ACKNOWLEDGEMENT; SIGNATURE. I, _______________________, in my capacity as ___________________ of the Issuer/Borrower/Selling Securityholder listed above and not in my individual capacity, hereby:
ACKNOWLEDGEMENT; SIGNATURE. I hereby agree to the terms and conditions set forth in this form and in the attached Common Stock Unit Agreement. In the event of any conflict between the terms of this form and the Common Stock Unit Agreement, I understand that the terms of the Common Stock Unit Agreement shall govern. Accepted and Agreed: Signature: Date
ACKNOWLEDGEMENT; SIGNATURE. I, , in my capacity as of the Issuer/Borrower/Selling Securityholder listed above and not in my individual capacity, hereby:
ACKNOWLEDGEMENT; SIGNATURE. I, _______________________________, in my capacity as _______________________________ of the Issuer/Borrower/Selling Securityholder listed above and not in my individual capacity, hereby: (a) acknowledge and authorize on behalf of the Issuer/Borrower/Selling Securityholder and each beneficial owner identified in paragraphs (c) and (d) of Section III above that this certification and the attachments hereto may be provided to each of the financial institutions involved in the applicable sale of securities or extension of credit; (b) agree on behalf of the Issuer/Borrower/Selling Securityholder identified above, from the date hereof until the closing of the applicable sale of securities or the termination of the agreement providing for the applicable extension of credit, as the case may be, to notify each of the financial institutions involved in such transaction of any change in the information provided herein that would result in a change to the list of beneficial owners identified in paragraph (c) or (d) of Section III above; (c) agree on behalf of the Issuer/Borrower/Selling Securityholder identified above, upon request by or on behalf of the financial institutions involved in the applicable sale of securities or extension of credit, to provide documentation supporting any applicable exclusion identified in Section II above; and (d) certify, to the best of my knowledge, that the information provided above is complete and correct. Signature: _______________________________ Date: _________________________ Legal Entity Identifier _________________ (Optional)
ACKNOWLEDGEMENT; SIGNATURE. I, _______________________________, in my capacity as _______________________________ of the Borrower listed above and not in my individual capacity, hereby:
ACKNOWLEDGEMENT; SIGNATURE. I hereby make the election designated in this form, and agree to the terms and conditions set forth in this form and in the Series A Preferred Stock Unit Agreement to which this form is attached. In the event of any conflict between the terms of this form and the Series A Preferred Stock Unit Agreement, I understand that the terms of the Series A Preferred Stock Unit Agreement shall govern. I also acknowledge and agree that my deferral election is irrevocable once made. Accepted and Agreed: Signature: Date
ACKNOWLEDGEMENT; SIGNATURE. By signing this application and agreement, I/we acknowledge, agree, and /or certify that; (a) I (we) have read, understand, and agree to the terms in the Client Agreement for Trust Administration, (b) if applicable, under penalties or perjury that the social security number/tax ID number listed on this form is correct, (c) I/we will have the primary responsibility for communication regarding my account except as may be otherwise required by law, rule or regulation, including without limitation account statements, and as Preferred Trust Company may otherwise reasonably deem necessary, (d) I have been advised of fees related to the administration of my account, (e) I/we acknowledge that Preferred Trust Company will verify the information I provide on this application through a third-party provider in accordance with federal and state law. I/we authorize Preferred Trust Company to make inquiries for the purpose of verifying my/our identity. I/we further authorize Preferred Trust Company to disclose the results of such inquiries relating to the verification of my/our identity with my investment advisor. I/we understand that Preferred Trust Company may share this information with its affiliates to determine my eligibility for other products and services those affiliates may offer. I may opt out of such information by providing Preferred Trust Company with written notification, (f) I authorize Preferred Trust Company to act upon my direction. This Client Trust Administration Agreement shall remain in effect until revoked, modified or amended by the Client upon thirty (30) days written notice to the Trustee. Signature of Trustor/Grantor Date Signature of Co-Trustee Date Signature Trustee/Custodian Date
ACKNOWLEDGEMENT; SIGNATURE. I hereby acknowledge receipt of a copy of this agreement and accept the responsibilities listed herein as renter of the Scandia Senior Community Center. I understand that violation of the terms of this rental agreement may result in the denial of future use of the facilities. Renter Signature: Date: City Representative Signature: Date: Food Safety Orientation, if required: Date: For City Use Only: Rental Fee Paid: Deposit Paid: Keys issued to: Key returned: Deposit retained/ refunded: Scandia Community Senior Center Rental Agreement
ACKNOWLEDGEMENT; SIGNATURE. I have read the Eastport-South Manor Central School District’s Internet Safety Acceptable Use Policy and consent to the terms and conditions included in the Student/Staff Use of Personal Computing Devices (BYOD) Agreement. I acknowledge that the Eastport-South Manor Central School District is not responsible for any Personal Computing Devices (BYOD) that are brought to school. The district will not service or repair any device that is not owned by the district and is not responsible for any loss, theft, damage, and/or malware that may occur to student or staff-owned devices. Students will be responsible for charging their device before the school day and will not be provided access to electric/power stations. Students will understand that the classroom teacher has the authority to determine when the use of personal computing devices is or is not appropriate. All student and staff-owned devices will require advanced registration prior to accessing the district’s wireless network and Internet. For Internet safety purposes, students will not be permitted to use their devices on any other broadband or wireless network other than the district’s wireless network. I understand that my network access rights may be removed by the school principal or designee if I violate any of the terms and conditions set forth above. Student/Staff/Owner Name – Please Print Student/Staff Owner Signature Date Parent/Guardian Name –Please Print
ACKNOWLEDGEMENT; SIGNATURE. I hereby make the election designated in this form, and agree to the terms and conditions set forth in this form and in the Plan document. In the event of any conflict between the terms of this form and the Plan, I understand that the terms of the Plan shall govern. Accepted and Agreed: Signature Date Company Use: Date of receipt: , 2010 Initials:
