Common use of TRUSTEE’S CERTIFICATE OF AUTHENTICATION Clause in Contracts

TRUSTEE’S CERTIFICATE OF AUTHENTICATION. This is one of the Subordinated Notes of Civista Bancshares, Inc. referred to in the within-mentioned Indenture: UMB BANK, NATIONAL ASSOCIATION, as Trustee By: Name: Title: Dated: ASSIGNMENT FORM To assign this Subordinated Note, fill in the form below: (I) or (we) assign and transfer this Subordinated Note to: (Print or type assignee’s name, address and zip code) (Insert assignee’s social security or tax I.D. No.) and irrevocably appoint _______________________ agent to transfer this Subordinated Note on the books of the Company. The agent may substitute another to act for him. Date: Your signature: (Sign exactly as your name appears on the face of this Subordinated Note) Tax Identification No: Signature Guarantee: (Signatures must be guaranteed by an eligible guarantor institution (banks, stockbrokers, savings and loan associations and credit unions with membership in an approved signature guarantee medallion program), pursuant to Exchange Act Rule 17Ad-15). The undersigned certifies that it [is / is not] an Affiliate of the Company and that, to its knowledge, the proposed transferee [is / is not] an Affiliate of the Company. In connection with any transfer or exchange of this Subordinated Note occurring prior to the date that is one year after the later of the date of original issuance of this Subordinated Note and the last date, if any, on which this Subordinated Note was owned by the Company or any Affiliate of the Company, the undersigned confirms that this Subordinated Note is being: CHECK ONE BOX BELOW: ☐ (1) acquired for the undersigned’s own account, without transfer;

Appears in 1 contract

Samples: Civista Bancshares, Inc.

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TRUSTEE’S CERTIFICATE OF AUTHENTICATION. This is one of the Subordinated Notes of Civista Shore Bancshares, Inc. referred to in the within-mentioned Indenture: UMB BANK, BANK NATIONAL ASSOCIATION, ASSOCIATION as Trustee By: Name: Title: Dated: ASSIGNMENT FORM To assign this Subordinated Note, fill in the form below: (I) or (we) assign and transfer this Subordinated Note to: (Print or type assignee’s name, address and zip code) (Insert assignee’s social security or tax I.D. No.) and irrevocably appoint _______________________ agent to transfer this Subordinated Note on the books of the Company. The agent may substitute another to act for him. Date: ____________________________ Your signature: (Sign exactly as your name appears on the face of this Subordinated Note) Tax Identification No: Signature Guarantee: (Signatures must be guaranteed by an eligible guarantor institution (banks, stockbrokersstockbroker’s, savings and loan associations and credit unions with membership in an approved signature guarantee medallion program), pursuant to Exchange Act Rule 17Ad-15). The undersigned certifies that it [is / is not] an Affiliate of the Company and that, to its knowledge, the proposed transferee [is / is not] an Affiliate of the Company. In connection with any transfer or exchange of this Subordinated Note occurring prior to the date that is one year after the later of the date of original issuance of this Subordinated Note and the last date, if any, on which this Subordinated Note was owned by the Company or any Affiliate of the Company, the undersigned confirms that this Subordinated Note is being: CHECK ONE BOX BELOW: ¨ (1) acquired for the undersigned’s own account, without transfer;

Appears in 1 contract

Samples: Shore Bancshares Inc

TRUSTEE’S CERTIFICATE OF AUTHENTICATION. This is one of the Subordinated Notes of Civista Bridgewater Bancshares, Inc. referred to in the within-mentioned Indenture: UMB BANK, U.S. BANK NATIONAL ASSOCIATION, ASSOCIATION as Trustee By: Name: Title: Dated: ASSIGNMENT FORM To assign this Subordinated Note, fill in the form below: (I) or (we) assign and transfer this Subordinated Note to: (Print or type assignee’s name, address and zip code) (Insert assignee’s social security or tax I.D. No.) and irrevocably appoint _______________________ agent to transfer this Subordinated Note on the books of the Company. The agent may substitute another to act for him. Date: Your signature: (Sign exactly as your name appears on the face of this Subordinated Note) Tax Identification No: Signature Guarantee: (Signatures must be guaranteed by an eligible guarantor institution (banks, stockbrokers, savings and loan associations and credit unions with membership in an approved signature guarantee medallion program), pursuant to Exchange Act Rule 17Ad-15). The undersigned certifies that it [is / is not] an Affiliate of the Company and that, to its knowledge, the proposed transferee [is / is not] an Affiliate of the Company. In connection with any transfer or exchange of this Subordinated Note occurring prior to the date that is one year after the later of the date of original issuance of this Subordinated Note and the last date, if any, on which this Subordinated Note was owned by the Company or any Affiliate of the Company, the undersigned confirms that this Subordinated Note is being: CHECK ONE BOX BELOW: (1) acquired for the undersigned’s own account, without transfer;

Appears in 1 contract

Samples: Bridgewater Bancshares Inc

TRUSTEE’S CERTIFICATE OF AUTHENTICATION. This is one of the Subordinated Notes of Civista Bancshares, Inc. referred to in the within-mentioned Indenture: UMB BANK, NATIONAL ASSOCIATION, ASSOCIATION as Trustee By: Name: Title: Dated: Trustee Certificate of Authentication – Page 1 ASSIGNMENT FORM To assign this Subordinated Note, fill in the form below: (I) or (we) assign and transfer this Subordinated Note to: (Print or type assignee’s name, address and zip code) (Insert assignee’s social security or tax I.D. No.) and irrevocably appoint _______________________ agent to transfer this Subordinated Note on the books of the Company. The agent may substitute another to act for him. Date: Your signature: (Sign exactly as your name appears on the face of this Subordinated Note) Tax Identification No: Signature Guarantee: (Signatures must be guaranteed by an eligible guarantor institution (banks, stockbrokers, savings and loan associations and credit unions with membership in an approved signature guarantee medallion program), pursuant to Exchange Act Rule 17Ad-15). The undersigned certifies that it [is / is not] an Affiliate of the Company and that, to its knowledge, the proposed transferee [is / is not] an Affiliate of the Company. In connection with any transfer or exchange of this Subordinated Note occurring prior to the date that is one year after the later of the date of original issuance of this Subordinated Note and the last date, if any, on which this Subordinated Note was owned by the Company or any Affiliate of the Company, the undersigned confirms that this Subordinated Note is being: CHECK ONE BOX BELOW: ☐ (1) acquired for the undersigned’s own account, without transfer;

Appears in 1 contract

Samples: Civista Bancshares, Inc.

TRUSTEE’S CERTIFICATE OF AUTHENTICATION. This is one of the Subordinated Notes of Civista BancsharesCounty Bancorp, Inc. referred to in the within-mentioned Indenture: UMB BANK, U.S. BANK NATIONAL ASSOCIATION, ASSOCIATION as Trustee By: Name: Name Title: Dated: ASSIGNMENT FORM To assign this Subordinated Note, fill in the form below: (I) or (we) assign and transfer this Subordinated Note to: (Print or type assignee’s name, address and zip code) (Insert assignee’s social security or tax I.D. No.) and irrevocably appoint _______________________ agent to transfer this Subordinated Note on the books of the Company. The agent may substitute another to act for him. Date: Your signature: (Sign exactly as your name appears on the face of this Subordinated Note) Tax Identification No: Signature Guarantee: (Signatures must be guaranteed by an eligible guarantor institution (banks, stockbrokers, savings and loan associations and credit unions with membership in an approved signature guarantee medallion program), pursuant to Exchange Act Rule 17Ad-15). The undersigned certifies that it [is / is not] an Affiliate of the Company and that, to its knowledge, the proposed transferee [is / is not] an Affiliate of the Company. In connection with any transfer or exchange of this Subordinated Note occurring prior to the date that is one year after the later of the date of original issuance of this Subordinated Note and the last date, if any, on which this Subordinated Note was owned by the Company or any Affiliate of the Company, the undersigned confirms that this Subordinated Note is being: CHECK ONE BOX BELOW: ☐ (1) acquired for the undersigned’s own account, without transfer;

Appears in 1 contract

Samples: County Bancorp, Inc.

TRUSTEE’S CERTIFICATE OF AUTHENTICATION. This is one of the Subordinated Notes of Civista BancsharesFinancial Institutions, Inc. referred to in the within-mentioned Indenture: UMB BANKWILMINGTON TRUST, NATIONAL ASSOCIATION, ASSOCIATION as Trustee By: Name: Title: Authorized Signatory Dated: ASSIGNMENT FORM To assign this Subordinated Note, fill in the form below: (I) or (we) assign and transfer this Subordinated Note to: (Print or type assignee’s name, address and zip code) (Insert assignee’s social security or tax I.D. No.) and irrevocably appoint _______________________ agent to transfer this Subordinated Note on the books of the Company. The agent may substitute another to act for him. Date: Your signature: (Sign exactly as your name appears on the face of this Subordinated Note) Tax Identification No: Signature Guarantee: (Signatures must be guaranteed by an eligible guarantor institution (banks, stockbrokersstockbroker’s, savings and loan associations and credit unions with membership in an approved signature guarantee medallion program), pursuant to Exchange Act Rule 17Ad-15). The undersigned certifies that it [is / is not] an Affiliate of the Company and that, to its knowledge, the proposed transferee [is / is not] an Affiliate of the Company. In connection with any transfer or exchange of this Subordinated Note occurring prior to the date that is one year after the later of the date of original issuance of this Subordinated Note and the last date, if any, on which this Subordinated Note was owned by the Company or any Affiliate of the Company, the undersigned confirms that this Subordinated Note is being: CHECK ONE BOX BELOW: ☐ (1) acquired 1)acquired for the undersigned’s own account, without transfer;

Appears in 1 contract

Samples: Indenture (Financial Institutions Inc)

TRUSTEE’S CERTIFICATE OF AUTHENTICATION. This is one of the Subordinated Notes of Civista Bancshares, Inc. First Northwest Bancorp referred to in the within-mentioned Indenture: UMB BANK, NATIONAL ASSOCIATION, ASSOCIATION as Trustee By: _________________________________ Name: ______________________________ Title: ________________________________ Dated: _______________________________ ASSIGNMENT FORM To assign this Subordinated Note, fill in the form below: (I) or (we) assign and transfer this Subordinated Note to: (Print or type assignee’s name, address and zip code) (Insert assignee’s social security or tax I.D. No.) and irrevocably appoint _______________________ agent to transfer this Subordinated Note on the books of the Company. The agent may substitute another to act for him. Date: Your signature: (Sign exactly as your name appears on the face of this Subordinated Note) Tax Identification No: Signature Guarantee: (Signatures must be guaranteed by an eligible guarantor institution (banks, stockbrokersstockbroker’s, savings and loan associations and credit unions with membership in an approved signature guarantee medallion program), pursuant to Exchange Act Rule 17Ad-15). The undersigned certifies that it [is / is not] an Affiliate of the Company and that, to its knowledge, the proposed transferee [is / is not] an Affiliate of the Company. In connection with any transfer or exchange of this Subordinated Note occurring prior to the date that is one year after the later of the date of original issuance of this Subordinated Note and the last date, if any, on which this Subordinated Note was owned by the Company or any Affiliate of the Company, the undersigned confirms that this Subordinated Note is being: CHECK ONE BOX BELOW: ☐ (1) acquired for the undersigned’s own account, without transfer;

Appears in 1 contract

Samples: First Northwest Bancorp (First Northwest Bancorp)

TRUSTEE’S CERTIFICATE OF AUTHENTICATION. This is one of the Subordinated Notes of Civista BancsharesGerman American Bancorp, Inc. Inc., referred to in the within-mentioned Indenture: UMB BANKU.S. Bank National Association, NATIONAL ASSOCIATIONa national banking association, as Trustee By: Name: Name Title: Dated: ASSIGNMENT FORM To assign this Subordinated Note, fill in the form below: (I) or (we) assign and transfer this Subordinated Note to: (Print or type assignee’s name, address and zip code) (Insert assignee’s social security or tax I.D. No.) and irrevocably appoint _______________________ agent to transfer this Subordinated Note on the books of the Company. The agent may substitute another to act for him. Date: Your signature: (Sign exactly as your name appears on the face of this Subordinated Note) Tax Identification No: Signature Guarantee: (Signatures must be guaranteed by an eligible guarantor institution (banks, stockbrokers, savings and loan associations and credit unions with membership in an approved signature guarantee medallion program), pursuant to Exchange Act Rule 17Ad-15). The undersigned certifies that it [is / is not] an Affiliate of the Company and that, to its knowledge, the proposed transferee [is / is not] an Affiliate of the Company. In connection with any transfer or exchange of this Subordinated Note occurring prior to the date that is one year after the later of the date of original issuance of this Subordinated Note and the last date, if any, on which this Subordinated Note was owned by the Company or any Affiliate of the Company, the undersigned confirms that this Subordinated Note is being: CHECK ONE BOX BELOW: ☐ (1) acquired for the undersigned’s own account, without transfer;:

Appears in 1 contract

Samples: Indenture (German American Bancorp, Inc.)

TRUSTEE’S CERTIFICATE OF AUTHENTICATION. This is one of the Subordinated Notes of Civista BancsharesCounty Bancorp, Inc. referred to in the within-mentioned Indenture: UMB BANK, U.S. BANK NATIONAL ASSOCIATION, ASSOCIATION as Trustee By: Name: Title: Dated: ASSIGNMENT FORM To assign this Subordinated Note, fill in the form below: (I) or (we) assign and transfer this Subordinated Note to: (Print or type assignee’s name, address and zip code) (Insert assignee’s social security or tax I.D. No.) and irrevocably appoint _______________________ agent to transfer this Subordinated Note on the books of the Company. The agent may substitute another to act for him. Date: Your signature: (Sign exactly as your name appears on the face of this Subordinated Note) Tax Identification No: Signature Guarantee: (Signatures must be guaranteed by an eligible guarantor institution (banks, stockbrokers, savings and loan associations and credit unions with membership in an approved signature guarantee medallion program), pursuant to Exchange Act Rule 17Ad-15). The undersigned certifies that it [is / is not] an Affiliate of the Company and that, to its knowledge, the proposed transferee [is / is not] an Affiliate of the Company. In connection with any transfer or exchange of this Subordinated Note occurring prior to the date that is one year after the later of the date of original issuance of this Subordinated Note and the last date, if any, on which this Subordinated Note was owned by the Company or any Affiliate of the Company, the undersigned confirms that this Subordinated Note is being: CHECK ONE BOX BELOW: ☐ (1) acquired for the undersigned’s own account, without transfer;

Appears in 1 contract

Samples: County Bancorp, Inc.

TRUSTEE’S CERTIFICATE OF AUTHENTICATION. This is one of the Subordinated Notes of Civista Bancshares, Inc. Excess Distribution Certificate referred to in the within-mentioned Indenture: UMB BANKTrust Agreement. CHASE MANHATTAN BANK USA, NATIONAL ASSOCIATION, not in its individual capacity but solely as Eligible Lender Trustee By: NameAuthorized Signatory OR JPMORGAN CHASE BANK, solely in its capacity as Authenticating Agent for the Eligible Lender Trustee By: TitleAuthorized Signatory Date: Dated: ASSIGNMENT FORM To assign this Subordinated Note[·] [Reverse of Excess Distribution Certificate] This Excess Distribution Certificate does not represent an obligation of, fill or an interest in, the Depositor, Sxxxxx Mxx, Inc., as servicer (in such capacity, the “Servicer”), Sxxxxx Mae, Inc., as administrator (in such capacity, the “Administrator”), the Eligible Lender Trustee, the Indenture Trustee, any Swap Counterparty, any Swap Agent, any Remarketing Agent or any Affiliates of any of them, and no recourse may be had against such parties or their assets, except as may be expressly set forth or contemplated herein, in the Trust Agreement or in the other Basic Documents. In addition, this Excess Distribution Certificate is not guaranteed by any governmental agency or instrumentality and is limited in right of payment to certain collections with respect to the Trust Student Loans, all as more specifically set forth in the Administration Agreement. A copy of each of the Trust Agreement, the Sale Agreement, the Purchase Agreement, the Administration Agreement, the Servicing Agreement, any Swap Agreement, the Interest Rate Cap Agreement, the Remarketing Agreement and the Indenture may be examined during normal business hours at the principal office of the Administrator, and at such other places, if any, designated by the Administrator, by the holder of this Excess Distribution Certificate upon request. The Trust Agreement permits, with certain exceptions therein provided, the amendment thereof and the certification of the rights and obligations of the Depositor and the rights of the holders of this Excess Distribution Certificate under the Trust Agreement at any time by the Depositor and the Eligible Lender Trustee with the consent of the holders of the Class A Notes and the Class B Notes, each voting as a class evidencing not less than a majority of the outstanding principal balance of each class of the Notes. The Trust Agreement also permits the amendment thereof, in certain limited circumstances, without the consent of the Noteholders. As provided in the Trust Agreement and subject to certain limitations therein set forth, the transfer of this Excess Distribution Certificate is registerable in the Excess Distribution Certificate Register upon surrender of this Excess Distribution Certificate for registration of transfer at the offices or agencies maintained by the Excess Distribution Certificate Registrar, or by any successor Excess Distribution Certificate Registrar, in the Borough of Manhattan, The City of New York, accompanied by a written instrument of transfer in form below: satisfactory to the Eligible Lender Trustee and the Excess Distribution Certificate Registrar duly executed by the holder hereof or such holder’s attorney duly authorized in writing, and thereupon a new Excess Distribution Certificate will be issued to the designated transferee. As provided in the Trust Agreement and subject to certain limitations therein set forth, this Excess Distribution Certificate is exchangeable for a new Excess Distribution Certificate as requested by the holder surrendering the same. No service charge will be made for any such registration of transfer or exchange, but the Eligible Lender Trustee or the Excess Distribution Certificate Registrar may require payment of a sum sufficient to cover any tax or governmental charge payable in connection therewith. The Eligible Lender Trustee, the Certificate Registrar and any agent of the Eligible Lender Trustee or the Excess Distribution Certificate Registrar may treat the person in whose name this Excess Distribution Certificate is registered as the owner hereof for all purposes, and none of the Eligible Lender Trustee or the Excess Distribution Certificate Registrar or any such agent shall be affected by any notice to the contrary. This Excess Distribution Certificate (Iincluding any beneficial interest herein) may not be acquired by or for the account of (i) an employee benefit plan (as defined in Section 3(3) of ERISA) that is subject to the provisions of Title I of ERISA, (ii) a plan described in section 4975(e)(1) of the Internal Revenue Code of 1986, as amended (the “Code”), including an individual retirement account described in Section 408(a) of the Code or a Kxxxx plan or (weiii) assign any entity whose underlying assets include plan assets by reason of a plan’s investment in the entity (each, a “Benefit Plan”). By accepting and transfer holding this Subordinated Note to: (Print or type assignee’s nameExcess Distribution Certificate, address the holder hereof shall be deemed to have represented and zip code) (Insert assignee’s social security or tax I.D. No.) warranted that it is not a Benefit Plan, it is not purchasing this Excess Distribution Certificate on behalf of a Benefit Plan, is not using assets of a Benefit Plan to purchase this Excess Distribution Certificate and irrevocably appoint _______________________ agent to transfer have agreed that if this Subordinated Note on Excess Distribution Certificate is deemed to be a plan asset, the books holder will promptly dispose of this Excess Distribution Certificate. The obligations and responsibilities created by the Trust Agreement and the Trust created thereby shall terminate upon the payment to Noteholders, any Swap Counterparty and the holder of this Excess Distribution Certificate of all amounts required to be paid to them pursuant to the Trust Agreement, the Administration Agreement and the Indenture and the disposition of all property held as part of the CompanyTrust. The agent Servicer may substitute another to act for him. Date: Your signature: (Sign exactly as your name appears on at its option purchase the face of this Subordinated Note) Tax Identification No: Signature Guarantee: (Signatures must be guaranteed by an eligible guarantor institution (banks, stockbrokers, savings and loan associations and credit unions with membership in an approved signature guarantee medallion program), pursuant to Exchange Act Rule 17Ad-15). The undersigned certifies that it [is / is not] an Affiliate corpus of the Company and thatTrust at a price specified in the Administration Agreement; however, to its knowledge, the proposed transferee [such right of purchase is / is not] an Affiliate of the Company. In connection with exercisable only on any transfer Distribution Date on or exchange of this Subordinated Note occurring prior to the date that is one year after the later of the date [·] Distribution Date or the first Distribution Date on which the Pool Balance is less than or equal to [·] % of original issuance the Initial Pool Balance. Any Trust Student Loans remaining in the Trust as of this Subordinated Note the later of the end of the Collection Period for the [·] Distribution Date or the end of the Collection Period immediately preceding the Trust Auction Date may be offered for sale by the Indenture Trustee by auction in accordance with the procedure described in the Indenture. This Excess Distribution Certificate shall be construed in accordance with the laws of the State of Delaware, without reference to its conflict of law provisions, and the last dateobligations, if any, on which this Subordinated Note was owned by the Company or any Affiliate rights and remedies of the Company, the undersigned confirms that this Subordinated Note is being: CHECK ONE BOX BELOW: ☐ (1) acquired for the undersigned’s own account, without transfer;parties hereunder shall be determined in accordance with such laws.

Appears in 1 contract

Samples: Trust Agreement (SLM Funding LLC)

TRUSTEE’S CERTIFICATE OF AUTHENTICATION. This is one of the Subordinated Notes of Civista Bancshares, Inc. California BanCorp referred to in the within-mentioned Indenture: UMB BANK, NATIONAL ASSOCIATION, ASSOCIATION as Trustee By: Name: Title: Dated: ASSIGNMENT FORM To assign this Subordinated Note, fill in the form below: (I) or (we) assign and transfer this Subordinated Note to: (Print or type assignee’s name, address and zip code) (Insert assignee’s social security or tax I.D. No.) and irrevocably appoint _______________________ agent to transfer this Subordinated Note on the books of the Company. The agent may substitute another to act for him. Date: Your signature: (Sign exactly as your name appears on the face of this Subordinated Note) Tax Identification No: Signature Guarantee: (Signatures must be guaranteed by an eligible guarantor institution (banks, stockbrokersstockbroker’s, savings and loan associations and credit unions with membership in an approved signature guarantee medallion program), pursuant to Exchange Act Rule 17Ad-15). The undersigned certifies that it [is / is not] an Affiliate of the Company and that, to its knowledge, the proposed transferee [is / is not] an Affiliate of the Company. In connection with any transfer or exchange of this Subordinated Note occurring prior to the date that is one year after the later of the date of original issuance of this Subordinated Note and the last date, if any, on which this Subordinated Note was owned by the Company or any Affiliate of the Company, the undersigned confirms that this Subordinated Note is being: CHECK ONE BOX BELOW: ☐ (1) acquired for the undersigned’s own account, without transfer;

Appears in 1 contract

Samples: California Bancorp (California BanCorp)

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TRUSTEE’S CERTIFICATE OF AUTHENTICATION. This is one of the Subordinated Notes of Civista BancsharesMidland States Bancorp, Inc. Inc., referred to in the within-mentioned Indenture: UMB BANK, BANK NATIONAL ASSOCIATION, a national banking association, as Trustee By: Name: Title: Dated: ASSIGNMENT FORM To assign this Subordinated Note, fill in the form below: (I) or (we) assign and transfer this Subordinated Note to: (Print or type assignee’s name, address and zip code) (Insert assignee’s social security or tax I.D. No.) and irrevocably appoint _______________________ agent to transfer this Subordinated Note on the books of the Company. The agent may substitute another to act for him. Date: Your signature: (Sign exactly as your name appears on the face of this Subordinated Note) Tax Identification No: Signature Guarantee: (Signatures must be guaranteed by an eligible guarantor institution (banks, stockbrokers, savings and loan associations and credit unions with membership in an approved signature guarantee medallion program), pursuant to Exchange Act Rule 17Ad-15). The undersigned certifies that it [is / is not] an Affiliate of the Company and that, to its knowledge, the proposed transferee [is / is not] an Affiliate of the Company. In connection with any transfer or exchange of this Subordinated Note occurring prior to the date that is one year after the later of the date of original issuance of this Subordinated Note and the last date, if any, on which this Subordinated Note was owned by the Company or any Affiliate of the Company, the undersigned confirms that this Subordinated Note is being: CHECK ONE BOX BELOW: ¨ (1) acquired for the undersigned’s own account, without transfer;

Appears in 1 contract

Samples: Indenture (Midland States Bancorp, Inc.)

TRUSTEE’S CERTIFICATE OF AUTHENTICATION. This is one of the Subordinated Notes of Civista Bancshares, Inc. Peapack-Gladstone Financial Corporation referred to in the within-mentioned Indenture: UMB BANK, NATIONAL ASSOCIATION, ASSOCIATION as Trustee By: Name: Title: Dated: ASSIGNMENT FORM To assign this Subordinated Note, fill in the form below: (I) or (we) assign and transfer this Subordinated Note to: (Print or type assignee’s name, address and zip code) (Insert assignee’s social security or tax I.D. No.) and irrevocably appoint _______________________ agent to transfer this Subordinated Note on the books of the Company. The agent may substitute another to act for him. Date: Your signature: (Sign exactly as your name appears on the face of this Subordinated Note) Tax Identification No: Signature Guarantee: (Signatures must be guaranteed by an eligible guarantor institution (banks, stockbrokersstockbroker’s, savings and loan associations and credit unions with membership in an approved signature guarantee medallion program), pursuant to Exchange Act Rule 17Ad-15). The undersigned certifies that it [is / is not] an Affiliate of the Company and that, to its knowledge, the proposed transferee [is / is not] an Affiliate of the Company. In connection with any transfer or exchange of this Subordinated Note occurring prior to the date that is one year after the later of the date of original issuance of this Subordinated Note and the last date, if any, on which this Subordinated Note was owned by the Company or any Affiliate of the Company, the undersigned confirms that this Subordinated Note is being: CHECK ONE BOX BELOW: ☐ (1) acquired for the undersigned’s own account, without transfer;

Appears in 1 contract

Samples: Peapack Gladstone Financial Corp

TRUSTEE’S CERTIFICATE OF AUTHENTICATION. This is one of the Subordinated Notes of Civista BancsharesMidland States Bancorp, Inc. Inc., referred to in the within-mentioned Indenture: UMB BANK, BANK NATIONAL ASSOCIATION, a national banking association, as Trustee By: Name: Title: Dated: [Signature page to Certificate of Authentication] ASSIGNMENT FORM To assign this Subordinated Note, fill in the form below: (I) or (we) assign and transfer this Subordinated Note to: (Print or type assignee’s name, address and zip code) (Insert assignee’s social security or tax I.D. No.) and irrevocably appoint _______________________ agent to transfer this Subordinated Note on the books of the Company. The agent may substitute another to act for him. Date: Your signature: (Sign exactly as your name appears on the face of this Subordinated Note) Tax Identification No: Signature Guarantee: (Signatures must be guaranteed by an eligible guarantor institution (banks, stockbrokers, savings and loan associations and credit unions with membership in an approved signature guarantee medallion program), pursuant to Exchange Act Rule 17Ad-15). The undersigned certifies that it [is / is not] an Affiliate of the Company and that, to its knowledge, the proposed transferee [is / is not] an Affiliate of the Company. In connection with any transfer or exchange of this Subordinated Note occurring prior to the date that is one year after the later of the date of original issuance of this Subordinated Note and the last date, if any, on which this Subordinated Note was owned by the Company or any Affiliate of the Company, the undersigned confirms that this Subordinated Note is being: CHECK ONE BOX BELOW: ¨ (1) acquired for the undersigned’s own account, without transfer;

Appears in 1 contract

Samples: Indenture (Midland States Bancorp, Inc.)

TRUSTEE’S CERTIFICATE OF AUTHENTICATION. This is one of the Subordinated Notes of Civista BancsharesMidWestOne Financial Group, Inc. referred to in the within-mentioned Indenture: UMB BANK, U.S. BANK NATIONAL ASSOCIATION, ASSOCIATION as Trustee By: Name: Title: Dated: ASSIGNMENT FORM To assign this Subordinated Note, fill in the form below: (I) or (we) assign and transfer this Subordinated Note to: (Print or type assignee’s name, address and zip code) (Insert assignee’s social security or tax I.D. No.) and irrevocably appoint _______________________ agent to transfer this Subordinated Note on the books of the Company. The agent may substitute another to act for him. Date: Your signature: (Sign exactly as your name appears on the face of this Subordinated Note) Tax Identification No: Signature Guarantee: (Signatures must be guaranteed by an eligible guarantor institution (banks, stockbrokers, savings and loan associations and credit unions with membership in an approved signature guarantee medallion program), pursuant to the Securities Exchange Act of 1934, as amended (the “Exchange Act”) Rule 17Ad-15). The undersigned certifies that it [is / is not] an Affiliate of the Company and that, to its knowledge, the proposed transferee [is / is not] an Affiliate of the Company. In connection with any transfer or exchange of this Subordinated Note occurring prior to the date that is one year after the later of the date of original issuance of this Subordinated Note and the last date, if any, on which this Subordinated Note was owned by the Company or any Affiliate of the Company, the undersigned confirms that this Subordinated Note is being: CHECK ONE BOX BELOW: ¨ (1) acquired for the undersigned’s own account, without transfer;

Appears in 1 contract

Samples: MidWestOne Financial Group, Inc.

TRUSTEE’S CERTIFICATE OF AUTHENTICATION. This is one of the Subordinated Notes of Civista Bancshares, Inc. designated therein referred to in the within-mentioned Indenture. Dated: UMB BANK, U.S. BANK NATIONAL ASSOCIATION, as Trustee By: Name: Title: Dated: ASSIGNMENT Authorized Signatory [FORM To assign this Subordinated NoteOF REVERSE SIDE OF NOTE] XXXXXX REALTY, fill L.P. [ ]% SENIOR NOTES DUE [ ] This Note is one of a duly authorized issue of Notes of the Issuer, designated as its [ ]% Senior Notes due [ ] (herein called the “Notes”), issued under and pursuant to an Indenture dated as of [ ] (as the same may be amended or supplemented from time to time, the “Indenture”) among the Issuer, the Guarantor and U.S. Bank National Association, as trustee (herein called the “Trustee”), to which Indenture and all indentures supplemental thereto reference is hereby made for a description of the rights, limitations of rights, obligations, duties and immunities thereunder of the Trustee, the Issuer, the Guarantor and the Holders of the Notes. Terms (whether or not capitalized) that are defined in the form below: Indenture and used but not otherwise defined in this Note shall have the respective meanings ascribed thereto in the Indenture. If an Event of Default (Iother than an Event of Default specified in Section 6.01(g) or 6.01(h) of the Indenture) occurs and is continuing, unless the principal of all the Notes shall have already become due and payable, either the Trustee or the Holders of at least 25% in aggregate principal amount of the Notes then outstanding, by notice in writing to the Issuer and the Guarantor (weand to the Trustee if given by Noteholders), may declare the principal amount of and Interest accrued and unpaid on all the Notes to be immediately due and payable. If an Event of Default specified in Section 6.01(g) assign or 6.01(h) of the Indenture occurs and transfer this Subordinated Note to: (Print is continuing, then the principal amount of and Interest accrued and unpaid on all the Notes shall be immediately due and payable without any declaration or type assignee’s name, address and zip code) (Insert assignee’s social security or tax I.D. No.) and irrevocably appoint _______________________ agent to transfer this Subordinated Note other action on the books part of the Company. The agent may substitute another to act for him. Date: Your signature: (Sign exactly as your name appears on the face of this Subordinated Note) Tax Identification No: Signature Guarantee: (Signatures must be guaranteed by an eligible guarantor institution (banks, stockbrokers, savings and loan associations and credit unions with membership in an approved signature guarantee medallion program), pursuant to Exchange Act Rule 17Ad-15). The undersigned certifies that it [is / is not] an Affiliate of the Company and that, to its knowledge, the proposed transferee [is / is not] an Affiliate of the Company. In connection with any transfer or exchange of this Subordinated Note occurring prior to the date that is one year after the later of the date of original issuance of this Subordinated Note and the last date, if any, on which this Subordinated Note was owned by the Company Trustee or any Affiliate Holder of the Company, the undersigned confirms that this Subordinated Note is being: CHECK ONE BOX BELOW: ☐ (1) acquired for the undersigned’s own account, without transfer;Notes.

Appears in 1 contract

Samples: Indenture (Kilroy Realty, L.P.)

TRUSTEE’S CERTIFICATE OF AUTHENTICATION. This is one of the Subordinated Notes of Civista Bancshares, Inc. First Northwest Bancorp referred to in the within-mentioned Indenture: UMB BANK, NATIONAL ASSOCIATION, ASSOCIATION as Trustee By: Name: Title: Dated: ASSIGNMENT FORM To assign this Subordinated Note, fill in the form below: (I) or (we) assign and transfer this Subordinated Note to: (Print or type assignee’s name, address and zip code) (Insert assignee’s social security or tax I.D. No.) and irrevocably appoint _______________________ agent to transfer this Subordinated Note on the books of the Company. The agent may substitute another to act for him. Date: Your signature: (Sign exactly as your name appears on the face of this Subordinated Note) Tax Identification No: Signature Guarantee: (Signatures must be guaranteed by an eligible guarantor institution (banks, stockbrokersstockbroker’s, savings and loan associations and credit unions with membership in an approved signature guarantee medallion program), pursuant to Exchange Act Rule 17Ad-15). The undersigned certifies that it [is / is not] an Affiliate of the Company and that, to its knowledge, the proposed transferee [is / is not] an Affiliate of the Company. In connection with any transfer or exchange of this Subordinated Note occurring prior to the date that is one year after the later of the date of original issuance of this Subordinated Note and the last date, if any, on which this Subordinated Note was owned by the Company or any Affiliate of the Company, the undersigned confirms that this Subordinated Note is being: CHECK ONE BOX BELOW: ☐ (1) acquired for the undersigned’s own account, without transfer;

Appears in 1 contract

Samples: First Northwest Bancorp (First Northwest Bancorp)

TRUSTEE’S CERTIFICATE OF AUTHENTICATION. This is one of the Subordinated Notes of Civista Southside Bancshares, Inc. referred to in the within-mentioned Indenture: UMB BANK, NATIONAL ASSOCIATIONN.A., as Trustee By: Name: Title: Dated: ASSIGNMENT FORM To assign this Subordinated Note, fill in the form below: (I) or (we) assign and transfer this Subordinated Note to: (Print or type assignee’s name, address and zip code) (Insert assignee’s social security or tax I.D. No.) and irrevocably appoint _______________________ agent to transfer this Subordinated Note on the books of the Company. The agent may substitute another to act for him. Date: Your signature: (Sign exactly as your name appears on the face of this Subordinated Note) Tax Identification No: Signature Guarantee: (Signatures must be guaranteed by an eligible guarantor institution (banks, stockbrokersstockbroker’s, savings and loan associations and credit unions with membership in an approved signature guarantee medallion program), pursuant to Exchange Act Rule 17Ad-15). The undersigned certifies that it [is / is not] an Affiliate of the Company and that, to its knowledge, the proposed transferee [is / is not] an Affiliate of the Company. In connection with any transfer or exchange of this Subordinated Note occurring prior to the date that is one year after the later of the date of original issuance of this Subordinated Note and the last date, if any, on which this Subordinated Note was owned by the Company or any Affiliate of the Company, the undersigned confirms that this Subordinated Note is being: CHECK ONE BOX BELOW: ¨ (1) acquired for the undersigned’s own account, without transfer;

Appears in 1 contract

Samples: Indenture (Southside Bancshares Inc)

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