Type of ownership. (You must check one box) Individual Custodian for Tenants in Common Uniform Gifts to Minors Act of the State of: __________ Joint Tenants with rights of Survivorship Corporation (Inc., LLC, LP) – Please List all officers, directors, partners, managers, etc.: Partnership (Limited Partnerships use “Corporation”) Trust Community Property Other (please explain)
Type of ownership. ☐ Individual ☐ Joint ☐ Institution
Type of ownership. ¨ Individual ¨ Joint ¨ Institution
Type of ownership. (You must check one box) [_] Individual [_] Custodian for [_] Tenants in Common [_] Uniform Gifts to Minors Act of the State of: __________ [_] Joint Tenants with rights of Survivorship [_] Corporation (Inc., LLC, LP) – Please List all officers, directors, partners, managers, etc.: [_] Partnership (Limited Partnerships use “Corporation”) [_] Trust [_] Community Property [_] Other (please explain)
Type of ownership. (You must check one box)
Type of ownership. (You must check one box) ☐ Individual ☐ Custodian for ☐ Tenants in Common ☐ Uniform Gifts to Minors Act of the State of: __________ ☐ Joint Tenants with rights of Survivorship ☐ Corporation (Inc., LLC, LP) – Please List all officers, directors, partners, managers, etc.: ☐ Partnership (Limited Partnerships use “Corporation”) ☐ Trust ☐ Community Property ☐ Other (please explain)
Type of ownership. (Select only one.) Non-Custodial Ownership Custodial Ownership ☐ Individual — One signature required. ☐ Joint Tenants with Rights of Survivorship — All parties must sign. ☐ Community Property — All parties must sign. ☐ Tenants in Common — All parties must sign. ☐ Uniform Gift to Minors Act — State of — Custodian signature required. ☐ Uniform Transfer to Minors Act — State of — Custodian signature required. ☐ Qualified Pension or Profit Sharing Plan — Include plan documents. ☐ Trust — Include title, signature and “Powers of the Trustees” pages. ☐ Corporation — Include corporate resolution, articles of incorporation and bylaws. Authorized signature required. ☐ Partnership — Include partnership agreement. Authorized signature(s) required. ☐ Other (Specify)— Include title and signature pages. ☐ Traditional IXX — Owner and custodian signatures required. ☐ Rxxx XXX — Owner and custodian signatures required. ☐ Simplified Employee Pension/Trust (SEP) — Owner and custodian signatures required. ☐ KXXXX — Owner and custodian signatures required. ☐ Other — ___________________________________ Owner and custodian signatures required. Custodian Information (To be completed by custodian.) Name of Custodian: Mailing Address: City: State: Zip Code: Custodian Tax ID #: Custodian Account #: Custodian Phone #:
Type of ownership. If the Subscriber is individual: If the Subscriber is not an individual: ☐ Individual ☐ Joint Tenant ☐ Tenants in Common ☐ Community Property If interests are to be jointly held: Name of the Joint Subscriber: Social Security Number of the Joint Subscriber: Check this box if the securities will be held in a custodial account: ☐ Type of account: EIN of account: Address of account provider:
Type of ownership. (You must check one box) 1. [ x ] Individual 6. [ ] Joint Tenants with rights of Survivorship
Type of ownership. Individual
