Commission Expires. (1) If the Affidavit is being made by a Beneficiary, a statement of the date of death of the Participant (and the Beneficiary in the case of the death of the Beneficiary receiving payments) must be added. Exhibit C FORM OF AFFIDAVIT WITH RESPECT TO FINAL DETERMINATION I, _______________________, under penalties of perjury, do hereby solemnly swear (i) that I make this affidavit in order to induce The Bank of New York, as Trustee under the Xxxxxxx Incorporated Grantor Trust For Senior Management Plans Trust Agreement, as amended and restated as of [______], 2015, between Xxxxxxx Incorporated (the “Company”) and The Bank of New York as Trustee (the “Trust Agreement”), to pay me the benefits to which I am entitled under such Trust Agreement, and (ii) that a Final Determination (within the meaning of Sections 1.1(i) and 4.3 of the Trust Agreement) has occurred with respect to my interest in the Trust Fund on _____________ __, 20__. Participant’s Signature (1) STATE OF ________________ ) ss.: COUNTY OF ______________ ) On this ___ day of ____________, 20__, before me personally came _______________, to me known, who, being by me duly sworn, said that he\she resides at ____________________ __________________________ and that the statements herein are all true and correct. Notary Public Commission Expires: Exhibit D FORM OF CHANGE OR REVOCATION OF BENEFICIARY DESIGNATION Pursuant to Section 4.6 of the Xxxxxxx Incorporated Grantor Trust For Senior Management Plans Trust Agreement, as amended and restated as of [_______], 2015, between Xxxxxxx Incorporated (the “Company”) and The Bank of New York as Trustee, I hereby revoke all prior beneficiary designations and designate the following Beneficiary of any payments to which my Beneficiary is entitled under the Trust Agreement. I hereby reserve the right to change or revoke this beneficiary designation without notice to any beneficiary. Name of Beneficiary (Primary) ________________Relationship _________________Social Security No. Address I understand that to be effective, any change or revocation must be received by the Trustee during my life at the address set forth below or at such other address as may from time to time be specified by the Trustee for notices to it under the Trust Agreement. Date Participant’s Signature Spouse’s Signature Return this form to: The Bank of New York Onx Xxxx Xxxxxx, 00xx Xxxxx Xxx Xxxx, Xxx Xxxx 00000 Xttention: Division Head Domestic/Custody Division Exhibit E TRUSTEE’S FEE SCHEDULE ...
Commission Expires. Notary Public
Commission Expires. Notary Public (SEAL) NOTARIAL ACKNOWLEDGMENTS STATE OF ____________________ ) ) ss. COUNTY OF ___________________ ) I HEREBY CERTIFY that before me, a Notary Public duly commissioned and qualified in and for the above stated jurisdiction, personally came and appeared XXXXX XXXXXXXXX, who after being duly sworn declared that he/she executed the foregoing UNWINDING AND STOCK EXCHANGE AGREEMENT as his/her free act and deed, and that the statements therein set forth are true and correct. Sworn to and Subscribed on November 29, 1999.
Commission Expires. CONSENT OF LESSEE TO ASSIGNMENT OF LEASE AND RENTS CONSENT AND ACKNOWLEDGMENT BY LESSEE The undersigned hereby acknowledges receipt of a counterpart original of, and consent to, the foregoing Assignment of Lease and Rent dated as of October 29, 1999. The foregoing is furnished for good and valuable consideration the receipt and sufficiency of which are hereby acknowledged by the undersigned, and the undersigned understand and intend that the Administrative Agent and the Lenders will rely on the foregoing and that the undersigned will be legally bound by the foregoing. This Consent and Acknowledgment shall inure to the benefit of the Administrative Agent, the Lenders and their respective successors and assigns.
Commission Expires. -29- EXHIBIT C-2 Schedule A to Mortgage, Assignment, Security Agreement and Financing Statement (Fixture Filing) ([Name of the Facility)/13/ (Facility No. [____])/14/ Land ---- [Reserved.] --------------------------- /13/ Insert the name of the Facility. /14/ Insert the number assigned to the Facility. Schedule B to Mortgage. Assignment, Security Agreement and Financing Statement (Fixture Filing) ([Name of the Facility)/15/ (Facility No. [___])16 Permitted Exceptions -------------------- [Reserved.] ------------------------------ /15/ Insert the name of the Facility. /16/ Insert the number assigned to the Facility. Schedule C to Mortgage, Assignment, Security Agreement and Financing Statement (Fixture Filing) ([Name of the Facility)/17/ (Facility No. [___])/18/ Affiliates/19/ ----------
Commission Expires. Feb. 16, 0000 ---------------------------- XXXXX XX XXXXXXXX ) ) ss. COUNTY OF OAKLAND ) The foregoing instrument was acknowledged before me this 9th day of May, 2003 by Xxxx X. Xxxxxx, the Executive Vice President of FITTINGS PRODUCTS CO., LLC, a Delaware limited liability company, on behalf of said company. /s/ Xxxxxx X. Xxxx --------------------------------- Notary Public, State of Michigan Printed Name: Xxxxxx X. Xxxx ------------------ Commission Expires: Oct. 16, 2005 ----------------------------
Commission Expires. Notary Public My County of Residence: ------------------------------ ------------------------------------------ Printed Name COUNTERPART SIGNATURE PAGE ROPART ASSET MANAGEMENT FUND, LLC By : ---------------------------------------- Manager TAMPA BAY FINANCIAL, INC. By: ----------------------------------------- Carl L. Smith, Sr., Chairman of Xxx Xxxxx xnd Chief Executive Officer -------------------------------------------- William R. Donaldson -------------------------------------------- Erik Risman OMITTED SCHEDULES NUMBER DESCRIPTION A Purchasers 4.3 Parent Company SEC Reports 4.7 Use of Proceeds 9.1(A) Location and Identification of Simulators
Commission Expires. Notary Public STATE OF FLORIDA COUNTY OF BROWARD Before me personally appeared SANNXX XXXXXXX, xx PRESIDENT of MLS PROPERTIES, INC. to me known to be the person who signed the foregoing instrument and severally acknowledged the execution thereof to be her free act and deed as such officer for the use and the purpose therein mentioned and that she affixed thereto the official seal of said corporation, and that the said instrument is the act and deed of said corporation.
Commission Expires. Notary Public This instrument prepared by: Fredxxxxx X. Xxxxxxx, Xxq. 6444 Xxxxxxxx Xxxx Xxxxxxx, XX 000-4100 4 MODIFICATION OF THE LEASE
Commission Expires. APPENDIX A ---------- INVESTOR SUITABILITY STANDARDS A PURCHASE OF THE SHARES OF COMMON STOCK PURSUANT TO THE SUBSCRIPTION AGREEMENT INVOLVES A HIGH DEGREE OF RISK AND IS SUITABLE ONLY FOR PERSONS OF SUBSTANTIAL FINANCIAL MEANS WHO HAVE NO NEED FOR LIQUIDITY IN THEIR INVESTMENTS. THE OFFER, OFFER FOR SALE, AND SALE OF THE SHARES OF COMMON STOCK ARE INTENDED TO BE EXEMPT FROM THE REGISTRATION REQUIREMENTS OF THE SECURITIES ACT OF 1933, AS AMENDED (THE "ACT"), PURSUANT TO REGULATION D PROMULGATED THEREUNDER ("REGULATION D") OR ANOTHER EXEMPTION THEREUNDER AND ARE INTENDED TO BE EXEMPT FROM THE REGISTRATION REQUIREMENTS OF APPLICABLE STATE SECURITIES LAWS. RULE 501(A) OF REGULATION D DEFINES AN "ACCREDITED INVESTOR" AS ANY PERSON WHO COMES WITHIN ANY OF THE FOLLOWING CATEGORIES, OR WHO THE ISSUER REASONABLY BELIEVES COMES WITHIN ANY OF THE FOLLOWING CATEGORIES, AT THE TIME OF THE SALE OF THE SECURITIES TO THAT PERSON:
