.

A designated beneficiary(ies) sets the life expectancy period fordistributions after an IRA owner's death. When there are multipledesignated beneficiaries, the age of the oldest beneficiary on thedetermination date is used for calculating required minimumdistributions for all of the beneficiaries, unless separate accountingapplies in accordance with Treasury Regulation 1.401(a)(9)-8,Q&A 2 and 3.

The IRA will be considered to have no designated beneficiary if anynamed beneficiary, with an interest still remaining on the determinationdate, is not an individual or an individual named as a beneficiary of aqualified trust which is a named beneficiary of the IRA.

If an individual is the beneficiary of a trust which is the beneficiary ofan IRA, he/she should determine his/her appropriate beneficiary statuswith the trustee.

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Caution. There are penalties for not paying enough federal income taxduring the year, either through withholding or estimated tax payments.New retirees, especially, should see IRS Publication 505, TaxWithholding and Estimated Tax. It explains the estimated taxrequirements and describes penalties in detail. You may be able toavoid quarterly estimated tax payments by having enough tax withheldfrom your IRA using Form W-4P or an appropriate substitute form.

Changing Your "No Withholding" Choice. If you previously chosenot to have income tax withheld and you now want 10% withholding,write "Revoked" next to the checkbox on line 1 of IRS Form W-4Pand provide a copy to your IRA custodian/trustee. To the extent youwant a greater amount withheld, complete a new Form W-4P or anappropriate substitute form for your IRA custodian/trustee.

Payments to Foreign Persons and Payments Outside the UnitedStates. Unless you are a nonresident alien, withholding (in the mannerdescribed above) is required on any nonperiodic payments that aredelivered to you outside the United States or its possessions. Youcannot choose not to have income tax withheld on Form W-4P. SeeIRS Publication 505, Tax Withholding and Estimated Tax for additionaldetails.

State Withholding. Your state may allow or require state income taxwithholding on any taxable distribution.

Local Withholding. Your local governing authority may allow or requirelocal income tax withholding on any taxable distribution.

-



In the absence of a tax treaty exemption, nonresident aliens,nonresident alien beneficiaries, and foreign estates generally aresubject to a 30% withholding tax under IRC Section 1441 on thetaxable portion of a nonperiodic pension or annuity payment that isfrom U.S. sources. However, most tax treaties provide that privatepensions and annuities are exempt from withholding and tax. Also,payments from certain pension plans are exempt from withholdingeven if no tax treaty applies. See IRS Publication 515, Withholding ofTax on Nonresident Aliens and Foreign Entities, and IRS Publication519, U.S. Tax Guide for Aliens, for details. A foreign person shouldsubmit IRS Form W-8BEN, Certificate of Foreign Status of BeneficialOwner for United States Tax Withholding, to the IRA custodian/trusteebefore receiving any payments. The Form W-8BEN must contain theforeign person's TIN.

If you are a foreign person who has provided an IRA custodian/trusteewith IRS W-8BEN, the IRA custodian/trustee will furnish a statementto you on IRS Form 1042-S, Foreign Person's U.S. Source IncomeSubject to Withholding, by March 15 of next year.

69

Sample

-

IRA OWNER/BENEFICIARY IRA ACCOUNTHOLDER INFORMATION

CURRENT CUSTODIAN/TRUSTEE NAME, ADDRESS, CITY, STATE AND ZIP

2RECHARACTERIZATION INFORMATION

IRA Recharacterization Noticefor Traditional, Roth, SIMPLE, TraditionalBeneficiary, and Roth Beneficiary IRAs

B. Initial Contribution Information

3

Provide information about the initial contribution of the assets being recharacterized. If the assets are no longer in the original account,provide the account (plan) number where the assets are currently held.

CONTRIBUTION AMOUNT

A recharacterization must be completed by your tax-filing due date (plus extensions). This recharacterization is (select one):

A. Type of Recharacterization (select one):l Traditional IRA regular contribution as a Roth IRA contribution. Tax Yearl Roth IRA regular contribution as a tradition IRA contribution. Tax Year

(Note: If the tax year is your age 70½ year or older, you cannot recharacterize a Roth IRA regular contribution as a traditionalIRA contribution.)

l Roth IRA conversion contribution back to a traditional or SIMPLE IRA.l Erroneous rollover or transfer from a traditional IRA to a SIMPLE IRA back to a traditional IRA.l Roth IRA rollover or direct rollover from an eligible retirement plan to a traditional IRA.l Roth Beneficiary IRA direct rollover from an eligible retirement plan to a traditional beneficiary IRA.

IRA Recharacterization Notice for Traditional, Roth, SIMPLE, Traditional Beneficiary, and Roth Beneficiary IRAsBankers SystemsWolters Kluwer Financial Services 1998, 2010 Page 1 of 3

*

RECHARACTERIZATION REQUEST

NAME, ADDRESS, CITY, STATE, AND ZIP1

PHONE NUMBER

SOCIAL SECURITY NUMBER


DATE OF BIRTH

IRA-RCHT-LAZ 1/1/2010

$

ACCOUNT (PLAN) NUMBER CONTRIBUTION DATE

ll

With the same custodian/trustee.To a different custodian/trustee. I authorize and direct my Current Custodian/Trustee to send the assets (and earnings attributable)indicated in the Transaction Instruction section to the Custodian/Trustee named in the upper right corner of this form.

70

Sample

4TRANSACTION INSTRUCTIONSComplete my recharacterization as directed. Note: Penalties and market fluctuation may affect the distribution amount.

A. Payment Amount (select one):l My entire contribution amount plus earnings attributable of $ .l A portion of my contribution amount plus earnings attributable. Describe

B. Payment Schedule and Investments (select one):l Immediately liquidate all investments and send cash proceeds.l Send all investments in kind.l Send and/or liquidate the investments as identified below.

l Other

C. Delivery Instructions(1) IRA Account (Plan) Number(2) Make check payable to or certificate registration in the name of as l custodian l trustee

for the l traditional l Roth l SIMPLE l traditional Beneficiary IRA of(3)

Account Number or Investment Transaction Datelll

ororor

$ $ $

Cash ProceedsCash ProceedsCash Proceeds

lll

shares shares shares

In KindIn KindIn Kind

Dollar Amount or Number of Shares Send

-


*IRA-RCHT-LAZ 1/1/2010

SIGNATURES


I certify that I am the IRA owner, beneficiary IRA accountholder, or individual legally authorized to complete this form. I acknowledge that I amelecting to make this recharacterization by providing this notice. I certify the accuracy of the information set forth in this form, and I authorizethis transaction. I understand the custodian/trustee may require me to provide and/or complete additional documents before processing thistransaction. I understand that my recharacterization election is irrevocable. I indemnify and agree to hold the custodian/trustee harmless againstany resulting liabilities. I acknowledge that the custodian/trustee cannot provide, and has not provided, me with tax or legal advice. I have beenadvised to seek the guidance of a tax or legal professional.

Signature of IRA Owner/Beneficiary IRA Accountholder Date

5

71

Sample

-


*IRA-RCHT-LAZ 1/1/2010

ADDITIONAL INFORMATIONEligible Retirement Plan. Eligible retirement plans includequalified trusts under Internal Revenue Code (IRC) Section401(a), annuity plans under IRC Section 403(a), annuitycontracts under IRC Section 403(b), and certain governmentalIRC Section 457(b) plans. Common names for these plansinclude 401(k), profit sharing, pension, money purchase,federal thrift savings, and tax-sheltered annuity plans.

Rollover. A rollover occurs when eligible assets paid directly toyou are redeposited within 60 days of receipt of the distribution.

Recharacterization Deadline. The deadline for recharacterizing anIRA contribution, plus earnings, for any tax year is the IRAowner's tax-filing due date, including extensions

Rollover or Direct Rollover from an Eligible Retirement Plan toa Roth IRA. As a plan participant or spouse beneficiary, you mayroll over or directly roll over eligible distribution amounts, otherthan designated Roth account balances, to a Roth IRA.You mayrecharacterize a rollover or direct rollover contribution from aneligible retirement plan.

Rollover or Direct Rollover from an Eligible Retirement Plan toa Roth Beneficiary IRA. As a beneficiary of a deceased planparticipant, you may roll over (available only to a spousebeneficiary) or directly roll over (available to a spouse ornonspouse beneficiary) eligible distribution amounts, other thandesignated Roth account balances, to a Roth beneficiary IRA. Youmay recharacterize a rollover or direct rollover contribution froman eligible retirement plan.

Conversion. A conversion is a reportable movement of assetsfrom a traditional IRA or SIMPLE IRA to a Roth IRA.

Direct Rollover. A direct rollover moves eligible distributionassets from an eligible retirement plan to the applicable IRA in amanner that prevents you from cashing or liquidating the planassets, or even depositing the assets anywhere except in thereceiving IRA. A direct rollover is reported to the IRS.

Purpose. The IRA Recharacterization Notice is designed to assistyou in treating a contribution made to one type of IRA as havingbeen made to a different type of IRA.

Additional Documents. Applicable law or policies of the IRAcustodian/trustee may require additional documentation such as acontribution or distribution form.

For Additional Guidance. It is in your best interest to seek theguidance of a tax or legal professional before completing thisdocument. You should also reference the IRA agreement anddisclosure statement and/or amendments provided by thecustodian/trustee. For more information, refer to Internal RevenueService (IRS) Publication 590, Individual Retirement Arrangements(IRAs), instructions to your federal income tax return, your localIRS office, or the IRS's web site at www.irs.gov.

Terms. A general understanding of the following terms may behelpful in completing your transaction.

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(page 1 of 2)

Request for Transfer or Conversion to an IRAfor Traditional, Roth, and SIMPLE IRAs

3}

B. Conversion: l Traditional IRA to a l SIMPLE IRA to aRoth IRA Roth IRA


-


2TYPE OF TRANSACTION (See Additional Information included with this form.)Complete A or B.

2001 Wolters Kluwer Financial Services - Bankers Systems* Form IRACMBTRCVLZ Rev. 2/1/2006

A. Transfer: l Traditional IRA to a l Roth IRA to a l SIMPLE IRA to a l SIMPLE IRA to aTraditional IRA Roth IRA SIMPLE IRA Traditional IRA

6

WITHHOLDING ELECTION (For Conversions Only. See IRS Form W-8BEN if you are a foreign person.)

TRANSFER/CONVERSION INSTRUCTIONS (See Additional Information included with this form.)

Account Number or Investment$ or shares$ or shares$ or shares$ or shares$ or shares

lllll

Dollar Amount or Number of SharesIn KindIn KindIn KindIn KindIn Kind

Send:Transaction DateCash ProceedsCash ProceedsCash ProceedsCash ProceedsCash Proceeds

lllll

Signature of Transferee Custodian/Trustee Date

4

5

Signature of IRA Owner Date

SIGNATURES

The instructions to Form W-4P (Withholding Certificate) are included in the Additional Information section of this form.l I elect not to have Federal income tax withheld from my IRA distribution.l I elect to have 10 percent Federal income tax withheld from my IRA distribution.



OMB No. 1545-0074

Complete my transfer/conversion as directed. Note: Penalties and market fluctuation may affect the distribution amount.

TRANSFEROR CUSTODIAN/TRUSTEE REQUEST

I certify that the information contained on this form is true and correct. I direct the transferor custodian/trustee to transfer or convert my IRAassets as set forth in this form. I understand I should seek the guidance of a tax or legal professional with regard to this decision. I understandthat if I establish a separate conduit account, it is my responsibility to keep my conduit account separate from my other accounts. I understandthat my custodian/trustee cannot provide legal advice. I indemnify and agree to hold the custodian/trustee harmless against any liabilities. Iassume full responsibility for the consequences of this transfer or conversion decision. The custodian/trustee agrees to accept these funds as atransfer or conversion.

TRANSFEROR PHONE NUMBER

TRANSFEROR IRA ACCOUNT NUMBER

TRANSFEROR ADDRESS, CITY, STATE AND ZIP

My IRA custodian/trustee (transferor), , should transfer/convert the assetsidentified in the Transfer/Conversion Instructions section.

B. Payment Schedule and Investments (select one):l Immediately liquidate investments and send cash proceeds.l Send all investments in kind.l Send the assets at maturity for each of the investments.l Liquidate the investments as identified below:

A. Payment Amount (select one):l My entire IRA balance.l A portion of my IRA balance. $

l OtherC. Delivery Instructions

(1) Transferee IRA Account Number(2) Make check payable to or certificate registration in the name of as l custodian / l trustee

for the l traditional / l Roth / l SIMPLE IRA of .

DATE OF BIRTH


E-MAIL (OPTIONAL)

If applicable, the required minimum distribution l has or l has not been satisfied for this distribution year prior to this transfer.If not, the transferee custodian/trustee may require additional documentation.SIMPLE IRA funds cannot be transferred to a traditional IRA or converted to a Roth IRA for two years following the date of the initialSIMPLE contribution.

} Required minimum distributions cannot be converted to a Roth IRA.}


73

Sample

(page 2 of 2)


Conversion. A conversion is a reportable movement of assetsfrom a traditional IRA or SIMPLE IRA to a Roth IRA.

In Kind. If an IRA contains stocks, bonds, mutual fund shares,or other types of property, it may be possible to move suchproperty to an IRA without liquidation. This type of "in kind"transfer or conversion would require that the property bereregistered in the name of the transferee custodian/trustee forthe benefit of your IRA. The tranferee's policies, charters, orapplicable law may prevent the transfer of property. Timedeposits and savings accounts are not transferable.

Required Minimum Distribution (RMD). IRA owners whoare age 70½ or older must satisfy an annual RMD. The penaltyfor failing to take the annual RMD for any distribution year is a50 percent excise tax on the amount not distributed. RMDscannot be converted to a Roth IRA. Although the rules permityou to transfer your RMD, it must still be satisfied by therequired distribution date.

Two-Year Rule. SIMPLE IRA funds cannot be transferred to atraditional IRA or converted to a Roth IRA within a two-yearperiod that begins on the date of the initial contribution to yourSIMPLE IRA. SIMPLE IRA funds transferred or convertedduring the two-year period are subject to an additional 25percent excise tax. You may, however, roll over or transfer aSIMPLE IRA to a SIMPLE IRA within the two-year period.

Conduit IRA. Retirement funds originally rolled over fromcertain employer-sponsored eligible retirement plans may havebeen maintained in a separate "conduit IRA" not commingledwith any other types of IRA contributions. Check with your taxor legal professional to determine if you need to continue tomaintain these funds in a separate conduit IRA when they aretransferred to a different custodian/trustee.

State Withholding. Your state may allow or require state incometax withholding on any taxable distribution.

Local Withholding. Your local governing authority may allow orrequire local income tax withholding on any taxable distribution.

Purpose. The Request for Transfer or Conversion to an IRA forTraditional, Roth, and SIMPLE IRAs form is designed to assistyou in transferring or converting assets from one individualretirement account (IRA) to another IRA. This form does not allowfor cost- and penalty-free SIMPLE IRA transfers from a designatedfinancial institution (DFI). Your DFI will require additionaldocumentation, such as an election form.

Additional Documents. A transfer can avoid income and penaltytaxes. A conversion by transfer is a taxable event that avoidspenalty taxes. For your transfer or conversion to be successful,additional contribution and distribution documents may be requiredby your IRA's custodian/trustee.

For Additional Guidance. It is in your best interest to seek theguidance of your tax or legal professional before completing thisdocument. Your first reference should be the IRA agreement anddisclosure statement you received upon establishing your IRA oramendments provided by your custodian/trustee. For moreinformation refer to Internal Revenue Service (IRS) Publication590f Individual Retirement Arrangements, IRS Publication505fTax Withholding and Estimated Tax, instructions to yourfederal income tax return, your local IRS office, or the IRS's website at www.irs.gov.

Terms. A general understanding of the following terms may behelpful in completing your transactions.

Withholding of Federal Income Tax. Generally, federal incometax withholding applies to your IRA distributions. The method andrate of withholding depends on (a) the type of distribution youreceive, (b) whether the distribution is delivered outside the UnitedStates or its possessions, and (c) whether you (or your beneficiaryafter your death) are a nonresident alien individual, a nonresidentalien beneficiary, or a foreign estate. Qualified distributions from aRoth IRA are nontaxable and, therefore, not subject towithholding. Because your tax situation may change from year toyear, you may want to change your withholding election each year.You can change the amount to be withheld by using IRS FormW-4P or an appropriate substitute form.

Nonperiodic Paymentsf10% Withholding. Distributions froman IRA that are payable on demand are treated as nonperiodicpayments. Your IRA custodian/trustee must withhold at a flat10% rate from your IRA distributions unless you choose not tohave federal income tax withheld. You can choose not to haveincome tax withheld from a nonperiodic payment by using IRSForm W-4P or an appropriate substitute form and providingyour correct tax identification number (TIN). Generally, yourchoice to have income tax withheld or not will apply to anylater distribution from your IRA. You may also specify anadditional amount that you want withheld.

Caution. If you do not provide your correct TIN, your IRAcustodian/trustee cannot honor your request not to have incometax withheld and must withhold 10% of the payment for federalincome tax.

Choosing Not to Have Income Tax Withheld. You (or in theevent of death, your beneficiary or estate) can choose not tohave income tax withheld from your payments by using FormW-4P or an appropriate substitute form. For an estate, theelection to have no income tax withheld may be made by theexecutor or personal representative of the decedent. Theexecutor/representative must provide the estate's TIN/employeridentification number (EIN).

Caution. There are penalties for not paying enough federalincome tax during the year, either through withholding orestimated tax payments. New retirees, especially, should see IRSPublication 505, Tax Withholding and Estimated Tax. Itexplains the estimated tax requirements and describes penaltiesin detail. You may be able to avoid quarterly estimated taxpayments by having enough tax withheld from your IRA usingForm W-4P or an appropriate substitute form.

Changing Your "No Withholding" Choice. If you previouslychose not to have income tax withheld and you now want 10%withholding, write "Revoked" next to the checkbox on line 1 ofIRS Form W-4P and provide a copy to your IRAcustodian/trustee. To the extent you want a greater amountwithheld, complete a new Form W-4P or an appropriatesubstitute form for your IRA custodian/trustee.

Payments to Foreign Persons and Payments Outside theUnited States. Unless you are a nonresident alien, withholding(in the manner described above) is required on any nonperiodicpayments that are delivered to you outside the United States orits possessions. You cannot choose not to have income taxwithheld on Form W-4P. See IRS Publication 505, TaxWithholding and Estimated Tax for additional details.

In the absence of a tax treaty exemption, nonresident aliens,nonresident alien beneficiaries, and foreign estates generally aresubject to a 30% withholding tax under IRC Section 1441 onthe taxable portion of a nonperiodic pension or annuity paymentthat is from U.S. sources. However, most tax treaties providethat private pensions and annuities are exempt from withholdingand tax. Also, payments from certain pension plans are exemptfrom withholding even if no tax treaty applies. See IRSPublication 515, Withholding of Tax on Nonresident Aliens andForeign Entities, and IRS Publication 519, U.S. Tax Guide forAliens, for details. A foreign person should submit IRS FormW-8BEN, Certificate of Foreign Status of Beneficial Owner forUnited States Tax Withholding, to the IRA custodian/trusteebefore receiving any payments. The Form W-8BEN mustcontain the foreign person's TIN.

If you are a foreign person who has provided an IRAcustodian/trustee with IRS W-8BEN, the IRA custodian/trusteewill furnish a statement to you on IRS Form 1042-S, ForeignPerson's U.S. Source Income Subject to Withholding, by March15 of next year.

-2001 Wolters Kluwer Financial Services - Bankers Systems* Form IRACMBTRCVLZ Rev. 2/1/2006

74

Sample

A. Rollover from a (check one): l Traditional IRA to a Traditional IRA l SIMPLE IRA to a Traditional IRAl Roth IRA to a Roth IRA l SIMPLE IRA to a SIMPLE IRA

B. Rollover or Direct Rollover from a Qualified Plan (QP), Tax-Sheltered Annuity (TSA), or 457(b) Plan to a Traditional IRA.

C. Rollover or Direct Rollover from a Designated Roth Account to a Roth IRA.

D. Rollover or Direct Rollover from an Eligible Retirement Plan to a Roth IRA.

E. Conversion to a Roth IRA from a (check one): l Traditional IRA l SIMPLE IRA

IRA OWNER INFORMATION1

l l

l ll l

2ROLLOVER OR CONVERSION ELIGIBILITY REVIEW

(For conversions by rollover only) I am completing this conversion within 60 days of receiving my distribution.I am eligible to make this conversion contribution. Assets ineligible for conversion include any required minimum distribution,any part of a series of substantially equal periodic payments, or any corrective distribution of certain SEP or SIMPLE IRA planexcess contributions. (For SIMPLE IRAs only) At least two years have passed since the date of the initial contribution to my SIMPLE IRA.

I have received an eligible rollover distribution from an Internal Revenue Code Section 401(a), 403(a), 403(b), or governmental457(b) plan.(For rollovers only) I am completing this rollover within 60 days of receiving my distribution.I am eligible to make this rollover contribution. Assets ineligible for rollover include any required minimum distribution, any partof a series of substantially equal periodic payments, a plan loan in default, certain dividends on employer securities,P.S. 58 costs of life insurance, a corrective distribution of certain excess contributions, or any hardship distribution.

Yes No

l ll l

l l

l ll ll l

l l

Yes No

Yes No

-

Yes No

} If "No" is checked, a rollover generally cannot occur.

I am completing this rollover within 60 days of receiving my distribution.I have met the requirements of the one rollover per 12-month rule. I am eligible to make this rollover contribution. Assets ineligible for rollover include any required minimum distribution,distributions to a nonspouse beneficiary, or any part of a series of substantially equal periodic payments.(For SIMPLE IRAs only) At least two years have passed since the date of the initial contribution to my SIMPLE IRA.

I have received an eligible rollover distribution from an Internal Revenue Code Section 401(a) or 403(b) plan.(For rollovers only) I am completing this rollover within 60 days of receiving my distribution.I am eligible to make this rollover contribution. Assets ineligible for rollover include any required minimum distribution, any partof a series of substantially equal periodic payments, a plan loan in default, P.S. 58 costs of life insurance, a correctivedistribution of certain excess contributions, or any hardship distribution.

l ll ll l

Complete A, B, C, D, or E. (For further explanation see Additional Information included with this form.)

IRA Rollover or Conversion Review for Traditional, Roth, and SIMPLE IRAsBankers SystemsWolters Kluwer Financial Services 1998, 2010 Page 1 of 3

*

l l

l ll l

Yes No

IRA Rollover or Conversion Reviewfor Traditional, Roth, and SIMPLE IRAs

I have received an eligible rollover distribution from an Internal Revenue Code Section 401(a), 403(a), 403(b), or governmental457(b) plan.(For rollovers only) I am completing this rollover within 60 days of receiving my distribution.I am eligible to make this rollover contribution. Assets ineligible for rollover include any required minimum distribution, any partof a series of substantially equal periodic payments, a plan loan in default, certain dividends on employer securities,P.S. 58 costs of life insurance, a corrective distribution of certain excess contributions, or any hardship distribution.


IRA ACCOUNT (PLAN) NUMBERNAME, ADDRESS, CITY, STATE, AND ZIP

DAYTIME PHONE NUMBERDATE OF BIRTH

IRACMBROLLAZ 1/1/2010

75

Sample

I certify that I am the IRA owner or individual legally authorized to complete this form. I certify the accuracy of the information set forth in thisform. I understand that my rollover or direct rollover election is irrevocable. I assume full responsibility for the consequences of this rollover orconversion decision. I indemnify and agree to hold the custodian/trustee harmless against any resulting liabilities. I acknowledge that thecustodian/trustee cannot provide, and has not provided, me with tax or legal advice. I have been advised to seek the guidance of a tax or legalprofessional.

SIGNATURES

Signature of IRA Owner Date Signature of Custodian/Trustee Date

3

-


*IRACMBROLLAZ 1/1/2010

76

Sample


}

}

}

}

A plan participant or IRA owner.A spouse who is the beneficiary of a deceased eligibleretirement plan participant or IRA owner.A nonspouse beneficiary of a deceased eligible retirementplan participant.An alternate payee. An alternate payee is a spouse orformer spouse under a qualified domestic relations order(QDRO).

Conversion. A conversion occurs when you move yourtraditional IRA or SIMPLE IRA assets to a Roth IRA.Conversions may be accomplished via a transfer method wherefunds are moved directly to a Roth IRA with the samecustodian/trustee or with a different custodian/trustee.Conversions may also be accomplished using a rollover method.

Designated Roth Account. A designated Roth account is anaccount that is part of an Internal Revenue Code (IRC) Section401(a) or 403(b) plan that accepts salary deferrals designated asRoth contributions. Common names for these plans includeRoth 401(k) and Roth 403(b) plans.

Direct Rollover. A direct rollover occurs when your retirementplan assets are paid directly to the traditional IRAcustodian/trustee for the benefit of your IRA. A direct rolloveris reported to the IRS.

Eligible Recipient. Only the following individuals may beeligible to receive eligible rollover distributions.

Eligible Retirement Plan. Eligible retirement plans includequalified trusts under IRC Section 401(a), annuity plans underIRC Section 403(a), annuity contracts under IRC Section403(b), and certain governmental IRC Section 457(b) plans.Common names for these plans include 401(k), profit sharing,pension, money purchase, federal thrift savings, andtax-sheltered annuity plans.

One Rollover Per 12-Month Rule. You are allowed oneIRA-to-IRA rollover per 12-month period. If you rolled over adistribution from the same IRA within the previous 12 months,you are not allowed to roll over this distribution. Additionally,IRA assets distributed and rolled over within the previous 12months are not eligible for rollover. The one rollover per

Nontaxable Distributions. A traditional IRA can accept rolloversof nontaxable distributions from any eligible retirement planincluding a traditional IRA. Nontaxable assets maintained in atraditional IRA can only be rolled over to another traditional IRAand not to any employer-sponsored eligible retirement plan.

The 60-Day Rule. You are allowed 60 calendar days from the dateyou receive your distribution to complete a rollover or conversionby rollover. The Secretary of the Treasury may waive the 60-dayperiod in certain situations such as casualty, disaster, or otherevents that are beyond your reasonable control. For a rollover froman IRA to an IRA, the 60-day period is extended to 120 days in thecase of a first-time homebuyer distribution where a delay orcancellation of the home purchase or construction occurs.Conversions by transfer, and direct rollovers, are not affected bythe 60-day rule.

Two-Year Rule. A rollover or transfer from a SIMPLE IRA to atraditional IRA is not allowed within a two-year period that beginson the date of the initial contribution to your SIMPLE IRA. Youmay, however, roll over or transfer a SIMPLE IRA to a SIMPLEIRA within the two-year period. A conversion from a SIMPLEIRA to a Roth IRA is not allowed within a two-year period thatbegins on the date of the initial contribution to your SIMPLE IRA.

-


*IRACMBROLLAZ 1/1/2010

12-month rule does not apply in the case of a first-timehomebuyer distribution where a delay or cancellation of thehome purchase or construction occurs. Conversions by transferor rollover are not subject to the one rollover per 12-monthrule. Rollovers and direct rollovers from eligible retirementplans (including designated Roth accounts) are not subject tothis rule.

Rollover. A rollover occurs when eligible assets paid directly toyou are redeposited within 60 days of receiving the distribution.If the assets are distributed to you from an eligible retirementplan, the plan administrator withholds 20 percent of the taxableportion for federal income tax purposes. The employer/planadministrator provides assistance in determining eligibility forrollover.

Rollover or Direct Rollover from an Eligible RetirementPlan. You may roll over or directly roll over any eligible assetsfrom an employer plan to a Roth IRA. The taxable portion ofthe direct rollover amount is subject to federal income tax.

Purpose. The IRA Rollover or Conversion Review for Traditional,Roth, and SIMPLE IRAs is designed to assist you in meeting yourresponsibility to only roll over or convert eligible assets.

For Additional Guidance. It is in your best interest to seek theguidance of your tax or legal professional before completing thisdocument. You should also reference the IRA agreement anddisclosure statement and/or amendments provided by thecustodian/trustee. For more information refer to Internal RevenueService (IRS) Publication 590, Individual Retirement Arrangements(IRAs), IRS Publication 505, Tax Withholding and Estimated Tax,instructions to your federal income tax return, your local IRSoffice, or the IRS's web site at www.irs.gov.

Terms. The following general terms may be helpful in completingyour transactions.

Tax Consequences of a Conversion. Converted assets and assetsrolled over or directly rolled over from an eligible retirement plan(other than designated Roth account assets) are generally subject toincome tax in the year of the distribution but are not subject to theadditional 10 percent early-distribution penalty tax. In 2010, theamounts taxable from converted IRA distributions and eligibleretirement plan distributions rolled over are included ratably inincome over the 2011 and 2012 tax years, unless elected to beincluded as income in 2010.

Distributions of Property. If you received a distribution ofproperty from an IRA, the rules require that the same property berolled over. If you received a distribution of property from aneligible retirement plan, the rules require that the same property, orthe proceeds of the sale of such property be rolled over.

77

SampleTraditional

IRA

................................................

Custodial

IndividualRetirementAccount

............................

78

Sample

-

Traditional IRA Organizer-CustodialBankers SystemsWolters Kluwer Financial Services 1983, 2009


For Additional Guidance. It is in your best interest to seek the guidanceof a tax or legal professional before completing this document. For moreinformation, refer to Internal Revenue Service (IRS) Publication 590,Individual Retirement Arrangements (IRAs), IRS Form 5498, IRAContribution Information, instructions to your federal income tax return,your local IRS office, or the IRS's web site at www.irs.gov.

How to use this IRA Organizer. The individual establishing this IRAmust complete the Application page. The IRA owner must sign thedocument. An original signed copy of the Application should be kept bythe custodian for its records. The IRA owner should receive a copy ofthe Application and keep the remaining contents of the IRA Organizer.Community or marital property state laws may require spousal consentfor nonspouse beneficiary designations.

Purpose. This Organizer contains the forms necessary to establish atraditional individual retirement account (IRA). This Organizer should notbe used to establish an inherited traditional IRA.

Additional Documents. Applicable law or policies of the IRA custodianmay require additional documentation such as IRS Form W-9, Request forTaxpayer Identification Number and Certification.

*Page 1 of 14

IRA-49-LAZ 7/1/2009

79

Sample

Traditional IRA Application

3

2CONTRIBUTION INFORMATION

DESIGNATION OF BENEFICIARY

Community or marital property state laws may require spousal consent for a nonspouse beneficiary designation. The laws of the state in whichthe financial organization is domiciled, the IRA owner resides, the trust is located, the spouse resides, or this transaction is consummatedshould be reviewed to determine if such a requirement exists. Spousal consent for the beneficiary designation may also be required by financialorganization policy.

DATE OF BIRTH GENDER:

Regular (including Catch-Up) Rollover/Direct Rollover from an Eligible Retirement PlanSimplified Employee Pension (SEP) Plan Qualified Reservist/Designated Disaster Distribution Repayment*Recharacterization Disaster/Combat Zone Postponed Contribution*Rollover *Reason Code (if applicable)Transfer

NAME, ADDRESS, CITY, STATE, AND ZIP IRA ACCOUNT (PLAN) NUMBER1 IRA OWNER INFORMATION (Custodian's name, address, and phone number above)

Signature of Spouse Date

I Am Not Married. I understand that if I marry in the future, I must complete a new Designation of Beneficiary form,which includes the spousal consent documentation.

I Am Married. I understand that if I designate a primary beneficiary other than my spouse, my spouse must consent bysigning below.(IRA Owner Initials)

SPOUSAL CONSENT4


INVESTMENT NUMBER AMOUNT CONTRIBUTION DATE

$TAX YEAR

Signature of Witness (if required) Date(Witness cannot be a beneficiary of this IRA)

(IRA Owner Initials)

DAYTIME PHONE NUMBER E-MAIL (OPTIONAL)

l Male l Female

At the time of my death, the primary beneficiaries named below will receive my IRA assets. If all of my primary beneficiaries die before me, thecontingent beneficiaries named below will receive my IRA assets. In the event a beneficiary dies before me, such beneficiary's share will bereallocated on a pro-rata basis to the other beneficiaries that share the deceased beneficiary's classification as a primary or contingentbeneficiary. If all of the beneficiaries die before me, my IRA assets will be paid to my estate. If no percentages are assigned to beneficiaries, or ifthe percentage total for any beneficiary classification exceeds 100 percent the beneficiaries in that beneficiary classification will share equally. Ifthe percentage total for each beneficiary classification is less than 100 percent, any remaining percentage will be divided equally among thebeneficiaries within such class. This designation revokes and supercedes all earlier beneficiary designations which may apply to this IRA.

NAME OF BENEFICIARY RELATIONSHIPTO IRA OWNER

A. Primary BeneficiaryNAME OF BENEFICIARY

PERCENTAGE

%%%

BENEFICIARYDATE OF BIRTH

Total 100%

SSN OR TAXPAYERIDENTIFICATION NUMBER

RELATIONSHIPTO IRA OWNER

PERCENTAGE

%%%


Total 100%


B. Contingent Beneficiary

I am the spouse of the IRA owner. Because of the significant consequences associated with giving up my interest in the IRA, the custodian hasnot provided me with legal or tax advice, but has advised me to seek tax or legal advice. I acknowledge that I have received a fair andreasonable disclosure of the IRA owner's assets or property and any financial obligations for a community property state. In the event I have alegal interest in the IRA assets, I hereby give to the IRA owner such interest in the assets held in this IRA and consent to the beneficiarydesignation set forth in this Application.

-


*Page 2 of 14

IRA-49-LAZ 7/1/2009

CONTRIBUTION TYPE: l ll ll lll

80

Sample

Signature of Custodian DateSignature of IRA Owner Date

I certify that the information provided by me on this Application is accurate, and that I have received a copy of IRS Form 5305-A, TraditionalIndividual Retirement Custodial Account, a Disclosure Statement, and a Financial Disclosure. I agree to be bound by the terms and conditionsfound in the Agreement, Disclosure Agreement, Financial Disclosure, and amendments thereto. I assume sole responsibility for all consequencesrelating to my actions concerning this IRA. I understand that I may revoke this IRA on or before seven (7) days after the date of establishment.My designation of the tax year for my contribution, and any election to treat a contribution as a rollover or recharacterization, is irrevocable. Iindemnify and agree to hold the custodian harmless against any liabilities. I understand that the custodian cannot provide, and has not provided,me with tax or legal advice. I have been advised to seek the guidance of a tax or legal professional.

SIGNATURES5

-


*Page 3 of 14

IRA-49-LAZ 7/1/2009

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Sample

Form 5305-A (Rev. March 2002) Department of the Treasury Internal Revenue ServiceThe depositor and the custodian make the following agreement:

TRADITIONAL INDIVIDUAL RETIREMENT CUSTODIAL ACCOUNT(Under section 408(a) of the Internal Revenue Code)

DO NOT File withInternal Revenue Service l Amendment

4. If the depositor dies before his or her entire interest has beendistributed and if the designated beneficiary is not the depositor'ssurviving spouse, no additional contributions may be accepted in theaccount.

5. The minimum amount that must be distributed each year, beginningwith the year containing the depositor's required beginning date, is knownas the "required minimum distribution" and is determined as follows:

(a)

(b)

(c)

6. The owner of two or more traditional IRAs may satisfy theminimum distribution requirements described above by taking from onetraditional IRA the amount required to satisfy the requirement for anotherin accordance with the regulations under section 408(a)(6).Article V.

1. The depositor agrees to provide the custodian with all informationnecessary to prepare any reports required by section 408(i) andRegulations sections 1.408-5 and 1.408-6.

2. The custodian agrees to submit to the Internal Revenue Service(IRS) and depositor the reports prescribed by the IRS.Article VI. Notwithstanding any other articles which may be added orincorporated, the provisions of Articles I through III and this sentence willbe controlling. Any additional articles inconsistent with section 408(a) andthe related regulations will be invalid.Article VII. This Agreement will be amended as necessary to complywith the provisions of the Code and the related regulations. Otheramendments may be made with the consent of the persons whosesignatures appear on the Application that accompanies this Agreement.

Article I. Except in the case of a rollover contribution described insection 402(c), 403(a)(4), 403(b)(8), 408(d)(3), or 457(e)(16), anemployer contribution to a simplified employee pension plan as describedin section 408(k), or a recharacterized contribution described in section408A(d)(6), the custodian will accept only cash contributions up to $3,000per year for tax years 2002 through 2004. That contribution limit isincreased to $4,000 for tax years 2005 through 2007 and $5,000 for 2008and thereafter. For individuals who have reached the age of 50 before theclose of the tax year, the contribution limit is increased to $3,500 per yearfor tax years 2002 through 2004, $4,500 for 2005, $5,000 for 2006 and2007, and $6,000 for 2008 and thereafter. For tax years after 2008, theabove limits will be increased to reflect a cost-of-living adjustment, if any.Article II. The depositor's interest in the balance in the custodial accountis nonforfeitable.Article III.

1. No part of the custodial account funds may be invested in lifeinsurance contracts, nor may the assets of the custodial account becommingled with other property except in a common trust fund orcommon investment fund (within the meaning of section 408(a)(5)).

2. No part of the custodial account funds may be invested incollectibles (within the meaning of section 408(m)) except as otherwisepermitted by section 408(m)(3), which provides an exception for certaingold, silver, and platinum coins, coins issued under the laws of any state,and certain bullion.Article IV.

1. Notwithstanding any provision of this agreement to the contrary, thedistribution of the depositor's interest in the custodial account shall bemade in accordance with the following requirements and shall otherwisecomply with section 408(a)(6) and the regulations thereunder, theprovisions of which are herein incorporated by reference.

2. The depositor's entire interest in the custodial account must be, orbegin to be, distributed not later than the depositor's required beginningdate, April 1 following the calendar year in which the depositor reachesage 70 1/2. By that date, the depositor may elect, in a manner acceptableto the custodian, to have the balance in the custodial account distributedin:

(a)(b)

3. If the depositor dies before his or her entire interest is distributed tohim or her, the remaining interest will be distributed as follows:

(a) If the depositor dies on or after the required beginning date and:(i)

(ii)

(iii)

(b)

A single sum; orPayments over a period not longer than the life of the depositor orthe joint lives of the depositor and his or her designated beneficiary.

If the depositor dies before the required beginning date, theremaining interest will be distributed in accordance with (i) belowor, if elected or there is no designated beneficiary, in accordancewith (ii) below:

The remaining interest will be distributed in accordance withparagraphs (a)(i) and (a)(ii) above (but not over the period inparagraph (a)(iii), even if longer), starting by the end of thecalendar year following the year of the depositor's death. If,however, the designated beneficiary is the depositor's survivingspouse, then this distribution is not required to begin before theend of the calendar year in which the depositor would havereached age 70 1/2. But, in such case, if the depositor'ssurviving spouse dies before distributions are required to begin,then the remaining interest will be distributed in accordance with(a)(ii) above (but not over the period in paragraph (a)(iii), evenif longer), over such spouse's designated beneficiary's lifeexpectancy, or in accordance with (ii) below if there is no suchdesignated beneficiary.The remaining interest will be distributed by the end of thecalendar year containing the fifth anniversary of the depositor'sdeath.

the designated beneficiary is the depositor's surviving spouse,the remaining interest will be distributed over the survivingspouse's life expectancy as determined each year until suchspouse's death, or over the period in paragraph (a)(iii) below iflonger. Any interest remaining after the spouse's death will bedistributed over such spouse's remaining life expectancy asdetermined in the year of the spouse's death and reduced by 1for each subsequent year, or, if distributions are being madeover the period in paragraph (a)(iii) below, over such period.the designated beneficiary is not the depositor's survivingspouse, the remaining interest will be distributed over thebeneficiary's remaining life expectancy as determined in theyear following the death of the depositor and reduced by 1 foreach subsequent year, or over the period in paragraph (a)(iii)below if longer.there is no designated beneficiary, the remaining interest willbe distributed over the remaining life expectancy of thedepositor as determined in the year of the depositor's death andreduced by 1 for each subsequent year.

(i)

(ii)

The required minimum distribution under paragraph 2(b) for anyyear, beginning with the year the depositor reaches age 70 1/2, isthe depositor's account value at the close of business on December31 of the preceding year divided by the distribution period in theuniform lifetime table in Regulations section 1.401(a)(9)-9.However, if the depositor's designated beneficiary is his or hersurviving spouse, the required minimum distribution for a year shallnot be more than the depositor's account value at the close ofbusiness on December 31 of the preceding year divided by thenumber in the joint and last survivor table in Regulations section1.401(a)(9)-9. The required minimum distribution for a year underthis paragraph (a) is determined using the depositor's (or, ifapplicable, the depositor and spouse's) attained age (or ages) in theyear.The required minimum distribution under paragraphs 3(a) and3(b)(i) for a year, beginning with the year following the year of thedepositor's death (or the year the depositor would have reached age70 1/2, if applicable under paragraph 3(b)(i)) is the account value atthe close of business on December 31 of the preceding year dividedby the life expectancy (in the single life table in Regulations section1.401(a)(9)-9) of the individual specified in such paragraphs 3(a)and 3(b)(i).The required minimum distribution for the year the depositorreaches age 70 1/2 can be made as late as April 1 of the followingyear. The required minimum distribution for any other year must bemade by the end of such year.

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Sample

8.10

8.11 Investment of IRA Assets. (a)

(b)

(c)

(d)

8.12

Representations and Indemnity. You represent that any informationyou and/or your agents provide to us is accurate and complete, andthat your actions comply with this Agreement and applicable lawsgoverning retirement plans. You understand that we will rely on theinformation provided by you, and that we have no duty to inquireabout or investigate such information. We are not responsible forany losses or expenses that may result from your information,direction, or actions, including your failure to act. You agree to holdus harmless, to indemnify, and to defend us against any and allactions or claims arising from, and liabilities and losses incurred byreason of your information, direction, or actions. Additionally, yourepresent that it is your responsibility to seek the guidance of a taxor legal professional for your IRA issues.

We are not responsible for determining whether any contributionsor distributions comply with this Agreement and/or the federal lawsgoverning retirement plans. We are not responsible for any taxes,judgments, penalties or expenses incurred in connection with yourIRA, or any losses that are a result of events beyond our control.We have no responsibility to process transactions until after we havereceived appropriate direction and documentation, and we have hada reasonable opportunity to process the transactions. We are notresponsible for interpreting or directing beneficiary designations ordivisions, including separate accounting, court orders, penaltyexception determinations, or other similar situations.

Distributions. Withdrawal requests must be in a format acceptableto us, and/or on forms provided by us. We may require you, oryour beneficiary after your death, to elect a distribution reason,provide documentation, and provide a proper tax identificationnumber before we process a distribution. These withdrawals may besubject to taxes, withholding, and penalties. Distributions willgenerally be in cash.

Deposit Investments Only. The deposit investments we offerare limited to savings, share and money market accounts, andcertificates of deposit (CDs). This IRA is not, and cannot be, aself-directed IRA. It does not permit you to invest yourcontributions or IRA assets in nondeposit investments such asproperty, annuities, stocks, bonds, and government, municipalor United States Treasury securities.Investment of Contributions. We will invest IRA contributionsand reinvest your IRA assets as directed by you based on ourthen current investment policies and procedures. If you fail toprovide us with investment direction for a contribution, we willreturn or hold all or part of such contribution based on ourpolicies and procedures. We will not be responsible for any lossof IRA income associated with your failure to provideappropriate investment direction.Directing Investments. All investment directions must be in aformat or manner acceptable to us. You may invest in any IRAinvestments that you are qualified to purchase, and that we areauthorized to offer and do offer at the time of the investmentselection, and that are acceptable under the applicable lawsgoverning retirement plans. Your IRA investments will beregistered in our name for the benefit of your IRA. Specificinvestment information may be provided at the time of theinvestment.

Based on our policies, we may allow you to delegate theinvestment responsibility of your IRA to an agent by providingus with written notice of delegation in a format acceptable to us.We will not review or guide your agent's decisions, and you areresponsible for the agent's actions or failure to act. We are notresponsible for directing your investments, or providinginvestment advice, including guidance on the suitability orpotential market value of various investments.Investment Fees and Asset Liquidation. We have the right toliquidate your IRA assets to pay fees and expenses, federal taxlevies, or other assessments on your IRA. If you do not directus on the liquidation, we will liquidate the assets of our choiceand will not be responsible for any losses or claims that mayarise out of the liquidation.

Article VIII.8.01

8.02

8.03

8.04

8.05

8.06

8.07

8.08

8.09

Our Fees and Expenses. We may charge reasonable fees and areentitled to reimbursement for any expenses we incur in establishingand maintaining your IRA. We may change the fees at any time byproviding you with notice of such changes. We will provide youwith fee disclosures and policies. Fees may be deducted directlyfrom your IRA assets, and/or billed separately to you. Fees billedseparately to you and paid by you may be claimed on your federalincome tax return as miscellaneous itemized deductions. Thepayment of fees has no effect on your contributions. Additionally,we have the right to liquidate your IRA assets to pay such fees andexpenses. If you do not direct us on the liquidation, we will liquidatethe assets of our choice and will not be responsible for any losses orclaims that may arise out of the liquidation. Amendments. We may amend your IRA in any respect and at anytime, including retroactively, to comply with applicable lawsgoverning retirement plans and the corresponding regulations. Anyother amendments shall require your consent, by action or noaction, and will be preceded by written notice to you. Unlessotherwise required, you are deemed to automatically consent to anamendment, which means that your written approval is not requiredfor the amendment to apply to the IRA. In certain instances thegoverning law or our policies may require us to secure your writtenconsent before an amendment can be applied to the IRA. If youwant to withhold your consent to an amendment, you must provideus with a written objection within 30 days of the receipt date of theamendment. Notice and Delivery. Any notice mailed to you will be deemeddelivered and received by you, five days after the postmark date.This fifth day following the postmark is the receipt date. Noticeswill be mailed to the last address we have in our records. You areresponsible for ensuring that we have your proper mailing address.Upon your consent, we may provide you with notice in a deliveryformat other than by mail. Such formats may include variouselectronic deliveries. Any notice, including terminations, change inpersonal information, or contributions mailed to us will be deemeddelivered when actually received by us based on our ordinarybusiness practices. All notices must be in writing unless our policiesand procedures provide for oral notices.Applicable Laws. This Agreement will be construed and interpretedin accordance with the laws of, and venued in, our state of domicile.Disqualifying Provisions. Any provision of this Agreement thatwould disqualify the IRA will be disregarded to the extent necessaryto maintain the account as an IRA.Interpretation. If any question arises as to the meaning of anyprovision of this Agreement, then we shall be authorized to interpretany such provision, and our interpretation will be binding upon allparties.

Your IRA Documents. This Internal Revenue Service (IRS) Forms5305 series agreement for traditional IRAs, and any amendments oradditional provisions to such agreement (the "Agreement") set forththe terms and conditions governing your individual retirementaccount (IRA) and your or, after your death, your beneficiary'srelationship with us. Your agreement will be accompanied by adisclosure statement, which sets forth various IRA rules in simplerlanguage, and a financial disclosure.Definitions. The IRS Forms 5305 series agreement contains adetailed definitions section. The definitions found in such sectionapply to this Agreement. The IRS refers to you as the depositor, andus as the custodian. References to "you," "your," and "IRA owner"will mean the depositor, and "we," "us," and "our" will mean thecustodian. The terms "you" and "your" will apply to you. In theevent you appoint a third party, or have a third party appointed onyour behalf, to handle certain transactions affecting your IRA, suchagent will be considered "you" for purposes of this Agreement.Additionally, references to "IRA" will mean the custodial account.Additional Provisions. Additional provisions may be attached to,and made a part of, this Agreement by either party. The provisionsmust be in writing, agreed to by us, and in a format acceptable tous.

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83

SampleSpecific InstructionsArticle IV. Distributions made under this articlemay be made in a single sum, periodic payment,or a combination of both. The distributionoption should be reviewed in the year thedepositor reaches age 70 1/2 to ensure that therequirements of section 408(a)(6) have beenmet.Article VIII. Article VIII and any that follow itmay incorporate additional provisions that areagreed to by the depositor and custodian tocomplete the agreement. They may include, forexample, definitions, investment powers, votingrights, exculpatory provisions, amendment andtermination, removal of the custodian,custodian's fees, state law requirements,beginning date of distributions, accepting onlycash, treatment of excess contributions,prohibited transactions with the depositor, etc.Attach additional pages if necessary.

General InstructionsSection references are to the Internal RevenueCode unless otherwise noted.Purpose of FormForm 5305-A is a model custodial accountagreement that meets the requirements ofsection 408(a) and has been pre-approved by theIRS. A traditional individual retirement account(traditional IRA) is established after the form isfully executed by both the individual (depositor)and the custodian and must be completed nolater than the due date of the individual'sincome tax return for the tax year (excludingextensions). This account must be created in theUnited States for the exclusive benefit of thedepositor and his or her beneficiaries.

Do not file Form 5305-A with the IRS.Instead, keep it with your records.

For more information on IRAs, including therequired disclosures the custodian must give thedepositor, see Pub. 590, Individual RetirementArrangements (IRAs).

DefinitionsCustodian. The custodian must be a bank orsavings and loan association, as defined insection 408(n), or any person who has theapproval of the IRS to act as custodian.Depositor. The depositor is the person whoestablishes the custodial account.Identifying NumberThe depositor's social security number willserve as the identification number of his or herIRA. An employer identification number (EIN)is required only for an IRA for which a return isfiled to report unrelated business taxableincome. An EIN is required for a common fundcreated for IRAs.Traditional IRA for Nonworking SpouseForm 5305-A may be used to establish the IRAcustodial account for a nonworking spouse.

Contributions to an IRA custodial account fora nonworking spouse must be made to aseparate IRA custodial account established bythe nonworking spouse.

IRS FORM 5305-A INSTRUCTIONS (Rev. 3-2002)

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8.16

8.17

following the receipt of proper notice. At the time of termination wemay retain the sum necessary to cover any fees and expenses, taxes,or investment penalties. Our Resignation. We can resign at any time by providing you with30 days written notice prior to the resignation date, or within fivedays of our receipt of your written objection to an amendment. Inthe event you materially breach this Agreement, we can terminatethis Agreement by providing you with five days prior written notice.Upon our resignation, you must appoint a qualified successorcustodian or trustee. Your IRA assets will be transferred to thesuccessor custodian or trustee once we have received appropriatedirection. Transfers will be completed within a reasonable timefollowing our resignation notice and the payment of your remainingIRA fees or expenses. At the time of termination we may retain thesum necessary to cover any fees and expenses, taxes, or investmentpenalties. If you fail to provide us with acceptable transfer directionwithin 30 days from the date of the notice, we can transfer the assetsto a successor custodian or trustee of our choice or distribute themto you in cash.Successor Organization. If we merge with, purchase, or areacquired by, another organization, such organization, if qualified,may automatically become the successor custodian or trustee of yourIRA.

Required minimum distributions will be based on TreasuryRegulations 1.401(a)(9) and 1.408-8 in addition to our then currentpolicies and procedures. The required minimum distributionregulations are described within the Disclosure Statement. In theevent you, or your beneficiary after your death, fail to take arequired minimum distribution we may do nothing, distribute yourentire IRA balance, or distribute the amount of your requiredminimum distribution based on our own calculation.Transfer and Rollover Contributions. We may accept transfers,rollovers, recharacterizations, and other similar contributions incash from other IRAs, eligible retirement plans, and as allowed bylaw. Prior to completing such transactions we may require that youprovide certain information in a format acceptable to us.Reports and Records. We will maintain the records necessary forIRS reporting on this IRA. Required reports will be provided to you,or your beneficiary after your death, and the IRS. If you believe thatyour report is inaccurate or incomplete you must notify us in writingwithin 30 days following the receipt date. Your investments mayrequire additional state and federal reporting.Termination. You may terminate this Agreement without ourconsent by providing us with a written notice of termination. Atermination and the resulting distribution or transfer will beprocessed and completed as soon as administratively feasible

8.13

8.14

8.15

84

Sample

TRADITIONAL IRA DISCLOSURE STATEMENT6.

7.8.

9.

10.

11.

12.

13.

14.

IRA Eligibility and Contributions.1.

2.

3.

4.

Right to Revoke Your IRA. With some exceptions, you have the right torevoke this individual retirement account (IRA) within seven days ofreceiving this Disclosure Statement. If you revoke your IRA, we willreturn your entire IRA contribution without any adjustment for items suchas sales commissions, administrative expenses, or fluctuation in marketvalue. Exceptions to your right of revocation include that you may notrevoke an IRA established with a recharacterized contribution, nor do youhave the right to revoke upon amendment of this Agreement.

You may revoke your IRA by providing us with written notice. Therevocation notice may be mailed by first-class mail, or hand delivered tous. If your notice is mailed by first-class, postage pre-paid mail, therevocation will be deemed mailed on the date of the postmark.

If you have any questions or concerns regarding the revocation of yourIRA, please call or write to us. Our telephone number, address, andcontact name, to be used for communications, can be found on theapplication that accompanies this Disclosure Statement and InternalRevenue Service (IRS) Forms 5305 series agreement.This Disclosure Statement. This Disclosure Statement provides you, andyour beneficiaries after your death, with a summary of the rules andregulations governing this IRA.Definitions. The IRS Forms 5305 series agreement for traditional IRAscontains a detailed definitions section. The definitions found in suchsection apply to this Agreement. The IRS refers to you as the depositor,and us as the custodian. References to "you," "your," and "IRA owner"will mean the depositor, and "we," "us," and "our" will mean thecustodian. The terms "you" and "your" will apply to you. In the eventyou appoint a third party, or have a third party appointed on your behalfto handle certain transactions affecting your IRA, such third party will beconsidered your agent and, therefore, "you" for purposes of thisAgreement. Additionally, references to "IRA" will mean the custodialaccount.For Additional Guidance. It is in your best interest to seek the guidanceof a tax or legal professional before completing any IRA establishmentdocuments. Your first reference for questions concerning your IRAshould be the IRS Forms 5305 series agreement, any additional provisionsor amendments to such document, and this Disclosure Statement. Formore information, you can also refer to IRS Publication 590, IndividualRetirement Arrangements (IRAs), instructions to your federal income taxreturn, your local IRS office, or the IRS's web site at www.irs.gov.IRA Restrictions and Approval.

1.

2.

3.

4.

5.

IRS Form 5305 or 5305-A Agreement. This Disclosure Statementand the IRS Forms 5305 series agreement, amendments, andadditional provisions, set forth the terms and conditions governingyour traditional IRA. Such documents are the "Agreement."Individual Benefit. This IRA must be for the exclusive benefit ofyou and, upon your death, your beneficiaries. The IRA must beestablished in your name and not in the name of your beneficiary,living trust, or another party or entity.Beneficiary Designation. By completing the appropriate section onthe corresponding IRA application you may designate any person(s)as your beneficiary to receive your IRA assets upon your death.You may also change or revoke an existing designation in suchmanner and in accordance with such rules as your IRA custodianprescribes for this purpose. If there is no beneficiary designation onfile at the time of your death, or if none of the beneficiaries on fileare alive at the time of your death, your IRA assets will be paid toyour estate. Your IRA custodian may rely on the latest beneficiarydesignation on file at the time of your death, will be fully protectedin doing so, and will have no liability whatsoever to any personmaking a claim to the IRA assets under a subsequently fileddesignation or for any other reason.Cash Contributions. Regular or annual IRA contributions must bein cash, which may include a check, money order, or wire transfer,unless the contributions are rollover, transfer, or other similartransactions.IRA Custodian. An IRA custodian must be a bank, federallyinsured credit union, savings and loan association, trust company,or other entity, which is approved by the Secretary of the Treasuryto act as an IRA custodian.

Regular or Annual IRA Contribution. An annual contribution,commonly referred to as a regular contribution, is your contributionfor the tax year, and is based on your and/or your spouse'scompensation. Your designation of the tax year for yourcontribution is irrevocable. You may direct all or a portion of anytax refund directly to an IRA.Compensation for Eligibility. You are eligible to contribute to yourIRA if you are younger than age 70 1/2 during the entire tax yearfor which your contribution applies, and you have compensation(also referred to as earned income).

Common examples of compensation include wages, salary, tips,bonuses, and other amounts received for providing personalservices, and earned income from self-employment. Compensationdoes not include earnings and profits from property such asdividends, interest, or capital gains, or pension, annuity, or deferredcompensation plan amounts. Your compensation includes anytaxable alimony or separate maintenance payments you may receiveunder a divorce decree or separate maintenance agreement.Contribution By Your Spouse. If you are married, file a jointfederal income tax return, and are younger than age 70 1/2 duringthe entire tax year, you and/or your spouse may make a contributionon your behalf for that tax year if you and/or your spouse havecompensation. This contribution must be made into your IRA, and itcannot exceed the contribution limits applicable to regular IRAcontributions.Catch-up Contributions. Catch-up contributions are IRAcontributions made in addition to any other regular IRAcontributions. You are eligible to make catch-up contributions if you

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Prohibition Against Life Insurance and Commingling. None ofyour IRA assets may be invested in life insurance contracts, orcommingled with other property, except in a common trust fund orcommon investment fund.Nonforfeitability. The assets in your IRA are not forfeitable.Collectibles. Generally, none of your IRA assets may be invested incollectibles, including any work of art, rug, or antique, metal orgem, stamp or coin, alcoholic beverage, or any other tangiblepersonal property. If we allow, you may invest your IRA assets inthe following coins and bullion: certain gold, silver, and platinumcoins minted by the United States; a coin issued under the laws ofany state; and any gold, silver, platinum, and palladium bullion of acertain fineness, and only if such bullion is held by us. Foradditional guidance on collectibles, see Section 408(m) of theInternal Revenue Code (IRC).Tax-Free Rollovers. You may be eligible to make a rollovercontribution to an IRA or certain employer-sponsored eligibleretirement plans. Rollovers to and from IRAs and eligible retirementplans are described in greater detail elsewhere in this DisclosureStatement.Required Minimum Distribution (RMD) Rules. Your IRA issubject to the RMD rules summarized in this Agreement. No Prohibited Transactions. If you engage in a prohibitedtransaction, the IRA loses its tax exempt status as of the first day ofthe year. You must include the fair market value of your IRA as ofthat first day in your gross income for the year during which theprohibited transaction occurred, and pay all applicable taxes andpenalties. No Pledging. If you pledge all or a portion of your IRA as securityfor a loan, the portion pledged will be treated as a distribution toyou, and the taxable portion will be included in gross income, andmay be subject to the 10 percent premature-distribution penalty tax.IRS Approval of Form. This Agreement includes an IRS Forms5305 series agreement. This IRS document has been approved bythe IRS. This approval is not a determination of its merits, and notan endorsement of the investments provided by us, or the operationof the IRA. State Laws. State laws may affect your IRA in certain situations,including deductions, beneficiary designations, agency relationships,consent, taxes, tax withholding, and reporting.

85

Sample

3.

4.

Nonrefundable Tax Credit. You may be eligible to take a tax credit foryour regular IRA contributions. The credit is equal to a percentage ofyour qualified contributions up to $2,000. The credit cannot exceed$1,000 for any tax year, and is in addition to any deduction that mayapply. To be eligible for the tax credit, you must be age 18 or older bythe end of the applicable tax year, not a dependent of another taxpayer,not a full-time student, and satisfy certain restrictions on distributions.Moving Assets To and From IRAs. There are a variety of transactionsthat allow you to move your retirement assets to and from IRAs andcertain other eligible retirement plans. We have sole discretion on whetherwe will accept, and how we will process, movements of assets to andfrom IRAs. We or any other financial organizations involved in thetransaction may require documentation for such activities.

1.

2.

7.

8.

Tax Deductions. Tax deductions apply only to your regular and catch-upIRA contribution amount, and the deduction may never exceed yourmaximum regular and catch-up contribution amount for the contributionyear. Your deduction depends on whether you and your spouse (ifapplicable) are active participants, and your modified adjusted grossincome (MAGI). Your MAGI is your adjusted gross income from yourfederal income tax return for the contribution year with certainsubtractions and additions. For more information on MAGI, see theinstructions to your federal income tax return or IRS Publication 590,Individual Retirement Arrangements (IRAs).

1.

2.

a qualified pension, profit sharing, 401(k), money purchasepension, employee stock ownership plan, or stock bonus plan;a SEP plan;a SIMPLE IRA or SIMPLE 401(k) plan;a qualified annuity plan of an employer;a tax-sheltered annuity plan for employees of certain tax-exemptorganizations or public schools;a Section 501(c)(18) trust;an H.R. 10 or Keogh plan (for self-employed individuals); ora plan established by the United States, a state, or politicalsubdivision of the state or by an agency or instrumentality ofsuch entity (excluding certain Section 457 plans).

Deduction Calculation. If your MAGI is equal to or is less than theapplicable Low End number in the chart based on your tax-filingstatus, then you may deduct your entire regular and catch-up IRAcontribution. If your MAGI meets or exceeds the High End number,you may not deduct any portion of your contribution. If your MAGIis between the Low End and High End numbers, which is thephaseout range, see your tax or legal professional for assistance indetermining your deduction amount. IRS Publication 590, IndividualRetirement Arrangements (IRAs), and the instructions to your federalincome tax return also contain helpful calculation information. Nondeductible Contributions. You may make nondeductiblecontributions to your IRA if you are not able to, or choose not to,deduct your contributions. You report nondeductible contributions tothe IRS on IRS Form 8606, Nondeductible IRAs, which is attachedto your federal income tax return for the year of the contribution.Failure to report nondeductible contributions, or the overstatementof nondeductible contributions, may result in IRS penalties.

Roth IRA and Traditional IRA Contribution Limit. Yourcombined regular and catch-up traditional IRA and Roth IRAcontributions may not exceed the maximum contribution limits setforth in the previous chart.

Active Participant. You could be an active participant in one of thefollowing employer-sponsored retirement plans:a.

b.c.d.e.

f.g.h.

For assistance in determining whether you (or your spouse) are anactive participant, see your employer or a tax or legal professional.IRS Form W-2, Wage and Tax Statement, as provided by youremployer, should indicate whether you are an active participant.Deduction Limits. If you are not an active participant, your entireregular contribution to your IRA is generally deductible. Yourmarital status may affect your deduction amount. If you are anactive participant, the amount you can deduct depends on yourMAGI for the tax year for which the contribution applies. The

$5,000$5,000+COLA*

ContributionTax Year

Regular ContributionLimit

Catch-up ContributionLimit

1,0001,000

2008 and 20092010 and later

$$

MAGI THRESHOLDS

High End

TaxYear

Filing Status

2009 and later

following chart shows how your active participant status andtax-filing status and MAGI affect your deduction. If you are anactive participant, the greater your MAGI, the lesser the amount youmay deduct.

$176,000*$166,000*

Married, FilingJointly, Not an

Active Participant,but Spouse is

$65,000*$55,000*

Single, ActiveParticipant

$109,000*

Married,Filing Jointly,

Active Participant

High EndLow End

$0 $10,000

Married, Filing Separately,

Active Participant

$89,000*

Low End

*The MAGI thresholds are subject to annual cost-of-living adjustments.

* The regular IRA contribution limits are subject to annual cost-of-living adjustments (COLAs).

Contribution Deadline. You may make regular and catch-up IRAcontributions any time for a taxable year up to and including yourfederal income tax return due date, excluding extensions, for thattaxable year. The due date for most taxpayers is April 15. Thedeadline may be extended in some situations. Examples include afederally declared disaster, a terroristic or military action, or servicein a combat zone.

5.

6.

IRA-to-IRA Transfers. You may transfer all or a portion of yourtraditional IRA assets from one traditional IRA to another traditionalIRA. An IRA transfer means that the IRA assets move from oneIRA to another IRA in a manner that prevents you from cashing theIRA assets, or even depositing the assets anywhere except in thereceiving IRA. Transfers are not taxable or reportable, and the IRSdoes not impose timing or frequency restrictions on transfers. Youmay be required to complete a transfer authorization form prior totransferring your IRA assets. IRA-to-IRA Rollovers. An IRA rollover is another way to moveassets tax-free between IRAs. You may roll over all or a portion ofyour IRA assets by taking a distribution from an IRA andrecontributing it as a rollover contribution into the same or anotherIRA. A rollover contribution is irrevocable. You must report yourIRA rollover to the IRS on your federal income tax return. Yourcontribution may only be designated as a rollover if the IRAdistribution is deposited within 60 calendar days following the dateyou receive the distributed assets. The 60-day period may beextended to 120 days for a first-time homebuyer distribution wherethere is a delay or cancellation in the purchase or construction of thehome. You are limited to one rollover per IRA per 12 months. Thedistributing and receiving IRA, including the IRA assets rolled over,are subject to this 12-month rule. The 12-month period begins onthe day after you receive a distribution that will be properly rolled

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meet the eligibility requirements for regular contributions and youattain age 50 by the end of the taxable year for which a catch-upcontribution is being made.

Regardless of age, if you participated in a 401(k) plan with abankrupt employer whose officers were indicted or convicted wherethe employer matched at least 50 percent of employee contributionsunder the 401(k) plan in the form of employer stock, you may makeadditional IRA contributions up to $3,000 per year for tax years2007 through 2009, and as provided by law.SEP and SIMPLE IRA Contributions. Your employer may makesimplified employee pension (SEP) plan contributions to this IRA inaddition to your own regular IRA contributions. Your employer isresponsible for verifying the SEP eligibility requirements anddetermining the SEP contribution amount. This IRA cannot acceptSavings Incentive Match Plan for Employees of Small Employers(SIMPLE) IRA contributions from your employer. Maximum Contribution Limits. Your regular and catch-up IRAcontributions are limited to the lesser of 100 percent of your and/oryour spouse's compensation or the dollar amounts set forth on thefollowing chart.

High EndLow End High EndLow End

$85,0002008 $63,000$53,000 $105,000 $0 $10,000 $159,000 $169,000

86

SampleIndirect Rollover and Withholding. An indirect rollover beginswith a plan distribution made payable to you. If you receivedistributions during the tax year totaling more than $200, youremployer is required to withhold 20 percent on the taxableportion of your eligible rollover distribution as a prepayment offederal income taxes on distributions. You may make up the 20percent withholding from your own funds at the time you depositthe distribution into an IRA. If the 20 percent is not made up atthe time you deposit your distribution into an IRA, that portion isgenerally treated as taxable income. If you are younger than age59 1/2, you are subject to a 10 percent premature-distributionpenalty tax on the taxable amount of the distribution that is notrolled over, unless a penalty tax exception applies. Yourdistribution is only eligible to be contributed to an IRA during the60 days following your receipt of a plan distribution. Yourdecision to contribute the assets to the IRA as a rollovercontribution is irrevocable. The 12-month rule does not apply torollovers from employer-sponsored eligible retirement plans.State withholding may apply to eligible rollover distributions.Separate or Conduit IRA. In certain cases, it may be to yourbenefit to make the rollover contribution into a separate orconduit IRA. Conduit IRAs can provide individuals with a meansof tracking IRA assets from different sources, which may besubject to certain restrictions or favorable tax treatment.

Traditional IRA to Employer-Sponsored Eligible RetirementPlans. You may directly or indirectly roll over a taxable distributionfrom your IRA to an employer-sponsored eligible retirement planwhich accepts rollover contributions. Nontaxable or nondeductibleIRA assets may not be rolled over into employer-sponsored eligibleretirement plans. You can generally roll over, to employer-sponsoredeligible retirement plans, only the aggregate taxable balance in all ofyour traditional IRAs and SIMPLE IRAs. The 12-month rule doesnot apply to these rollovers.Transfers Due to Divorce. Your former spouse, pursuant to adivorce decree or legal separation order, may transfer assets fromyour traditional IRA to his/her traditional IRA.Qualified Reservist Contributions. If you are a qualified reservistordered or called to active duty after September 11, 2001 for morethan 179 days (or for an indefinite period), and take an IRAdistribution or take certain elective deferrals from an eligibleretirement plan after September 11, 2001, and before the end ofyour active duty, you may make one or more contributions of theseassets to your IRA within two years of the end of your active duty.Qualified Settlement Income. You may roll over certain qualifiedsettlement income (e.g. an amount received in connection with theExxon Valdez litigation) to your IRA under limits provided by law.Generally, the 12-month rule does not apply to such rollovers. It isin your best interest to seek the guidance of a tax or legalprofessional before taking advantage of such rollover and/or takingsuch assets from the IRA.

Traditional IRA to Roth IRA Conversions. You are eligible toconvert all or a portion of your traditional IRA assets to Roth IRAassets if your MAGI, as defined in the instructions to your federalincome tax return, is not more than $100,000 for the year of theIRA distribution. The $100,000 MAGI limit does not apply afterDecember 31, 2009. Your conversion assets (excluding proratednondeductible contributions) are subject to federal income tax. Yourconversion must be reported to the IRS. The 10 percentpremature-distribution penalty tax does not apply to conversions. Ifyou elect to convert your assets using a rollover transaction, the60-day rule applies. The 12-month rule does not apply toconversions. If you are married, and you and your spouse are filingseparate federal income tax returns, you are not eligible to convertyour traditional IRA assets to a Roth IRA prior to January 1, 2010.

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Eligible Retirement Plan. IRC Section 402(c)(8)(B) defineseligible retirement plans. Such plans include qualified trustsunder IRC Section 401(a), annuity plans under IRC Section403(a), annuity contracts under IRC Section 403(b), and certaingovernmental IRC Section 457(b) plans. Eligible Distribution. Not all distributions from an employer-sponsored eligible retirement plan are eligible for rollover to anIRA. The most common distributions, which are not eligible forrollover, include RMDs, defaulted loans, substantially equalperiodic payments as defined in IRC Section 402(c)(4)(A),distributions paid to nonspouse beneficiaries, and hardshipdistributions. Your employer determines which assets may not berolled over, and must provide you with an IRC Section 402(f)notice of taxation, which explains the tax issues concerningdistributions.Direct Rollover. A direct rollover moves eligible retirement planassets from your employer-sponsored eligible retirement plan toyour IRA in a manner that prevents you from cashing the planassets, or even depositing the assets anywhere except in thereceiving IRA. A direct rollover is reported to the IRS but, ifproperly completed, the transaction is not subject to tax orpenalty. There are no IRS limitations, such as the 60-day periodor 12-month rule, on direct rollovers. This Agreement should notbe used for a direct rollover from an eligible retirement plan toan inherited traditional IRA.

over into an IRA. The 12-month rule does not apply to rolloversrelated to first-time homebuyer distributions. Rollovers and Transfers from SIMPLE IRAs. You may not rollover or transfer assets from a SIMPLE IRA to a traditional IRA orother eligible retirement plan until two years have passed since thedate on which you first participated in an employer's SIMPLE,which is the initial contribution date. If you participated in SIMPLEsof different employers, the initial contribution date and two-yearperiod are determined separately for SIMPLE IRA assets from eachemployer.Rollovers from Employer-Sponsored Eligible Retirement Plans.If certain requirements are met, you may directly or indirectly rollover assets from an eligible retirement plan, sponsored by youremployer, into your IRA. Your plan administrator or employer isresponsible for determining the amount of your assets in its eligibleretirement plan that are eligible for rollover to an IRA or othereligible retirement plan. a.

b.

c.

d.

3.

4.

5.

e.

Waiver of the 60-Day Period. The Secretary of the Treasury maywaive the 60-day period for completing rollovers in certainsituations such as casualty, disaster, or other events beyond thereasonable control of the individual who is subject to the 60-dayperiod.

6.

7.

8.

9.

Movement of Assets Between Traditional and Roth IRAs.1.

2.

3.

Traditional IRA and Roth IRA Recharacterizations. You mayrecharacterize, or choose to treat all or a portion of your regular andcatch-up traditional IRA contribution as a regular Roth IRAcontribution. Similarly, you may recharacterize your regular andcatch-up Roth IRA contribution as a regular traditional IRAcontribution. You may cancel a conversion through arecharacterization of all or a portion of the amount converted from atraditional IRA to a Roth IRA. You may also recharacterize theamount rolled or directly rolled over to a Roth IRA from an eligibleretirement plan, or other recharacterization as provided by law. Arecharacterization election is irrevocable. You must complete arecharacterization no later than your federal income tax-filing duedate, including extensions, for the year you make the initialcontribution. If you timely file your federal income tax return, youmay still recharacterize as late as October 15 for calendar yearfilers. Recharacterizations must occur by transfer, which means thatthe assets, adjusted for gains and losses on therecharacterized amount, must be transferred into another IRA. Therecharacterized contribution is treated as though you deposited itinto the second IRA on the same day you actually deposited it in thefirst IRA. Recharacterization transactions are reported to the IRS.The election to recharacterize may be completed on your behalfafter your death. A written notice of recharacterization, as definedby Treasury Regulation 1.408A-5, Q&A 6(a), is required forrecharacterization transactions.Traditional IRA to Roth IRA Reconversions. A reconversionoccurs when all or a portion of traditional IRA assets previouslyconverted to a Roth IRA are recharacterized back to a traditionalIRA and then converted again. After recharacterizing a conversion,you cannot reconvert until the later of: (1) the beginning of the year

87

Sample

2.

3.

4.

5.

6.

7.

RMDs For Your Beneficiaries. Your beneficiaries will generally haveuntil December 31 of the year following your death year to begin RMDs.Exceptions exist for your surviving spouse and for any beneficiary whomust distribute or chooses to distribute his/her share of your traditionalIRA within a five-year period. If your death occurs on or after your RBD,your beneficiaries must withdraw any of your RMD that you had notreceived during the year of your death.

1.

IRA Distributions. You, or after your death your beneficiary, may takean IRA distribution at any time. However, depending on the timing andamount of your distribution you may be subject to income taxes and/orpenalty taxes.

1.

2.

3.

4.

5.

RMDs For You.1.

Failure to Withdraw an RMD. If you do not withdraw your RMDby its required distribution date, you will owe a 50 percent excessaccumulation penalty tax on the amount not withdrawn. You canalways take more than your RMD in any year but no additionalamounts can be credited to a subsequent year's RMD.Multiple IRAs. If you have more than one traditional IRA orSIMPLE IRA you must calculate a separate RMD for each one. Youmay, however, take the aggregate total of your RMDs from any oneor more of your personal traditional IRAs or SIMPLE IRAs. No Rollovers of RMDs. An RMD must be satisfied before you canroll over any portion of your IRA account balance. The firstdistributions made during a year will be considered RMDs and canbe satisfied by earlier distributions from your other traditional IRAsor SIMPLE IRAs that are aggregated. Any RMD that is rolled overwill be fully taxable and considered an excess contribution untilcorrected. Transfers of RMDs. Transfers are not considered distributions.You can transfer any portion of your traditional IRA or SIMPLEIRA at any time during the year provided you satisfy your aggregateRMDs before the end of the distribution year.2009 RMDs Waived for IRA Owners. The RMD requirement hasbeen waived for 2009. The information provided in RMDs For Youis modified for 2009. There is no requirement to calculate or take anRMD for the 2009 distribution year. There is no penalty for failingto take a 2009 RMD. An amount inadvertently taken to satisfy a2009 RMD may be eligible for rollover if the 12-month rule issatisfied and it is rolled over within 60 days (see IRA-to-IRARollovers for further explanation of these rules).

Distribution of Nondeductible and Nontaxable Contributions. Ifany of your traditional IRAs or SIMPLE IRAs contain nondeductiblecontributions or rollovers of nontaxable distributions fromemployer-sponsored eligible retirement plans, any distributions youtake from any of your traditional IRAs or SIMPLE IRAs, that arenot rolled over, will return to you a proportionate share of thetaxable and nontaxable balances in all of your traditional IRAs andSIMPLE IRAs at the end of the tax year of your distributions. IRSForm 8606, Nondeductible IRAs, has been specifically designed tocalculate this proportionate return. You must complete IRS Form8606 each year you take distributions under these circumstances,and attach it to your tax return for that year to validate thenontaxable portion of your IRA distributions reported for that year.Qualified Health Savings Account (HSA) Funding Distribution. Ifyou are an HSA eligible individual, you may elect to take a qualifiedHSA funding distribution from your IRA (not including ongoingSEP and SIMPLE IRAs) to the extent such distribution iscontributed to your HSA in a trustee-to-trustee transfer. This amountis aggregated with all other annual contributions and is subject toyour annual contribution limit. A qualified HSA funding distributionelection is irrevocable and is generally available once in yourlifetime. A testing period applies. The testing period for thisprovision begins with the month of the contribution to your HSAand ends on the last day of the 12th month following such month. Ifyou are not an eligible individual for the entire testing period, unlessyou die or become disabled, the amount of the distribution madeunder this provision will be includable in gross income for the taxyear of the month you are not an eligible individual, and is subjectto a 10 percent penalty tax.Tax-Free Distributions to Charities. If you have attained age70 1/2, you may make tax-free distributions directly from your IRAto a qualified charitable organization. Tax-free distributions arelimited to $100,000 per year and only apply to distributions madethrough December 31, 2009. This deadline is subject to extensionby an act of Congress.

After Age 70 1/2. Your first RMD must be taken by April 1following the year you attain age 70 1/2, which is your requiredbeginning date (RBD). Second year and subsequent distributions

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must be taken by December 31 of each such year. An RMD istaxable in the calendar year you receive it. Distribution Calculations. Your RMD will generally be calculatedby dividing your previous year-end adjusted balance in your IRA bya factor from the uniform lifetime table provided by the IRS. Thistable is indexed to your age attained during a distribution year. Thistable is used whether you have named a beneficiary and regardlessof the age or type of beneficiary you may have named. However, iffor any distribution year, you have as your only named beneficiaryfor the entire year, your spouse, who is more than ten yearsyounger than you, the uniform lifetime table will not be used. Tocalculate your RMD for that year you will use the ages of you andyour spouse at the end of that year to determine a joint lifeexpectancy factor from the IRS's joint and last survivor table. Thiswill be the case even if your spouse dies, or you become divorcedand do not change your beneficiary, during that year.

following the year the amount was converted, or (2) the end of the30-day period following the day of the recharacterization. In otherwords, you cannot reconvert in the same year as the firstconversion. Reconversion transactions are reported to the IRS.

Removal of Excess Contributions. You may withdraw all or aportion of your excess contribution and attributable earnings beforeyour federal income tax return due date, including extensions, forthe taxable year for which you made the contribution. The excesscontribution amount distributed will not be taxable but theattributable earnings on the contribution will be taxable in the yearin which you made the contribution and may be subject to the 10percent premature-distribution penalty tax. In certain situations, youmay treat your excess as a regular and catch-up IRA contributionfor the next year. If you timely file your federal income tax return,you may still remove your excess contribution, plus attributableearnings, as late as October 15 for calendar year filers.Distributions of Unwanted IRA Contributions by Tax-FilingDate. You may withdraw all or a portion of your regular andcatch-up IRA contribution and attributable earnings in the samemanner as an excess contribution. However, you cannot apply yourunwanted contribution as a regular IRA contribution for a futureyear. The unwanted contribution amount distributed will not betaxable, but the attributable earnings on the contribution will betaxable in the year in which you made the contribution, and may besubject to the 10 percent premature-distribution penalty tax. If youtimely file your federal income tax return, you may still removeyour unwanted contribution, plus attributable earnings, as late asOctober 15 for calendar year filers.

Distribution Calculations In General. Most beneficiaries will use asingle life expectancy method to satisfy these RMDs unless theyelect the five-year rule. The five-year rule requires your beneficiaryto completely withdraw your IRA assets by the end of the fifth yearfollowing your death year. The single life expectancy factor, usingthe IRS's single life table, will be determined by using the age onDecember 31 of the oldest designated beneficiary unless multiplebeneficiaries exist and separate accounting applies. This initiallydetermined factor is reduced by one for each subsequent year'scalculation.

This general rule for determining life expectancy applies if yourIRA has at least one designated beneficiary, whether your deathoccurs before or on or after your RBD. However, if you die on orafter your RBD, your remaining life expectancy, determined in yourdeath year and reduced by one in each subsequent year, may beused to determine the distribution each year. This is true if yourremaining life expectancy is longer than the beneficiary's lifeexpectancy that same year, determined in the year after your deathand reduced by one in each subsequent year, or if your IRA istreated as having no designated beneficiary.

88

Sample

Annual Statements. Each year we will furnish you and the IRS withstatements reflecting the activity in your IRA. You and the IRS willreceive IRS Forms 5498 and 1099-R. IRS Form 5498 or an appropriatesubstitute indicates the fair market value of the account, including IRAcontributions, for the year. IRS Form 1099-R reflects your IRAdistributions for the year.

By January 31 of each year, you will receive a report of your fairmarket value as of the previous calendar year. If applicable, you will alsoreceive a report concerning your annual RMD.Federal Tax Penalties and IRS Form 5329. Several tax penalties mayapply to your various IRA transactions, and are in addition to any federal,state, or local taxes. Federal penalties and excise taxes are generallyreported and remitted to the IRS by completing IRS Form 5329, andattaching the form to your federal income tax return. The penalties mayinclude any of the following taxes:

Estate and Gift Tax. The designation of a beneficiary to receive IRAdistributions upon your death will not be considered a transfer of propertyfor federal gift tax purposes. Upon your death, the value of all assetsremaining in your IRA will usually be included in your gross estate forestate tax purposes, regardless of the named beneficiary or manner ofdistribution. There is no specific estate tax exclusion for assets held withinan IRA. After your death, beneficiaries should pay careful attention to therules for the disclaiming any portion of your IRA under IRC Section2518. Federal Income Tax Withholding. IRA distributions are subject tofederal income tax withholding unless you or, upon your death, yourbeneficiary affirmatively elect not to have withholding apply. Therequired federal income tax withholding rate is 10 percent of thedistribution. Upon your request for a distribution, by providing IRS FormW-4P or an appropriate substitute, we will notify you of your right towaive withholding or elect to have greater than 10 percent withheld.

2009 RMDs Waived for Beneficiaries. The RMD requirement hasbeen waived for the 2009 distribution year. Beneficiaries takingRMDs under the life expectancy method have no requirement tocalculate or take an RMD for 2009. Also, if a beneficiary is subjectto the five-year rule and the five-year period was set to endDecember 31, 2009, such beneficiary must take all IRA assets byDecember 31, 2010. An amount inadvertently taken to satisfy a2009 RMD is eligible for rollover by a spouse beneficiary;however, it is not eligible for rollover by a nonspouse beneficiary.Additionally, the RBD of an IRA owner who is age 70 1/2 in 2009is April 1, 2010. This date will be used to determine if the IRAowner died before, or on or after the RBD.

Taxation. IRA distributions which are not rolled over will be taxedas income in the year distributed except for the portion of youraggregate SIMPLE IRA and traditional IRA distributions thatrepresents your nondeductible contributions and/or nontaxablerollover amounts. You may also be subject to state or local taxesand withholding on your IRA distributions. Earnings. Earnings, including gains and losses, on your IRA willnot be subject to federal income taxes until they are considereddistributed.Ordinary Income Taxation. Your taxable IRA distribution isusually included in gross income in the distribution year. IRAdistributions are not eligible for special tax treatments, such as tenyear averaging, that may apply to other employer-sponsoredretirement plan distributions.

your beneficiaries. This distribution would be in accordance withArticle IV.3 of the Agreement, and generally would not allow asuccessor beneficiary to calculate RMDs based on his/her own lifeexpectancy. Separate Accounting. Our policies may permit separate accountingto be applied to your IRA for the benefit of your beneficiaries. Ifpermitted, separate accounting must be applied in accordance withTreasury Regulation 1.401(a)(9)-8, Q&A 2 and 3. A beneficiary isconsidered the only designated beneficiary of his/her share of theIRA assets if separate accounting applies.

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If you name a qualified trust, which is defined in TreasuryRegulation 1.401(a)(9)-4, Q&A 5, as your IRA beneficiary, thebeneficiaries of the qualified trust are treated as the beneficiaries ofyour IRA for purposes of determining designated beneficiaries andthe appropriate life expectancy period after your death. A qualifiedtrust provides documentation of its beneficiaries to the custodian.Death Before Your RBD With No Designated Beneficiary. If youdie before your RBD and your IRA is treated as having nodesignated beneficiary, your named beneficiaries will be required tocompletely withdraw your IRA assets by the end of the fifth yearfollowing your death year.

7.

8.

Federal Income Tax Status of Distributions.1.

2.

3.

A special exception to the five-year rule allows certain deathbeneficiaries to exclude 2009 when calculating the five-year period.In order to apply this exception, the IRA owner or plan participantmust have died before his/her RBD, after 2003, and prior to 2009.For example, assume the IRA owner died in 2008. If the deathbeneficiary, by affirmative election or default, selected the five-yearrule, the five-year period would normally require total distributionby December 31, 2013. However, by applying the exception, thebeneficiary must now take total distribution by December 31, 2014.Designated Beneficiary. A designated beneficiary is any namedbeneficiary who has an interest in your IRA on the determinationdate, which is September 30 of the year following your death year.Named beneficiaries who completely distribute their interests inyour IRA, or completely disclaim their interests in your IRA underIRC Section 2518, will not be considered when designatedbeneficiaries are determined. Named beneficiaries who die afteryour death but before the determination date will still be consideredfor the sake of determining the distribution period. If any namedbeneficiary that is not an individual, such as an estate or charity, hasan interest in your IRA on the determination date, and separateaccounting does not apply, your IRA will be treated as having nodesignated beneficiary.

2.

3.

4.

5.

6.

Death On or After Your RBD With No Designated Beneficiary.If you die on or after your RBD and your IRA is treated as havingno designated beneficiary, RMDs will continue to your namedbeneficiaries over your remaining single expectancy as determinedin your death year. Once determined, this life expectancy factorwill be reduced by one for each subsequent year of the distributionperiod. Spouse Beneficiary. If your spouse is your only designatedbeneficiary on the determination date, or if there are multipledesignated beneficiaries and separate accounting applies, he/she willuse his/her age each year to determine the life expectancy factor forcalculating that year's RMD. If your spouse is the only designatedbeneficiary, or if there are multiple designated beneficiaries andseparate accounting applies, and you die before your RBD, yoursurviving spouse can postpone commencement of his/her RMDsuntil the end of the year in which you would have attained age70 1/2. If you die on or after your RBD, your surviving spouse willuse the longer of his/her single life expectancy, determined eachyear after the death year using his/her attained age, or yourremaining single life expectancy determined in your death year andreduced by one each subsequent year.

If your spouse is the only designated beneficiary, or if there aremultiple designated beneficiaries and separate accounting applies,he/she can treat your IRA as his/her own IRA after your death. Thisgenerally happens after any of your remaining RMD amount for theyear of your death has been distributed. This is not available to yoursurviving spouse if he/she is the sole beneficiary of a qualified trustthat is named as beneficiary of your IRA.

Your spouse beneficiary could take a distribution of his/her shareof your IRA and roll it over to an IRA of his/her own.Beneficiaries Naming Successor Beneficiaries. Our policy mayallow your beneficiaries to name their own successor beneficiariesto your IRA. A successor beneficiary would receive any of yourIRA assets that remain after your death and the subsequent death of

89

Sample

Premature-Distribution Penalty Tax. If you take a distributionfrom your IRA before reaching age 59 1/2, you are subject to a 10percent premature-distribution penalty tax on the taxable portion ofthe distribution. However, certain exceptions apply. Exceptions tothe 10 percent penalty tax are distributions due to death, disability,first-time home purchase, eligible higher education expenses,medical expenses exceeding a certain percentage of adjusted grossincome, health insurance premiums due to your extendedunemployment, a series of substantially equal periodic payments,IRS levy, traditional IRA conversions, qualified reservistdistributions, and qualified HSA funding distributions. Properlycompleted rollovers, transfers, recharacterizations, and conversionsare not subject to the 10 percent penalty tax.Excess Contribution Penalty Tax. If you contribute more to yourIRA than you are eligible to contribute, you have created an excesscontribution, which is subject to a 6 percent excise tax. The excisetax applies each year that the excess contribution remains in yourIRA. If you timely file your federal income tax return, you may stillremove your excess contribution, plus attributable earnings, as lateas October 15 for calendar year filers.

1.

2.

3.

Disaster Tax Relief. Subject to IRC Section 1400Q, individuals in certainfederally-declared disaster areas may be given the opportunity to takequalified distributions (subject to applicable time periods defined by law)in aggregation from IRAs and other eligible retirement plans up to theprescribed limit (e.g., $100,000 for Midwestern Disaster and HurricaneKatrina). Typically, these rules permit an individual to prorate anyamounts required to be included in gross income over a three tax yearperiod or include it all in the year of distribution. In addition, anindividual may be allowed three years after the date of receipt to roll overor repay all or part of the qualified distribution without being subject tothe one rollover per 12-month rule or the 60-day requirement. Certainfirst-time homebuyer or hardship distributions may be eligible for rolloverwithin a prescribed time period. Also, for additional disaster areainformation and IRS guidance on associated tax relief, refer to IRS noticesand publications, or visit the IRS's web site at www.irs.gov.

Excess Accumulation Penalty Tax. Any portion of a RMD that isnot distributed by its deadline is subject to a 50 percent excessaccumulation penalty tax. The IRS may waive this penalty uponyour proof of reasonable error and that reasonable steps were takento correct the error, including remedying the shortfall. See IRSForm 5329 instructions when requesting a waiver.

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90

SamplePROJECTION METHODS (Check one):

FINANCIAL DISCLOSURE

If no fees are disclosed, follow the instructions located above thepreprinted tables to determine the appropriate projected values for yourIRA.

l

If a fee was disclosed and it is only charged on a distribution transactionor an IRA termination, the After Fees column will be completed on theappropriate table taking the fee(s) into account for each applicableprojected value.

The purpose of this Financial Disclosure is to provide you with an IRSrequired growth projection of the value of your IRA available forwithdrawal at the end of each of the first five years of its existence and atthe end of the years in which you attain the ages of 60, 65, and 70.Certain assumptions are applied that may vary from your actualinvestment provisions.

NoneIRA Establishment Fee $Annual Service/Administration Fee of $or % of assets will be charged at l end l beginningof each year for purposes of this projection.Transfer/Direct Rollover Fee $IRA Termination Fee $Other: $ or % of AssetsOther: $ or % of Assets

None l 1-Month l 3-Month6-Month l Other:

This Section Applies To The Projection Method Selected.

Three projection methods are provided for the situations where the natureof your initial investment allows for a reasonable projection.

IRA FEES AND LOSS OF EARNINGS PENALTIES

The growth projection must be made assuming either a $1,000contribution made on January 1 of each year or a $1,000 one-timecontribution made on January 1 of your first year. The annualcontribution represents an initial contribution that is a regular, SEP, orrecharacterized regular Roth IRA contribution. One-time contributionsinclude a rollover, transfer, recharacterized conversion, orrecharacterized Roth IRA rollover contribution. These projected amountsare not guaranteed.

Earnings rate - One-half (.5) percent compounded annually on a365-day year.Projected values - Calculated using numbers rounded to thenearest one cent ($.01).Loss of earnings penalties - The 1-, 3-, and 6-month penalties arecalculated on a 30-day month and a 360-day year.Calculated loss of earnings penalty - The 1-, 3-, and 6-monthpenalties are not rounded prior to subtraction from the No Penaltycolumn's projected value.

Fees:lll

llll

Loss of Earnings Penalty (Check one):ll

The fees and penalties listed below may affect the projected value of yourIRA. The disclosed fees and penalties will be included in that projectionmethod applicable to your Financial Disclosure. Projection Method Onecannot be used if an IRA Establishment Fee, Annual Service/Administration Fee, and/or certain Other boxes are checked below,including the Other box under Loss of Earnings Penalty.

l

(Check one):l Annual Contributions.l Rollover/Transfer (one-time) Contribution.

Your age on January 1 of this initial contribution year: Earnings Rate: %Compounding Method:

.Loss of Earnings Calculation Method:

.

Projection Method OnefUse Preprinted Tables.The preprinted financial disclosure tables on the following pageprovide you with the IRA's projected values. The assumptions used tocalculate each table's projected IRA values are:}

}

}

}

Projection Method ThreefSee Separate Financial Disclosure andAssumptions Provided by Your IRA's Custodian.

l Projection Method TwofCustom Projection.Your IRA's values projected below are based on the followingassumptions:

606570

AgeProjectedValue

ProjectedValue

End ofYear

$$$

12345

$$$$$

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IRA-49-LAZ 7/1/2009

91

Sample

FINANCIAL DISCLOSURE - PROJECTION METHOD ONE

If we disclosed a distribution transaction or termination fee in the IRA FEES AND LOSS OF EARNINGS PENALTIES of this disclosure, the After Fees column hasbeen completed to reflect your IRA's projected values. We have reduced the value in the No Penalty column or loss of earnings penalty column applicable to yourinitial investment. The same factors affect each of your projected values.Find your age as of January 1 of this year of establishment on the appropriate table. If your birthday is January 1 of this year, find your age as of December 31 of theprevious year on the appropriate table. The amounts to the right of your age are the projected values of your IRA at the end of the year you attain age 70. Your valuesmay be subject to a 1-, 3-, or 6-month penalty. See IRA FEES AND LOSS OF EARNINGS PENALTIES to determine the applicable loss of earnings penalty. Theloss of earnings penalty determines the appropriate column to use for your projection.Your IRA's projected value at the end of the year you attain age 65 is found in the fifth row below your age 70 values.Your IRA's projected value at the end of the year you attain age 60 is found in the fifth row below your age 65 values.Your IRA's projected value at the end of each of the first five years is identified at the bottom of each table.

How to Use the Preprinted Tables. Your projection will come from the Annual Contributions table if your initial IRA contribution is a regular, SEP, or recharacterizedregular Roth IRA contribution. The Rollover/Transfer Contribution table is used if your initial contribution is a rollover, transfer, recharacterized conversion, orrecharacterized Roth IRA rollover contribution.1.

2.

3.4.5.

ROLLOVER/TRANSFER CONTRIBUTION

After FeesYourAge

ANNUAL CONTRIBUTIONSNo

Penalty1-MonthPenalty

3-MonthPenalty

123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960616263646566676869

82,566.1181,155.3379,751.5778,354.8076,964.9875,582.0774,206.0472,836.8671,474.4970,118.9068,770.0567,427.9166,092.4564,763.6363,441.4262,125.7960,816.7159,514.1458,218.0556,928.4155,645.1854,368.3453,097.8551,833.6850,575.8049,324.1848,078.7946,839.5945,606.5644,379.6643,158.8741,944.1540,735.4739,532.8138,336.1337,145.4035,960.6034,781.6933,608.6532,441.4431,280.0430,124.4228,974.5527,830.4026,691.9425,559.1424,431.9823,310.4322,194.4621,084.0419,979.1418,879.7417,785.8116,697.3215,614.2514,536.5713,464.2512,397.2611,335.5810,279.189,228.048,182.137,141.426,105.895,075.514,050.263,030.112,015.031,005.00

82,531.8881,121.6879,718.5178,322.3276,933.0775,550.7374,175.2872,806.6671,444.8670,089.8368,741.5467,399.9666,065.0564,736.7863,415.1262,100.0360,791.5059,489.4758,193.9156,904.8155,622.1154,345.8053,075.8451,812.1950,554.8349,303.7348,058.8646,820.1745,587.6544,361.2643,140.9841,926.7640,718.5839,516.4238,320.2437,130.0035,945.6934,767.2733,594.7232,427.9931,267.0730,111.9328,962.5427,818.8626,680.8725,548.5424,421.8523,300.7722,185.2621,075.3019,970.8618,871.9117,778.4416,690.4015,607.7814,530.5413,458.6712,392.1211,330.8810,274.929,224.218,178.747,138.466,103.365,073.414,048.583,028.852,014.191,004.58

82,463.4281,054.3979,652.3878,257.3576,869.2575,488.0674,113.7572,746.2771,385.5970,031.6968,684.5267,344.0566,010.2564,683.0863,362.5162,048.5260,741.0759,440.1258,145.6456,857.6055,575.9754,300.7253,031.8151,769.2150,512.9049,262.8348,018.9946,781.3345,549.8444,324.4643,105.1941,891.9840,684.8139,483.6438,288.4537,099.2035,915.8734,738.4333,566.8532,401.0931,241.1430,086.9528,938.5127,795.7926,658.7425,527.3524,401.5923,281.4422,166.8621,057.8219,954.2918,856.2617,763.6916,676.5515,594.8314,518.4913,447.5012,381.8411,321.4810,266.409,216.568,171.957,132.546,098.305,069.204,045.223,026.342,012.521,003.75

82,360.7280,953.4579,553.1978,159.8976,773.5375,394.0674,021.4572,655.6871,296.7069,944.4868,598.9867,260.1865,928.0464,602.5363,283.6161,971.2560,665.4359,366.1058,073.2356,786.8055,506.7654,233.1052,965.7751,704.7450,449.9949,201.4947,959.1946,723.0845,493.1144,269.2743,051.5141,839.8140,634.1439,434.4738,240.7737,053.0035,871.1534,695.1733,525.0532,360.7431,202.2330,049.4928,902.4827,761.1726,625.5425,495.5624,371.2123,252.4522,139.2521,031.5919,929.4418,832.7817,741.5716,655.7915,575.4114,500.4113,430.7612,366.4211,307.3810,253.619,205.098,161.787,123.666,090.705,062.894,040.193,022.572,010.021,002.50

1,407.271,400.271,393.311,386.381,379.481,372.621,365.791,358.991,352.231,345.511,338.811,332.151,325.531,318.931,312.371,305.841,299.341,292.881,286.441,280.041,273.681,267.341,261.041,254.761,248.521,242.301,236.121,229.971,223.851,217.771,211.711,205.691,199.691,193.731,187.791,181.891,176.011,170.151,164.331,158.531,152.771,147.031,141.331,135.651,130.001,124.381,118.781,113.221,107.681,102.171,096.691,091.231,085.801,080.401,075.021,069.671,064.351,059.051,053.781,048.541,043.321,038.131,032.971,027.831,022.711,017.621,012.561,007.521,002.50

123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960616263646566676869

1,410.781,403.761,396.781,389.831,382.921,376.041,369.191,362.381,355.601,348.861,342.151,335.471,328.831,322.221,315.641,309.091,302.581,296.101,289.651,283.231,276.851,270.501,264.181,257.891,251.631,245.401,239.201,233.031,226.901,220.801,214.731,208.691,202.681,196.701,190.751,184.831,178.941,173.071,167.231,161.421,155.641,149.891,144.171,138.481,132.821,127.181,121.571,115.991,110.441,104.921,099.421,093.951,088.511,083.091,077.701,072.341,067.001,061.691,056.411,051.151,045.921,040.721,035.541,030.391,025.261,020.161,015.081,010.031,005.00

1,410.201,403.181,396.201,389.251,382.351,375.471,368.621,361.821,355.041,348.301,341.591,334.921,328.281,321.671,315.091,308.551,302.041,295.561,289.121,282.701,276.321,269.971,263.661,257.371,251.111,244.881,238.691,232.521,226.391,220.291,214.231,208.191,202.181,196.201,190.261,184.341,178.451,172.581,166.751,160.941,155.161,149.411,143.701,138.011,132.351,126.711,121.111,115.531,109.981,104.461,098.961,093.501,088.061,082.641,077.251,071.901,066.561,061.251,055.971,050.711,045.491,040.291,035.111,029.961,024.841,019.741,014.661,009.611,004.58

1,409.031,402.021,395.041,388.101,381.201,374.331,367.491,360.691,353.921,347.181,340.481,333.811,327.181,320.581,314.001,307.461,300.961,294.491,288.051,281.641,275.261,268.921,262.611,256.331,250.071,243.851,237.661,231.501,225.381,219.281,213.221,207.191,201.191,195.211,189.271,183.361,177.471,171.611,165.781,159.981,154.201,148.461,142.751,137.071,131.411,125.781,120.181,114.601,109.061,103.551,098.051,092.591,087.161,081.741,076.361,071.011,065.671,060.371,055.101,049.841,044.621,039.431,034.251,029.111,023.991,018.891,013.821,008.771,003.75

After FeesYourAge

Year 5Year 4Year 3Year 2Year 1

1-MonthPenalty

3-MonthPenalty

6-MonthPenalty

6-MonthPenalty

NoPenalty


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Custodial

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IndividualRetirementAccount

............................

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For Additional Guidance. It is in your best interest to seek the guidanceof a tax or legal professional before completing this document. For moreinformation, refer to Internal Revenue Service (IRS) Publication 590,Individual Retirement Arrangements (IRAs), IRS Form 5498, IRAContribution Information, instructions to your federal income tax return,your local IRS office, or the IRS's web site at www.irs.gov.

How to use this Roth IRA Organizer. The individual establishing thisRoth IRA must complete the Application page. The Roth IRA ownermust sign the document. An original signed copy of the Applicationshould be kept by the custodian for its records. The Roth IRA ownershould receive a copy of the Application and keep the remainingcontents of the Roth IRA Organizer. Community or marital propertystate laws may require spousal consent for nonspouse beneficiarydesignations.

Purpose. This Organizer contains the forms necessary to establish a Rothindividual retirement account (IRA). This Organizer should not be used toestablish an inherited Roth IRA.

Additional Documents. Applicable law or policies of the Roth IRAcustodian may require additional documentation such as IRS Form W-9,Request for Taxpayer Identification Number and Certification.

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Roth IRA Organizer-CustodialBankers SystemsWolters Kluwer Financial Services 1998, 2009 Page 1 of 13

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Roth IRA Application

3DESIGNATION OF BENEFICIARY

DATE OF BIRTH GENDER:

NAME, ADDRESS, CITY, STATE, AND ZIP ROTH IRA ACCOUNT (PLAN) NUMBER



1ROTH IRA OWNER INFORMATION (Custodian's name, address, and phone number above)

2CONTRIBUTION INFORMATION

E-MAIL (OPTIONAL)

INVESTMENT NUMBERTAX YEAR OF FIRST ROTH IRACONTRIBUTION/CONVERSIONAMOUNT CONTRIBUTION DATE

$TAX YEAR

l Male l Female

At the time of my death, the primary beneficiaries named below will receive my Roth IRA assets. If all of my primary beneficiaries die beforeme, the contingent beneficiaries named below will receive my Roth IRA assets. In the event a beneficiary dies before me, such beneficiary'sshare will be reallocated on a pro-rata basis to the other beneficiaries that share the deceased beneficiary's classification as a primary orcontingent beneficiary. If all of the beneficiaries die before me, my Roth IRA assets will be paid to my estate. If no percentages are assigned tobeneficiaries, or if the percentage total for any beneficiary classification exceeds 100 percent, the beneficiaries in that beneficiary classificationwill share equally. If the percentage total for each beneficiary classification is less than 100 percent, any remaining percentage will be dividedequally among the beneficiaries within such class. This designation revokes and supercedes all earlier beneficiary designations which may applyto this Roth IRA.

NAME OF BENEFICIARY

A. Primary BeneficiaryNAME OF BENEFICIARY

PERCENTAGE

%%%


Total 100%


RELATIONSHIP TOROTH IRA OWNER

PERCENTAGE

%%%


Total 100%


B. Contingent Beneficiary

RELATIONSHIP TOROTH IRA OWNER

-



CONTRIBUTION TYPE: l Regular (including Catch-Up) l Rollover/Direct Rollover from an Eligible Retirement Planl Rollover l Rollover/Direct Rollover from a Designated Roth Accountl Transfer l Qualified Reservist/Designated Disaster Distribution Repayment*l Recharacterization l Disaster/Combat Zone Postponed Contribution*l Conversion *Reason Code (if applicable)

95

Sample5 I certify that the information provided by me on this Application is accurate, and that I have received a copy of IRS Form 5305-RA, Roth

Individual Retirement Custodial Account, a Disclosure Statement, and a Financial Disclosure. I agree to be bound by the terms and conditionsfound in the Agreement, Disclosure Agreement, Financial Disclosure, and amendments thereto. I assume sole responsibility for all consequencesrelating to my actions concerning this Roth IRA. I understand that I may revoke this Roth IRA on or before seven (7) days after the date ofestablishment. My designation of the tax year for my contribution, and any election to treat a contribution as a rollover or recharacterization, isirrevocable. I indemnify and agree to hold the custodian harmless against any liabilities. I understand that the custodian cannot provide, and hasnot provided, me with tax or legal advice. I have been advised to seek the guidance of a tax or legal professional.

SIGNATURES

Signature of Custodian DateSignature of Roth IRA Owner Date

I am the spouse of the Roth IRA owner. Because of the significant consequences associated with giving up my interest in the Roth IRA, thecustodian has not provided me with legal or tax advice, but has advised me to seek tax or legal advice. I acknowledge that I have received a fairand reasonable disclosure of the Roth IRA owner's assets or property and any financial obligations for a community property state. In the eventI have a legal interest in the Roth IRA assets, I hereby give to the Roth IRA owner such interest in the assets held in this Roth IRA and consentto the beneficiary designation set forth in this Application

Signature of Witness (if required) Date(Witness cannot be a beneficiary of this Roth IRA)

Signature of Spouse Date

I Am Not Married. I understand that if I marry in the future, I must complete a new Designation of Beneficiary form,which includes the spousal consent documentation.

I Am Married. I understand that if I designate a primary beneficiary other than my spouse, my spouse must consent bysigning below.

Community or marital property state laws may require spousal consent for a nonspouse beneficiary designation. The laws of the state in whichthe financial organization is domiciled, the Roth IRA owner resides, the trust is located, the spouse resides, or this transaction is consummatedshould be reviewed to determine if such a requirement exists. Spousal consent for the beneficiary designation may also be required by financialorganization policy.

SPOUSAL CONSENT4(Roth IRA Owner Initials)

(Roth IRA Owner Initials)

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Form 5305-RA (Rev. March 2002) Department of the Treasury Internal Revenue ServiceThe depositor and the custodian make the following agreement:

ROTH INDIVIDUAL RETIREMENT CUSTODIAL ACCOUNT(Under Section 408A of the Internal Revenue Code) Do Not File with

Internal Revenue Service l Amendment

Your Roth IRA Documents. This Internal Revenue Service (IRS)Forms 5305 series agreement for Roth IRAs, and any amendmentsor additional provisions to such agreement (the "Agreement") setforth the terms and conditions governing your Roth individualretirement account (IRA) and your or, after your death, yourbeneficiary's relationship with us. Your agreement will beaccompanied by a disclosure statement, which sets forth variousRoth IRA rules in simpler language, and a financial disclosure. Definitions. This IRS Forms 5305 series agreement contains adetailed definitions section. The definitions found in such sectionapply to this Agreement. The IRS refers to you as the depositor, andus as the custodian. References to "you," "your," and "Roth IRAowner" will mean the depositor, and "we," "us," and "our" willmean the custodian. The terms "you" and "your" will apply to you.In the event you appoint a third party, or have a third partyappointed on your behalf, to handle certain transactions affectingyour Roth IRA, such third party will be your agent and will beconsidered "you" for purposes of this Agreement. Additionally,references to "Roth IRA" will mean the custodial account.Additional Provisions. Additional provisions may be attached to,and made a part of, this Agreement by either party. The provisionsmust be in writing, agreed to by us, and in a format acceptable to us.

The remaining interest will be distributed, starting by the end ofthe calendar year following the year of the depositor's death,over the designated beneficiary's remaining life expectancy asdetermined in the year following the death of the depositor.The remaining interest will be distributed by the end of thecalendar year containing the fifth anniversary of the depositor'sdeath.

Article I. Except in the case of a rollover contribution described insection 408A(e), a recharacterized contribution described in section408A(d)(6), or an IRA Conversion Contribution, the custodian will acceptonly cash contributions up to $3,000 per year for tax years 2002 through2004. That contribution limit is increased to $4,000 for tax years 2005through 2007 and $5,000 for 2008 and thereafter. For individuals whohave reached the age of 50 before the close of the tax year, thecontribution limit is increased to $3,500 per year for tax years 2002through 2004, $4,500 for 2005, $5,000 for 2006 and 2007, and $6,000for 2008 and thereafter. For tax years after 2008, the above limits will beincreased to reflect a cost-of-living adjustment, if any.Article II.

1. The annual contribution limit described in Article I is graduallyreduced to $0 for higher income levels. For a single depositor, the annualcontribution is phased out between adjusted gross income (AGI) of$95,000 and $110,000; for a married depositor filing jointly, betweenAGI of $150,000 and $160,000; and for a married depositor filingseparately, between AGI of $0 and $10,000. In the case of a conversion,the custodian will not accept IRA Conversion Contributions in a tax yearif the depositor's AGI for the tax year the funds were distributed from theother IRA exceeds $100,000 or if the depositor is married and files aseparate return. Adjusted gross income is defined in section 408A(c)(3)and does not include IRA Conversion Contributions.

2. In the case of a joint return, the AGI limits in the precedingparagraph apply to the combined AGI of the depositor and his or herspouse.Article III. The depositor's interest in the balance in the custodial accountis nonforfeitable.Article IV.

1. No part of the custodial account funds may be invested in lifeinsurance contracts, nor may the assets of the custodial account becommingled with other property except in a common trust fund orcommon investment fund (within the meaning of section 408(a)(5)).

2. No part of the custodial account funds may be invested incollectibles (within the meaning of section 408(m)) except as otherwisepermitted by section 408(m)(3), which provides an exception for certaingold, silver, and platinum coins, coins issued under the laws of any state,and certain bullion.Article V.

1. If the depositor dies before his or her entire interest is distributed tohim or her and the depositor's surviving spouse is not the designatedbeneficiary, the remaining interest will be distributed in accordance with(a) below or, if elected or there is no designated beneficiary, inaccordance with (b) below:

(a)

(b)

2. The minimum amount that must be distributed each year underparagraph 1(a) above is the account value at the close of business onDecember 31 of the preceding year divided by the life expectancy (in thesingle life table in Regulations section 1.401(a)(9)-9) of the designatedbeneficiary using the attained age of the beneficiary in the year followingthe year of the depositor's death and subtracting 1 from the divisor foreach subsequent year.

3. If the depositor's surviving spouse is the designated beneficiary,such spouse will then be treated as the depositor.Article VI.

1. The depositor agrees to provide the custodian with all informationnecessary to prepare any reports required by sections 408(i) and408A(d)(3)(E), Regulations sections 1.408-5 and 1.408-6, or otherguidance published by the Internal Revenue Service (IRS).

2. The custodian agrees to submit to the IRS and depositor the reportsprescribed by the IRS.Article VII. Notwithstanding any other articles which may be added orincorporated, the provisions of Articles I through IV and this sentence willbe controlling. Any additional articles inconsistent with section 408A, therelated regulations, and other published guidance will be invalid.

Our Fees and Expenses. We may charge reasonable fees and areentitled to reimbursement for any expenses we incur in establishingand maintaining your Roth IRA. We may change the fees at anytime by providing you with notice of such changes. We will provideyou with fee disclosures and policies. Fees may be deducted directlyfrom your Roth IRA assets, and/or billed separately to you. Feesbilled separately to you and paid by you may be claimed on yourfederal income tax return as miscellaneous itemized deductions. Thepayment of fees has no effect on your contributions. Additionally,we have the right to liquidate your Roth IRA assets to pay such feesand expenses. If you do not direct us on the liquidation, we willliquidate the assets of our choice and will not be responsible for anylosses or claims that may arise out of the liquidation. Amendments. We may amend your Roth IRA in any respect and atany time, including retroactively, to comply with applicable lawsgoverning retirement plans and the corresponding regulations. Anyother amendments shall require your consent, by action or noaction, and will be preceded by written notice to you. Unlessotherwise required, you are deemed to automatically consent to anamendment, which means that your written approval is not requiredfor the amendment to apply to the Roth IRA. In certain instances thegoverning law or our policies may require us to secure your writtenconsent before an amendment can be applied to the Roth IRA. Ifyou want to withhold your consent to an amendment, you mustprovide us with a written objection within 30 days of the receipt dateof the amendment. Notice and Delivery. Any notice mailed to you will be deemeddelivered and received by you, five days after the postmark date.This fifth day following the postmark is the receipt date. Noticeswill be mailed to the last address we have in our records. You areresponsible for ensuring that we have your proper mailing address.Upon your consent, we may provide you with notice in a deliveryformat other than by mail. Such formats may include variouselectronic deliveries. Any notice, including terminations, change inpersonal information, or contributions mailed to us will be deemeddelivered when actually received by us based on our ordinarybusiness practices. All notices must be in writing unless our policiesand procedures provide for oral notices.

Article VIII. This Agreement will be amended as necessary to complywith the provisions of the Code, the related regulations, and otherpublished guidance. Other amendments may be made with the consent ofthe persons whose signatures appear on the Application that accompaniesthis Agreement.Article IX.9.01

9.02

9.03

9.04

9.05

9.06

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Sample

Spouse Beneficiary. Notwithstanding Article V, a spousebeneficiary shall be permitted all the beneficiary options allowedunder law or applicable regulations. If your surviving spouse is yoursole beneficiary, your spouse may treat your Roth IRA as his/herown Roth IRA and would not be subject to the RMD rules.Transfer and Rollover Contributions. We may accept transfers,rollovers, and other similar contributions in cash from other IRAs,eligible retirement plans, and as allowed by law. Prior to completingsuch transactions we may require that you provide certaininformation in a format acceptable to us.Reports and Records. We will maintain the records necessary forIRS reporting on this Roth IRA. Required reports will be providedto you, or your beneficiary after your death, and the IRS. If youbelieve that your report is inaccurate or incomplete, you must notifyus in writing within 30 days following the receipt date. Yourinvestments may require additional state and federal reporting.Termination. You may terminate this Agreement without ourconsent by providing us with a written notice of termination. Atermination and the resulting distribution or transfer will beprocessed and completed as soon as administratively feasiblefollowing the receipt of proper notice. At the time of termination wemay retain the sum necessary to cover any fees and expenses, taxes,or investment penalties. Our Resignation. We can resign at any time by providing you with30 days written notice prior to the resignation date, or within fivedays of our receipt of your written objection to an amendment. Inthe event you materially breach this Agreement, we can terminatethis Agreement by providing you with five days prior written notice.Upon our resignation, you must appoint a qualified successorcustodian or trustee. Your Roth IRA assets will be transferred to thesuccessor custodian or trustee once we have received appropriatedirection. Transfers will be completed within a reasonable timefollowing our resignation notice and the payment of your remainingRoth IRA fees or expenses. At the time of termination we mayretain the sum necessary to cover any fees and expenses, taxes, orinvestment penalties. If you fail to provide us with acceptabletransfer direction within 30 days from the date of the notice we cantransfer the assets to a successor custodian or trustee of our choiceor distribute them to you in cash. Successor Organization. If we merge with, purchase, or areacquired by, another organization, such organization, if qualified,may automatically become the successor custodian or trustee of yourRoth IRA.

9.12

9.13

9.14

9.15

9.16

9.17

9.18

(d)

Distributions. Withdrawal requests must be in a format acceptableto us, and/or on forms provided by us. We may require you, oryour beneficiary after your death, to elect a distribution reason,provide documentation, and provide a proper tax identificationnumber before we process a distribution. These withdrawals may besubject to taxes, withholding, and penalties. Distributions willgenerally be in cash.

Required minimum distributions for your beneficiaries will bebased on Treasury Regulations 1.408A-6, 1.401(a)(9) and 1.408-8in addition to our then current policies and procedures. The requiredminimum distribution regulations are described within theDisclosure Statement. In the event a beneficiary, after your death,fails to take a required minimum distribution we may do nothing,distribute the entire IRA balance, or distribute the requiredminimum distribution based on our own calculation.

Deposit Investments Only. The deposit investments we offerare limited to savings, share and money market accounts, andcertificates of deposit (CDs). This Roth IRA is not, and cannotbe, a self-directed Roth IRA. It does not permit you to investyour contributions or Roth IRA assets in nondeposit investmentssuch as property, annuities, stocks, bonds, and government,municipal or United States Treasury securities.Investment of Contributions. We will invest contributions andreinvest your Roth IRA assets as directed by you based on ourthen current investment policies and procedures. If you fail toprovide us with investment direction for a contribution, we willreturn or hold all or part of such contribution based on ourpolicies and procedures. We will not be responsible for any lossof Roth IRA income associated with your failure to provideappropriate investment direction.Directing Investments. All investment directions must be in aformat or manner acceptable to us. You may invest in any RothIRA investments that you are qualified to purchase, and that weare authorized to offer and do offer at the time of the investmentselection, and that are acceptable under the applicable lawsgoverning retirement plans. Your Roth IRA investments will beregistered in our name for the benefit of your Roth IRA.Specific investment information may be provided at the time ofthe investment.

Based on our policies, we may allow you to delegate theinvestment responsibility of your Roth IRA to an agent byproviding us with written notice of delegation in a formatacceptable to us. We will not review or guide your agent'sdecisions, and you are responsible for the agent's actions orfailure to act. We are not responsible for directing yourinvestments, or providing investment advice, including guidanceon the suitability or potential market value of variousinvestments.

9.07

9.08

9.09

9.10

9.11

Applicable Laws. This Agreement will be construed and interpretedin accordance with the laws of, and venued in, our state of domicile.Disqualifying Provisions. Any provision of this Agreement thatwould disqualify the Roth IRA will be disregarded to the extentnecessary to maintain the account as a Roth IRA.Interpretation. If any question arises as to the meaning of anyprovision of this Agreement, then we shall be authorized to interpretany such provision, and our interpretation will be binding upon allparties. Representations and Indemnity. You represent that anyinformation you and/or your agents provide to us is accurate andcomplete, and that your actions comply with this Agreement andapplicable laws governing retirement plans. You understand that wewill rely on the information provided by you, and that we have noduty to inquire about or investigate such information. We are notresponsible for any losses or expenses that may result from yourinformation, direction, or actions, including your failure to act. Youagree to hold us harmless, to indemnify, and to defend us againstany and all actions or claims arising from, and liabilities and lossesincurred by reason of your information, direction, or actions.Additionally, you represent that it is your responsibility to seek theguidance of a tax or legal professional for your Roth IRA issues.

We are not responsible for determining whether your contributionsor distributions comply with this Agreement and/or the federal lawsgoverning retirement plans. We are not responsible for any taxes,judgments, penalties, or expenses incurred in connection with yourRoth IRA, or any losses that are a result of events beyond ourcontrol. We have no responsibility to process transactions until afterwe have received appropriate direction and documentation, and wehave had a reasonable opportunity to process the transactions. Weare not responsible for interpreting or directing beneficiarydesignations or divisions, including separate accounting, courtorders, penalty exception determinations, or other similar situations.Investment of Roth IRA Assets.(a)

(b)

(c)

Investment Fees and Asset Liquidation. We have the right toliquidate your Roth IRA assets to pay fees and expenses, federaltax levies, or other assessments on your Roth IRA. If you do notdirect us on the liquidation, we will liquidate the assets of ourchoice and will not be responsible for any losses or claims thatmay arise out of the liquidation.

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98

Sample

IRS FORM 5305-RA INSTRUCTIONS (Rev. 3-2002)Article V. This article describes howdistributions will be made from the Roth IRAafter the depositor's death. Elections madepursuant to this article should be reviewedperiodically to ensure they correspond to thedepositor's intent. Under paragraph 3 of ArticleV, the depositor's spouse is treated as the ownerof the Roth IRA upon the death of the depositor,rather than as the beneficiary. If the spouse is tobe treated as the beneficiary, and not the owner,an overriding provision should be added toArticle IX.Article IX. Article IX and any that follow itmay incorporate additional provisions that areagreed to by the depositor and custodian tocomplete the agreement. They may include, forexample, definitions, investment powers, votingrights, exculpatory provisions, amendment andtermination, removal of the custodian,custodian's fees, state law requirements,beginning date of distributions, accepting onlycash, treatment of excess contributions,prohibited transactions with the depositor, etc.Attach additional pages if necessary.

DefinitionsIRA Conversion Contributions. IRA ConversionContributions are amounts rolled over,transferred, or considered transferred from anonRoth IRA to a Roth IRA. A nonRoth IRA isan individual retirement account or annuitydescribed in section 408(a) or 408(b), other thana Roth IRA.Custodian. The custodian must be a bank orsavings and loan association, as defined insection 408(n), or any person who has theapproval of the IRS to act as custodian.Depositor. The depositor is the person whoestablishes the custodial account.Specific InstructionsArticle I. The depositor may be subject to a 6%tax on excess contributions if (1) contributions toother individual retirement arrangements of thedepositor have been made for the same tax year,(2) the depositor's adjusted gross incomeexceeds the applicable limits in Article II for thetax year, or (3) the depositor's and spouse'scompensation is less than the amount contributedby or on behalf of them for the tax year. Thedepositor should see the disclosure statement orPub. 590 for more information.

General InstructionsSection references are to the Internal RevenueCode unless otherwise noted.Purpose of FormForm 5305-RA is a model custodial accountagreement that meets the requirements of section408A and has been pre-approved by the IRS. ARoth individual retirement account (Roth IRA) isestablished after the form is fully executed byboth the individual (depositor) and the custodian.This account must be created in the United Statesfor the exclusive benefit of the depositor and hisor her beneficiaries.

Do not file Form 5305-RA with the IRS.Instead, keep it with your records.

Unlike contributions to traditional individualretirement arrangements, contributions to a RothIRA are not deductible from the depositor'sgross income; and distributions after 5 years thatare made when the depositor is 59 1/2 years ofage or older or on account of death, disability, orthe purchase of a home by a first-time homebuyer(limited to $10,000), are not includible in grossincome. For more information on Roth IRAs,including the required disclosures the custodianmust give the depositor, see Pub. 590,Individual Retirement Arrangements (IRAs).

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99

SampleRequired Minimum Distribution (RMD) Rules For Beneficiaries.This Roth IRA is subject to the RMD rules summarized in thisAgreement. No Prohibited Transactions. If you engage in a prohibitedtransaction, the Roth IRA loses its tax exempt status as of the first dayof the year. Subject to the Roth IRA ordering rules, you must includethe fair market value of your Roth IRA as of that first day in yourgross income for the year during which the prohibited transactionoccurred, and pay all applicable taxes and penalties. No Pledging. If you pledge all or a portion of your Roth IRA assecurity for a loan, the portion pledged will be treated as adistribution to you, subject to the Roth IRA ordering rules, potentiallyincluded in gross income, and may be subject to the 10 percentpremature-distribution penalty tax.IRS Approval of Form. This Agreement includes an IRS Forms5305 series agreement. This IRS document has been approved by theIRS. This approval is not a determination of its merits, and not anendorsement of the investments provided by us, or the operation ofthe Roth IRA.State Laws. State laws may affect your Roth IRA in certainsituations, including beneficiary designations, agency relationships,consent, taxes, and reporting.

Regular or Annual Roth IRA Contribution. An annual contribution,commonly referred to as a regular contribution, is your contributionfor the tax year, and is based on your and/or your spouse'scompensation. Your designation of the tax year for your contributionis irrevocable. You may direct all or a portion of any tax refunddirectly to an IRA.

If you are married and file a joint federal income tax return, youand/or your spouse may make a contribution on your behalf for thattax year if you and/or your spouse have compensation. Thiscontribution must be made into your Roth IRA, and it cannot exceedthe contribution limits applicable to regular Roth IRA contributions.Compensation for Eligibility. You are eligible to contribute to yourRoth IRA if you have compensation (also referred to as earnedincome). The amount you may contribute may be limited based onyour modified adjusted gross income (MAGI). The instructions toyour federal income tax return will provide helpful information indetermining your compensation and MAGI amounts.

Common examples of compensation include wages, salary, tips,bonuses, and other amounts received for providing personal services,and earned income from self-employment. Compensation does notinclude earnings and profits from property such as dividends, interest,or capital gains, or pension, annuity, or deferred compensation planamounts. Your compensation includes any taxable alimony orseparate maintenance payments you may receive under a divorcedecree or separate maintenance agreement.

Right to Revoke Your Roth IRA. With some exceptions, you have theright to revoke this Roth individual retirement account (IRA) within sevendays of receiving this Disclosure Statement. If you revoke your Roth IRA,we will return your entire Roth IRA contribution without any adjustmentfor items such as sales commissions, administrative expenses, orfluctuation in market value. Exceptions to your right of revocation includethat you may not revoke a Roth IRA established with a recharacterizedcontribution, nor do you have the right to revoke upon amendment of thisAgreement.

You may revoke your Roth IRA by providing us with written notice.The revocation notice may be mailed by first-class mail, or hand deliveredto us. If your notice is mailed by first-class, postage pre-paid mail, therevocation will be deemed mailed on the date of the postmark.

If you have any questions or concerns regarding the revocation of yourRoth IRA, please call or write to us. Our telephone number, address, anda contact name to be used for communications can be found on theapplication that accompanies this Disclosure Statement and InternalRevenue Service (IRS) Forms 5305 series agreement.This Disclosure Statement. This Disclosure Statement provides you, oryour beneficiaries after your death, with a summary of the rules andregulations governing this Roth IRA. Definitions. The IRS Forms 5305 series agreement for Roth IRAscontains a detailed definitions section. The definitions found in suchsection apply to this Agreement. The IRS refers to you as the depositor,and us as the custodian. References to "you," "your," and "Roth IRAowner" will mean the depositor, and "we," "us," and "our" will mean thecustodian. The terms "you" and "your" will apply to you. In the eventyou appoint a third party, or have a third party appointed on your behalfto handle certain transactions affecting your Roth IRA, such third partywill be considered your agent and, therefore, "you" for purposes of thisAgreement. Additionally, references to "Roth IRA" will mean thecustodial account.For Additional Guidance. It is in your best interest to seek the guidanceof a tax or legal professional before completing any Roth IRAestablishment documents. Your first reference for questions concerningyour Roth IRA should be the IRS Forms 5305 series agreement, anyadditional provisions or amendments to such document, and thisDisclosure Statement. For more information, you can also refer to IRSPublication 590, Individual Retirement Arrangements (IRAs), instructionsto your federal income tax return, your local IRS office, or the IRS's website at www.irs.gov.Roth IRA Restrictions and Approval.1.

2.

3.

4.

5.

company, or other entity, which is approved by the Secretary of theTreasury to act as a Roth IRA custodian.Prohibition Against Life Insurance and Commingling. None ofyour Roth IRA assets may be invested in life insurance contracts, orcommingled with other property, except in a common trust fund orcommon investment fund.Nonforfeitability. The assets in your Roth IRA are not forfeitable.Collectibles. Generally, none of your Roth IRA assets may beinvested in collectibles, including any work of art, rug, or antique,metal or gem, stamp or coin, alcoholic beverage, or any othertangible personal property. If we allow, you may invest your RothIRA assets in the following coins and bullion: certain gold, silver, andplatinum coins minted by the United States; a coin issued under thelaws of any state; and any gold, silver, platinum, and palladiumbullion of a certain fineness, and only if such bullion is held by us.For additional guidance on collectibles, see Section 408(m) of theInternal Revenue Code (IRC).Tax-Free Rollovers. You may be eligible to make a rollovercontribution of your Roth IRA distribution to a Roth IRA. Rolloversto and from Roth IRAs are described in greater detail elsewhere inthis Disclosure Statement.

IRS Form 5305-R or 5305-RA Agreement. This DisclosureStatement and the IRS Forms 5305 series agreement, amendments,and additional provisions, set forth the terms and conditionsgoverning your Roth IRA. Such documents are the "Agreement."Individual Benefit. This Roth IRA must be for the exclusive benefitof you and, upon your death, your beneficiaries. The Roth IRA mustbe established in your name and not in the name of your beneficiary,living trust, or another party or entity.Beneficiary Designation. By completing the appropriate section onthe corresponding Roth IRA application you may designate anyperson(s) as your beneficiary to receive your Roth IRA assets uponyour death. You may also change or revoke an existing designation insuch manner and in accordance with such rules as your Roth IRAcustodian prescribes for this purpose. If there is no beneficiarydesignation on file at the time of your death, or if none of thebeneficiaries on file are alive at the time of your death, your RothIRA assets will be paid to your estate. Your Roth IRA custodian mayrely on the latest beneficiary designation on file at the time of yourdeath, will be fully protected in doing so, and will have no liabilitywhatsoever to any person making a claim to the Roth IRA assetsunder a subsequently filed designation or for any other reason.Cash Contributions. Regular or annual Roth IRA contributions mustbe in cash, which may include a check, money order, or wire transferunless the contributions are rollover, transfer, or other similartransactions.Roth IRA Custodian. A Roth IRA custodian must be a bank,federally insured credit union, savings and loan association, trust

ROTH IRA DISCLOSURE STATEMENT

6.

7.8.

9.

10.

11.

12.

13.

14.

Roth IRA Eligibility and Contributions. 1.

2.

-



100

Sample

2008 CONTRIBUTION CHART

10,000 -

101,001 -

116,000 -

159,001 -

Single

Phaseout

No Contribution

No Contribution

No Contribution

No Contribution

No Contribution

Full Contribution

Full Contribution

Full Contribution

Full Contribution

Phaseout

No Contribution

Modified AGI(MAGI)*

Married, FilingJointly

Married, FilingSeparately**

Less than $10,000

$

$

$

$

$169,000 or over

Full Contribution

Full Contribution

Phaseout

No Contribution

No Contribution

No Contribution

$101,000

$115,999

$159,000

$168,999

* The regular IRA contribution limits are subject to annualcost-of-living adjustments (COLAs).

Catch-up Contributions. Catch-up contributions are Roth IRAcontributions made in addition to any other regular Roth IRAcontributions. You are eligible to make catch-up contributions if youmeet the eligibility requirements for regular contributions and youattain age 50 by the end of the taxable year for which a catch-upcontribution is being made.

Regardless of age, if you participated in a 401(k) plan with abankrupt employer whose officers were indicted or convicted wherethe employer matched at least 50 percent of employee contributionsunder the 401(k) plan in the form of employer stock, you may makeadditional IRA contributions up to $3,000 per year for tax years 2007through 2009, and as provided by law.Maximum Contribution Limits. Your regular and catch-up RothIRA contributions are limited to the lesser of 100 percent of yourand/or your spouse's compensation or the dollar amounts set forth onthe following chart.

$5,000

$5,000+COLA*

ContributionTax Year

Regular ContributionLimit

Catch-up ContributionLimit1,000

1,000

2008 and 2009

2010 and later

$

$

4.

5.

IRS Publication 590, Individual Retirement Arrangements (IRAs), andthe instructions to your federal income tax return also contain helpfulcalculation information.

Limitations on Contributions. The amount you can contributedepends on your MAGI for the tax year for which the contributionapplies, your marital status, and your tax-filing status. The followingchart shows how your MAGI and status affect your contribution limit.The greater your MAGI, the lesser the amount you may contribute.The limits are set forth on the following charts.

-



* Subject to annual cost-of-living adjustments (COLAs).**An individual who is married, filing separately, and who lived

apart from his/her spouse the entire year, can use the MAGI limitfor a single filer to determine his/her contribution limit.

2009 CONTRIBUTION CHART

3.

10,000 -

105,001 -

120,000 -

166,001 -

Single

Phaseout

No Contribution

No Contribution

No Contribution

No Contribution

No Contribution

Full Contribution

Full Contribution

Full Contribution

Full Contribution

Phaseout

No Contribution

Modified AGI(MAGI)*

Married, FilingJointly

Married, FilingSeparately**

Less than $10,000

$

$

$

$

$176,000 or over

Full Contribution

Full Contribution

Phaseout

No Contribution

No Contribution

No Contribution

$ 105,000

$119,999

$166,000

$175,999

Roth IRA and Traditional IRA Contribution Limit. Your combinedregular and catch-up traditional IRA and Roth IRA contributions maynot exceed the maximum contribution limits set forth in the previouschart.SEP and SIMPLE IRA Contributions. Your employer may notmake simplified employee pension (SEP) plan or Savings IncentiveMatch Plan for Employees of Small Employers (SIMPLE) IRAcontributions to this Roth IRA.

Roth IRA-to-Roth IRA Transfers. You may transfer all or a portionof your Roth IRA assets from one Roth IRA to another Roth IRA. ARoth IRA transfer means that the Roth IRA assets move from oneRoth IRA to another Roth IRA in a manner that prevents you fromcashing the Roth IRA assets, or even depositing the assets anywhereexcept in the receiving Roth IRA. Transfers are not taxable orreportable, and the IRS does not impose timing or frequencyrestrictions on transfers. You may be required to complete a transferauthorization form prior to transferring your Roth IRA assets. Roth IRA-to-Roth IRA Rollovers. A Roth IRA rollover is anotherway to move assets tax-free between Roth IRAs. You may roll overall or a portion of your Roth IRA assets by taking a distribution froma Roth IRA and recontributing it as a rollover contribution into thesame or another Roth IRA. A rollover contribution is irrevocable.You must report your Roth IRA rollover to the IRS on your federalincome tax return. Your contribution may only be designated as arollover if the Roth IRA distribution is deposited within 60 calendardays following the date you receive the distributed assets. Any portionnot rolled over will be subject to the Roth IRA ordering rules todetermine income taxes and penalty taxes. The 60-day period may beextended to 120 days for a first-time homebuyer distribution wherethere is a delay or cancellation in the purchase or construction of thehome. You are limited to one rollover per Roth IRA per 12 months.The distributing and receiving Roth IRA, including the Roth IRAassets rolled over, are subject to this 12-month rule. The 12-monthperiod begins on the day after you receive a distribution that will beproperly rolled over into a Roth IRA. The 12-month rule does notapply to rollovers related to first-time homebuyer distributions.Waiver of the 60-Day Period. The Secretary of the Treasury maywaive the 60-day period for completing rollovers in certain situationssuch as casualty, disaster, or other events beyond the reasonablecontrol of the individual who is subject to the 60-day period. Transfers Due to Divorce. Your former spouse, pursuant to adivorce decree or legal separation order, may transfer assets fromyour Roth IRA to his/her Roth IRA.Qualified Reservist Contributions. If you are a qualified reservistordered or called to active duty after September 11, 2001 for morethan 179 days (or for an indefinite period), and take an IRAdistribution or take certain elective deferrals from an eligibleretirement plan after September 11, 2001, and before the end of youractive duty, you may make one or more contributions of these assetsto your Roth IRA within two years of the end of your active duty.Qualified Settlement Income. You may roll over certain qualifiedsettlement income (e.g., an amount received in connection with theExxon Valdez litigation) to your IRA under limits provided by law.Generally, the 12-month rule does not apply to such rollovers. Theseamounts are generally not subject to the conversion or qualifiedrollover eligibility rules. It is in your best interest to seek the guidanceof a tax or legal professional before taking advantage of such rolloverand/or taking such assets from the IRA.

7.

8.

Nonrefundable Tax Credit. You may be eligible to take a tax credit foryour regular Roth IRA contributions. The credit is equal to a percentageof your qualified contributions up to $2,000. The credit cannot exceed$1,000 for any tax year, and is in addition to any deduction that mayapply. To be eligible for the tax credit, you must be age 18 or older bythe end of the applicable tax year, not a dependent of another taxpayer,not a full-time student, and satisfy certain restrictions on distributions.Moving Assets To and From Roth IRAs. There are a variety oftransactions that allow you to move your retirement assets to and fromRoth IRAs. We have sole discretion on whether we will accept, and howwe will process, movements of assets to and from Roth IRAs. We or anyother financial organizations involved in the transaction may requiredocumentation for such activities.1.

2.

3.

4.

5.

6.Contribution Deadline. You may make regular and catch-up RothIRA contributions any time for a taxable year up to and includingyour federal income tax return due date, excluding extensions, forthat taxable year. The due date for most taxpayers is April 15. Thedeadline may be extended in some situations. Examples include afederally declared disaster, a terroristic or military action, or servicein a combat zone.

6.

101

Sample

Traditional IRA and Roth IRA Recharacterizations. You mayrecharacterize, or choose to treat all or a portion of your regular andcatch-up traditional IRA contribution as a regular Roth IRAcontribution. Similarly, you may recharacterize all or a portion ofyour regular and catch-up Roth IRA contribution as a regulartraditional IRA contribution. You may cancel a conversion through arecharacterization of all or a portion of the amount converted from atraditional IRA to a Roth IRA. You may also recharacterize theamount rolled or directly rolled over to a Roth IRA from an eligibleretirement plan, or other recharacterization as provided by law. Arecharacterization election is irrevocable. You must complete arecharacterization no later than your federal income tax-filing duedate, including extensions, for the year you make the initialcontribution. If you timely file your federal income tax return, youmay still recharacterize as late as October 15 for calendar year filers.Recharacterizations must occur by transfer, which means that theassets, adjusted for gains and losses on the recharacterized amount,must be transferred into another IRA. The recharacterizedcontribution is treated as though you deposited it into the second IRAon the same day you actually deposited it in the first IRA.Recharacterization transactions are reported to the IRS. The electionto recharacterize may be completed on your behalf after your death.A written notice of recharacterization, as defined in TreasuryRegulation 1.408A-5, Q&A 6(a), is required for recharacterizationtransactions.Traditional IRA to Roth IRA Reconversions. A reconversionoccurs when all or a portion of traditional IRA assets previouslyconverted to a Roth IRA are recharacterized back to a traditional IRAand then converted again. After recharacterizing a conversion, youcannot reconvert until the later of: (1) the beginning of the yearfollowing the year the amount was converted, or (2) the end of the30-day period following the day of the recharacterization. In otherwords, you cannot reconvert in the same year as the first conversion.Reconversion transactions are reported to the IRS.

Traditional IRA to Roth IRA Conversions. You are eligible toconvert all or a portion of your traditional IRA assets to Roth IRAassets if your MAGI, as defined in the instructions to your federalincome tax return, is not more than $100,000 for the year of thetraditional IRA distribution. The $100,000 MAGI limit does not applyafter December 31, 2009. Your conversion assets (excluding proratednondeductible contributions) are subject to federal income tax. Yourconversion must be reported to the IRS. The 10 percentpremature-distribution penalty tax does not apply to conversions. Ifyou elect to convert your assets using a rollover transaction, the60-day rule applies. The 12-month rule does not apply to conversions.If you are married, and you and your spouse are filing separatefederal income tax returns, you are not eligible to convert yourtraditional IRA assets to a Roth IRA prior to January 1, 2010.

Conversions from SIMPLE IRAs. You may not convert assets froma SIMPLE IRA to a Roth IRA until two years have passed since thedate on which you first participated in an employer's SIMPLE plan,which is the initial contribution date. If you participated in SIMPLEplans of different employers, the initial contribution date and two-yearperiod are determined separately for SIMPLE IRA assets from eachemployer.Rollovers or Direct Rollovers from Eligible Retirement Plans. Ifcertain requirements are met, you may directly or indirectly roll overassets from an eligible retirement plan sponsored by your employerinto your Roth IRA. You are responsible for determining if you areeligible to roll over assets, other than designated Roth account assets,to a Roth IRA. Your plan administrator or employer is responsible fordetermining the amount of your assets in its eligible retirement planthat is eligible for rollover to a Roth IRA. Assets in a Roth IRA arenot eligible to be rolled over to an eligible retirement plan.a.

Direct Rollover. A direct rollover moves eligible distributionassets from your eligible retirement plan to your Roth IRA in amanner that prevents you from cashing or liquidating the planassets, or even depositing the assets anywhere except in thereceiving Roth IRA. A direct rollover is reported to the IRS.There are no IRS limitations, such as the 60-day period or12-month rule, on direct rollovers.Indirect Rollover and Withholding. An indirect rollover beginswith a plan distribution made payable to you. In general, youremployer is required to withhold 20 percent on the taxable portionof your eligible distribution as a prepayment of federal incometaxes on distributions. You may make up the 20 percentwithholding from your own funds at the time you deposit thedistribution into a Roth IRA. If you are younger than age 59 1/2,you are subject to a 10 percent premature-distribution penalty taxon the taxable amount of the distribution that is not rolled over,unless a penalty tax exception applies. Your eligible distributionmay be contributed to a Roth IRA during the 60 days followingyour receipt of a plan distribution. Your decision to contribute theassets to a Roth IRA as a rollover contribution is irrevocable. The12-month rule does not apply to rollovers from eligible retirementplans. State withholding may apply to eligible distributions. TheSecretary of the Treasury may waive the 60-day period forcompleting rollovers in certain situations such as casualty,disaster, or other events beyond the reasonable control of theindividual who is subject to the 60-day period.

Eligible Retirement Plan (ERP). IRC Section 402(c)(8)(B)defines eligible retirement plans. Such plans include qualifiedtrusts under IRC Section 401(a), annuity plans under IRC Section403(a), annuity contracts under IRC Section 403(b), and certaingovernmental IRC Section 457(b) plans.

b.

c.

d.

e.

f.

g.

h.

Movement of Assets Between Traditional and Roth IRAs.1.

2.

3.

Movement of Other Assets to Roth IRAs.1.

2.

-



Rollover or Direct Rollover Eligibility. You must meet eligibilityrequirements in order to roll or directly roll over eligibledistribution amounts, other than designated Roth accountbalances, to a Roth IRA. These eligible rollover amounts arereferred to as "qualified rollover contributions." For tax yearsbeginning before January 1, 2010, you cannot make a qualifiedrollover contribution from an ERP if, for the year the distributionis made, you have modified adjusted gross income exceeding$100,000 or are married and file a separate tax return. You mayrecharacterize the rollover and earnings attributable to atraditional IRA by the deadline if you are ineligible.Taxes and Treatment of Qualified Rollover Contributions. Thetaxable portion that is rolled or directly rolled over to a Roth IRAis subject to federal income tax. The 10 percentpremature-distribution penalty tax does not apply to these taxableamounts. However, if the taxable portion of the qualified rollovercontribution is distributed from the Roth IRA within five yearsand an exception does not apply, the 10 percent penalty tax wouldapply in this later year. With respect to subsequent distributionsfrom this Roth IRA that are nonqualified distributions, thequalified rollover contribution amount is considered as part of thenontaxable conversion category for purposes of the orderingrules.Rollover or Direct Rollover of Designated Roth AccountAssets. You do not need to meet eligibility requirements to makequalified rollover contributions to a Roth IRA. Rollovers ofdesignated Roth account assets to a Roth IRA are not taxable. Theplan administrator will inform you if the distribution amount fromthe designated Roth account is qualified or nonqualified. Qualifieddistributions rolled over from designated Roth accounts areconsidered regular contributions for the Roth IRA "nonqualifieddistribution" ordering rules. The earnings portion of nonqualifieddistributions rolled over from designated Roth accounts isconsidered earnings for the Roth IRA ordering rules while theremainder is considered a regular contribution.

Designated Roth Account. This is an account within an ERPunder either IRC Sections 401(a) or 403(b) that holds Rothcontributions and earnings. Roth contributions are made byelective deferral with after-tax dollars.Eligible Distributions. Not all distributions from an ERP areeligible for rollover to a Roth IRA. The most common amountswhich are not eligible for rollover include RMDs, defaulted loans,substantially equal periodic payments defined in IRC Section402(c)(4)(A), and hardship distributions. Your employerdetermines which assets may not be rolled over and must provideyou with an IRC Section 402(f) notice of taxation which explainsthe tax issues concerning the distribution.

102

Sample

3.

4.

Roth IRA Distributions. You, or after your death your beneficiary, maytake a Roth IRA distribution at any time. Income and penalty taxes maybe avoided by taking qualified distributions.1.

2.

3.

4.

5.

Distributions made on or after the date on which you attain age59 1/2;Distributions made to your beneficiary upon your death;Distributions attributable to you being disabled; andQualified first-time homebuyer distributions.

Five-Year Holding Period. The five-year holding period begins withthe earlier of the first year for which you made any regular Roth IRAcontribution, the first year in which you made a conversion from atraditional IRA to any Roth IRA, the first year of a rollover or directrollover of designated Roth account assets to any Roth IRA, the firstyear of a rollover or direct rollover of ERP assets to any Roth IRA,or the first year of any other contribution treated as a qualifiedrollover contribution.Qualified Distributions. A qualified distribution is a distributionwhich is made after the expiration of the five-year holding period andas the result of certain events. The events which will create a qualifieddistribution after the expiration of the five-year holding period are asfollows:

a.

b.c.d.

Nonqualified Distributions and the Ordering Rules. If yourdistribution is not a qualified distribution, any earnings you withdrawfrom your Roth IRA will be included in your gross income for federalincome tax purposes. Additionally, for each conversion or qualifiedrollover completed while you are younger than age 59 1/2, a separatefive-year holding period will be applied solely for determining if youowe a 10 percent premature-distribution penalty. The ordering rulesfor Roth IRAs determine what portion of your distribution will besubject to income and penalty taxes. The ordering rules, which takeinto account all of your Roth IRAs, state that you are deemed to takeyour Roth IRA asset types in the following order: (1) all regular orannual contributions and amounts treated as such, (2) conversion andqualified rollover contributions and amounts treated as such on a firstin first out basis, and (3) your earnings. All of your assets within acertain type must be removed before you may move on to the nextasset type. For each conversion or qualified rollover contributionremoved, the originally taxable portion is removed first and thenontaxable portion is removed last.Removal of Excess Contributions. You may withdraw all or aportion of your excess contribution and attributable earnings beforeyour federal income tax return due date, including extensions, for thetaxable year for which you made the contribution. The excesscontribution amount distributed will not be taxable, but the attributableearnings on the contribution will be taxable in the year in which youmade the contribution and may be subject to the 10 percentpremature-distribution penalty tax. In certain situations, you may treatyour excess as a regular and catch-up contribution for the next year.If you timely file your federal income tax return, you may stillremove your excess contribution, plus attributable earnings, as late asOctober 15 for calendar year filers.Distributions of Unwanted Roth IRA Contributions by Tax-FilingDate. You may withdraw all or a portion of your regular and catch-upRoth IRA contribution and attributable earnings in the same manneras an excess contribution. However, you cannot apply your unwantedcontribution as a regular Roth IRA contribution for a future year. Theunwanted contribution amount distributed will not be taxable, but the

attributable earnings on the contribution will be taxable in the year inwhich you made the contribution, and may be subject to the 10percent premature-distribution penalty tax. If you timely file yourfederal income tax return, you may still remove your unwantedcontribution, plus attributable earnings, as late as October 15 forcalendar year filers.

6.

7.

RMDs. 1.

2.

RMDs for Your Beneficiaries. Your beneficiaries of this Roth IRA willgenerally have until December 31 of the year following your death year tobegin RMDs. Exceptions exist for your surviving spouse and for anybeneficiary who must distribute or chooses to distribute his/her share ofyour Roth IRA within a five year period.1.

2.

-



Qualified Health Savings Account (HSA) Funding Distribution. Ifyou are an HSA eligible individual, you may elect to take a qualifiedHSA funding distribution from your Roth IRA to the extent suchdistribution is contributed to your HSA in a trustee-to-trustee transfer.This amount is aggregated with all other annual contributions and issubject to your annual contribution limit. A qualified HSA fundingdistribution election is irrevocable and is generally available once inyour lifetime. A testing period applies. The testing period for thisprovision begins with the month of the contribution to your HSA andends on the last day of the 12th month following such month. If youare not an eligible individual for the entire testing period, unless youdie or become disabled, the amount of the distribution made underthis provision will be includable in gross income for the tax year ofthe month you are not an eligible individual, and is subject to a 10percent penalty tax.Tax-Free Distributions to Charities. If you have attained age 70 1/2,you may make tax-free distributions directly from your IRA to aqualified charitable organization. Tax-free distributions are limited to$100,000 per year and only apply to distributions made throughDecember 31, 2009. This deadline is subject to extension by an act ofCongress.

After Age 70 1/2. You are not required to take RMDs from yourRoth IRA when you reach age 70 1/2. Furthermore, you cannotsatisfy any RMDs for your traditional IRAs or SIMPLE IRAs bytaking a distribution from any of your Roth IRAs.Failure to Withdraw an RMD. If your beneficiary does notwithdraw an RMD by his/her required distribution date, he/she willowe a 50 percent excess accumulation penalty tax on the amount notwithdrawn. Your beneficiary can always take more than his/her RMDin any year but no additional amounts can be credited to a subsequentyear's RMDs.

Rollover of Military Death Gratuity. If a person serving in themilitary dies from injuries received in such service and you are thebeneficiary of either a military death gratuity or an amount under aServicemembers Group Life Insurance (SGLI) program for suchperson, you may roll over part or all of these amounts to a Roth IRA.If the death occurred on or after June 17, 2008, the rollovercontribution must be completed within one year of when each amountwas received. If the death occurred on or after October 7, 2001 butbefore June 17, 2008, you have until June 17, 2009 to roll over anyeligible amounts. These contributions are qualified rollovercontributions.Rollovers Due to Airline Carrier Bankruptcy. If you are a qualifiedairline employee and receive an "airline payment amount" as definedby law, this amount may be rolled over to a Roth IRA. You must rollover the airline payment amount within 180 days of its receipt or byJune 21, 2009, whichever is later.

Distribution Calculations In General. Most beneficiaries will use asingle life expectancy method to satisfy these RMDs unless they electthe five-year rule. The five-year rule requires your beneficiary tocompletely withdraw your Roth IRA assets by the end of the fifth yearfollowing your death year. The single life expectancy factor, using theIRS's single life table, will be determined by using the age onDecember 31 of the oldest designated beneficiary, unless multiplebeneficiaries exist and separate accounting applies. This initiallydetermined factor is reduced by one for each subsequent year'scalculation. This general rule of using the single life expectancymethod applies if your Roth IRA has at least one designatedbeneficiary.A special exception to the five-year rule allows certain deathbeneficiaries to exclude 2009 when calculating the five-year period. Inorder to apply this exception, the IRA owner or plan participant musthave died after 2003 and prior to 2009. For example, assume the IRAowner died in 2008. If the death beneficiary, by affirmative electionor default, selected the five-year rule, the five-year period wouldnormally require total distribution by December 31, 2013. However,by applying the exception, the beneficiary must now take totaldistribution by December 31, 2014.Designated Beneficiary. A designated beneficiary is any namedbeneficiary who has an interest in your Roth IRA on the determinationdate, which is September 30 of the year following your death year.Named beneficiaries who completely distribute their interests in yourRoth IRA, or completely disclaim their interests in your Roth IRAunder IRC Section 2518, will not be considered when designatedbeneficiaries are determined. Named beneficiaries who die after yourdeath but before the determination date will be considered for the sake

103

Sample

Estate and Gift Tax. The designation of a beneficiary to receive RothIRA distributions upon your death will not be considered a transfer ofproperty for federal gift tax purposes. Upon your death, the value of allassets remaining in your Roth IRA will usually be included in your gross

estate for estate tax purposes, regardless of the named beneficiary ormanner of distribution. There is no specific estate tax exclusion for assetsheld within a Roth IRA. After your death, beneficiaries should pay carefulattention to the rules for the disclaiming any portion of your Roth IRAunder IRC Section 2518.Annual Statements. Each year we will furnish you and the IRS withstatements reflecting the activity in your Roth IRA. You and the IRS willreceive IRS Forms 5498 and 1099-R. IRS Form 5498 or an appropriatesubstitute indicates the fair market value of the account, including RothIRA contributions, for the year. IRS Form 1099-R reflects your Roth IRAdistributions for the year.Federal Tax Penalties and IRS Form 5329. Several tax penalties mayapply to your various Roth IRA transactions, and are in addition to anyfederal, state, or local taxes. Federal penalties and excise taxes aregenerally reported and remitted to the IRS by completing IRS Form 5329,and attaching the form to your federal income tax return. The penaltiesmay include any of the following taxes:1.

2.

3.

Disaster Tax Relief. Subject to IRC Section 1400Q, individuals in certainfederally-declared disaster areas may be given the opportunity to takequalified distributions (subject to applicable time periods defined by law)in aggregation from IRAs and other eligible retirement plans up to theprescribed limit (e.g., $100,000 for Midwestern Disaster and HurricaneKatrina). Typically, these rules permit an individual to prorate anyamounts required to be included in gross income over a three tax yearperiod or include it all in the year of distribution. In addition, anindividual may be allowed three years after the date of receipt to roll overor repay all or part of the qualified distribution without being subject tothe one rollover per 12-month rule or the 60-day requirement. Certainfirst-time homebuyer or hardship distributions may be eligible for rolloverwithin a prescribed time period. Also, for additional disaster areainformation and IRS guidance on associated tax relief, refer to IRS noticesand publications, or visit the IRS's web site at www.irs.gov.

Premature-Distribution Penalty Tax. If you take a distribution fromyour Roth IRA before reaching age 59 1/2, you are subject to a 10percent premature-distribution penalty tax on the taxable portion ofthe distribution and certain converted or qualified rollovercontribution assets distributed during the five-year holding period.However, certain exceptions apply. Exceptions to the 10 percentpenalty tax include: the qualified distributions reasons previouslylisted, distributions due to eligible higher education expenses, medicalexpenses exceeding a certain percentage of adjusted gross income,health insurance premiums due to your extended unemployment, aseries of substantially equal periodic payments, IRS levy, traditionalIRA conversions, qualified reservist distributions, and qualified HSAfunding distributions. Additional exceptions include distributionstaken during the five year holding period as a result of your attainingage 59 1/2, death, disability, or a first-time home purchase. Properlycompleted rollovers, transfers, recharacterizations, qualified rollovercontributions, and conversions are not subject to the 10 percentpenalty tax. Excess Contribution Penalty Tax. If you contribute more to yourRoth IRA than you are eligible to contribute, you have created anexcess contribution, which is subject to a 6 percent excise tax. Theexcise tax applies each year that the excess contribution remains inyour Roth IRA. If you timely file your federal income tax return, youmay still remove your excess contribution, plus attributable earnings,as late as October 15 for calendar year filers.Excess Accumulation Penalty Tax. Any portion of an RMD that isnot distributed to your beneficiary by its deadline is subject to a 50percent excess accumulation penalty tax. The IRS may waive thispenalty upon proof of reasonable error and that reasonable steps weretaken to correct the error, including remedying the shortfall. Abeneficiary should review IRS Form 5329 instructions whenrequesting a waiver.

3.

4.

5.

6.

Federal Income Tax Status of Your Roth IRA.1.

2.

3.

4.

Separate Accounting. Our policies may permit separate accountingto be applied to your Roth IRA for the benefit of your beneficiaries. Ifpermitted, separate accounting must be applied in accordance withTreasury Regulation 1.401(a)(9)-8, Q&A 2 and 3. A beneficiary isconsidered the only designated beneficiary of his/her share of theRoth IRA assets if separate accounting applies.2009 RMDs Waived. The RMD requirement has been waived for the2009 distribution year. Beneficiaries taking RMDs under the lifeexpectancy method have no requirement to calculate or take an RMDfor 2009. Also, if a beneficiary is subject to the five-year rule and thefive-year period was set to end December 31, 2009, such beneficiarymust take all IRA assets by December 31, 2010. An amountinadvertently taken to satisfy a 2009 RMD is eligible for rollover by aspouse beneficiary; however, it is not eligible for rollover by anonspouse beneficiary.

No Deduction for Contributions. Roth IRA contributions are notdeductible on your federal income tax return at any time.Tax-free Earnings. The earnings, including gains and losses, onyour Roth IRA contributions accumulate tax-deferred. At the time ofyour distribution, the earnings will be free from federal income tax ifyour distribution is a qualified distribution.Taxation of Distributions. The taxation of your Roth IRAdistribution, which is not rolled over, is dependent upon whether yourdistribution is a qualified distribution and is subject to the orderingrules. Roth IRA distributions are not subject to federal income taxwithholding. You may also be subject to state or local taxes on yourRoth IRA distributions. No Special Tax Treatment. Roth IRA distributions are not eligiblefor special tax treatments, such as ten year averaging, that may applyto other employer-sponsored retirement plan distributions.

-



of determining the distribution period. If any named beneficiary that isnot an individual, such as an estate or charity, has an interest in yourRoth IRA on the determination date, and separate accounting does notapply, your Roth IRA will be treated as having no designatedbeneficiary.

If you name a qualified trust, which is defined in TreasuryRegulation 1.401(a)(9)-4, Q&A 5, as your Roth IRA beneficiary, thebeneficiaries of the qualified trust are treated as the beneficiaries ofyour Roth IRA for purposes of determining designated beneficiariesand the appropriate life expectancy period after your death.Death With No Designated Beneficiary. If you die and your RothIRA is treated as having no designated beneficiary, your namedbeneficiaries will be required to completely withdraw your Roth IRAassets by the end of the fifth year following your death year. Spouse Beneficiary. If your spouse is your only designatedbeneficiary on the determination date, or if there are multipledesignated beneficiaries and separate accounting applies, he/she willuse his/her age each year to determine the life expectancy factor forcalculating that year's RMD.

If your spouse is the only designated beneficiary, or if there aremultiple designated beneficiaries and separate accounting applies,he/she can postpone commencement of his/her RMDs until the end ofthe year in which you would have attained age 70 1/2. If your spouseis the only designated beneficiary, or if there are multiple designatedbeneficiaries and separate accounting applies, he/she can treat yourRoth IRA as his/her own Roth IRA after your death. This is notavailable to your surviving spouse if he/she is the sole beneficiary ofa qualified trust that is named as beneficiary of your Roth IRA.

Your spouse beneficiary could take a distribution of his/her share ofyour Roth IRA and roll it over to a Roth IRA of his/her own.

104

SamplePROJECTION METHODS (Check one):

FINANCIAL DISCLOSURE

If no fees are disclosed, follow the instructions located above thepreprinted tables to determine the appropriate projected values for yourRoth IRA.

l

If a fee was disclosed and it is only charged on a distribution transactionor a Roth IRA termination, the After Fees column will be completed onthe appropriate table taking the fee(s) into account for each applicableprojected value.

The purpose of this Financial Disclosure is to provide you with an IRSrequired growth projection of the value of your Roth IRA available forwithdrawal at the end of each of the first five years of its existence and atthe end of the years in which you attain the ages of 60, 65, and 70.Certain assumptions are applied that may vary from your actualinvestment provisions.

NoneRoth IRA Establishment Fee $Annual Service/Administration Fee of $or % of assets will be charged at l end l beginningof each year for purposes of this projection.Transfer/Direct Rollover Fee $Roth IRA Termination Fee $Other: $ or % of AssetsOther: $ or % of Assets

None l 1-Month l 3-Month6-Month l Other:

This Section Applies To The Projection Method Selected.

Three projection methods are provided for the situations where the natureof your initial investment allows for a reasonable projection.

ROTH IRA FEES AND LOSS OF EARNINGS PENALTIES

The growth projection must be made assuming either a $1,000contribution made on January 1 of each year or a $1,000 one-timecontribution made on January 1 of your first year. The annualcontribution represents an initial contribution that is a regular Roth orrecharacterized traditional IRA contribution. One-time contributionsinclude a rollover, transfer, or conversion contribution. These projectedamounts are not guaranteed.

Earnings rate - One-half (.5) percent compounded annually on a365-day year.Projected values - Calculated using numbers rounded to thenearest one cent ($.01).Loss of earnings penalties - The 1-, 3-, and 6-month penalties arecalculated on a 30-day month and a 360-day year.Calculated loss of earnings penalty - The 1-, 3-, and 6-monthpenalties are not rounded prior to subtraction from the No Penaltycolumn's projected value.

Fees:lll

llll

Loss of Earnings Penalty (Check one):ll

The fees and penalties listed below may affect the projected value of yourRoth IRA. The disclosed fees and penalties will be included in thatprojection method applicable to your Financial Disclosure. ProjectionMethod One cannot be used if a Roth IRA Establishment Fee, AnnualService/Administration Fee, and/or certain Other boxes are checkedbelow, including the Other box under Loss of Earnings Penalty.

l

(Check one):l Annual Contributions.l Rollover/Transfer (one-time) Contribution.

Your age on January 1 of this initial contribution year: Earnings Rate: %Compounding Method:

.Loss of Earnings Calculation Method:

.

Projection Method OnefUse Preprinted Tables.The preprinted financial disclosure tables on the following pageprovide you with the Roth IRA's projected values. The assumptionsused to calculate each table's projected Roth IRA values are:}

}

}

}

Projection Method ThreefSee Separate Financial Disclosure andAssumptions Provided by Your Roth IRA's Custodian.

l Projection Method TwofCustom Projection.Your Roth IRA's values projected below are based on the followingassumptions:

606570

AgeProjectedValue

ProjectedValue

End ofYear

$$$

12345

$$$$$

-



105

Sample

FINANCIAL DISCLOSURE - PROJECTION METHOD ONE

ROLLOVER/TRANSFER CONTRIBUTION

After FeesYourAge

ANNUAL CONTRIBUTIONSNo

Penalty1-MonthPenalty

3-MonthPenalty

123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960616263646566676869

82,566.1181,155.3379,751.5778,354.8076,964.9875,582.0774,206.0472,836.8671,474.4970,118.9068,770.0567,427.9166,092.4564,763.6363,441.4262,125.7960,816.7159,514.1458,218.0556,928.4155,645.1854,368.3453,097.8551,833.6850,575.8049,324.1848,078.7946,839.5945,606.5644,379.6643,158.8741,944.1540,735.4739,532.8138,336.1337,145.4035,960.6034,781.6933,608.6532,441.4431,280.0430,124.4228,974.5527,830.4026,691.9425,559.1424,431.9823,310.4322,194.4621,084.0419,979.1418,879.7417,785.8116,697.3215,614.2514,536.5713,464.2512,397.2611,335.5810,279.189,228.048,182.137,141.426,105.895,075.514,050.263,030.112,015.031,005.00

82,531.8881,121.6879,718.5178,322.3276,933.0775,550.7374,175.2872,806.6671,444.8670,089.8368,741.5467,399.9666,065.0564,736.7863,415.1262,100.0360,791.5059,489.4758,193.9156,904.8155,622.1154,345.8053,075.8451,812.1950,554.8349,303.7348,058.8646,820.1745,587.6544,361.2643,140.9841,926.7640,718.5839,516.4238,320.2437,130.0035,945.6934,767.2733,594.7232,427.9931,267.0730,111.9328,962.5427,818.8626,680.8725,548.5424,421.8523,300.7722,185.2621,075.3019,970.8618,871.9117,778.4416,690.4015,607.7814,530.5413,458.6712,392.1211,330.8810,274.929,224.218,178.747,138.466,103.365,073.414,048.583,028.852,014.191,004.58

82,463.4281,054.3979,652.3878,257.3576,869.2575,488.0674,113.7572,746.2771,385.5970,031.6968,684.5267,344.0566,010.2564,683.0863,362.5162,048.5260,741.0759,440.1258,145.6456,857.6055,575.9754,300.7253,031.8151,769.2150,512.9049,262.8348,018.9946,781.3345,549.8444,324.4643,105.1941,891.9840,684.8139,483.6438,288.4537,099.2035,915.8734,738.4333,566.8532,401.0931,241.1430,086.9528,938.5127,795.7926,658.7425,527.3524,401.5923,281.4422,166.8621,057.8219,954.2918,856.2617,763.6916,676.5515,594.8314,518.4913,447.5012,381.8411,321.4810,266.409,216.568,171.957,132.546,098.305,069.204,045.223,026.342,012.521,003.75

82,360.7280,953.4579,553.1978,159.8976,773.5375,394.0674,021.4572,655.6871,296.7069,944.4868,598.9867,260.1865,928.0464,602.5363,283.6161,971.2560,665.4359,366.1058,073.2356,786.8055,506.7654,233.1052,965.7751,704.7450,449.9949,201.4947,959.1946,723.0845,493.1144,269.2743,051.5141,839.8140,634.1439,434.4738,240.7737,053.0035,871.1534,695.1733,525.0532,360.7431,202.2330,049.4928,902.4827,761.1726,625.5425,495.5624,371.2123,252.4522,139.2521,031.5919,929.4418,832.7817,741.5716,655.7915,575.4114,500.4113,430.7612,366.4211,307.3810,253.619,205.098,161.787,123.666,090.705,062.894,040.193,022.572,010.021,002.50

1,407.271,400.271,393.311,386.381,379.481,372.621,365.791,358.991,352.231,345.511,338.811,332.151,325.531,318.931,312.371,305.841,299.341,292.881,286.441,280.041,273.681,267.341,261.041,254.761,248.521,242.301,236.121,229.971,223.851,217.771,211.711,205.691,199.691,193.731,187.791,181.891,176.011,170.151,164.331,158.531,152.771,147.031,141.331,135.651,130.001,124.381,118.781,113.221,107.681,102.171,096.691,091.231,085.801,080.401,075.021,069.671,064.351,059.051,053.781,048.541,043.321,038.131,032.971,027.831,022.711,017.621,012.561,007.521,002.50

123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960616263646566676869

1,410.781,403.761,396.781,389.831,382.921,376.041,369.191,362.381,355.601,348.861,342.151,335.471,328.831,322.221,315.641,309.091,302.581,296.101,289.651,283.231,276.851,270.501,264.181,257.891,251.631,245.401,239.201,233.031,226.901,220.801,214.731,208.691,202.681,196.701,190.751,184.831,178.941,173.071,167.231,161.421,155.641,149.891,144.171,138.481,132.821,127.181,121.571,115.991,110.441,104.921,099.421,093.951,088.511,083.091,077.701,072.341,067.001,061.691,056.411,051.151,045.921,040.721,035.541,030.391,025.261,020.161,015.081,010.031,005.00

1,410.201,403.181,396.201,389.251,382.351,375.471,368.621,361.821,355.041,348.301,341.591,334.921,328.281,321.671,315.091,308.551,302.041,295.561,289.121,282.701,276.321,269.971,263.661,257.371,251.111,244.881,238.691,232.521,226.391,220.291,214.231,208.191,202.181,196.201,190.261,184.341,178.451,172.581,166.751,160.941,155.161,149.411,143.701,138.011,132.351,126.711,121.111,115.531,109.981,104.461,098.961,093.501,088.061,082.641,077.251,071.901,066.561,061.251,055.971,050.711,045.491,040.291,035.111,029.961,024.841,019.741,014.661,009.611,004.58

1,409.031,402.021,395.041,388.101,381.201,374.331,367.491,360.691,353.921,347.181,340.481,333.811,327.181,320.581,314.001,307.461,300.961,294.491,288.051,281.641,275.261,268.921,262.611,256.331,250.071,243.851,237.661,231.501,225.381,219.281,213.221,207.191,201.191,195.211,189.271,183.361,177.471,171.611,165.781,159.981,154.201,148.461,142.751,137.071,131.411,125.781,120.181,114.601,109.061,103.551,098.051,092.591,087.161,081.741,076.361,071.011,065.671,060.371,055.101,049.841,044.621,039.431,034.251,029.111,023.991,018.891,013.821,008.771,003.75

After FeesYourAge


1-MonthPenalty

3-MonthPenalty

6-MonthPenalty

6-MonthPenalty

NoPenalty


If we disclosed a distribution transaction or termination fee in the ROTH IRA FEES AND LOSS OF EARNINGS PENALTIES of this disclosure, the After Feescolumn has been completed to reflect your Roth IRA's projected values. We have reduced the value in the No Penalty column or loss of earnings penalty columnapplicable to your initial investment. The same factors affect each of your projected values.Find your age as of January 1 of this year of establishment on the appropriate table. If your birthday is January 1 of this year, find your age as of December 31 of theprevious year on the appropriate table. The amounts to the right of your age are the projected values of your Roth IRA at the end of the year you attain age 70. Yourvalues may be subject to a 1-, 3-, or 6-month penalty. See ROTH IRA FEES AND LOSS OF EARNINGS PENALTIES to determine the applicable loss of earningspenalty. The loss of earnings penalty determines the column appropriate to your projection.Your Roth IRA's projected value at the end of the year you attain age 65 is found in the fifth row below your age 70 values.Your Roth IRA's projected value at the end of the year you attain age 60 is found in the fifth row below your age 65 values.Your Roth IRA's projected value at the end of each of the first five years is identified at the bottom of each table.

How to Use the Preprinted Tables. Your value projection will come from the Annual Contributions table if your initial Roth IRA contribution is a regular Roth orrecharacterized traditional IRA contribution. The Rollover/Transfer Contribution table is used if your initial contribution is a rollover, transfer, or conversion contribution.1.

2.

3.4.5.

-



106

Sample

(page 1 of 2)-

Request for Direct Rolloverto a Traditional IRA

3


NAME AND ADDRESS

NAME OF EMPLOYER'S PLAN


2PLAN ADMINISTRATOR PHONE NUMBER

DIRECT ROLLOVER REQUEST

PLAN ADMINISTRATOR ADDRESS

4

The plan administrator of my employer's plan should send the assets identified in the Direct Rollover Instructions section.

Account Number or Investment

$ or shares$ or shares$ or shares$ or shares$ or shares

lllll

Dollar Amount or Number of Shares

In KindIn KindIn KindIn KindIn Kind

Send:Transaction Date

Cash ProceedsCash ProceedsCash ProceedsCash ProceedsCash Proceeds

B. Payment Schedule and Investments (select one)l Immediately liquidate all investments and send cash proceeds.l Send all investments in kind.l Liquidate the investments as identified below:

lllll

...................................................................................Signature of Custodian/Trustee DateSignature of IRA Owner Date

...................................................................................

SIGNATURES

DIRECT ROLLOVER INSTRUCTIONS (See Additional Information included with this form.)

SOCIAL SECURITY NUMBER DATE OF BIRTH

PLAN ACCOUNT NUMBER

I certify that the information contained on this form is true and correct. I direct the plan administrator to send my assets as set forth in this form. Iunderstand that my direct rollover is irrevocable. I understand I should seek the guidance of a tax or legal professional with regard to thisdecision. I understand that if I establish a separate conduit account, it is my responsibility to keep my conduit account separate from my otheraccounts. I understand that my custodian/trustee cannot provide legal advice. I indemnify and agree to hold the custodian/trustee harmless againstany liabilities. I assume full responsibility for the consequences of this direct rollover decision.

(Custodian's/Trustee's name, address, and phone number above)

2001 Bankers Systems, Inc., St. Cloud, MN Form IRA-DIRROLLZ 1/1/2002

Complete my direct rollover as indicated. Note: Penalties and market fluctuation may affect the distribution amount.

A. Payment Amount (select one)l My entire plan balance.l A portion of my plan balance. $

l Other

C. Delivery Instructions(1) IRA Account Number(2) Make check payable to or certificate registration in the name of as l custodian / l trustee

for the traditional IRA of

107

Sample

(page 2 of 2)

ADDITIONAL INFORMATIONTerms. A general understanding of the following terms may behelpful in completing your transactions.

Purpose. The Request for Direct Rollover to a Traditional IRAform is designed to assist you in moving assets from your eligibleretirement plan to your traditional individual retirement account(IRA). Eligible retirement plans include qualified plansunder Internal Revenue Code (IRC) Section 401(a), [whichinclude Section 401(k) plans], tax-sheltered annuities underIRC Section 403(b), and deferred compensation plans underIRC Section 457(b).

Additional Documents. Eligibility for a direct rollover will bedetermined by your employer or its plan administrator. For yourdirect rollover to be successful, your employer's plan and/or yourIRA's custodian/trustee may require additional documentation.

For Additional Guidance. It is in your best interest to seek theguidance of your tax or legal professional before completing thisdocument. For additional assistance, refer to your employer's plandocument, the summary plan description you received when youentered the plan, or the notice of taxation you received when youbecame eligible for a distribution. For more information, refer toInternal Revenue Service (IRS) Publication 590f IndividualRetirement Arrangements, IRS Publication 560fRetirement Plansfor Small Business, your local IRS office, or the IRS's website atwww.irs.gov.

Direct Rollover. A direct rollover avoids federal income taxwithholding and, though similar to an IRA-to-IRA transfer, isreported to the IRS. Your employer or the plan administrator ofyour employer's eligible retirement plan can inform you of youreligibility to roll your retirement assets directly to yourtraditional IRA.

In Kind. If an eligible retirement plan contains stocks, bonds,mutual fund shares, or other types of property, it may bepossible to move such property to an IRA without liquidation.This type of "in kind" direct rollover of property would requirethat the property be re-registered in the name of the IRAcustodian/trustee for the benefit of your IRA. The IRAcustodian's/trustee's policies, charters, or applicable law mayprevent the direct rollover of property.

-2001 Bankers Systems, Inc., St. Cloud, MN Form IRA-DIRROLLZ 1/1/2002108

Resolutions and Authorizations

This section includes the following sample document:

Entity Authorization (AUTH-ENTITY)Business Purpose Statement

109

110

Sample

ENTITY AUTHORIZATION

(a)

(b)

(c)

(d)

(e)

(f)

Individual's Name, Title, & if applicable,Representative Entity's Name and Relationship to Authorizing Entity

Signature or Facsimile Signature

Authorizing Entity authorizes and directs the designated Agents to act, as indicated, on Authorizing Entity's behalf to:(Indicate a, b, c, d, e and/or f to exercise each specific power):

Open or close any share or deposit accounts in Authorizing Entity's name, including, without limitation, accounts such asshare draft, checking, savings, certificates of deposit or term share accounts, escrow, demand deposit, reserve, andoverdraft line-of-credit accounts. Number of signatures required .Enter into and execute any preauthorized electronic transfer agreements for automatic withdrawals, deposits or transfersinitiated through an electronic ATM or point-of-sale terminal, telephone, computer or magnetic tape using an access devicelike an ATM or debit card, a code or other similar means. Number of signatures required .Enter into and execute commercial wire transfer agreements that authorize transfers by telephone or other communicationsystems through the network chosen by Financial Institution. Number of signatures required .

,AUTH-ENTITY 12/15/2006

VMPC591 (0612)Page 1 of 2

Institution) is designated to provide Authorizing Entity the financial accommodations indicated in this Authorization, subject to the Financial Institution'srules and regulations from time to time. All prior transactions obligating Authorizing Entity to Financial Institution by or on behalf of Authorizing Entityare ratified by execution of this Authorization. Any Agent, while acting on behalf of Authorizing Entity, is authorized, subject to any expressedrestrictions, to make all other arrangements with Financial Institution which are necessary for the effective exercise of the powers indicated within thisAuthorization. The signatures of the Agents are conclusive evidence of their authority to act on behalf of Authorizing Entity. Unless otherwise agreedto in writing, this Authorization replaces any earlier related Authorization and will remain effective until Financial Institution receives and records anexpress written notice of its revocation, modification or replacement. Any revocation, modification or replacement of this Authorization must beaccompanied by documentation, satisfactory to Financial Institution, establishing the authority for the change. Authorizing Entity agrees not to combineproceeds from collateral securing any debts owed to Financial Institution with unrelated funds.SPECIFIC AUTHORIZATIONS. The following persons (Agents) are authorized to act on behalf of Authorizing Entity in fulfilling the purposes of thisAuthorization:

Authorizing Entity operates or owns or leases property. Authorizing Entity has the power and authority to provide this Authorization, to confer thepowers granted in this Authorization and to carry on Authorizing Entity's business and activities as now conducted. The designated Agents have thepower and authority to exercise the actions specified in this Authorization and Authorizing Entity properly adopted these authorizations and appointedthe Agents and me to act on its behalf. Authorizing Entity will notify Financial Institution before reorganizing, merging, consolidating, recapitalizing,dissolving or otherwise materially changing ownership, management or organizational form. Authorizing Entity will be fully liable for failing to notifyFinancial Institution of these material changes.

ENTITY CERTIFICATIONS. I, (Authorization Signer's name), certify that: I am a/the(Authorization Signer's title) designated to act on behalf of

(Authorizing Entity). Authorizing Entity is a(type of entity, like a "non-profit" corporation) and its Taxpayer Identification Number . I am authorized and directed to execute anoriginal or a copy of this Authorization to Financial Institution, and anyone else requiring a copy. Authorizing Entity is duly organized, validly existingand in good standing under the laws of and is duly qualified, validly existing and in good standing in all jurisdictions where

l Authorizing Entity conducts business and other activities under the additional trade name or fictitious name ofand Authorizing Entity has the legal power and authority to use this trade name or

fictitious name. Authorizing Entity will not use any trade name or fictitious name without Financial Institution's prior written consent and willpreserve Authorizing Entity's existing name, trade names, fictitious names and franchises.

GENERAL AUTHORIZATIONS. I certify Authorizing Entity authorizes and agrees that: (Financial

Authorizing Entity has adopted any facsimile signatures indicated above. Financial Institution may rely on those facsimile signatures that resemble thespecimens within this Authorization or the specimens that Authorizing Entity periodically files with Financial Institution, regardless of by whom or bywhat means the signatures were affixed.

Initials:*

Entity AuthorizationVMP Bankers SystemsWolters Kluwer Financial Services 2000, 2006-

Endorse for cash, deposit, negotiation, collection or discount by Financial Institution any and all deposit checks, drafts,certificates of deposit and other instruments and orders for the payment of money owned or held by Trust. Number ofsignatures required .

111

Sample

AUTHORIZATION'S SIGNERS:

INTERPRETATION. Whenever used, the singular includes the plural and the plural includes the singular. The section headings are for convenience onlyand are not to be used to interpret or define the terms of this Authorization.

l All Debts. All debts, liabilities and obligations of every type and description owed now or in the future by AuthorizingEntity to Financial Institution.

Number of signatures required .Receive and acknowledge receipt for funds, whether payable to the order of Authorizing Entity or an Agent, withoutadditional certification as to the use of the proceeds. Number of signatures required .Guaranty the payment and performance of debts, liabilities and obligations owed to Financial Institution or its successors andassigns by (Borrower):l Specific Debts. The debts, liabilities and obligations, and their renewals, extensions, refinancing and modifications,

evidenced by (describe):l All Debts. All debts, liabilities and obligations, and their renewals, extensions, refinancing and modifications, that

Borrower owes now or in the future to Financial Institution, to the extent allowed by law.Number of signatures required .The designated Agents may also grant a security interest, lien or other encumbrance to Financial Institution in any or all realor personal property that Authorizing Entity now owns or may acquire in the future for the payment or performance of thisguaranty. Number of signatures required .Periodically amend, restructure, renew, extend, modify, substitute or terminate any agreements or arrangements withFinancial Institution that relate to this Authorization. Number of signatures required .Execute other agreements that Financial Institution may require, and perform or cause to be performed any further actionnecessary to carry out the purposes of this Authorization. Number of signatures required .Other (specify) .Number of signatures required .

By:

SIGNATURES. By signing, I certify and agree to the terms contained in this Authorization on behalf of Authorizing Entity on. I also acknowledge receipt of a copy of this Authorization.

Name Attest: Name

Grant a security interest, lien or other encumbrance to Financial Institution in any or all real or personal property thatAuthorizing Entity now owns or may acquire in the future for the payment or performance of:l Specific Debts. The debts, liabilities and obligations, and their renewals, extensions, refinancing and modifications,

evidenced by (describe):

By:

promissory notes, acceptances or other evidences of indebtedness. l If checked, the maximum outstanding credit limit forall available credit and financial accommodation to Authorizing Entity from Financial Institution must not exceed$ . Number of signatures required .

Pennsylvania. The designation of an Agent does not create a power of attorney; therefore, Agents are not subject to the provisions of 20 Pa.C.S.A.Section 5601 et seq. (Chapter 56; Decedents, Estates and Fiduciaries Code) unless the agency was created by a separate power of attorney. Anyprovision that assigns Financial Institution rights to act on behalf of any person or entity is not subject to the provisions of 20 Pa.C.S.A. Section 5601et seq. (Chapter 56; Decedents, Estates and Fiduciaries Code).

FOR FINANCIAL INSTITUTION USE ONLYAcct/Loan # Authorization and agreement completed and effective .By for the Financial Institution.

,AUTH-ENTITY 12/15/2006

VMPC591 (0612)Page 2 of 2Initials:

*Entity AuthorizationVMP Bankers SystemsWolters Kluwer Financial Services 2000, 2006-

Sign checks or orders for the payment of money, withdraw or transfer funds on deposit with you. Number of signaturesrequired .Enter into and execute a written night depository agreement, a lock-box agreement or a safe deposit box lease agreement.Number of signatures required .Borrow money or obtain other credit or financial accommodation from Financial Institution on behalf of and in the name ofAuthorizing Entity on the terms agreed to with Financial Institution. The designated Agents may execute and endorse

112

Government Documents


Cert of Foreign Stat. of Ben. Owner for US Tax Withholding (W-8BEN)

Request for Taxpayer ID Number and Certification (W-9)

Application for Individual Taxpayer ID Number-IRS Form (W-7)

Suspicious Activity Report (SAR-LAZ)

Direct Deposit Sign-Up Form (1200)

Currency Transaction Report (CTR)

113

114

Sample

-9008 (0603)

W-8ECI

VMP Mortgage Solutions, Inc.

OMB No. 1545-1621W-8BEN Certificate of Foreign Status of Beneficial Owner

for United States Tax Withholding

Give this form to the withholding agent or payer. Do not send to the IRS.

Form W-8BEN (Rev. 2-2006)

See separate instructions.Department of the TreasuryInternal Revenue Service

Form(Rev. February 2006)

Do not use this form for:

A foreign government, international organization, foreign central bank of issue, foreign tax-exempt organization, foreign privatefoundation, or government of a U.S. possession that received effectively connected income or that is claiming the applicabilityof section(s) 115(2), 501(c), 892, 895, or 1443(b) (see instructions)

Instead, use Form:W-9

W-8IMY

W-8ECI or W-8EXPNote: These entities should use Form W-8BEN if they are claiming treaty benefits or are providing the form only toclaim they are a foreign person exempt from backup withholding.

W-8ECI or W-8IMY

A U.S. citizen or other U.S. person, including a resident alien individual

Capacity in which actingSignature of beneficial owner (or individual authorized to sign for beneficial owner) Date (MM-DD-YYYY)

A foreign partnership, a foreign simple trust, or a foreign grantor trust (see instructions for exceptions)

Sign Here

For Paperwork Reduction Act Notice, see separate instructions. Cat. No. 25047Z

A person claiming that income is effectively connected with the conduct of a trade orbusiness in the United States

A person acting as an intermediaryNote: See instructions for additional exceptions.

Partnership

CertificationPart IV

EINForeign tax identifying number, if any (optional)

Country of incorporation or organization

Type of beneficial owner:

Private foundation

IndividualComplex trust

CorporationGovernment

Simple trustInternational organization

Permanent residence address (street, apt. or suite no., or rural route). Do not use a P.O. box or in-care-of address.

City or town, state or province. Include postal code where appropriate.

City or town, state or province. Include postal code where appropriate.

Mailing address (if different from above)

U.S. taxpayer identification number, if required (see instructions)

% rate of withholding on (specify type of income):

Country (do not abbreviate)

.

Estate

Identification of Beneficial Owner (See instructions.)

SSN or ITIN

Part I

Reference number(s) (see instructions)

Country (do not abbreviate)

Special rates and conditions (if applicable-see instructions): The beneficial owner is claiming the provisions of Article

I have provided or will provide a statement that identifies those notional principal contracts from which the income is not effectivelyconnected with the conduct of a trade or business in the United States. I agree to update this statement as required.

of thetreaty identified on line 9a above to claim a

Claim of Tax Treaty Benefits (if applicable)Part II

Notional Principal Contracts

Explain the reasons the beneficial owner meets the terms of the treaty article:

Part III

Under penalties of perjury, I declare that I have examined the information on this form and to the best of my knowledge and belief it is true, correct, andcomplete. I further certify under penalties of perjury that:

3. The income to which this form relates is (a) not effectively connected with the conduct of a trade or business in the United States, (b) effectivelyconnected but is not subject to tax under an income tax treaty, or (c) the partner's share of a partnership's effectively connected income, and

Furthermore, I authorize this form to be provided to any withholding agent that has control, receipt, or custody of the income of which I am the beneficial owneror any withholding agent that can disburse or make payments of the income of which I am the beneficial owner.

4. For broker transactions or barter exchanges, the beneficial owner is an exempt foreign person as defined in the instructions.

within the meaning of the income tax treaty between the United

If required, the U.S. taxpayer identification number is stated on line 6 (see instructions).

The beneficial owner is a resident ofStates and that country.

The beneficial owner is related to the person obligated to pay the income within the meaning of section 267(b) or 707(b), and will fileForm 8833 if the amount subject to withholding received during a calendar year exceeds, in the aggregate, $500,000.

The beneficial owner is not an individual, derives the item (or items) of income for which the treaty benefits are claimed, and, ifapplicable, meets the requirements of the treaty provision dealing with limitation on benefits (see instructions).

The beneficial owner is not an individual, is claiming treaty benefits for dividends received from a foreign corporation or interest from aU.S. trade or business of a foreign corporation, and meets qualified resident status (see instructions).

1. I am the beneficial owner (or am authorized to sign for the beneficial owner) of all the income to which this form relates,2. The beneficial owner is not a U.S. person,

Name of individual or organization that is the beneficial owner

Grantor trustCentral bank of issue Tax-exempt organization

Disregarded entity

I certify that (check all that apply):

Section references are to the Internal Revenue Code.

115

SamplePart II

Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholdingbecause you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgageinterest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), andgenerally, payments other than interest and dividends, you are not required to sign the Certification, but you must provide your correct TIN. See theinstructions on page 4.

Certification

Request for TaxpayerIdentification Number and Certification

3.

or

Social security number

DateSignature ofU.S. person

Give form to the requester.Do not send to the IRS.

Requester's name and address (optional)

Name (as shown on your income tax return)

Business name, if different from above

Taxpayer Identification Number (TIN)

Address (number, street, and apt. or suite no.)

Check appropriate box:

City, state, and ZIP code

Corporation

Employer identification number

Limited liability company. Enter the tax classification (D=disregarded entity, C=corporation, P=partnership)

Under penalties of perjury, I certify that:

Part I

I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the InternalRevenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS hasnotified me that I am no longer subject to backup withholding, and

List account number(s) here (optional)

Form W-9(Rev. October 2007)Department of the TreasuryInternal Revenue Service

I am a U.S. citizen or other U.S. person (defined below).

1.2.

The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me), and

SignHere

Enter your TIN in the appropriate box. The TIN provided must match the name given on Line 1 to avoidbackup withholding. For individuals, this is your social security number (SSN). However, for a resident alien,sole proprietor, or disregarded entity, see the Part I instructions on page 3. For other entities, it is youremployer identification number (EIN). If you do not have a number, see How to get a TIN on page 3.Note. If the account is in more than one name, see the chart on page 4 for guidelines on whose number toenter.

Request for Taxpayer Identification Number and CertificationVMP9030 (0901).00VMP

Wolters Kluwer Financial Services Bankers Systems

Page 1 of 4

Individual/Sole proprietor Partnership

Exempt payee

Other (see instructions)

Purpose of Form

Certify that you are not subject to backup withholding, or

A person who is required to file an information return with the IRSmust obtain your correct taxpayer identification number (TIN) to report,for example, income paid to you, real estate transactions, mortgageinterest you paid, acquisition or abandonment of secured property,cancellation of debt, or contributions you made to an IRA.

Use Form W-9 only if you are a U.S. person (including a residentalien), to provide your correct TIN to the person requesting it (therequester) and, when applicable, to:

Claim exemption from backup withholding if you are a U.S.

Certify that the TIN you are giving is correct (or you are waiting

An estate (other than a foreign estate), or

3.

for a number to be issued),

exempt payee. If applicable, you are also certifying that as a U.S.person, your allocable share of any partnership income from a U.S.trade or business is not subject to the withholding tax on foreignpartners' share of effectively connected income.

1.

2.

Definition of a U.S. person. For federal tax purposes, you areconsidered a U.S. person if you are:

A partnership, corporation, company, or association created ororganized in the United States or under the laws of the United States,

An individual who is a U.S. citizen or U.S. resident alien,

The U.S. owner of a disregarded entity and not the entity,

Special rules for partnerships. Partnerships that conduct a trade orbusiness in the United States are generally required to pay awithholding tax on any foreign partners' share of income from suchbusiness. Further, in certain cases where a Form W-9 has not beenreceived, a partnership is required to presume that a partner is aforeign person, and pay the withholding tax. Therefore, if you are aU.S. person that is a partner in a partnership conducting a trade orbusiness in the United States, provide Form W-9 to the partnership toestablish your U.S. status and avoid withholding on your share ofpartnership income.

A domestic trust (as defined in Regulations section 301.7701-7).

General Instructions

Note. If a requester gives you a form other than Form W-9 to requestyour TIN, you must use the requester's form if it is substantially similarto this Form W-9.

The person who gives Form W-9 to the partnership for purposes ofestablishing its U.S. status and avoiding withholding on its allocableshare of net income from the partnership conducting a trade orbusiness in the United States is in the following cases:

Section references are to the Internal Revenue Code unless otherwisenoted.

116

SampleOther entities. Enter your business name as shown on required federaltax documents on the "Name" line. This name should match the nameshown on the charter or other legal document creating the entity. Youmay enter any business, trade, or DBA name on the "Business name"line.

Form W-9 (Rev. 10-2007)

Specific Instructions

You do not certify your TIN when required (see the Part II

Payments you receive will be subject to backup withholding if:You do not furnish your TIN to the requester,

You will not be subject to backup withholding on payments youreceive if you give the requester your correct TIN, make the propercertifications, and report all your taxable interest and dividends on yourtax return.

You do not certify to the requester that you are not subject to

The IRS tells the requester that you furnished an incorrect TIN,

Certain payees and payments are exempt from backup withholding.

Failure to furnish TIN. If you fail to furnish your correct TIN to arequester, you are subject to a penalty of $50 for each such failureunless your failure is due to reasonable cause and not to willfulneglect. Civil penalty for false information with respect to withholding. If youmake a false statement with no reasonable basis that results in nobackup withholding, you are subject to a $500 penalty.Criminal penalty for falsifying information. Willfully falsifyingcertifications or affirmations may subject you to criminal penaltiesincluding fines and/or imprisonment.Misuse of TINs. If the requester discloses or uses TINs in violation offederal law, the requester may be subject to civil and criminalpenalties.

Penalties

Example. Article 20 of the U.S.-China income tax treaty allows anexemption from tax for scholarship income received by a Chinesestudent temporarily present in the United States. Under U.S. law, thisstudent will become a resident alien for tax purposes if his or her stayin the United States exceeds 5 calendar years. However, paragraph 2of the first Protocol to the U.S.-China treaty (dated April 30, 1984)allows the provisions of Article 20 to continue to apply even after theChinese student becomes a resident alien of the United States. AChinese student who qualifies for this exception (under paragraph 2 ofthe first protocol) and is relying on this exception to claim anexemption from tax on his or her scholarship or fellowship incomewould attach to Form W-9 a statement that includes the informationdescribed above to support that exemption.

What is backup withholding? Persons making certain payments to youmust under certain conditions withhold and pay to the IRS 28% ofsuch payments. This is called "backup withholding." Payments thatmay be subject to backup withholding include interest, tax-exemptinterest, dividends, broker and barter exchange transactions, rents,royalties, nonemployee pay, and certain payments from fishing boatoperators. Real estate transactions are not subject to backupwithholding.

If you are a nonresident alien or a foreign entity not subject tobackup withholding, give the requester the appropriate completed FormW-8.

5.

1.2.

3.

backup withholding under 4 above (for reportable interest and dividendaccounts opened after 1983 only).

Also see Special rules for partnerships on page 1.

See the instructions below and the separate Instructions for theRequester of Form W-9.

instructions on page 3 for details),

Sufficient facts to justify the exemption from tax under the

Foreign person. If you are a foreign person, do not use Form W-9.Instead, use the appropriate Form W-8 (see Publication 515,Withholding of Tax on Nonresident Aliens and Foreign Entities).Nonresident alien who becomes a resident alien. Generally, only anonresident alien individual may use the terms of a tax treaty to reduceor eliminate U.S. tax on certain types of income. However, most taxtreaties contain a provision known as a "saving clause." Exceptionsspecified in the saving clause may permit an exemption from tax tocontinue for certain types of income even after the payee hasotherwise become a U.S. resident alien for tax purposes.

If the account is in joint names, list first, and then circle, the nameof the person or entity whose number you entered in Part I of the form.

If you are a U.S. resident alien who is relying on an exceptioncontained in the saving clause of a tax treaty to claim an exemptionfrom U.S. tax on certain types of income, you must attach a statementto Form W-9 that specifies the following five items:

The treaty country. Generally, this must be the same treaty

The treaty article addressing the income.The article number (or location) in the tax treaty that contains

The type and amount of income that qualifies for the exemption

5.

under which you claimed exemption from tax as a nonresident alien.

the saving clause and its exceptions.

1.

2.3.

4.from tax.

terms of the treaty article.

The IRS tells you that you are subject to backup withholding4.because you did not report all your interest and dividends on your taxreturn (for reportable interest and dividends only), or

The U.S. trust (other than a grantor trust) and not the beneficiariesof the trust.

Sole proprietor. Enter your individual name as shown on your incometax return on the "Name" line. You may enter your business, trade, or"doing business as (DBA)" name on the "Business name" line.

The U.S. grantor or other owner of a grantor trust and not thetrust, and

Name

Note. You are requested to check the appropriate box for your status(individual/sole proprietor, corporation, etc.).

If you are an individual, you must generally enter the name shown onyour income tax return. However, if you have changed your last name,for instance, due to marriage without informing the Social SecurityAdministration of the name change, enter your first name, the lastname shown on your social security card, and your new last name.



Page 2 of 4

Limited liability company (LLC). Check the "Limited liability company"box only and enter the appropriate code for the tax classification ("D"for disregarded entity, "C" for corporation, "P" for partnership) in thespace provided.

For a single-member LLC (including a foreign LLC with a domesticowner) that is disregarded as an entity separate from its owner underRegulations section 301.7701-3, enter the owner's name on the"Name" line. Enter the LLC's name on the "Business name" line.

For an LLC classified as a partnership or a corporation, enter theLLC's name on the "Name" line and any business, trade, or DBA nameon the "Business name" line.

Exempt PayeeIf you are exempt from backup withholding, enter your name asdescribed above and check the appropriate box for your status, thencheck the "Exempt Payee" box in the line following the business name,sign and date the form.

Generally, individuals (including sole proprietors) are not exemptfrom backup withholding. Corporations are exempt from backupwithholding for certain payments, such as interest and dividends.

117

Sample

Part I. Taxpayer Identification Number (TIN)

If you are a single-member LLC that is disregarded as an entityseparate from its owner (see Limited liability company (LLC) on page2), enter the owner's SSN (or EIN, if the owner has one). Do not enterthe disregarded entity's EIN. If the LLC is classified as a corporation orpartnership, enter the entity's EIN.

Enter your TIN in the appropriate box. If you are a resident alien andyou do not have and are not eligible to get an SSN, your TIN is yourIRS individual taxpayer identification number (ITIN). Enter it in thesocial security number box. If you do not have an ITIN, see How to geta TIN below.

If you are a sole proprietor and you have an EIN, you may entereither your SSN or EIN. However, the IRS prefers that you use yourSSN.

Note. See the chart on page 4 for further clarification of name and TINcombinations.How to get a TIN. If you do not have a TIN, apply for one immediately.To apply for an SSN, get Form SS-5, Application for a Social SecurityCard, from your local Social Security Administration office or get thisform online at www.ssa.gov. You may also get this form by calling1-800-772-1213. Use Form W-7, Application for IRS IndividualTaxpayer Identification Number, to apply for an ITIN, or Form SS-4,Application for Employer Identification Number, to apply for an EIN.You can apply for an EIN online by accessing the IRS website atwww.irs.gov/businesses and clicking on Employer IdentificationNumber (EIN) under Starting a Business. You can get Forms W-7 andSS-4 from the IRS by visiting www.irs.gov or by calling1-800-TAX-FORM (1-800-829-3676).

If you are asked to complete Form W-9 but do not have a TIN,write "Applied For" in the space for the TIN, sign and date the form,and give it to the requester. For interest and dividend payments, andcertain payments made with respect to readily tradable instruments,generally you will have 60 days to get a TIN and give it to therequester before you are subject to backup withholding on payments.The 60-day rule does not apply to other types of payments. You will besubject to backup withholding on all such payments until you provideyour TIN to the requester.Note. Entering "Applied For" means that you have already applied for aTIN or that you intend to apply for one soon.Caution: A disregarded domestic entity that has a foreign owner mustuse the appropriate Form W-8.

Form W-9 (Rev. 10-2007)

THEN the payment is exemptfor . . .

A futures commission merchant registered with the Commodity

An entity registered at all times during the tax year under the

A common trust fund operated by a bank under section 584(a),A financial institution,A middleman known in the investment community as a

A trust exempt from tax under section 664 or described in

The chart below shows types of payments that may be exempt

Generally, exempt payees 1 through 7

IF the payment is for . . .

Interest and dividend payments All exempt payees except for 9

Broker transactions Exempt payees 1 through 13.Also, a person registered underthe Investment Advisers Act of1940 who regularly acts as abroker

2

Barter exchange transactions and patronage dividends

2

Exempt payees 1 through 5

However, the following payments made to a corporation (including gross proceeds paid to anattorney under section 6045(f), even if the attorney is a corporation) and reportable on Form1099-MISC are not exempt from backup withholding: medical and health care payments,attorneys' fees, and payments for services paid by a federal executive agency.

1

Payments over $600 required to be reported and direct sales over $5,000

See Form 1099-MISC, Miscellaneous Income, and its instructions.1

A real estate investment trust,Futures Trading Commission,

15.

Investment Company Act of 1940,

9.

10.11.

12.13.14.

nominee or custodian, or

section 4947.

from backup withholding. The chart applies to the exempt payeeslisted above, 1 through 15.

Note. If you are exempt from backup withholding, you should stillcomplete this form to avoid possible erroneous backup withholding.

The following payees are exempt from backup withholding:

An organization exempt from tax under section 501(a), any IRA,

The United States or any of its agencies or instrumentalities,A state, the District of Columbia, a possession of the United

A foreign government or any of its political subdivisions,

An international organization or any of its agencies or

Other payees that may be exempt from backup withholdinginclude:

A corporation,A foreign central bank of issue,

8.

or a custodial account under section 403(b)(7) if the account satisfiesthe requirements of section 401(f)(2),

States, or any of their political subdivisions or instrumentalities,

1.

2.3.

4.

5.

6.7.

agencies, or instrumentalities, or

instrumentalities.

A dealer in securities or commodities required to register in theUnited States, the District of Columbia, or a possession of the UnitedStates,



Page 3 of 4

For a joint account, only the person whose TIN is shown in Part Ishould sign (when required). Exempt payees, see Exempt Payee onpage 2.

Part II. CertificationTo establish to the withholding agent that you are a U.S. person, orresident alien, sign Form W-9. You may be requested to sign by thewithholding agent even if items 1, 4, and 5 below indicate otherwise.

Signature requirements. Complete the certification as indicated in 1through 5 below.

Interest, dividend, and barter exchange accounts opened before1984 and broker accounts considered active during 1983. You mustgive your correct TIN, but you do not have to sign the certification.

1.

2. Interest, dividend, broker, and barter exchange accounts openedafter 1983 and broker accounts considered inactive during 1983. Youmust sign the certification or backup withholding will apply. If you aresubject to backup withholding and you are merely providing yourcorrect TIN to the requester, you must cross out item 2 in thecertification before signing the form.

Real estate transactions. You must sign the certification. You

Other payments. You must give your correct TIN, but you do

3.

4.may cross out item 2 of the certification.

not have to sign the certification unless you have been notified that

118

Sample

Mortgage interest paid by you, acquisition or abandonment of

Privacy Act Notice

What Name and Number To Give the Requester

Two or more individuals (jointaccount)

1. Individual The individual

The actual owner of the accountor, if combined funds, the firstindividual on the account 1

2.

Give name and SSN of:

Form W-9 (Rev. 10-2007)

Section 6109 of the Internal Revenue Code requires you to provide your correct TIN to persons who must file information returns with the IRS toreport interest, dividends, and certain other income paid to you, mortgage interest you paid, the acquisition or abandonment of secured property,cancellation of debt, or contributions you made to an IRA, or Archer MSA or HSA. The IRS uses the numbers for identification purposes and to helpverify the accuracy of your tax return. The IRS may also provide this information to the Department of Justice for civil and criminal litigation, and tocities, states, and the District of Columbia, and U.S. possessions to carry out their tax laws. We may also disclose this information to othercountries under a tax treaty, to federal and state agencies to enforce federal nontax criminal laws, or to federal law enforcement and intelligenceagencies to combat terrorism.

5.

you have previously given an incorrect TIN. "Other payments" includepayments made in the course of the requester's trade or business forrents, royalties, goods (other than bills for merchandise), medical andhealth care services (including payments to corporations), payments toa nonemployee for services, payments to certain fishing boat crewmembers and fishermen, and gross proceeds paid to attorneys(including payments to corporations).

secured property, cancellation of debt, qualified tuition programpayments (under section 529), IRA, Coverdell ESA, Archer MSA orHSA contributions or distributions, and pension distributions. You mustgive your correct TIN, but you do not have to sign the certification.

You must provide your TIN whether or not you are required to file a tax return. Payers must generally withhold 28% of taxable interest,dividend, and certain other payments to a payee who does not give a TIN to a payer. Certain penalties may also apply.



Page 4 of 4

Legal entity

Give name and EIN of:

12.

For this type of account:

4.

2

Account with the Departmentof Agriculture in the name of a public entity (such as a state or local government,school district, or prison) thatreceives agricultural programpayments

So-called trust account that is not a legal or validtrust under state law

The public entity

a. The usual revocablesavings trust (grantor isalso trustee)

b.

3. Custodian account of a minor(Uniform Gift to Minors Act)

The minor

1

The grantor-trustee1

The actual owner1

5. Sole proprietorship ordisregarded entity owned byan individual

Disregarded entity not ownedby an individual

6.

7. A valid trust, estate, orpension trust

Corporate or LLC electingcorporate status on Form8832

8.

Association, club, religious,charitable, educational, orother tax-exempt organization

9.

10. Partnership or multi-memberLLC

A broker or registerednominee

11.

3The owner

The owner

The corporation

The organization

The partnership

The broker or nominee

4

4

1

2

3

joint account has an SSN, that person's number must be furnished.

on the second name line. You may use either your SSN or EIN (if you have one), but the IRSencourages you to use your SSN.

Note. If no name is circled when more than one name is listed, thenumber will be considered to be that of the first name listed.

TIN of the personal representative or trustee unless the legal entity itself is not designated inthe account title.) Also see Special rules for partnerships on page 1.

List first and circle the name of the person whose number you furnish. If only one person on a

Circle the minor's name and furnish the minor's SSN.

You must show your individual name and you may also enter your business or "DBA" name

List first and circle the name of the trust, estate, or pension trust. (Do not furnish the

Secure Your Tax Records from Identity TheftIdentity theft occurs when someone uses your personal informationsuch as your name, social security number (SSN), or other identifyinginformation, without your permission, to commit fraud or other crimes.An identity thief may use your SSN to get a job or may file a tax returnusing your SSN to receive a refund.

Protect your SSN,Ensure your employer is protecting your SSN, and

To reduce your risk:

Call the IRS at 1-800-829-1040 if you think your identity has beenused inappropriately for tax purposes.

Be careful when choosing a tax preparer.

Victims of identity theft who are experiencing economic harm or asystem problem, or are seeking help in resolving tax problems thathave not been resolved through normal channels, may be eligible forTaxpayer Advocate Service (TAS) assistance. You can reach TAS bycalling the TAS toll-free case intake line at 1-877-777-4778 orTTY/TDD 1-800-829-4059.

Protect yourself from suspicious emails or phishing schemes. Phishingis the creation and use of email and websites designed to mimiclegitimate business emails and websites. The most common act issending an email to a user falsely claiming to be an establishedlegitimate enterprise in an attempt to scam the user into surrenderingprivate information that will be used for identity theft.

The IRS does not initiate contacts with taxpayers via emails. Also,the IRS does not request personal detailed information through email orask taxpayers for the PIN numbers, passwords, or similar secretaccess information for their credit card, bank, or other financialaccounts.

If you receive an unsolicited email claiming to be from the IRS,forward this message to [email protected]. You may also report misuseof the IRS name, logo, or other IRS personal property to the TreasuryInspector General for Tax Administration at 1-800-366-4484. You canforward suspicious emails to the Federal Trade Commission at:[email protected] or contact them at www.consumer.gov/idtheft or1-877-IDTHEFT(438-4338).

Visit the IRS website at www.irs.gov to learn more about identitytheft and how to reduce your risk.

For this type of account:

119

Sample

See instructions.For use by individuals who are not U.S. citizens or permanent residents.

Form

(Rev. January 2007)W-7

Department of the TreasuryInternal Revenue Service

OMB No. 1545-0074

FOR IRS USE ONLY

Cat. No. 10229LFor Paperwork Reduction Act Notice, see page 4.

5

Name

Applicant'smailing address

6e Have you previously received a U.S. temporary taxpayer identification number (TIN) or employer identification number (EIN)?

Nonresident alien required to obtain ITIN to claim tax treaty benefitNonresident alien filing a U.S. tax returnU.S. resident alien (based on days present in the United States) filing a U.S. tax returnDependent of U.S. citizen/resident alien Enter name and SSN/ITIN of U.S. citizen/resident alien (see instructions) ...............Spouse of U.S. citizen/resident alien ..........................................................................................................................Nonresident alien student, professor, or researcher filing a U.S. tax return or claiming an exception. Dependent/spouse of a nonresident alien holding a U.S. visa. Other (see instructions) ......................................................................................................................................................Additional information for a and f: Enter treaty country .................................. and treaty article number ...............................

Reason you are submitting Form W-7. Read the instructions for the box you check. Caution: If you check box b,c, d, e, f, or g, you must file a tax return with Form W-7 unless you meet one of the exceptions (see instructions).

abcdefgh

llllllll

}

Signature of applicant (if delegate, see instructions)

Name of delegate, if applicable (type or print)

Signature

Name and title (type or print)

Date (month, day, year)

/ /

Phone ( )

Fax ( )

EIN

EFIN/Office Code

Date (month, day, year)

/ /

Name of company

Delegate's relationshipto applicant

l Parent l Court-appointed guardian

l Power of Attorney

Phone number

( )

Foreignaddress

Birthinformation

(see instructions)Name at birth ifdifferent . .

(if different fromabove)(see instructions)

1a First name

1b First name

Middle name

Middle name

Last name

Last name

6fName under which it was issuedEnter: TIN or EIN ........................................................................................................................................... and

6g Name of college/university or/company (see instructions) ..................................................................................City and State Length of stay

..Before you begin:

Do not submit this form if you have, or are eligible to obtain, a U.S. social security number (SSN).Getting an ITIN does not change your immigration status or your right to work in the United States

and does not make you eligible for the earned income credit.

Otherinformation

l Male

l Female

AcceptanceAgent'sUse ONLY

SignHere

6d Identification document(s) submitted (see instructions)

l Passport l Driver's license/State I.D. l USCIS documentation l Other ............................Issued by: No.: Exp. date: / / Entry date in U.S. / /

Keep a copy foryour records.

l No/Do not know. Skip line 6f.l Yes. Complete line 6f. If more than one, list on a sheet and attach to this form (see instructions).

An IRS individual taxpayer identification number (ITIN) is for Federal tax purposes only.

Under penalties of perjury, I (applicant/delegate/acceptance agent) declare that I have examined this application, includingaccompanying documentation and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Iauthorize the IRS to disclose to my acceptance agent returns or return information necessary to resolve matters regarding theassignment of my IRS individual taxpayer identification number (ITIN), including any previously assigned taxpayer identifyingnumber.

Application for IRS IndividualTaxpayer Identification Number

2 Street address, apartment number, or rural route number. If you have a P.O. box, see page 4.

City or town, state or province, and country. Include ZIP code or postal code where appropriate.

3 Street address, apartment number, or rural route number. Do not use a P.O. box number.

City or town, state or province, and country. Include ZIP code or postal code where appropriate.

4 Date of birth (month/day/year) Country of birth City and state or province (optional)

/ /

6a Country(ies) of citizenship 6b Foreign tax I.D. number (if any) 6c Type of U.S. visa (if any), number and expiration date

Application for ITINBankers SystemsWolters Kluwer Financial Services Page 1 of 1Initials:

*IRS Form W-7 (Rev. 1-2007)

W-7 11/14/2007120

Sample

July 2003Previous editions will not be accepted after December 31, 2003

cd

FRB: FR 2230 OMB No. 7100-0212FDIC: 6710/06 OMB No. 3064-0077OCC: 8010-9, 8010-1 OMB No. 1557-0180OTS: 1601 OMB No. 1550-0003NCUA: 2362 OMB No. 3133-0094TREASURY: TD F 90-22.47 OMB No. 1506-0001

8 Zip Code

Apprv. 044

SuspiciousActivity Report

ALWAYS COMPLETE ENTIRE REPORT(see instructions)

l Suspect Information Unavailable

1

Part II

Part I Reporting Financial Institution Information

4 Address of Financial Institution

14 Account number(s) affected, if any

13 If institution closed, date closed10 City

7 State

3 EIN

l Multiple Branches (include information in narrative, Part V)9 Address of Branch Office(s) where activity occurred

12 Zip Code

5 Primary Federal Regulator

11 State

15 Last Name or Name of Entity

32 Date of Suspension, Termination, Resignation

17 Middle

18 Address

21 State 22 Zip Code 23 Country20 City

25 Phone Number - Work (include area code)( )

24 Phone Number - Residence (include area code)( )

28 Admission/Confession?

Closed?l Yes l Nol Yes l No

a l Driver's License/State ID b l Passport c l Alien Registration d l Other

Number Issuing Authority

29 Forms of Identification for Suspect:

al Federal Reserve dl OCCbl FDIC el OTScl NCUA

Bankers Systems, Inc., St. Cloud, MN Form SAR-LAZ 6/10/2003

l Corrects Prior Report (see instruction #3 under "How to Make a Report")

16 First Name

31 Is the relationship an insider relationship?

If Yes specify:

30 Relationship to Financial Institution:

al Accountant dl Attorney gl Customer j l Officerbl Agent el Borrower hl Director kl Shareholdercl Appraiser f l Broker i l Employee l l Other

ab

6 City

Suspect Information

26 Occupation/Type of Business 27 Date of Birth

Closed?l Yes l Nol Yes l No

MM DD YYYY

a l Yes b l No

1 Check box below only if correcting a prior report.

19 SSN, EIN or TIN

2 Name of Financial Institution

MM DD YYYY

cl Still employed at financial institution el Terminateddl Suspended f l Resigned MM DD YYYY

41-1792530

a l Yes bl No

121

SamplePart IV

40 Has any law enforcement agency already been advised by telephone, written communication, or otherwise?

Suspicious Activity Information 2Part III

Contact for Assistance

51 Agency (if not filed by financial institution)

43 Name of person(s) contacted at Law Enforcement Agency

50 Date Prepared

44 Phone Number (include area code)

( )


( )

46 First Name

36 Amount of loss prior to recovery(if applicable)

$ .00

a l DEA d l Postal Inspection g l Other Federalb l FBI e l Secret Service h l Statec l IRS f l U.S. Customs i l Localj l Agency Name (for g, h or i)

37 Dollar amount of recovery (if applicable)

$ .00

a l Yes b l No

39 Has the institution's bonding company been notified?


( )

47 Middle

MM DD YYYY

48 Title/Occupation

41 Name of person(s) contacted at Law Enforcement Agency

45 Last Name

, ,

41-1792530Bankers Systems, Inc., St. Cloud, MN Form SAR-LAZ 6/10/2003

, ,

35 Summary characterization of suspicious activity:

MM DD YYYY

MM DD YYYY

f l Computer Intrusiong l Consumer Loan Fraudh l Counterfeit Checki l Counterfeit Credit/Debit Cardj l Counterfeit Instrument (other)k l Credit Card Fraud

a l Bank Secrecy Act/Structuring/Money Laundering

b l Bribery/Gratuityc l Check Fraudd l Check Kitinge l Commercial Loan Fraud

s l Other

l l Debit Card Fraudm l Defalcation/Embezzlementn l False Statemento l Misuse of Position or Self-Dealingp l Mortgage Loan Fraudq l Mysterious Disappearancer l Wire Transfer Fraudt l Terrorist Financingu l Identity Theft(type of activity)

a l Yes b l No

38 Has the suspicious activity had amaterial impact on, or otherwiseaffected, the financial soundnessof the institution?

33 Date or date range of suspicious activityFrom To

, , ,$

34 Total dollar amount involved in known or suspicious activity

.00

Apprv. 044

122

Sample

Paperwork Reduction Act Notice: The purpose of this form is to provide an effective and consistent means for financial institutions to notify appropriatelaw enforcement agencies of known or suspected criminal conduct or suspicious activities that take place at or were perpetrated against financialinstitutions. This report is required by law, pursuant to authority contained in the following statutes. Board of Governors of the Federal Reserve System:12 U.S.C. 324, 334, 611a, 1844(b) and (c), 3105(c) (2) and 3106(a). Federal Deposit Insurance Corporation: 12 U.S.C. 93a, 1818, 1881-84, 3401-22.Office of the Comptroller of the Currency: 12 U.S.C. 93a, 1818, 1881-84, 3401-22. Office of Thrift Supervision: 12 U.S.C. 1463 and 1464. NationalCredit Union Administration: 12 U.S.C. 1766(a), 1786(q). Financial Crimes Enforcement Network: 31 U.S.C. 5318(g). Information collected on this reportis confidential (5 U.S.C. 552(b)(7) and 552a(k)(2), and 31 U.S.C. 5318(g)). The Federal financial institutions' regulatory agencies and the U.S.Departments of Justice and Treasury may use and share the information. Public reporting and recordkeeping burden for this information collection isestimated to average 30 minutes per response, and includes time to gather and maintain data in the required report, review the instructions, andcomplete the information collection. Send comments regarding this burden estimate, including suggestions for reducing the burden, to the Office ofManagement and Budget, Paperwork Reduction Project, Washington, DC 20503 and, depending on your primary Federal regulatory agency, to Secretary,Board of Governors of the Federal Reserve System, Washington, DC 20551; or Assistant Executive Secretary, Federal Deposit Insurance Corporation,Washington, DC 20429; or Legislative and Regulatory Analysis Division, Office of the Comptroller of the Currency, Washington, DC 20219; or Office ofThrift Supervision, Enforcement Office, Washington, DC 20552; or National Credit Union Administration, 1775 Duke Street, Alexandria, VA 22314; orOffice of the Director, Financial Crimes Enforcement Network, Department of the Treasury, 2070 Chain Bridge Road, Vienna, VA 22182. The agenciesmay not conduct or sponsor, and an organization (or a person) is not required to respond to, a collection of information unless it displays a currently validOMB control number.

3Part V Suspicious Activity Information Explanation/DescriptionIndicate where the possible violation took place (e.g., mainoffice, branch, other).Indicate whether the possible violation is an isolated incidentor relates to other transactions.Indicate whether there is any related litigation; if so, specify.Recommend any further investigation that might assist lawenforcement authorities.Indicate whether any information has been excluded fromthis report; if so, why?If you are correcting a previously filed report, describe thechanges that are being made.

Indicate whether currency and/or monetary instruments wereinvolved. If so, provide the amount and/or description ofthe instrument (for example, bank draft, letter of credit,domestic or international money order, stocks, bonds,traveler's checks, wire transfers sent or received,cash, etc.).Indicate any account number that may be involved oraffected.

Explanation/description of known or suspected violation of lawor suspicious activity.

This section of the report is critical. The care with which it iswritten may make the difference in whether or not the describedconduct and its possible criminal nature are clearly understood.Provide below a chronological and complete account of thepossible violation of law, including what is unusual, irregular orsuspicious about the transaction, using the following checklist asyou prepare your account. If necessary, continue the narrativeon a duplicate of this page.

ab

c

d

e

Describe supporting documentation and retain for 5 years.Explain who benefited, financially or otherwise, from thetransaction, how much, and how.Retain any confession, admission, or explanation of thetransaction provided by the suspect and indicate to whomand when it was given.Retain any confession, admission, or explanation of thetransaction provided by any other person and indicate towhom and when it was given.Retain any evidence of cover-up or evidence of an attempt todeceive federal or state examiners or others.

41-1792530Bankers Systems, Inc., St. Cloud, MN Form SAR-LAZ 6/10/2003

f

g

hi

j

k

For Bank Secrecy Act/Structuring/Money Laundering reports,include the following additional information:l

m

Apprv. 044

Tips on SAR form preparation and filing are available in the SAR activity Review at www.fincen.gov/pub_reports.html

123

Sample

FMS Form 1200 (July 2009)1200 7/15/2010

Page 1 of 2

OMB No. 1510-0007

DATE

,

DIRECTIONS

Update your name or address

Change your account information if you already receive your payment by direct deposit, or

Sign up for direct deposit for military, federal salary, veterans benefits, or other federal payments

not processed by Go Direct

(for social security, railroad retirement board, civil (non-military)retirement payments or VA only).

FMS Form 1200 (July 2009) Previous versions obsolete

A. FEDERAL BENEFIT RECIPIENT INFORMATION(print name[s] and address exactly as they appear on your benefit check)

B. BANK OR CREDIT UNION INFORMATION

C. TYPE OF PAYMENT (check only one) You must complete a separate form for each type of federal payment.

F. CERTIFICATION

FOR JOINT ACCOUNT HOLDERS

(If yes, entername at right

DATESIGNATURE

Go Direct Processing CenterU.S. Department of the TreasuryP.O. Box 650527Dallas, TX 75265-0527

Be sure to complete all sections of this form.

Otherwise, the form cannot be processed.

Return the completed form to:

**You may also attach a voided personal check. If you are depositing into a savings account, you

may need to contact your financial institution to obtain the routing and account numbers.

I certify that I am entitled to receive the payment identified above, and that Ihave read and understand the back of this form. In signing this form, Iauthorize this payment to be sent to the financial institution named in Part Babove, to be deposited into the account above.

This form is only to be used for switching from check payments to direct deposit of certain federal

benefits listed in Box C. Use of this form for any other purposes will result in the form being rejected.

Contact your paying agency to:

.

SUPPLEMENTAL SECURITY INCOME

I certify that I have read the SPECIAL NOTICE TO JOINT ACCOUNT

HOLDERS on the back of this form.

SOCIAL SECURITY

Unemploymentsurvivor benefit

SAMPLE CHECK (bottom left corner)

For military, federal salary, veterans benefits or other federal payments not available

through Go Direct, please contact the paying agency(see page 2 for a partial list of paying agencies).

You must also enter the amountof your last benefit payment.

CHECK NUMBER (YOUR MOST RECENT PAYMENT)

In order to process your request, either the claimnumber (found on documents from your payingagency) or the check number from your lastpayment (found in the upper right-hand corner ofyour Treasury check) must be entered at left. $

AMOUNT OF YOUR MOST RECENT PAYMENT

CLAIM NUMBER

VA (COMP/PENSION ONLY) RAILROAD RETIREMENT(specify below)

Retirementannuity

Survivorannuity

Annuitybenefit

...

SIGNATURE

NAME OF PERSON ENTITLED TO GOVERNMENT BENEFITS (BENEFICIARY)

ADDRESS (street, route, P.O. box, apartment number)

YES

REPRESENTATIVE PAYEE?

)NAME OF REPRESENTATIVE PAYEE

SOCIAL SECURITY NUMBER OF PERSON ENTITLED TO GOVERNMENT BENEFITS

(BENEFICIARY)

STATE

DAYTIME TELEPHONE NUMBER

ZIP CODECITY (or APO/FPO)

NO

( ) -

( ACCOUNT TYPE

Checking Savings

**ACCOUNT NUMBER (see sample check below; do not include check number)

**9-DIGIT ROUTING NUMBER (see sample check below)

DEPOSITOR ACCOUNT TITLE (name[s] on account)

CIVIL (NON-MILITARY) RETIREMENT(specify below)

Please read the information on page 2 before completing this form. You must complete boxes A, B, C, D, E and F.

Only complete this form to sign up for direct deposit if you are an individual, or a representative payee of an individual, who receives checks for the following

types of federal benefits: social security, supplemental security income, railroad retirement, civil (non-military) retirement, or VA (compensation or

pension only). If you currently receive your payment by direct deposit you may not use this form. Please refer to page 2 for further instructions.

Direct Deposit Sign-UpBankers SystemsWolters Kluwer Financial Services

*

E. PAYMENT VERIFICATIOND. IDENTIFICATION

OR

You may also sign up online today at www.GoDirect.org

or call Go Direct toll free at 1 (800) 333-1795

124

Sample

The estimated average time (burden hours) associated with filling out this paperwork is 10 minutes per respondent or recordkeeper,

depending on individual circumstances. Comments concerning the accuracy of this time estimate and suggestions for reducing the

burden should be directed to the Financial Management Service, Administrative Programs Division, Records and Information

Management Program, 3700 East-West Highway, Room 135, Hyattsville, MD 20782. THIS ADDRESS SHOULD ONLY BE USED FOR

COMMENTS AND/OR SUGGESTIONS CONCERNING THE AMOUNT OF TIME SPENT COLLECTING THE DATA. DO NOT SEND THE

COMPLETED PAPERWORK TO THE ADDRESS ABOVE FOR PROCESSING.

PLEASE READ THIS CAREFULLY

PRIVACY ACT NOTICEYour social security number and the other information requested will allow the federal government to make payments to you by direct

deposit. This collection of information is authorized by Title 31 of the United States Code, Section 3332(g). Also, Executive Order 9397,

November 22, 1943, authorizes the use of your social security number. Your social security number is requested to ensure the accurate

identification and retention of records pertaining to you and to distinguish you from other recipients of federal payments.

This information will be disclosed to the Department of the Treasury or another disbursing official to process federal payments to you by

direct deposit. This information may also be disclosed to a court, congressional committee or another government agency as authorized or

required by federal law and to your financial institution to verify receipt of your federal payments. Although providing the requested

information is voluntary, your direct deposit payment may be delayed or Treasury may be unable to send it if you fail to provide the

information.

SPECIAL NOTICE TO JOINT ACCOUNT HOLDERSIf your account is a joint account and receives direct deposit benefit payments, you must inform the federal agency and the financial

institution of the death of a beneficiary. Payments sent by direct deposit after the date of death or ineligibility of a beneficiary (except for

salary payments) must be returned to the federal agency. The federal agency will then determine if the survivor is eligible for benefits.

CANCELLATIONYour payment will be sent by direct deposit until the federal agency that issues the payments is notified to cancel, such as in the case of

death or legal incapacity of the person receiving the payment.

Your financial institution may cancel your direct deposit authorization. Your financial institution is required to give you written notice 30 days

in advance of the cancellation date. If this occurs, you must notify the federal agency that the direct deposit authorization was cancelled.

Office of Personnel Management(888) 767-6738(800) 878-5707 TDD

Please contact your paying agency to:

BURDEN ESTIMATE STATEMENT

Update your name or address

Change your account information if you already receive your payment by direct deposit, or

Sign up for direct deposit for military, federal salary, veterans benefits, or other federal

payments not processed by Go Direct

...Department of Veterans Affairs(877) 838-2778(800) 827-1000(800) 829-4833 TDD

Social Security Administration(800) 772-1213(800) 325-0778 TTY

Railroad Retirement Board(Automated System)(877) 772-5772(312) 751-4701 TTY

FMS Form 1200 (July 2009)1200 7/15/2010

Page 2 of 2

Direct Deposit Sign-UpBankers SystemsWolters Kluwer Financial Services

*

125

SamplePart II

Section Bf Individual(s) Conducting Transaction(s) (if other than above).If Section B is left blank or incomplete, check the box(es) below to indicate the reason(s)

1 Check all box(es) that apply: a Amends prior report b Multiple persons c Multiple transactions

Department of the TreasuryFinCEN

FINCEN Form 104

OMB No. 1506-0004

Currency Transaction ReportPrevious editions will not be accepted after August 31, 2004.

Please type or print.

(Complete all parts that applyfSee instructions)

( ) -

Part III

47 Type or print preparer's name 48 Type or print name of person to contact 49 Telephone numberSignHere

Cat. No. 37683N

(Formerly Form 4789)(Eff. December 2003)

Financial Institution Where Transaction(s) Takes Place

d l Other e Issued by: f Number:

15 Individual's last name 16 First name 17 Middle Initial

18 Address (number, street, and apt. or suite no.)

20 City

39 EIN or SSN

43 Routing (MICR) number

46 Date of signature

41 State 42 ZIP code

/ /MM DD YYYY

Part I

Section AfPerson(s) on Whose Behalf Transaction(s) Is Conducted

25 If an individual, describe method used to verify identity: a l Driver's license/State I.D. b l Passport c l Alien Registration

19 SSN

28 Date of transaction

21 State 22 ZIP code 23 Country code(if not U.S.)

/ /MM DD YYYY


a l Armored Car Service b l Mail Deposit or Shipment c l Night Deposit or Automated Teller Machine d l Multiple Transactions e l Conducted On Own Behalf

Person(s) Involved in Transaction(s)

26 Total cash in $ .00 27 Total cash out $ .00

26a Foreign cash in .00 27a Foreign cash out .00

29 l Foreign Country 30 l Wire Transfer(s) 31 l Negotiable Instrument(s) Purchased

32 l Negotiable Instrument(s) Cashed 33 l Currency Exchange(s) 34 l Deposit(s)/Withdrawal(s)

35 l Account Number(s) Affected (if any): 36 l Other (specify)

(see instructions, page 4)

Amount and Type of Transaction(s). Check all boxes that apply.

6 SSN or EIN

8 Date of birth

10 State 11 ZIP code 12 Country code 13 Occupation, profession, or business(if not U.S.)

/ /MM DD YYYY

24 Date of birth

37 Name of financial institution


40 City

44 Title of approving official 45 Signature of approving official

Enter Regulator or BSAExaminer code number (see instructions)

FinCEN Form 104 (Formerly Form 4789) (Rev. 8-03)

l l l

/ /MM DD YYYY

(see instructions, page 4)

For Paperwork Reduction Act Notice, see page 4.

2 Individual's last name or entity's name 3 First name 4 Middle Initial

5 Doing business as (DBA)


9 City


Wolters Kluwer Financial Services 2004, 2008-Wolters Kluwer Financial Services 2004, 2008 CTR 11/7/2008126

Sample

Page 2FinCEN Form 104 (Formerly Form 4789) (Eff. 12-03)

Multiple PersonsComplete applicable parts below if box 1b on page 1 is checked

Part I


Section Bf Individual(s) Conducting Transaction(s) (if other than above).



6 SSN or EIN

8 Date of birth


/ /MM DD YYYY




9 City




20 City/ /

MM DD YYYY


19 SSN



24 Date of birth

Part I


Section Bf Individual(s) Conducting Transaction(s) (if other than above).



6 SSN or EIN

8 Date of birth


/ /MM DD YYYY




9 City




20 City/ /

MM DD YYYY


19 SSN



24 Date of birth

- CTR 11/7/2008Wolters Kluwer Financial Services 2004, 2008 127

SampleGenerally, financial institutions are defined as banks,

other types of depository institutions, brokers or dealers insecurities, money transmitters, currency exchangers,check cashers, and issuers and sellers of money orders andtraveler's checks. Should you have questions, see thedefinitions in 31 CFR Part 103.

When and Where To File. This form should be e-filedthrough the Bank Secrecy Act E-filing System. Go tohttp: //bsaefiling.fincen.treas.gov/index.jsp to register. Thisform is also available for download on the Financial CrimesEnforcement Network's Web site at www.fincen.gov, ormay be ordered by calling the IRS Forms DistributionCenter at (800) 829-3676. File this CTR by the 15thcalendar day after the day of the transaction with the:

Enterprise Computing Center - DetroitATTN: CTRP.O. Box 33604Detroit, MI 48232-5604

Keep a copy of each CTR for five years from the datefiled.

A financial institution may apply to file the CTRsmagnetically. To obtain an application to file magnetically,write to the:

IRS Detroit Computing CenterATTN: CTR Magnetic Media CoordinatorP.O. Box 33604Detroit, MI 48232-5604

Identification Requirements. All individuals (exceptemployees of armored car services) conducting areportable transaction(s) for themselves or for anotherperson, must be identified by means of an official

Currency. The coin and paper money of the United Statesor any other country, which is circulated and customarilyused and accepted as money.

Person. An individual, corporation, partnership, trust orestate, joint stock company, association, syndicate, jointventure or other unincorporated organization or group.

Organization. Entity other than an individual.

Transaction in Currency. The physical transfer of currencyfrom one person to another. This does not include atransfer of funds by means of bank check, bank draft,wire transfer or other written order that does not involvethe physical transfer of currency.

Negotiable Instruments. All checks and drafts (includingbusiness, personal, bank, cashier's and third-party), moneyorders, and promissory notes. For purposes of this CTR, alltraveler's checks shall also be considered negotiableinstruments whether or not they are in bearer form.

Foreign exchange rate. If foreign currency is a part of acurrency transaction that requires the completion of aCTR, use the exchange rate in effect for the business dayof the transaction to compute the amount, in US dollars,to enter in item 26/27. The source of the exchange ratethat is used will be determined by the reporting institution.

Specific InstructionsBecause of the limited space on the front and back of theCTR, it may be necessary to submit additional informationon attached sheets. Submit this additional information onplain paper attached to the CTR. Be sure to put theindividual's or entity's name and identifying number (items2, 3, 4, and 6 of the CTR) on any additional sheets sothat if it becomes separated, it may be associated with theCTR.

Item 1a. Amends Prior Report. If this CTR is being filedbecause it amends a report filed previously, check Item 1a.Staple a copy of the original CTR to the amended one,complete Part III fully and only those other entries whichare being amended.

Item 1b. Multiple Persons. If this transaction is beingconducted by more than one person or on behalf of morethan one person, check Item 1b. Enter information in Part Ifor one of the persons and provide information on anyother persons on the back of the CTR.

document(s). Acceptable forms of identification includedriver's license, military and military/dependentidentification cards, passport, state issued identificationcard, cedular card (foreign), non-resident alienidentification cards, or any other identification document ordocuments, which contain name and preferably addressand a photograph and are normally acceptable by financialinstitutions as a means of identification when cashingchecks for persons other than established customers.

Acceptable identification information obtainedpreviously and maintained in the financial institution'srecords may be used. For example, if documents verifyingan individual's identity were examined and recorded on asignature card when an account was opened, the financialinstitution may rely on that information. In completing theCTR, the financial institution must indicate on the form themethod, type, and number of the identification.Statements such as "known customer" or "signature cardon file" are not sufficient for form completion.

Penalties. Civil and criminal penalties are provided forfailure to file a CTR or to supply information or for filing afalse or fraudulent CTR. See 31 U.S.C. 5321, 5322 and5324.

For purposes of this CTR, the terms below have thefollowing meanings:

Item 1c. Multiple Transactions. If the financial institutionhas knowledge that there are multiple transactions, checkItem 1c.

PART I - Person(s) Involved in Transaction(s)

Section A must be completed. If an individual conducts atransaction on his own behalf, complete Section A andleave Section "B" BLANK. If an individual conducts atransaction on his own behalf and on behalf of anotherperson(s), complete Section "A" for each person and leaveSection "B" BLANK. If an individual conducts a transactionon behalf of another person(s), complete Section "B" forthe individual conducting the transaction, and completeSection "A" for each person on whose behalf thetransaction is conducted of whom the financial institutionhas knowledge.

Section A. Person(s) on Whose Behalf Transaction(s)Is Conducted. See instructions above.

Items 2, 3, and 4. Individual/Organization Name. If theperson on whose behalf the transaction(s) is conducted isan individual, put his/her last name in Item 2, first name inItem 3, and middle initial in Item 4. If there is no middleinitial, leave item 4 BLANK. If the transaction is conductedon behalf of an entity, enter the name in Item 2 and leaveItems 3 and 4 BLANK.

Item 5. Doing Business As (DBA). If the financialinstitution has knowledge of a separate "doing businessas" name, enter it in Item 5. For example, if SmithEnterprise is doing business as MJ's Pizza, enter "MJ'sPizza" in item 5.

Item 6. SSN or EIN. Enter the Social Security Number(SSN) or Individual Taxpayer Identification Number (ITIN)or Employer Identification Number (EIN) of the person orentity identified in Item 2. If none, write NONE.

Items 7, 9, 10, 11, and 12. Address. Enter the permanentaddress including ZIP Code of the person identified in Item2. Use the U.S. Postal Service's two letter stateabbreviation code. A P.O. Box should not be used byitself, and may only be used if there is no street address. Ifa P.O. Box is used, the name of the apartment or suitenumber, road or route number where the person residesmust also be provided. If the address is outside the U.S.,provide the street address, city, province or state, postalcode (if known), and the two letter country code. Forcountry code list go to www.fincen.gov/reg_bsaforms.html or telephone 800-949-2732 and selectoption number 5. If U.S., leave item 12 blank.

Item 8. Date of Birth. Enter the date of birth. Eightnumerals must be inserted for each date. The first two willreflect the month, the second two the day, and the lastfour the year. A zero (0) should precede any single digitnumber. For example, if an individual's birth date is April 31948, Item 8 should read 04 03 1948.

Item 13. Occupation, profession, or business. If known,identify the occupation, profession or business that bestdescribes the individual or entity in Part I (e.g., attorney,car dealer, carpenter, doctor, farmer, plumber, truck driver,etc.). Do not use nondescript terms such as businessman,merchant, store owner (unless store's name is provided),or self employed. If unemployed, or retired are used enterthe regular or former occupation if known.

Item 14. If an Individual, Describe Method Used To VerifyIdentity. If an individual conducts the transaction(s) onhis/her own behalf, his/her identity must be verified byexamination of an acceptable document (see GeneralInstructions). For example, check box a if a driver's licenseis used to verify an individual's identity, and enter thestate that issued the license and the number in items e andf. If the transaction is conducted by an individual on behalfof another individual not present, or on behalf of an entity,check box "14d" "Other" and enter "NA" on the lineprovided.

FinCEN Form 104 (Eff.12-03) Page 3

Suspicious Transactions

This Currency Transaction Report (CTR) should NOT befiled for suspicious transactions involving $10,000 or lessin currency OR to note that a transaction of more than$10,000 is suspicious. Any suspicious or unusual activityshould be reported by a financial institution in the mannerprescribed by its appropriate federal regulator or BSAexaminer. (See the instructions for Item 37). If atransaction is suspicious and in excess of $10,000 incurrency, then both a CTR and the appropriate SuspiciousActivity Report form must be filed.

In situations involving suspicious transactions requiringimmediate attention, such as when a reportabletransaction is ongoing, the financial institution shallimmediately notify, by telephone, appropriate lawenforcement and regulatory authorities in addition to filinga timely suspicious activity report.

General Instructions

Who Must File. Each financial institution (other than acasino, which instead must file FinCEN Form 103, and theU.S. Postal Service for which there are separate rules)must file FinCEN Form 104 (CTR) for each deposit,withdrawal, exchange of currency, or other payment ortransfer, by, through, or to the financial institution whichinvolves a transaction in currency of more than $10,000.Multiple transactions must be treated as a singletransaction if the financial institution has knowledge that(1) they are by or on behalf of the same person, and (2)they result in either currency received (Cash In) orcurrency disbursed (Cash Out) by the financial institutiontotaling more than $10,000 during any one business day.For a bank, a business day is the day on whichtransactions are routinely posted to customers' accounts,as normally communicated to depository customers. For allother financial institutions, a business day is a calendarday.


SamplePART II - Amount and Type of Transaction(s)Complete Part II to identify the type of transaction(s) andthe amount(s) involved.

Items 26 and 27. Total Cash In/Total Cash Out. In thespaces provided, enter the total amount of currencyreceived (Total Cash In) or total currency disbursed (TotalCash Out) by the financial institution. If foreign currency isexchanged, use the U.S. dollar equivalent on the day ofthe transaction (See "Foreign exchange rates") andcomplete item 26a or 27a, whichever is appropriate.

If less than a full dollar amount is involved, increase thatfigure to the next highest dollar. For example, if thecurrency totals $20,000.05, show the total as$20,001.00.

Items 26a and 27a. Foreign cash in/Foreign cash out. Ifforeign currency is exchanged, enter the amount of foreigncurrency (Do not convert to U.S. dollars) in items 26a and27a. Report country of origin in item 29.

Item 28. Date of Transaction. Insert eight numerals foreach date. (See instructions for Item 8.)

Item 29. Foreign Country. If items 26a and/or 27a arecompleted indicating that foreign currency is involved,check Item 29 and identify the country. If multiple foreigncurrencies are involved, check box 36 and identify theadditional country(s) and/or currency(s) involved.

Determining Whether Transactions Meet the ReportingThreshold.

Only cash transactions that, if alone or when aggregated,exceed $10,000 should be reported on the CTR.Transactions shall not be offset against one another.

If there are both Cash In and Cash Out transactions thatare reportable, the amounts should be consideredseparately and not aggregated. However, they may bereported on a single CTR.

Section B. Individual(s) Conducting Transaction(s) (if otherthan above). Financial institutions should enter as muchinformation as is available. However, there may beinstances in which Items 15-25 may be left BLANK orincomplete. If Items 15-25 are left BLANK or incomplete,check one or more of the boxes provided to indicate thereasons.

Example: If there are multiple transactions that, if onlywhen aggregated, the financial institution has knowledgethe transactions exceed the reporting threshold, andtherefore, did not identify the transactor(s), check box dfor Multiple Transactions.

Items 15, 16, and 17. Individual's Name. Complete theseitems if an individual conducts a transaction(s) on behalf ofanother person. For example, if John Doe, an employee ofXY Grocery Store, makes a deposit to the store's account,XY Grocery Store should be identified in Section A andJohn Doe should be identified in section B.

Items 18, 20, 21, 22, and 23. Address. Enter thepermanent street address including ZIP Code of theindividual. (See the instructions for Items 7 and 9 through12.) Enter country code if not U.S. (Reference item 12).

Item 19. SSN/ITIN. If the individual has a Social SecurityNumber, or Individual Taxpayer Indentifcation Number,enter it in Item 19. If the individual does not have anSSN/ITIN, enter NONE.

Item 24. Date of Birth. Enter the individual's date of birth.(See the instructions for Item 8.)

Item 25. If an Individual, Describe Method Used To VerifyIdentity. Enter the method used to identify the individual'sidentity. (See General Instructions and the instructions forItem 14.)

FinCEN Form 104 (Eff.12-03) Page 4

If there is a currency exchange, it should be aggregatedseparately with each of the Cash In and Cash Out totals.

Example 1: A person deposits $11,000 in currency to hissavings account and withdraws $3,000 in currency fromhis checking account. The CTR should be completed asfollows:

Cash In $11,000 and no entry for Cash Out. This isbecause the $3,000 transaction does not meet thereporting threshold.

Example 2: A person deposits $11,000 in currency to hissavings account and withdraws $12,000 in currency fromhis checking account. The CTR should be completed asfollows:

Cash In $11,000, Cash Out $12,000. This is becausethere are two reportable transactions. However, one CTRmay be filed to reflect both.

Example 3: A person deposits $6,000 in currency to hissavings account and withdraws $4,000 in currency fromhis checking account. Further, he presents $5,000 incurrency to be exchanged for the equivalent in Euro's. TheCTR should be completed as follows:

Cash In $11,000 and no entry for Cash Out. This isbecause in determining whether the transactions arereportable, the currency exchange is aggregated with eachof the Cash In and Cash Out amounts. The result is areportable $11,000 Cash In transaction. The total CashOut amount is $9,000, which does not meet the reportingthreshold. Therefore, it is not entered on the CTR.

Example 4: A person deposits $6,000 in currency to hissavings account and withdraws $7,000 in currency fromhis checking account. Further, he presents $5,000 incurrency to be exchanged for the equivalent in Euro's. TheCTR should be completed as follows:

Cash In $11,000, Cash Out $12,000. This is becausein determining whether the transactions are reportable, thecurrency exchange is aggregated with each of the Cash Inand Cash Out amounts. In this example, each of the CashIn and Cash Out totals exceed $10,000 and must bereflected on the CTR.

Items 30-33. Check the appropriate item(s) to identifythe following type of transaction(s):

30. Wire Transfer(s)31. Negotiable Instrument(s) Purchased32. Negotiable Instrument(s) Cashed33. Currency Exchange(s)

Item 34. Deposits/Withdrawals. Check this item to identifydeposits to or withdrawals from accounts, e.g. demanddeposit accounts, savings accounts, time deposits, mutualfund accounts, or any other account held at the financialinstitution. Enter the account number(s) in Item 35.

Item 35. Account Numbers Affected (if any). Enter theaccount numbers of any accounts affected by thetransactions that are maintained at the financial institutionconducting the transaction(s).

Example 1: If a person cashes a check drawn on anaccount held at the financial institution, the CTR should becompleted as follows:

Indicate negotiable instrument(s) cashed and providethe account number of the check.

If the transaction does not affect an account, make noentry.

Example 2: A person cashes a check drawn on anotherfinancial institution. In this instance, negotiableinstrument(s) cashed would be indicated, but no accountat the financial institution has been affected. Therefore,Item 35 should be left BLANK.

SIGNATURE

Items 44 and 45. Title and signature of ApprovingOfficial. The official who reviews and approves the CTRmust indicate his/her title and sign the CTR.

Item 46. Date of Signature. The approving official mustenter the date the CTR is signed. (See the instructions forItem 8.)

Item 47. Preparer's Name. Type or print the full name ofthe individual preparing the CTR. The preparer and theapproving official may not necessarily be the sameindividual.

Items 48 and 49. Contact Person/Telephone Number.Type or print the name and telephone number of anindividual to contact concerning questions about the CTR.

Paperwork Reduction Act Notice. The requestedinformation is useful in criminal, tax, and regulatoryinvestigations and proceedings. Financial institutions arerequired to provide the information under 31 U.S.C. 5313and 31 CFR Part 103, commonly referred to as the BankSecrecy Act (BSA). The BSA is administered by the U.S.Department of the Treasury's Financial CrimesEnforcement Network (FinCEN). You are not required toprovide the requested information unless a form displaysa valid OMB control number. The time needed tocomplete this form will vary depending on individualcircumstances. The estimated average time is 19minutes. If you have comments concerning the accuracyof this time estimate or suggestions for making this formsimpler, you may write to the Financial CrimesEnforcement Network, P. O. Box 39, Vienna, VA 22183.Do not send this form to this office. Instead, see Whenand Where to File in the instructions.

Item 36. Other (specify). If a transaction is not identifiedin Items 30-34, check Item 36 and provide an additionaldescription. For example, a person presents a check topurchase "foreign currency." If multiple (more than one)foreign currencies are involved in the transaction, enterthe amount of the largest foreign currency transaction initem 26a or 27a and that currency's country-code oforigin in item 29. Then check box 36 and enter theadditional foreign currencies amount(s) andcountry-code(s) of origin in the space provided.

PART III - Financial Institution Where Transaction(s) TakePlace

Item 37. Name of Financial Institution and Identity ofRegulator or BSA Examiner. Enter the financialinstitution's full legal name and identify the regulator orBSA examiner, using the following codes:

Regulator or BSA Examiner CODEComptroller of the Currency (OCC).............................1Federal Deposit Insurance Corporation (FDIC)................2Federal Reserve System (FRS)....................................3Office of Thrift Supervision (OTS)...............................4National Credit Union Administration (NCUA)................5Securities and Exchange Commission (SEC)..................6Internal Revenue Service (IRS)....................................7U.S. Postal Service (USPS)........................................8Commodity Futures Trading Commission (CFTC)...........9State Regulator......................................................10

Items 38, 40, 41, and 42. Address. Enter the streetaddress, city, state, and ZIP Code of the financialinstitution where the transaction occurred. If there aremultiple transactions, provide information of the office orbranch where any one of the transactions has occurred.

Item 39. EIN or SSN. Enter the financial institution's EIN.If the financial institution does not have an EIN, enter theSSN of the financial institution's principal owner.

Item 43. Routing (MICR) Number. If a depositoryinstitution, enter the routing (Magnetic Ink CharacterRecognition (MICR)) number.


130

Application and Support Documents


Card Application (CARD-APP)

Business Purpose Account Service Application (CARD-APP-B)

Automatic Transfer Authorization (ATA-PL)

Authorization for Preauthorized Payments (ACH-PW)

Funds Transfer Agreement and Authorization (FTAA-LAZ)

ACH Origination Agreement (ACHORIGAGRLZ)

Power of Attorney (POA-MN)

Night Depository Agreement (NDA-COMB)

Credit Report Authorization (FCRA-CRA)

Notice of Action Taken (DN-FCRA-D) (all purpose)

Notice of Action Taken (DNFCRA-D-CRA) (Consumer Reporting Agency)

Fair Credit Reporting Act-Notice of Reporting Address (FCRA-NRA)

Federal Sale of Insurance Disclosure (INS-WARN)

Notice of Delayed Availability (FFAD-NDA-CBC) (case-by-case delay)

Notice of Delayed Availability (FFAD-NDA-SE) (safeguard exception hold)

Notice of Delayed Availability (FFAD-NDA-LD) (large deposit/redeposited items blanket notice)

Notice of Delayed Availability (FFAD-NDA-RO) (repeated overdrafts)

r

131

132

Sample

CONSUMER ACCOUNT SERVICE APPLICATION

I'd like to apply for the following:l ATM Card l Debit/Check Card lNumber of Cards Requested

Name(s) of Person(s) to issue cards to:

Name:

Name:

Name:

Name:

Name:

Additional Terms:

For Institution Use Additional Informationl Approved l DeclinedByDate

-

Card ApplicationBankers SystemsWolters Kluwer Financial Services 2002, 2006

Savings #:

Checking #:

Acct. Title:

Street Address:

City:

State: Zip:

ID#

ID#

ID#

ID#

ID#

Signatures: By signing below, the undersigned request(s) the described service(s) and agree(s) to the terms andconditions governing the service(s), including any fees and charges. The undersigned agree(s) that all informationis accurate and authorize(s) the financial institution to verify credit and employment history by any necessarymeans, including preparation of a consumer report by a consumer reporting agency. The undersignedacknowledges receipt of and agrees to the terms of the following:

l Electronic Funds Transfer l

Signature Date

Signature Date

Signature Date

Signature Date

Signature Date

CARD-APP 12/20/2009

Page 1 of 1Initials:*

133

Sample

BUSINESS PURPOSE ACCOUNTSERVICE APPLICATION

Additional Terms:

Signatures: By signing below, you, the undersigned, request the described service(s) and agree that all informationin this application is accurate. You agree to the terms of the requested service, including fees and charges, and youacknowledge receipt of the following on behalf of yourself and the entity you represent:l Business Debit Card Agreement ll You authorize us to verify your creditworthiness and employment history, as an individual, through anynecessary means, including preparation of a credit report by a consumer reporting agency.

X XName/Title: Name/Title:ID: ID:

X XName/Title: Name/Title:ID: ID:

-

Service Application-BusinessBankers SystemsWolters Kluwer Financial Services 2005, 2006

(Date)(Date)

CARD-APP-B 5/1/2010

Page 1 of 1

The terms "we," "us," and "our" mean thefinancial institution identified above.

Applicant (Business) Name and Address:

Acct Type: #Acct Type: #Tax ID #:Phone:Fax:

Name(s) of Person(s) Transaction Limitation(s)to issue cards to: Type (e.g., ATM/Point of Sale), Amount, Frequency

$ per

$ per

$ per

$ per

$ per

Service Requested: l Debit/Check Card l ATM Card Number of Cards Requested:l

Initials:*

INSTITUTION USE ONLYl Approved l Resolution/Authorization datedl Declined (l Notice given) Notes:By Date

134

Sample

AUTOMATIC TRANSFER AUTHORIZATIONIn this authorization, the words "we," "our," or "us" mean the Financial Institution and the words "you" or "your" meanthe Account Holder(s). Text following a box which is not checked does not apply to this agreement. You authorize us tomake the following transfer of funds:

Account No.Account Title

Typel Savings/Share l Checking/Share Draft l NOWl

To Credited Account:

FINANCIAL INSTITUTIONACCOUNT HOLDER(S)

From Debited Account:

Account/Loan No.Account Title/Loan Description

Typel Savings/Share l Checking/Share Draft l NOW l Club Acct.l Safe Deposit Fee l Mortgage Loan Paymentl Installment Loan Paymentl

We will make transfers on the following basis:l PERIODIC TRANSFERS

Amount to be Transferred $ Effective Date Termination DateFrequency: l Weekly l Monthly l

l MAINTENANCE TRANSFER OF FUNDS

You authorize us to charge your Debited Account and to transfer and deposit money into your Credited Account tocover each overdraft on your Credited Account. We will make all transfers in multiples of $ .You authorize us to charge your Debited Account $ for each

.

l INSUFFICIENT FUNDS TRANSFER

You authorize us to charge your Debited Account when the account balance of your Credited Account falls below aminimum of $ and to transfer and deposit these funds in this account. The amount we can chargeand transfer shall equal the amount necessary to raise your Credited Account balance to equal or exceed theminimum balance (if any). We will make all transfers in multiples of $ .You authorize us to charge your Debited Account $ for each

TERMINATION OF THIS AGREEMENT: Any one of you may cancel this agreement by giving us written notice. Yournotice will be effective ( ) days after we receive it.

Effective (date) the undersigned cancels this Automatic Transfer Authorization.

Signed

.

Signature Signature

Authorization Number Date

If a transfer date is a non-processing day for us then the transfer will be made on the first processing day l before l afterthe scheduled transfer date.

By signing below, the undersigned agree(s) to all the terms and conditions beginning on page 1 through the bottom ofpage 2 of this Authorization.

1992 Bankers Systems, Inc., St. Cloud, MN Form ATA-PL 6/12/2002 (page 1 of 2)- 135

Sample

(page 2 of 2)

GENERALLY - The accounts listed on page one are covered by their individual terms and conditions,unless modified by this Authorization. If a transfer is made from a savings account, we reserve theright to require not less than 7 days written notice of withdrawal.

You agree to keep enough money in your Debited Account to cover the transfers you request bythis Authorization. If your Debited Account balance is insufficient to cover the transfers youauthorize, we may cancel this Authorization immediately without notice. We may use our rights andremedies under applicable law and our rules and regulations governing these types of accounts.These may include returning your checks or drafts unpaid and closing your account(s) by mailing aproper notice to you with a check or draft equal to the balance in the account.

You agree, in consideration of this service rendered by us, to indemnify (repay us for any loss) andhold us harmless (release us from any responsibility) from any liability or loss occurring due to thedishonor of any check or draft presented which results from any charge made or refused to bemade by us under this Authorization. You agree to abide by our rules and regulations governingyour account(s) as stated on your account agreement and as amended from time to time. We maytake any security measures that we believe are necessary (such as recording telephone transferconversations) without notice to you.

LOAN PAYMENT AUTHORIZATION - If your Credited Account listed on page one is a debt you oweus (e.g. a mortgage or installment loan), then you agree that we may continue to charge theDebited Account until the loan is paid or until you provide us with written notice of cancellation.

If your Debited Account does not have a sufficient balance on a day that a payment is to bedebited, we may stop further efforts to debit your Debited Account and ask you for the paymentand all subsequent payments until all payments under the loan are current. We will not use theavailability of any credit line that you may have with us in determining whether your DebitedAccount has a sufficient balance. At our option and discretion, we may resume charging theDebited Account without further instruction from you once all payments are current. If we do notresume charging your Debited Account, we will notify you in writing that we have cancelled thisAuthorization. Cancellation of this Authorization does not excuse you from making timely paymentunder the terms of the loan.

AMENDMENTS AND TERMINATION - We will give you reasonable notice when we amend thisAuthorization. If this Authorization needs to be amended because of a change in State or Federallaw, the change shall be effective immediately without notice. If no termination date is specified onpage one, this Authorization will remain in effect until terminated by any one of you. We mayterminate this Authorization by giving you written notice at the address stated on page one. Anynotice will be effective immediately when mailed or delivered by us. Notice to any one of you isnotice to all of you.

1992 Bankers Systems, Inc., St. Cloud, MN Form ATA-PL 6/12/2002- 136

Sample

AUTHORIZATION FOR PREAUTHORIZED PAYMENTS

COMPANY NAME COMPANY ID#AMOUNT: l $

l

FREQUENCY: l Weekly l Monthly lOPTIONAL: Effective Date Termination Datel New Authorization l Change to Previous Authorization

My/Our account will remain subject to its individual terms and conditions,which are not modified by this authorization. I/We acknowledge that theorigination of these transactions must comply with the provisions of U.S. law.

I/We understand that this authorization will remain in full force and effect untilthe termination date stated above or until the COMPANY has received writtennotification from me (or either of us) of its termination in such time and in suchmanner as to afford the COMPANY and the DEPOSITORY a reasonableopportunity to act on it.

DEPOSITORY NAME:BRANCH: PHONE:CITY: STATE: ZIP:ROUTING NO.:ACCOUNT NO.:

(l Voided check/draft/deposit slip attached)l CHK l SAV l

NAME(S) (Print or Type):ID #

I/We authorize the COMPANY (named below) to initiate debit entries to my/ouraccount at the DEPOSITORY (identified below), for the purpose of accomplishingthe following preauthorized payments:

(Signature) (date) (Signature) (date)

An amount which may vary. l If checked, the amount of thepayment must not exceed $ .I have the right to receive notice at least 10 days in advance of thedue date of any payment of a varying amount. However, I choose toreceive this notice l ONLY when the amount of my payment fallsoutside of the following range: $ to $ .l ONLY when the amount of my payment differs from the mostrecent payment by more than $ .

-

Preauthorized Payment AuthorizationBankers SystemsWolters Kluwer Financial Services 1995, 2006

ACH-PW 12/15/2006


137

Sample

Funds Transfer Agreement and Authorization

"You" or "your" mean the account holder

Account Name and Address Account #Contact personTelephone numberAccount typeCut-off time

Security procedure - Select your security procedure(s) below. See page 2 for additional terms.The circumstances of account holder, if any, which are relevant to the establishment of a commercially reasonablesecurity procedure are

Security procedure(s) we offer you are l below. Initial next to the l the procedure(s) that you select:l Communication of Order - Authorized payment orders must be communicated to us

.l Code - You must give us your code with your payment order. Your code is

.l Call back - Upon our receipt of your payment order, we will call the listed phone number to confirm your

payment order with any of the following persons:

"We", "our" or "us" mean the financial institution

l Beneficiary limitation - The beneficiary of payment orders that you authorize will be limited to.

l Frequency limitation - l You will not authorize payment orders more frequently than. l You will authorize payment orders

.l Dollar limitation - l Maximum. No authorized payment order will exceed the amount of $ .

l Minimum. No authorized payment order will be in an amount less than $ .l

.Security procedure(s) you have designed and selected:

.Additional comments:

(a)(b)(c)(d)

Name

l Beneficiary limitation - The beneficiary of payment orders that you authorize will be limited to.

l Frequency limitation - l You will not authorize payment orders more frequently than. l You will authorize payment orders

.l Dollar limitation - l Maximum. No authorized payment order will exceed the amount of $ .

l Minimum. No authorized payment order will be in an amount less than $ .l

.Security procedure(s) you have designed and selected:

.Additional comments:

(financial institution)

(please type name and title)

(signature)

By

X X

( )( )( )( )

Telephone Number

Dated:

By

(account holder)

(please type name and title)

(signature)

By signing below, the undersigned agree to all the terms and conditions beginning on page 1 through the bottom of page2 of this Funds Transfer and Authorization Agreement.

-

Funds Transfer AgreementBankers SystemsWolters Kluwer Financial Services 1994, 2006

FTAA-LAZ 12/15/2006


138

Sample

not be entitled to interest on any refund you receive because thebeneficiary's bank does not accept the payment order.Duty to report unauthorized or erroneous payment - You mustexercise ordinary care to determine that all payment orders oramendments to payment orders that we accept that are issued inyour name are authorized, enforceable, in the correct amount, to thecorrect beneficiary and not otherwise erroneous. If you discover (orwith reasonable care should have discovered) an unauthorized,unenforceable or erroneously executed payment order oramendment, you must exercise ordinary care to notify us of therelevant facts. The time you have to notify us will depend on thecircumstances, but that time will not in any circumstance exceed 14days from when you are notified of our acceptance or execution ofthe payment order or amendment or that your account was debitedwith respect to the order or amendment. If you do not provide uswith timely notice you will not be entitled to interest on anyrefundable amount. If we can prove that you failed to perform eitherof these duties with respect to an erroneous payment and that weincurred a loss as a result of the failure, you are liable to us for theamount of the loss not exceeding the amount of your order.Identifying number - If your payment order identifies an intermediatebank, beneficiary bank, or beneficiary by name and number, we andevery receiving or beneficiary bank may rely upon the identifyingnumber rather than the name to make payment, even if the numberidentifies an intermediate bank, person or account different than thebank or beneficiary identified by name. Neither we nor any receivingor beneficiary bank have any responsibility to determine whether thename and identifying number refer to the same financial institution orperson.Record of oral or telephone orders - You agree that we may, if wechoose, record any oral or telephone payment order orcommunication of amendment or cancellation.Notice of credit - If we receive a payment order to credit an accountyou have with us, we are not required to provide you with anynotice of the payment order or the credit.Provisional credit - You agree to be bound by the automated clearinghouse association operating rules that provide that payments madeto you, or originated by you, by funds transfer through theautomated clearing house system are provisional until finalsettlement is made through a Federal Reserve Bank or payment isotherwise made as provided in Article 4A-403(a) of the UniformCommercial Code.Refund of credit - You agree that if we do not receive payment of anamount credited to your account, we are entitled to a refund fromyou in the amount credited and the party originating such paymentwill not be considered to have paid the amount so credited.Amendment of funds transfer agreement - From time to time wemay amend any term of this agreement by giving you reasonablenotice in writing. We may give notice to anyone who is authorized tosend payment orders to us in your name, or to anyone who isauthorized to accept service.Cancellation or amendment of payment order - You may cancel oramend a payment order you give us only if we receive thecommunication of cancellation or amendment before our cut-off timeand in time to have a reasonable opportunity to act on it before weaccept the payment order. The communication of cancellation oramendment must be presented in conformity with the same securityprocedure that has been agreed to for payment orders.Intermediaries - We are not liable for the actions of any intermediary,regardless of whether or not we selected the intermediary. We arenot responsible for acts of God, outside agencies or nonsalariedagents.Limit on liability - You waive any claim you may have against us forconsequential or special damages, including loss of profit arising outof a payment order or funds transfer, unless the waiver is prohibitedby law. We are not responsible for attorney fees you might incur dueto erroneous execution of payment order.Erroneous execution - If we receive an order to pay you, and weerroneously pay you more than the amount of the payment order,we are entitled to recover from you the amount in excess of theamount of the payment order, regardless of whether you may havesome claim to the excess amount against the originator of the order.Objection to payment - If we give you a notice that reasonablyidentifies a payment order issued in your name as sender that wehave accepted and received payment for, you cannot claim that weare not entitled to retain the payment unless you notify us of yourobjection to the payment within one year of our notice to you.

Authorized account - An authorized account is a deposit account you have with us that you have designated as a sourceof payment of payment orders that you issue to us. The account identified by name and number above is an authorizedaccount. Additional authorized accounts, if any, are subject to this agreement and are listed below or in a separatewriting.

Account typeAccount numberAdditional authorized account name

are denoted on page 1 by l . (The blanks describing the securityprocedure(s) we offer you may not be filled in if you must supply theinformation required to be filled in and you have not selected thatsecurity procedure.) You may choose any security procedure(s) weoffer you, or you may design your own security procedure if it isacceptable to us. If you refuse a commercially reasonable securityprocedure that we have offered you, you agree that you will bebound by any payment order issued in your name, whether or not itis authorized, that we accept in good faith and in compliance withthe security procedure you have chosen. If more than one securityprocedure is selected, compliance with any one of them will verifythe authenticity of a payment order or communication canceling oramending a payment order unless instructions to the contrary areprovided as Additional Comments on page 1. You affirm that thereare no circumstances relevant to the determination of a commerciallyreasonable security procedure unless they are described on page 1.You agree that the security procedure you have selected iscommercially reasonable. You must safeguard your securityprocedure and not let anyone other than authorized persons haveaccess to your security procedure.Cut-off time - If we do not receive your payment order orcommunication canceling or amending your payment order before thecut-off time listed on page 1 on a funds transfer day for that type oforder or communication, we will consider the order orcommunication to be received at the opening of our next fundstransfer day.Acceptance of your payment order - We are not obligated to acceptany payment order that you give us, although we normally willaccept your payment order if you have a withdrawable credit in anauthorized account sufficient to cover the order. If we do notexecute your payment order, but give you notice of our rejection ofyour payment order after the execution date or give you no notice,we are not liable to pay you as restitution any interest on awithdrawable credit in a non-interest-bearing account.Payment of your order - If we accept a payment order you give us,we may receive payment by automatically deducting from anyauthorized account the amount of the payment order plus theamount of any expenses and charges for our services in execution ofyour payment order. We are entitled to payment on the payment orexecution date. Unless your payment order specifies otherwise, thepayment or execution date is the funds transfer date we receive thepayment order. The funds transfer is completed upon acceptance bythe beneficiary's bank. Your obligation to pay your payment order isexcused if the funds transfer is not completed, but you are stillresponsible to pay us any expenses and charges for our services.However, if you told us to route the funds transfer through anintermediate bank, and we are unable to obtain a refund because theintermediate bank that you designated has suspended payments,then you are still obligated to pay us for the payment order. You will

X

Agreement - The terms used in this agreement have the meaninggiven to them in Article 4A of the Uniform Commercial Code - FundsTransfers (UCC 4A). This agreement will be governed by the law ofthe state in which your account with us is located. This agreementis also subject to all funds-transfer system rules, rules of the Boardof Governors of the Federal Reserve System and their operatingcirculars. If any part of this agreement is determined to beunenforceable, the rest of the agreement remains effective. Thisagreement controls funds transfers unless supplemented or amendedin a separate written agreement signed by us.Funds transfer - A funds transfer is the transaction or series oftransactions that begin with the originator's payment order, made forthe purpose of making payment to the beneficiary of the order. Afunds transfer is completed by the acceptance by the beneficiary'sbank of a payment order for the benefit of the beneficiary of theoriginator's order. A funds transfer does not include any transactionif any part of the transfer is covered by the Electronic Fund TransferAct of 1978, as amended from time to time. You may give us apayment order orally, electronically or in writing, but your ordercannot state any condition to payment to the beneficiary other thanthe time of payment.Security procedure - The authenticity of a payment order orcommunication canceling or amending a payment order issued inyour name as sender may be verified by the security procedure(s)you have selected on page 1. The security procedure(s) we offer you

-

Funds Transfer AgreementBankers SystemsWolters Kluwer Financial Services 1994, 2006

FTAA-LAZ 12/15/2006


139

SampleWhere. By delivery to:

-

Identification Information

ACH Origination Agreement

Agreement Date:

Account Number:

Cushion: $

Originating Depository Originator(s) Names and Addresses Financial Institution

International ACH Transaction (IAT) Debit and Credit and any of the following selected:l Accounts Receivable (ARC) Debit l Point-of-Sale (POS) Debitl Back Office Conversion (BOC) Debit l Prearranged Payment and Deposit (PPD) l Debit l Creditl Corporate Credit or Debit (CCD) l Debit l Credit l Re-presented Check (RCK) Debitl Corporate Trade Exchange (CTX) l Debit l Credit l Shared Network Transaction (SHR) Debitl Internet-Initiated (WEB) Debit l Telephone-Initiated (TEL) Debitl Point-of-Purchase (POP) Debit

Types of Entries That Can Be Initiated

How Entries Will Be Initiated

Security Procedures

Important Account Opening Information. Federal law requires us to obtain sufficient information to verify your identity. Youmay be asked several questions and to provide one or more forms of identification to fulfill this requirement. In some instances wemay use outside sources to confirm the information. The information you provide is protected by our privacy policy and federal law.

When. By on one of our Banking Days at least Business Days, but no more than Business Days,before the effective entry dates.Medium. By the following medium: l Internet E-mail l Fax l Diskette lFormat. l In accordance with ACH Rules Appendix Two. l In the following format:

ACH Origination AgreementBankers SystemsWolters Kluwer Financial Services 2003, 2009

ACHORIGAGRLZ 7/14/2009

Page 1 of 5*

Telephone Number(s):Contact Person(s):Principal Owner(s):

Nature of Business:

Birth Date(s) (for individuals):Taxpayer Identification Number(s):Driver's License Number(s), State(s), Issue Date(s), Exp. Date(s) (for individuals):

Other ID Information (Description, Details):

Your circumstances, if any, which are relevant to the establishment of commercially reasonable security procedures are:

We have offered the following security procedures if the boxes preceding them are marked, and you have accepted or refused theoffered security procedures by marking the appropriate boxes:l Code. l Accepted l Refused Your initiations will be accompanied by your code, which is the following:

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Sample

Security Procedures, continued

l Other Confirmation. l Accepted l Refused Your initiations will be confirmed by separate l e-mail l faxl containing such information as we may require.l Frequency Limitation. l Accepted l Refused The frequency of debit entries cannot exceedper . The frequency of credit entries cannot exceed per .l Dollar Limitation. l Accepted l Refused No debit entry can exceed $ or be less than$ . No credit entry can exceed $ or be less than $ .l Others. l Accepted l Refused

You have designed and selected, and we have consented to, the following security procedure(s):

Authorizing Signature Requirements

Information Retention

Transmittal Deadline

Fees

For IAT Entries

For IAT entries, our rights and responsibilities in the event of an error or duplicate entries will be as follows:

l $ per and $ perl $ per l $ per uncompleted entryl ll l

Your initiations will be accompanied by at least of the following Authorizing Signature(s):

In addition to the retention requirements of the ACH Rules, you will retain detailed records of your initiations fordays after delivering them to us and will provide us with copies on request.

We will transmit entries received in accordance with this Agreement as to which we are not the RDFI to an ACH Operator no laterthan its cut-off time at least l one l two Business Day(s) before the effective entry dates, provided the ACH Operator is thenopen for business, and if not, on the next day it is open for business.

l Telephone Confirmation. l Accepted l Refused Your initiations will be confirmed by one of the following TelephoneConfirmers, whom we will call at the telephone numbers indicated:Name Telephone Number Name Telephone Number

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Page 2 of 5*

For IAT entries, the allocation of gains, losses, and assumption of risk for foreign exchange conversion will be determined by thefollowing terms and conditions:

141

Sample

Terms and Conditions

all the requirements necessary for us not to be in breachof the ODFI warranties specified in the ACH Rules,except for those specified in the Subsections entitledVerification of Identity of Originator or Third-PartySender, Documentation of Originators, Provision ofOriginator Information to RDFI, Sending Points, Audits,and ODFI Exposure Limits, which are our soleresponsibility, except that you will not be responsible forany failure on our part not involving you to comply withU.S. law, including, but not limited to, our obligationsunder programs administered by OFAC and FinCEN, andexcept that you will not be responsible for any inaccuratetransmission by us of information that you accuratelyprovide to us.

for all credit entries initiated and processed under thisAgreement,for all uncompleted debit entries,for all adjustments regarding debit entries initiated andprocessed under this Agreement, and for all fees and related taxes and other amounts due usunder this Agreement.

A l means that the provision immediately following is part ofthis Agreement only if a mark is placed therein.ACH Origination. You as Originator authorize us as ODFI totransmit, and to debit or credit the amounts of, entries to theaccounts of Receivers through the ACH system. Thisauthorization extends only to IAT entries and to the other Typesof Entries selected in this Agreement. When initiating an entry,you will comply with the How Entries Will Be Initiatedrequirements, Security Procedures, and Authorizing SignatureRequirements selected in this Agreement. You agree to bebound by the ACH Rules, including all the Originatorobligations under the ACH Rules. You also agree to satisfy andbe solely responsible as between you and us for:

(a) all the requirements of the ACH Rules Subsections entitledReceiver Authorization and Agreement, Notification forAccounts Receivable Entries and Re-presented CheckEntries, Authorization for Telephone-Initiated Entries,and Notice by RDFI; and

Definitions. You and your refer to the Originator(s). We, us,and our refer to the Originating Depository Financial Institution(ODFI). Account refers to your account with us identified bynumber on page 1, which will receive debits and/or creditspursuant to this Agreement. ACH refers to Automated ClearingHouse. ACH Rules refers to the Operating Rules of the NationalAutomated Clearing House Association as amended from timeto time and any superseding operating rules of local ACHAssociation(s). Except as otherwise provided herein, the termsin this Agreement have the meanings provided in the ACHRules. References to Sections and Subsections of the ACHRules include any pertinent superseding local rules. Referencesto such Sections and Subsections include provisions dealing withthe same subject matter in any subsequently amended ACHRules, even if they are entitled differently or have differentnumbers or other designations. Initiate includes reinitiate.Uncompleted entry means an entry that you initiate and weprocess, but which is returned, reversed, or otherwise notcompleted.

(b)

You also agree to satisfy any requests we make regardingcompliance with the ACH Rules Section entitled Transmissionof ACH Information Via Unsecured Electronic Networks.Acknowledgment and Hold Harmless. You acknowledge thatentries cannot be initiated that violate the laws of the UnitedStates, including, but not limited to, programs administered byOFAC and FinCEN, or other laws, including, but not limitedto, the laws and payment system rules of the receivingcountries, and agree to indemnify and hold us harmless withrespect to any entries that you initiate that do violate such laws.If you breach this Agreement, including any breach of the ACHRules, in addition to our other remedies you will indemnify andhold us harmless with respect to any fines or liabilities that wemay incur as a result of your breach.Debits and Credits to Account. We will debit the Account: (a)

(b)(c)

(d)

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Page 3 of 5*

Execution

Signed forOriginating Depository Financial Institution

(Seal)X

(Seal)X

By signing under seal, you and we agree to be bound by this Agreement, including the Terms and Conditions, and youacknowledge receipt of a copy.

Other Provisions

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Sample

Terms and Conditions, continued

Authorizing Signatures. Any requirement in this Agreement ofan Authorizing Signature will be satisfied, even if theAuthorizing Signature is not genuine, if we compare it to agenuine Authorizing Signature and still reasonably believe it tobe genuine.Inconsistent Names and Numbers. Any inconsistencies in yourinitiations between Receivers' names and identifying numbers,or between RDFIs' names and identifying numbers, will beresolved in favor of the numbers, and you will be boundthereby.Article 4A Notice. You acknowledge that you have received thefollowing notice with respect to each credit entry subject toArticle 4A of the Uniform Commercial Code of the state orjurisdiction whose laws govern this Agreement (Article 4A):

(a)(b)

(c)

(d)

Reversing Files and Entries. If you initiate, or ask us toinitiate, a reversing and/or correcting file or a reversing entry,we will not be required to proceed with it unless:

(a)

(b)

Exposure Limits. We can establish exposure limits with respectto this Agreement and change them from time to time. Theexposure limits will be effective immediately upon theirestablishment or change. We will notify you of the exposurelimits promptly after they are established or changed.Information. You will promptly provide us with anyinformation, explanations, and copies we request which arenecessary for us to comply with the ACH Rules or which arepertinent in any way to your initiation of entries. We can audityour compliance with this Agreement and the ACH Rules, andyou will give us access to your premises and records andprovide us with all information we request in connection withsuch audits.Irreconcilable Conflicts. This Agreement supersedes youraccount agreement to the extent that they can't be reconciled.You expressly waive any account agreement requirement of oneor more signatures for withdrawal regarding initiations underthis Agreement.

The entry may be transmitted through the ACH;The rights and obligations of the Originator concerningthe entry shall be governed by the laws of the state orjurisdiction whose laws govern this Agreement;Credit given by the RDFI to the Receiver for the entry asprovided in Subsection 4.4.1 (Availability of CreditEntries to Receivers) of the ACH Rules is provisionaluntil the RDFI has received final settlement through aFederal Reserve Bank or otherwise has received paymentas provided for in Section 4A-403(a) of Article 4A; andIf the RDFI does not receive such payment for the entry,the RDFI is entitled to a refund from the Receiver in theamount of the credit to the Receiver's account, and theOriginator will not be considered to have paid the amountof the credit entry to the Receiver.

you deliver your request and the required information tous at least 24 hours (not including any period that is not aBanking Day for us) before the deadline for ourtransmitting the same to the Originating ACH Operatorunder the ACH Rules, andyou agree to indemnify us to the full extent of theindemnification required of us under the ACH Rules.

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Page 4 of 5*

We will credit the Account:(a)

(b)(c)

Account Balance. We will not be required to process initiationsfor you unless the balance in the Account is at least equal to thesum of any credit entries initiated by you plus any cushionindicated on page 1. If there is ever a negative balance in theAccount:

(a)

(b)

Process Obligation. We will process entries received inaccordance with this Agreement:

(a)

(b)

We are required to process entries with respect to yourinitiations only if they are received by us in accordance with thisAgreement, and we can reject any that are not so received. Wewill give you notice of such rejection no later than the BusinessDay we would otherwise have transmitted them to an ACHOperator, or in the case of on-us entries regarding which we donot involve an ACH Operator no later than their effective entrydates. We will have no liability for interest or otherwise forrejecting entries in accordance with this paragraph.Notwithstanding anything in this Agreement to the contrary, weare entitled to reject on-us entries, and thus not process them,for any of the reasons RDFIs can return them.Purpose of Security Procedures. You acknowledge that thesecurity procedures under this Agreement are solely for thepurpose of corroborating that the entries initiated are yours, andnot for the purpose of detecting errors in transmission or in thecontent of the information provided, which are your soleresponsibility. You will be bound by all the entries that youinitiate, even if we do not follow the security procedures underthis Agreement, and even if an error would have beendiscovered if we had followed such security procedures.Unauthorized Initiations. You are solely responsible foravoiding unauthorized initiations received by us in accordancewith this Agreement. Unless otherwise required by law orprovided by the ACH Rules, you will be bound by all initiationspurporting to be yours, even if they are not authorized by you,if we receive and process them in accordance with thisAgreement.

for all debit entries initiated and processed under thisAgreement,for all uncompleted credit entries, andfor all adjustments regarding credit entries initiated andprocessed under this Agreement.

you will be indebted to us for the amount of the negativebalance and will immediately deposit funds into theAccount sufficient to eliminate the negative balance, andwe will be entitled (without prior notice and unlessprohibited by law) to apply against such indebtedness thefunds in any other accounts you have with us and tocollect on such indebtedness by any lawful means.

as to entries regarding which we are the RDFI as well asthe ODFI (on-us entries) and regarding which we do notinvolve an ACH Operator, by debiting or crediting theReceivers' accounts on the effective entry dates, andas to other entries, by transmitting them to an ACHOperator in accordance with the ACH Rules no later thanthe Transmittal Deadline, using or not using Third-PartyService Providers as we deem appropriate.

143

Sample

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Page 5 of 5*

the ACH Rules, we can terminate or suspend this Agreementimmediately by giving you written notice. Either party canterminate this Agreement without fault by giving 30 dayswritten notice to the other.Waiver. We can waive rights under, and violations of, thisAgreement without affecting other rights under, or otherviolations of, this Agreement.Assignment. You are not entitled to assign this Agreement oryour rights and obligations hereunder without our consent.Benefit. This Agreement is for your benefit and our benefitonly, and no other entities have rights hereunder.Invalidity. The invalidity or illegality of any provision of thisAgreement will not affect the remainder of this Agreement,which will continue to be in effect.Headings. Headings are for reference purposes only and are nota part of this Agreement.Governing Law. This Agreement will be governed by the lawsof the state or jurisdiction referred to in our address stated onpage 1.Time Periods and Deadlines Extended. Notwithstandinganything in this Agreement to the contrary, all deadlines andtime periods under this Agreement are automatically extended tothe extent necessary for compliance with the laws of the UnitedStates, including, but not limited to, programs administered byOFAC and FinCEN, or other laws, including, but not limitedto, the laws and payment system rules of the receivingcountries. This may result in delays in processing, settlement,and/or availability if, for example, we determine that enhancedscrutiny or verification is necessary. Unlawful Internet Gambling Notice. Restricted transactionsas defined by Federal Reserve Regulation GG are prohibitedfrom being processed through this account or relationship.

Terms and Conditions, continued

Limitation on Responsibility. We will not be responsible forfailure to act or delay in acting pursuant to this Agreement if thefailure or delay is the result of legal constraint, interruption oftransmission or communication facilities, equipment failure, waremergency conditions, or other circumstances beyond ourcontrol.Limitation on Damages. Unless otherwise required by law, wewill not under any circumstances be liable to you for interest;attorneys' fees; litigation expenses; or consequential, special,incidental, indirect, or punitive damages.Fees. You will pay us the fees designated in this Agreement,even if we reject your entries as permitted by this Agreement.We can change the fees you are required to pay under thisAgreement and the amounts thereof by giving you 30 dayswritten notice. In addition to the fees due under this Agreement,you will pay us the amount of any taxes due on such fees (notincluding any income taxes we owe).Changes in Codes, Telephone Confirmers, and AuthorizingSignatures. You can change Codes, Telephone Confirmers, andAuthorizing Signatures by written notice actually received byus. Notices. All notices under this Agreement will be in writingaddressed to the party's address stated herein, unless suchaddress has been changed by 30 days written notice actuallyreceived, in which event the changed address will be used.Notices, other than changes in Codes, Telephone Confirmers,Authorizing Signatures, and addresses, will be effective onmailing, postage prepaid and properly addressed, whether or notreceived, provided the mailing is documented at the time it ismade.Duration and Termination. This Agreement will continue untilit is terminated. If you breach the terms of this Agreement or

144

Sample

,POA-MN 12/15/2006


*Power of Attorney-MNVMP Bankers SystemsWolters Kluwer Financial Services 1984, 2006-

POWER OF ATTORNEY

IMPORTANT NOTICE: The powers granted by this document are broad and sweeping. They are defined in Minnesota Statutes, section 523.24. If you have any questionsabout these powers, obtain competent advice. This power of attorney may be revoked by you if you wish to do so. This power of attorney is automatically terminated ifit is to your spouse and proceedings are commenced for dissolution, legal separation, or annulment of your marriage. This power of attorney authorizes, but does notrequire, the attorney-in-fact to act for you.

PRINCIPAL (Name and Address of Person Granting the Power)

ATTORNEY(S)-IN-FACT (Name and Address) SUCCESSOR ATTORNEY(S)-IN-FACT (Optional) To act if any named attorney-in-fact dies, resigns, or is otherwise unable to serve.

(Name and Address)

First Successor

Second Successor

EXPIRATION DATE (Optional)

Use Specific Month Day Year Only

NOTICE: If more than one attorney-in-fact is designated, make a check or "x" onthe line in front of one of the following statements:

Each attorney-in-fact may independently exercise the powers granted.

All attorneys-in-fact must jointly exercise the powers granted.

I, (the above-named Principal) hereby appoint the above named Attorney(s)-in-Fact to act as my attorney(s)-in-fact:FIRST: To act for me in any way that I could act with respect to the following matters, as each of them is defined in Minnesota Statutes, section 523.24:

(To grant to the attorney-in-fact any of the following powers, make a check or "x" on the line in front of each power being granted. You may, but need not, cross outeach power not granted. Failure to make a check or "x" on the line in front of the power will have the effect of deleting the power unless the line in front of the power of(N) is checked or x-ed.

Check or "x"

(A) real property transactions;

I choose to limit this power to real property in County, Minnesota, described as follows: (Use legal description. Do notuse street address.)

FOURTH: (You may indicate below whether or not the attorney-in-fact is required to make an accounting. Make a check or "x" on the line in front of the statementthat expresses your intent.)

This power of attorney shall continue to be effective if I become incapacitated or incompetent.

This power of attorney shall not be effective if I become incapacitated or incompetent.

This power of attorney authorizes the attorney-in-fact to transfer my property to the attorney-in-fact.

This power of attorney does not authorize the attorney-in-fact to transfer my property to the attorney-in-fact.

My attorney-in-fact need not render an accounting unless I request it or the accounting is otherwise required by Minnesota Statutes, section 523.21.

My attorney-in-fact must render (Monthly, Quarterly, Annual) accountings to me or

SECOND: (You must indicate below whether or not this power of attorney will be effective if you become incapacitated or incompetent. Make a check or "x" on theline in front of the statement that expresses your intent.)

THIRD: (You must indicate below whether or not this power of attorney authorizes the attorney-in-fact to transfer your property to the attorney-in-fact. Make a checkor "x" on the line in front of the statement that expresses your intent.)

(Name and Address)

during my lifetime, and a final accounting to the personal representative of my estate, if any is appointed, after my death.

,

(If more space is needed, continue on the back or on an attachment.)

above and all other matters.

(B) tangible personal property transactions; (G) beneficiary transactions; (L) benefits from military service;

(C) bond, share, and commodity transactions; (H) gift transactions; (M) records, reports, and statements;

(D) banking transactions; (I) fiduciary transactions; (N) all of the powers listed in (A) through (M)

(E) business operating transactions; (J) claims and litigation;

(F) insurance transactions; (K) family maintenance;

145

SampleIF YOU SELECTED BANKING TRANSACTIONS, YOU HAVE AUTHORIZED THE ATTORNEY-IN-FACT:

to continue, modify, and terminate any deposit account or other banking arrangement made by or on behalf of the principal prior to the executionof the power of attorney;

to open in the name of the principal alone, or in a way that clearly evidences the principal and attorney-in-fact relationship, a deposit account ofany type with any bank, trust company, savings and loan association, credit union, thrift company, brokerage firm, or other institution whichserves as a depository for funds selected by the attorney-in-fact, to hire safe deposit box or vault space and to make other contracts for theprocuring of other services made available by the banking institution as the attorney-in-fact deems desirable;

to make, sign, and deliver checks or drafts for any purpose, to withdraw by check, order, or otherwise any funds or property of the principaldeposited with or left in the custody of any banking institution, wherever located, either before or after the execution of the power of attorney;

to prepare any necessary financial statements of the assets and liabilities or income and expenses of the principal for submission to any bankinginstitution;

to receive statements, vouchers, notices, or other documents from any banking institution and to act with respect to them;

to enter at any time any safe deposit box or vault which the principal could enter if personally present;

to borrow money at any interest rate the attorney-in-fact selects, to pledge as security any assets of the principal the attorney-in-fact deemsdesirable or necessary for borrowing, to pay, renew, or extend the time of payment of any debt of the principal;

to make, assign, draw, endorse, discount, guarantee, and negotiate, all promissory notes, bills of exchange, checks, drafts, or other negotiable ornonnegotiable paper of the principal, or payable to the principal or the principal's order, to receive the cash or other proceeds of any of thosetransactions, to accept any bill of exchange or draft drawn by any person upon the principal, and to pay it when due;

to receive for the principal and to deal in and to deal with any sight draft, warehouse receipt, or other negotiable or nonnegotiable instrument inwhich the principal has or claims to have an interest;

to apply for and to receive letters of credit from any banking institution selected by the attorney-in-fact, giving indemnity or other agreement inconnection with the letters of credit which the attorney-in-fact deems desirable or necessary;

to consent to an extension in the time of payment with respect to any commercial paper or any banking transaction in which the principal has aninterest or by which the principal is, or might be, affected in any way;

to demand, receive, obtain by action, proceeding, or otherwise any money or other thing of value to which the principal is, or may become, ormay claim to be entitled as the proceeds of any banking transaction, and to reimburse the attorney-in-fact for any expenditures properly made inthe execution of the powers conferred upon the attorney-in-fact by the statutory short form power of attorney;

to execute, acknowledge, and deliver any instrument of any kind, in the name of the principal or otherwise, which the attorney-in-fact deemsuseful for the accomplishment of any of the purposes enumerated in this subdivision;

to prosecute, defend, submit to arbitration, settle, and propose or accept a compromise with respect to any claim existing in favor of or againstthe principal based on or involving any banking transaction or to intervene in any related action or proceeding;

to hire, discharge, and compensate any attorney, accountant, expert witness, or other assistant when the attorney-in-fact deems that action to bedesirable for the proper execution of any of the powers described in this subdivision, and for the keeping of needed records; and

in general, and in addition to all the specific acts listed in this subdivision, to do any other acts in connection with any banking transaction whichdoes or might in any way affect the financial or other interests of the principal.

(1)

(2)

(3)

(4)

(5)

(6)

(7)

(8)

(9)

(10)

(11)

(12)

(13)

(14)

(15)

(16)

All powers described above are exercisable equally with respect to any banking transaction engaged in by the principal at the giving of the powerof attorney or engaged in after that time, and whether conducted in the state of Minnesota or elsewhere.

In Witness Whereof I have hereunto signed my name this day of , .

(Signature of Notary Public or other Official)

(Acknowledgment of Principal)

STATE OF MINNESOTA

COUNTY OF } ss.

The foregoing instrument was acknowledged before me this day of , by .(Insert Name of Principal)

Specimen Signature of Attorney(s)-in-Fact (Notarization not required)

(Signature of Principal)

This instrument was drafted by:

,POA-MN 12/15/2006


*Power of Attorney-MNVMP Bankers SystemsWolters Kluwer Financial Services 1984, 2006-

146

Sample

Night Depository User(s)

(Seal)

(Seal)

(Seal)

Agreement Date:

Account Number: Description ofContainers with Locks: Description ofContainer Keys: Description ofDepository Keys: Plan Type: l Plan 1 l Plan 2

Initial Annual Fee: $

General Information

, and if we sign below weacknowledge that you have made any required return ofcontainers and keys provided under this Agreement asof the same date.

Authorized Persons under Plan 1

Night Depository AgreementFinancial Institution

Other Terms

Execution

Termination

Identification Information

X

X

X

Signed ForFinancial Institution

By execution below you and we agree to be bound bythis Agreement. You also acknowledge receipt of thecontainers and keys described above and a copy of thisAgreement.

Birth Date(s) (for individuals):

Taxpayer Identification Number(s):

Driver's License No(s)., State(s), Issue Date(s),Exp. Date(s) (for individuals):

Other ID Information (Description, Details):

-

X

X

X

X

Each of the persons who sign in the Execution sectionof this Agreement and each of the persons whosesignatures and names are set forth below are AuthorizedPersons. You may also designate other AuthorizedPersons by written notice to us, including theirsignatures and names. The authority of each AuthorizedPerson will continue until you give us written notice tothe contrary.

Important Account Opening Information. Federal lawrequires us to obtain sufficient information to verify youridentity. You may be asked several questions and toprovide one or more forms of identification to fulfill thisrequirement. In some instances we may use outsidesources to confirm the information. The information youprovide is protected by our privacy policy and federal law.

(Seal)

(Seal)

(Seal)

X

X

X

Signed ForFinancial Institution

On termination of this Agreement, if you sign below youacknowledge that all amounts and property placed in thenight depository by you or on your behalf have beenreturned to you or credited to the Account as of

Night Depository AgreementBankers SystemsWolters Kluwer Financial Services 2003, 2006

NDA-COMB 12/15/2006


147

SampleTermination. Either you or we may terminate thisAgreement on thirty days written notice. Upontermination by us, you will be entitled to a refund of anyunearned portion of the annual fee paid in advance. Youwill not be entitled to any other refunds.Temporary Suspension. We may temporarily suspenduse of the night depository, without any resultingliability, by posting a sign to that effect at or near thenight depository in the event of an emergency or tomake alterations or repairs.Notices. Written notices granting or terminatingauthority to act on your behalf in claiming, opening, ormaking deposits from containers placed in the nightdepository and written notices changing addresses willnot be effective until actually received. Other noticeswill be effective on mailing, postage prepaid andproperly addressed, whether or not actually received,provided such mailing is documented at the time it ismade.Changes. These Terms and Conditions, other than theright to terminate this Agreement on thirty days writtennotice and the right to a refund upon termination by usof any unearned portion of the annual fee, may bechanged by us at any time upon thirty days writtennotice to you. No notice to you is required for annualfee changes. Entire Agreement. This Agreement is the entire and onlyagreement between the parties concerning this nightdepository relationship.

Plan 1: We will provide you with containers for use inthe night depository which can be locked or whichcannot be opened once sealed without obviousdamage. You will not place items in the nightdepository without first locking or sealing them in theprovided containers along with itemized lists of thecontents, copies of which you will retain. Once placedin the night depository, the containers can be removedby us, but must not be opened by us for at least fiveBusiness Days. If the containers are claimed andsigned for by an Authorized Person before we openthem, we must deliver them unopened to theAuthorized Person. At that time the Authorized Personmay, but is not required to, open the containers anddeposit the contents in the Account.After five Business Days have passed without thecontainers being thus claimed, we may, but are notrequired to, open the containers by any meansnecessary. If we open the containers, two of ourofficers or employees will be present to witness andrecord the contents, and we will credit the contents tothe Account. If there are any discrepancies betweenthe amounts shown on the itemized lists of contentsand the actual contents, we will promptly notify you inwriting of the discrepancies. You will be entitled tocredit only for the actual contents as determined bythe two officers or employees, regardless of what isstated on the itemized lists of contents. Plan 2: We will provide you with containers for use inthe night depository. You will not place items in thenight depository without first enclosing them in theprovided containers along with itemized deposit slipsfor the enclosures, copies of which you will retain. Wewill remove and open the containers and credit thecontents to the Account no later than the nextBusiness Day after they are placed in the nightdepository. When we open the containers, two of ourofficers or employees will be present to witness andrecord the contents. If there are any discrepanciesbetween the amounts shown on the deposit slips andthe actual contents, we will promptly notify you inwriting of the discrepancies. You will be entitled tocredit only for the actual contents as determined bythe two officers or employees, regardless of what isstated on the deposit slips.

Terms and Conditions

Definitions. Account refers to the account that willreceive any debits or credits in connection with thisAgreement. The pronouns you and your refer to theNight Depository User(s). We, us and our refer to theFinancial Institution. Authorized Persons are thoseindividuals authorized to act on your behalf in claiming,opening, or making deposits from containers placed inthe night depository under Plan 1. Business Day refers toany day on which we are open to the public for carryingon substantially all our business functions.Plan Types. We will provide you with night depositoryservices under the plan type selected.

Keys and Containers. If keys are provided to you foraccess to the night depository or to secure a container,you agree not to duplicate them and to return them tous on termination of this Agreement. If containers withlocks are provided, you agree to return them to us ontermination of this Agreement.Deposits. Notwithstanding anything in this Agreementto the contrary, items placed in the night depository willnot become deposits until we open the containers oruntil the items are deposited by an Authorized Person

opening the containers on your behalf, and the itemswill not become deposits, and the Account will not becredited, unless the items would ordinarily becomedeposits and be credited to the Account if youpresented them to a teller for deposit, without using thenight depository. Nothing in this Agreement is intendedto determine the extent, if any, to which the items areinsured once they become deposits.Pre-Deposit Responsibility. Prior to items placed in thenight depository becoming deposits, our responsibilitywill be limited to the exercise of reasonable care, andunless otherwise required by law we will not insuresuch items, and our not insuring them will notconstitute failure to exercise reasonable care. We willnot under any circumstances be liable for consequentialdamages.Permissible Items. The only items that can be placed inthe night depository are cash and checks, drafts, orsimilar items that would ordinarily be credited to theAccount if you presented them to a teller for deposit. Ifany other items are placed in the night depository youwill, upon written notice by us, immediately appearduring our normal business hours and retrieve them. Thenight depository will not be used for any unlawful ordangerous purpose. If we suspect the night depositoryis being used for any unlawful or dangerous purpose,we may turn any unopened containers and the contentsof any opened containers over to law enforcementagencies, and we may report our suspicions and theirbases to law enforcement agencies, without any liabilitywhatsoever.Due Care. You must exercise due care when placingitems into the night depository and must promptlyreport to us any problems or unsafe or insecureconditions that you observe regarding the nightdepository.Fees. You will pay us an annual fee for night depositoryservices in a reasonable amount determined by us. Theannual fee may be changed by us after the first year.The annual fee is payable in advance. The annual feemay be debited to the Account without notice.

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Night Depository AgreementBankers SystemsWolters Kluwer Financial Services 2003, 2006

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148

Sample

Credit Report Authorization

Internal use only

Date

Name Date Name Date

Identifying information Identifying information

Name Date Name Date

Identifying information Identifying information

You understand that we have a current need to review your creditworthiness. By signing below, you agree that we may verifyyour credit record and/or employment history by any means necessary, including preparation of a credit report by a consumerreporting agency. If signing on behalf of a business or other entity, you also acknowledge that we will verify the creditworthinessof that business entity.

As used in this document, the words "you" and "your" mean the individual(s) signing below, and the words "we" and "us" mean the financial institution identified above.

,FCRA-CRA 5/11/2007

VMPC584C (0505)Page 1 of 1Initials:

*

We need to verify your creditworthiness for the following reason(s):l You have applied for a loan from us.l The business or other entity listed below with which you are associated, has applied for a loan from us.

l You have applied to open a deposit or share account with us.l The business or other entity listed below with which you are associated, has applied to open a deposit or share account with us.

l

Business or other entity information (if applicable):

Credit Report AuthorizationVMP Bankers SystemsWolters Kluwer Financial Services 2005, 2007-

149

Sample

NOTICE OF ACTION TAKEN

-

Regarding your.

This notice is to inform you that:l We are unable to approve your request.

l We are unable to approve your request in its entirety. We have approved:.

We are unable to:.

l We are unable to make a decision regarding your request because it is missing the following information:

.Please furnish this information to us on or before at the address listed above or we will be unable togive your request further consideration.

l.

REASONS FOR ACTION TAKENl Unable to verify residence.l

.DISCLOSURE OF USE OF INFORMATION OBTAINED FROM AN OUTSIDE SOURCE:l

l

Name: Telephone:Address:Name: Telephone:Address:

Our decision was based in whole or in part on information obtained in a report from the consumer reporting agency(ies) listedbelow. However, the reporting agency did not make the decision and is unable to supply you with specific reasons for whywe have denied your request. You have a right under the Fair Credit Reporting Act to know the information contained in yourfile at the consumer reporting agency. Under the Fair Credit Reporting Act, you have the right to obtain a free copy of thisreport if you submit a written request to the agency(ies) named below no later than 60 days after you receive this notice.Under the Fair Credit Reporting Act you also have the right to dispute with the consumer reporting agency the accuracy orcompleteness of any information in the report.

Our decision was based in whole or in part on information obtained from an affiliate or from an outside source other than aconsumer reporting agency. Under the Fair Credit Reporting Act, you have the right to obtain a disclosure of the nature of thisinformation if you submit a written request to us no later than 60 days after you receive this notice.

DateSSN/TIN

Notice of Action TakenBankers SystemsWolters Kluwer Financial Services 1997, 2007 Page 1 of 1Initials:*

DN-FCRA-D 5/11/2007

150

Sample

NOTICE OF ACTION TAKENDATE

SSN/TIN

Our decision was based in whole or in part on informationobtained in a report from the consumer reporting agencylisted below. However, the reporting agency did not makethe decision and is unable to supply you with specificreasons for why we have denied your request. You havea right under the Fair Credit Reporting Act to know theinformation contained in your file at the consumerreporting agency. Under the Fair Credit Reporting Act,you have the right to obtain a free copy of this report ifyou submit a written request to the agency named belowno later than 60 days after you receive this notice. Underthe Fair Credit Reporting Act you also have the right todispute with the consumer reporting agency the accuracyor completeness of any information in the report.

Thank you for your inquiry regarding.

This notice is to inform you that:ll

l

l

We are unable to approve your request.We are unable to approve your request in its entirety. We have approved:

.We are unable to:

.We are unable to make a decision regarding your request because it is missing the following information:

.Please furnish this information to us on or before at the address listed above or we will be unable to

.

DISCLOSURE OF USE OF INFORMATION OBTAINEDFROM AN OUTSIDE SOURCE:

- 1997 Bankers Systems, Inc., St. Cloud, MN Form DNFCRA-D-CRA 6/2/97 (page 1 of 1)

give your request further consideration.

151

Sample

As a participant in the consumer reporting system, we furnish information about ourexperience with you to consumer reporting agencies. These consumer reports allow us to makecredit and other opportunities available to you. If you believe that we have furnishedinformation to a consumer reporting agency that is inaccurate please notify us at the followingaddress and identify the specific information that is inaccurate.

NOTICE REGARDING INACCURATE INFORMATION

1997 Bankers Systems, Inc., St. Cloud, MN Form FCRA-NRA 5/15/97- (page 1 of 1)

152

Sample

FEDERAL SALE OF INSURANCE DISCLOSURE

Consumer Date Consumer Date

-

The Product is NOT A DEPOSIT ACCOUNT OR OTHER OBLIGATION of any depository institution orany affiliate of any depository institution.

The Product is NOT GUARANTEED OR INSURED by any depository institution or any affiliate of anydepository institution.

The Product is NOT INSURED by the Federal Deposit Insurance Corporation (FDIC).

The Product, except in the case of Federal Flood Insurance or Federal Crop Insurance, is NOTINSURED by any federal government agency.

l There is INVESTMENT RISK associated with the Product, including the POSSIBLE LOSS OF VALUE.

}

}

}

}

}

I am purchasing the following insurance product or annuity (Product) from you: .......................................................................................................................................................................................................

I understand that disclosures following a l only apply if checked. By signing, I acknowledge that I havereceived a copy of this form on today's date. Unless these disclosures are provided electronically or I havepurchased the Product by mail, I also acknowledge that you have provided these disclosures to me orally.

........................................................................... ...........................................................................

INS-WARN 12/15/2006


Insurance DisclosureBankers SystemsWolters Kluwer Financial Services 2001, 2006

153

Sample

NOTICE OF DELAYED AVAILABILITY

TO: FROM:

Date l of deposit l when check

was cashed:

We are delaying the availability of $ from this transaction. These funds will be

available on the business day after the day of the transaction (subject to our cash withdrawal

limitation policy, if this box is checked l ).

If you did not receive this notice at the time of the transaction and the check you deposited or cashed is paid,

we will refund to you any fees for overdrafts or returned checks that result solely from the additional delay that

we are imposing. To obtain a refund of such fees, please call us at

or write to us at our address stated above.

Bankers Systems, Inc., St. Cloud, MN (1-800-397-2341) Form FFAD-NDA-CBC 12/29/97-

Account Number:

Date of this Notice:

154

Sample

DATE


Account Number:

Date of Deposit:

DESCRIPTION OF DEPOSIT

We are delaying the availability of l $ from the deposit described above. l the funds you deposited by the following

check . These funds will be available on the business day after the day of your deposit.

We are taking this action because:

l A check you deposited was previously returned unpaid.

l You have overdrawn your account repeatedly in the last six months.

l The checks you deposited on this day exceed $5,000.00.

l An emergency, such as failure of computer or communications equipment, has occurred.

l We believe a check you deposited will not be paid for the following reasons*:

l We received notice that the check is being returned unpaid.

l We have confidential information that indicates that the check may not be paid.

l The check is drawn on an account with repeated overdrafts.

l We are unable to verify the endorsement of a joint payee.

l Some information on the check is not consistent with other information on

l Other:

l There are erasures or other apparent alterations on the check.

l The routing number of the paying bank is not a current routing number.

l The check is postdated or has a stale date.

l Information from the paying bank indicates that the check may not be paid.

l We have been notified that the check has been lost or damaged in

or write to us at our address listed above.

Bankers Systems, Inc., St. Cloud, MN (1-800-397-2341) Form FFAD-NDA-SE 5/14/97-

the check. collection.

(description of check, such as amount and drawer)

*If you did not receive this notice at the time you made the deposit and the check you deposited is paid, we will refund to you any fees for overdrafts or returned

checks that result solely from the additional delay that we are imposing. To obtain a refund of such fees, call us at

155

Sample


TO: FROM:

ACCOUNT NUMBER: DATE:

first adding together the , then the

, then the , then the .

} A check that has been returned unpaid, the funds will generally be available on the business

day after the day of deposit for checks drawn on us, the business day after the day of deposit for

local checks and the business day after the day of deposit for nonlocal checks. Checks (not drawnon us) that otherwise would receive next-day availability will be treated as either local or nonlocal checksdepending on the location of the paying bank.

-

If you deposit into your account:} Checks totaling more than $5,000 on any one day, the first $5,000 deposited on any one banking day

will be available to you according to our general policy. The amount in excess of $5,000 will generally be available

on the business day after the day of deposit for checks drawn on us, the

business day after the day of deposit for local checks and business day after the day ofdeposit for nonlocal checks. If checks (not drawn on us) that otherwise would receive next-day availabilityexceed $5,000, the excess will be treated as either local or nonlocal checks depending on the location of thepaying bank. If your check deposit, exceeding $5,000 on any one day, is a mix of local checks, nonlocal checks,checks drawn on us, or checks that generally receive next-day availability, the excess will be calculated by

Hold Notice-Large DepositsBankers SystemsWolters Kluwer Financial Services 1992, 2008 Page 1 of 1Initials:

*FFAD-NDA-LD 3/13/2008

156

Sample


TO: FROM:

ACCOUNT NUMBER: DATE OF NOTICE:

We are delaying the availability of checks deposited into your account due to repeated overdrafts

of your account. For the next six months, deposits will generally be available on the

business day after the day of your deposit for checks drawn on us, the

business day after the day of your deposit for local checks, and the

business day after the day of your deposit for nonlocal checks. Checks (not drawn on us) that

otherwise would have received next-day availability will be treated as either local or nonlocal

checks depending on the location of the paying bank.

-

Hold Notice-Repeat OverdraftsBankers SystemsWolters Kluwer Financial Services 1992, 2008 Page 1 of 1Initials:

*FFAD-NDA-RO 3/11/2008

157

Sample

NOTICE OF

RETURNED ITEM

DATE:

FROM:

Check DatePaying BankDeposited to your Account NumberReason For Return

l

l

l

TO:

Amount of Check $Amount of Deposit $Deposit DateCheck NumberMaker's Name

NOTICE: l The above item was returned unpaid.

REGARDING THE ITEM DESCRIBED BELOW:

1988 Bankers Systems, Inc., St. Cloud, MN Form FFAD-NRI-NDA 12/8/88

l We believe an item you deposited will not be paid because we received notificationof non-payment of the above item.

If the check you deposited is paid, we will refund to you any fees that we have imposed for overdrafts or returned checks that result solelyfrom the additional delay that we are imposing. To obtain a refund of such fees, call us at or write us atour address listed above.

-

We have charged back your account in the amount of the item. We l are returning the item with this notice l will return this itemwhen we receive it from the paying bank.The funds have not been credited to your account. We l are returning the item with this notice l will return this item when we receiveit from the paying bank.We will redeposit this item and send it to the paying bank for collection. If the funds were previously credited to your account, we havecharged back your account in the full amount of the item. For the reason given above, we are delaying the availability of the full amount ofthe item. These funds will be available on .

158

Check Order Forms


Deluxe Check Order Form-Personal Check Order Form (DELUXE-PER)

Deluxe Check Order Form-Business Products Order Form (DELUXE-BUS)

Harland Check/Deposit/Savings Order Form (HAR-31G-COMB)

Clarke American Personal Check Order Form (CLRK-EB1-PER)

Clarke American Commercial Check Order Form (CLRK-COMM)

Liberty Check Order Form

159

160

Sample

PERSONALIZED DOCUMENT ORDER FORM

SEND THIS ORDER TO DELUXE FINANCIAL SERVICES, INC. f DOCUMENTS WILL BE MAILED DIRECTLY TO ACCOUNT HOLDER

PLEASE PRINT OR TYPE CLEARLY } ASK ACCOUNT HOLDER TO REVIEW FOR CORRECTNESS

2 BOXES

FOR INTERNAL USE

22.

4 BOXES

PLEASE PRINT COMPLETE ACCOUNT NUMBER BELOW23.

1.

2.

3.

7.

9.

8.

6.

4.

10.

11.

12.

13.

21.

20.

19.

16.

15.

14.

18.

17.

SPECIAL INSTRUCTIONS / ALTERNATE MAILING ADDRESS

FINANCIAL INSTITUTION PROGRAM NAME (PLEASE PRINT)

BRANCH NO.

1 BOX

INTRO-50

DRIVERS LICENSE NUMBER/ALTERNATE ID

BYLINE NO.

QUANTITY

ORDERING CODEFORMAT/DESIGN

MONOGRAM STYLEOR WOODCUT NO.

STARTING NO.USE 101 OR HIGHER

COVER (IF NEEDED)LETTERING

(I HAVE VERIFIED ALL INFORMATION FOR ACCURACY)

FI VERIFICATION DATE

CUSTOMER APPROVAL DATE

Form DELUXE-PER 10/5/2000

OTHER

ACCOUNT NAME

SECOND ACCOUNT NAME

APT. NO.

CITY & STATE

SECOND DRIVERS LICENSE NUMBER/ALTERNATE ID

DRIVERS LICENSE NUMBER/ALTERNATE ID

ADDRESS

WORK PHONE NO. (OPTIONAL)

PHONE NO.

ZIP CODE5.

+

161

Sample

PLEASE TYPE OR PRINT CLEARLY } KEEP A DUPLICATE COPY

ASK ACCOUNT HOLDER TO REVIEW FOR CORRECTNESSBUSINESS PRODUCTS

CHECK FORM

PLEASE INITIAL

ORDER FORM

l l

ORDERING ASSISTANCE

INDICATE ACCOUNT NAME(S) AND ADDRESS TO BE PRINTED ON CHECKS

CITY STATE ZIP CODEFOR SHIPMENT TO A DIFFERENT ADDRESS FROM THAT ABOVE, COMPLETE THE ALTERNATE SHIPPING AREA LOWER RIGHT.

THREE-ON-A-PAGE CHECKS

BY-LINE NUMBER

LETTERING STYLE

STARTING NO.

(IF NONE, PLEASE INDICATE)

CHECK IF TWO SIGNATURE LINES REQUIREDPLEASE PRINT COMPLETE ACCOUNT NUMBER BELOW

TITLE(S) OVER SIGNATURE LINE(S)

CUSTOMER APPROVAL

CUT NUMBERFOR CUSTOM CUT ATTACH SAMPLE

ONE-WRITE CHECK SYSTEMS1-800-328-7205

FAX 1-800-526-1112

SINGLE CHECK SETSCOMPUTER & LASER CHECKS1-800-328-7205

FAX 1-800-526-1112

CHECK FORM, COLOR & QUANTITYSOFTWARE & VERSIONDEPOSIT TICKET STYLE, COPIES & QUANTITYPRE-INKED ENDORSEMENT STAMP

COMPUTER CHECKS, LASER & CONTINUOUS

2

1

3

4

ACCOUNT INFORMATION

PRODUCT INFORMATIONINTRO PACKS

DEPOSIT TICKETS

STAMPS (COMPLETE ALL APPROPRIATE BOXES)

ALTERNATE SHIPPING ADDRESS IF DIFFERENT FROM ADDRESS ABOVE

ACCESSORIESQUANTITY

VOUCHER NO.(FOR VOUCHER CHECKS ONLY)

PAYROLL DEDUCTION CAPTIONSCOLORQUANTITY

FOR COMPUTER CHECK AND ONE-WRITE ORDERS, PLEASE INCLUDE CUSTOMER'S PHONE NUMBER.

FINANCIAL INSTITUTION CONTACT:

PHONE NO: DATE:

81 2 3 4 5 6 7

SPECIAL INSTRUCTIONS

STYLE/ORDER CODE

SIZE:

QTY:

COPIES

ll

NONE

9 x 12 SINGLE POCKET - SPK6

11 X 15 DUAL POCKET - SPK5

EXPRESS DELIVERY AVAILABLE FOR MOST BUSINESS PRODUCTS.CALL DELUXE CUSTOMER SERVICE FOR EXPRESS DELIVERY OPTIONS.

SECURITY PACKS (SPECIFY SIZE & QUANTITY)

PRINT EXACTLY WHAT WILL APPEAR ON STAMP IN THIS SPACE

WOODCUTNUMBER

STYLE / ORDER CODE(INCLUDES COLOR)

NAME / ADDRESSTYPESTYLE

MONOGRAMLETTER

MONOGRAMSTYLE

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

C

C

C

COLORITEM QTY. STYLE / FORM

ENDORSEMENT

NAME & ADDRESS ONLY

NAME & ADDRESS WITH WOODCUT

NAME & ADDRESS WITH MONOGRAM

READY-MADE

ENDORSEMENT

NAME & ADDRESS ONLY

NAME & ADDRESS WITH WOODCUT

NAME & ADDRESS WITH MONOGRAM

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

Blue Only

Blue Only

C1081

C583C

ORIGINAL TRIPLICATE

DUPLICATE QUAD

SELF-INKING

l

ll

COVER

ENVELOPES

JOURNAL / REGISTER

POST BINDER

BUS. DEPOSIT COVER

PRE-INKED

OTHER

25 QTY. INTRO PACK 100 QUANTITY

OTHER (MULTIPLES OF 100)

ll

l l l l

ll

AREA CODE

ORIG DUP TRIP QUAD

COPIES(SEE CATALOG FOR AVAILABILITY)

FOR COMPUTER CHECKS, PLEASE INCLUDE SOFTWAREAND VERSION.

( )

Form DELUXE-BUS 10/5/2000 1083069

C

C

C

lll

lll

200 800

400 1600

ll

QTY.

lll

lll

A

A

A

B

B

B

lll

lll

A

A

A

B

B

B

CHECKS

CHECK FORM, COLOR & QUANTITYCOVER & COLORJOURNAL (FOR THREE-0N-A-PAGE ONLY)DEPOSIT TICKET STYLE , COPIES & QUANTITYPRE-INKED ENDORSEMENT STAMP

500 CONTINUOUS CHECKSWITHOUT COPIES

COMPLETE SECTIONS 1-3 BELOW(USE APPROPRIATE CATALOG ORDERING CODES)

}

}

}}}}

1-

2-

3-

ORTHREE-ON-A-PAGE EKONOMIKCHECKS SYSTEM

300 CHECKS 500 CHECKSWITH COPIES WITHOUT COPIES


}

}}}}}

}

DEPOSIT TICKET STYLE , COPIES & QUANTITYPRE-INKED ENDORSEMENT STAMP

GENERAL EXPENSE SYSTEMWITHOUT COPIES

ONE-WRITE CHECK SYSTEMS

COMBINATION SYSTEMWITHOUT COPIES

(USE APPROPRIATE CATALOG ORDERING CODES)

CHECK ( ) SYSTEM OPTION ABOVE &COMPLETE SECTIONS 2 & 3 BELOW

}}

PAYROLL SYSTEMWITHOUT COPIES

CHECK FORM, COLOR & QUANTITYVOUCHER NUMBERJOURNALPOST BINDERDEPOSIT TICKET STYLE, COPIES & QUANTITYPRE-INKED ENDORSEMENT STAMP

500 SINGLE CHECK SETSIN DUPLICATE

SINGLE CHECK SETS

500 SINGLE CHECK SETSIN TRIPLICATE


}

}

}}}}}}

lll

500 LASER CHECKSWITHOUT COPIES

+

162

SampleCUT NO.

WalletTop-StubEnd-StubDuplicateTrial 50

llllll

QUANTITY

2 ORDERS

BINDING

Small 3-to-the-page

Large 3-to-the-page

ll

llll

1 Order

2 Orders

3 Orders

l

l

l Other

Personal Single

Personal Duplicates

133 Universal

121 Single

}

}

}

Commercial

122 DuplicateCommercial

123 TriplicateCommercial

COVER

Bankers Systems, Inc., St. Cloud, MN Form HAR-31G-COMB 2/20/2003

DISPOSABLE MONEY BAGS (100 PER ORDER)1 ORDERSAVINGS

MAIL TO:

PERSONAL CHECKS 3-TO-THE-PAGE CHECKS (PERSONAL & BUSINESS)

LINE CHECKS

llll

When mailing address is different from printed checks

When ordering Savings Tickets, Line Checks or Deposit Tickets

When no address is to be printed

STYLE COLOR

NAME

ADDRESS

CITY & STATE ZIP CODE

31 G

HAR-31G-COMB

CUT NO.STAMPS1 Order

2 Orders

3 OrdersSeven-Ring

Style 30

Deskmaster

Style 27

lllll

l

lll

Endorsement Stamp

Self-Inking Stamp

I.D. Stamp

Stamp Pad

Customer

Bank

END-STUB

Other

ll

ll

1 Order 2 Ordersl

l

l l

DATE/SIGNATURE AND OFFICE OF PERSON PREPARING

COVER

SPECIAL INSTRUCTIONS

SEND THIS ORDER TO JOHN H. HARLAND COMPANY

Trial 99

DEPOSIT TICKETS

COMPLETE MAILING LABEL ONLY...

ASK CUSTOMER TOPROOFREAD ANDINITIAL HERE.

QUANTITY

SHIP TO:

STARTING NUMBER

COLOR/DESIGN

ACCOUNT NUMBER

COPY AT TOP OF CHECK

llll

2 Signature lines desired

Trial 150

l

l

163

Sample

PERSONAL ORDER FORM

COMPLETE LABEL IF ADDRESS IS NOTPRINTED OR MAILING ADDRESS ISDIFFERENT FROM PRINTED COPY.

PLEASE TYPE OR PRINT INFORMATION.

NAME

ADDRESS APT. NO.


......................................................................................................................

......................................................................................................................

......................................................................................................................

CUT LINE

Please cut around the entire check order form above at the bold "CUT LINE" before sending to Clarke American.Send only the actual check order form, discarding the excess paper.

INSTRUCTIONS

ACCT. HOLDER APPROVAL

CLRK-EB1-PER 3/8/2002

REV. 11/92 EB-1

SEND THIS ORDER TO CLARKE AMERICAN ASK ACCOUNT HOLDER TO REVIEW FOR CORRECTNESS

STARTING NUMBERDESIGN/COLOR

DATE

PREPARED BY: COVER

USE 101 UP

DISTINCTIVE TYPE

lllll

CUT NO. NAME

ADDRESS PH #


........................................................................................

.......................................................................................................

.......................................................................................................

164

Sample

COMMERCIAL ORDER FORM 1. PLEASE TYPE OR PRINT TO ASSURE CLEAR COPY.2. SEND ORIGINAL COPY TO CLARKE AMERICAN.

SHIPPING ADDRESS

COMPLETE LABEL IF ADDRESS IS NOTPRINTED OR MAILING ADDRESS ISDIFFERENT FROM PRINTED COPY.

Note: Street address required for shipping.Cannot ship to a P.O. Box.

.................................................................................................................................

.................................................................................................................................

.................................................................................................................................

ADDRESS APT. NO.


NAME

SHIPTO

CUT NUMBER (CATALOG) STARTING NUMBER

ABA NUMBER

COPY TO BE PRINTED ON CHECKS (PLEASE TYPE OR PRINT)

DATE/PERSON PREPARING SPECIAL INSTRUCTIONS COPY TO BE PRINTED OVER SIGNATURE LINE.

l CHECK IF TWO SIGNATURE LINES REQUIRED.

..........................................................................................................................

..........................................................................................................................

..........................................................................................................................

DISTINCTIVE TYPEFOR CUSTOM CUT ATTACH SAMPLE

(IF NONE, PLEASE INDICATE)

l ll l l

INTROKITS

CHECKS

To order an IntroKit, simply check the appropriate box and indicate the desired check form, color, and apron style (for voucher checks) in the sections below.

THREE-TO-A-PAGE

THREE-TO-A-PAGE/PAYROLL/SPECIAL PURPOSE CHECKS

VOUCHER CHECKS COMPUTER CHECKSCHECKSDEPOSIT TICKETSCHECKMATE COVERVINYL BILL ORGANIZER

l l TRIPLICATE CHECKSDEPOSIT TICKETSVOUCHER REGISTER

150100

11

150100

1

250 DUPLICATE CHECKS

l THREE-TO-A-PAGE

l THE PROFESSIONAL

l PAYROLL

l SPECIAL PURPOSE

PRODUCT CODE

QUANTITY

COLOR/DESIGN COPIESl DUP (Orig+1 copy)

l TRIP (Orig+2 copies)

l QUAD (Orig+3 copies)

PAYROLL CAPTION NUMBERS

ONE-WRITE SYSTEMS (Send sample if possible)SYSTEM CODE PEGBOARD COLORCHECK COLOR

SPECIFY CAPTION NUMBERS AS THEY WILL APPEAR LEFT TO RIGHT

COLORQUANTITYPRODUCT CODE

CHECKS**

JOURNALS

LEDGERS

ENVELOPES

OTHER**SEND VOIDED CHECK SAMPLE WITH HOLES ATTACHED.

DEPOSIT TICKETS

ACCESSORIESCOVERS

VOUCHER APRON(A1 THRU A9)

CARBON-INTERLEAVED

FOR SPECIAL CHECK OR APRON FORMATAND/OR OTHER FEATURES COMPLETE

ORDER FORM AND ATTACH A SAMPLE.

l Check To Check

l Three To Page

l Stub (Laser)

COLOR

l Top (Blue Only)

l 3-Part-Original+2 copies

CHECKS

ENVELOPES

CONTINUOUS CHECKS COPIES: (Mark one) l Original l Duplicate l Triplicate

LASER CHECKS FORM SIZE: l 8½" x 11" l 8½" x 7" (for adjustable laser printer trays only)FILL IN FOLLOWING INFORMATION ONLY IF CHECKS ARE TO BE PRINTED DIFFERENTLY FROM

HOW SAMPLE IS SHOWN IN THE CATALOG.

l B1 (The Prestige-Burg. Leather) l B5 (Prof. I-Blue Leather) l Voucher Register

l B2 (Checkmate I-Blue Leather) l B6 (Prof. II-Blue Vinyl) l Voucher Post Binder

l B3 (Checkmate II-Black Leather) l B7 (Prof. III-Brown Vinyl) ll B4 (The Collector) l Professional Register lVinyl bill organizer included with the seven-ring, three-to-a-page covers at an additional charge.

TYPE STYLEINKQTY.

l Rubber Endorsement Stamp

PRINT COPY IN SPECIAL INSTRUCTIONS FOR CUSTOMSTAMPS. PRE-INKED STAMPS MAILED SEPARATELY.

CLRK-COMM 3/8/2002

CUSTOMER APPROVAL

FOR COMPUTER CHECK ANDONE-WRITE ORDERS, PLEASE

INCLUDE CUSTOMER'S TELEPHONENUMBER AND CONTACT NAME

( )

ONE-WRITE SYSTEM

VOUCHER CHECKS

l l1507

1575

CHECKSJOURNAL SHEETSLEDGER CARDSWINDOW ENVELOPES

(One-On Only)

ENVELOPES STAMPS

COLORQUANTITYPRODUCT CODE

(500 AND MULT. 500)CARBONLESS

COMPUTER CHECKS (Send sample if possible)

CHECK POSITION:

NO. OF PARTS:

SOFTWARE NAME AND VERSION (Very Important)

CHECK POSITION:

NO. OF PARTS:

l Top (All Colors)

l Bottom (Blue Only)

QUANTITYPRODUCT CODE

CHECK POSITION:

CHECK NUMBER PRINTS: (Mark all that apply)

CONTINUOUSLASER

l 2-Part - Original+1 Copy

l 3-Part - Original+2 Copies

l 4-Part - Original+3 Copies

l Top

l Top

l Check

l Bottom

l Middle

l Apron

(Mark one)

QTY. (500 MIN)

QTY. (500 MIN)

QTY. (500 MIN)

QTY. (500 MIN)

l

l

l

lE4-Imprinted Single Window(Three-To-A-Page)

E1-Imprinted Single Window(Voucher & One-On)

E2-Double Window(Voucher & One-On)

E3-Double Window(Three-To-A-Page)

CODENO.

PRE-INKED

Stock Titles

Custom Made

165

Sample

ShippingAddress(If differentfrom check)

Line 1

Line 2

Line 3

Line 4

Line 5

Line 6

Acct #:

Optional Accessories:

CoversWalletsStamps

Please type or print information as it appears on checks.

l Check if 2nd Line for 2nd Signature needed

Typestyle (if different from default):

Enter Product Code

StyleCode

StartingCheck No.

Billingl Account Holderl Financial Institutionl FI Employeel Other:

Sig Line Message (two 40-character lines max):

Date

FI Contact Phone:Name:

CenterAccent:

l 1 Box l 3 Boxes

l 2 Boxes Boxes

SigCut:

Monogram orAccent:

Form LIBERTY 2/28/2008

166

Miscellaneous


Rate Sheet

Deposit Certificate (CD)

Deposit Account Summary

167

168

Sample

Rate Sheet 4/27/201105:51 PM

Training OrganizationTraining Organization

123 This Street123 This Street

This City, MN 12345

Member of the Federal Deposit Insurance CorporationThis Rate Sheet contains information about Interest Rate(s) ("Rate(s)") and Annual Percentage Yield(s) ("APY(s)") for some of

the accounts we offer.Minimum MinimumDeposit BalanceTo Open To ObtainAccount APY Rate APY

CERTIFICATE OF DEPOSITConsumer 12 Month CD * $1,000 $0 1.250% 1.26%

Term: 12 month(s) CHECKINGConsumer NOW Checking $0 $0 0.025% 0.03%IRA12 Month IRA CD * $500 $0 1.250% 1.26%

Term: 12 month(s) SAVINGSConsumer Savings $200 $0 0.250% 0.25%Business Savings $0 $0 1.000% 1.01%Child Savings ++ $200 $200**HSA $0 $0 1.000% 1.00%

* A penalty may be imposed for early withdrawal.** Daily balance. The amount of principal in the account each day.

*** Average Daily balance. A periodic rate is applied to the average daily balance in the account for the period.The Average Daily Balance is calculated by adding the principal in the account for each day of the period and dividing that figure by the number of daysin the period.

++ The interest rate and annual percentage yield may change after account opening.~ Fees could reduce the earnings on the account.# This account requires the distribution of interest and does not allow interest to remain in the account.

Interest Rates and Annual Percentage Yields are current as of the date at the top of this Rate Sheet.For current rate information, call (222)555-1212

169

Sample

Account Date 4/27/2008 to 4/27/2011

Summary: Total Accounts = 2

Training Organization

Accounts = 2

Customer Name

SSN or EIN

Account Title

Account Number Product Marketing Account

DateMaturity

Date Rate Amount Opened By

Bob Smith 000000023 Bob Smith 000048329 Consumer 12 Month CD

4/27/2011 4/27/2012 1.25 150000 SSKROCH

John Doe 000000055 John Doe 7898989Consumer 12

Month CD 4/27/2011 4/27/2012 1.25 30000 SSKROCH

Deposit Certificate (CD) Summary Report 4/27/20115:58 PM

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Account Date 4/27/2008 to 4/27/2011

Summary: Total Accounts = 5

Training Organization

Accounts = 5

Customer Name

SSN or EIN Account Title Account

NumberAccount

Date Amount Marketing Account Officer Name

Opened By

Bob Smith 000000023 Bob Smith 0000001122 4/27/2011 400 || SSKROCH

Bob Smith 000000023 Bob Smith 000048329 4/27/2011 150000 || SSKROCH

Roger Dodger

666666666 Roger Dodger 48739879 4/27/2011 6000 || SSKROCH

Roger Dodger 666666666

Training Organization as custodian for Roger Dodger, Health Savings

Account45840390 4/27/2011 4000 || SSKROCH

John Doe 000000055 John Doe 7898989 4/27/2011 30000 || SSKROCH

Deposit Account Summary Report 4/27/20115:57 PM

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