EFTA00123688.pdf

Fec/25/2O14 5.40:04 PM Bank of America 7186871266 Y:8 Bank of America VP Personal Signature Card BANK OF AMERICA. N.A. (TIM 'ANK') with Substitute Form W-9 Account Number: Account Type DDA SAV K CD Account Title: Bank Number: a Individual Owner na NC: IF JOINT OWNERS, TOE JOINT OWNER SURVIVORSHIP MUST BE SELECTED ON PAGE 2. ALL OTHER STATES: IF JOINT OWNERS, SELECT FROM THE APPROPRIATE SURVIVORSHIP BELOW, U Joint with Right of Survivorship K Tenants by Entireties (POrm ofJoint with Right of Sarritorehlp for spousal co-owners atty.Nome DIAS% to Joint with Right of Sun/Wont:1p If state law does not recognize Tenants by Entireties tor balk accounts.) Check If designating beneficiaries: K Payable on Death (POD) / In Trust For (ITP) Totten Trust (Refer to Beneficiary Addendum for details) By Signing below, I/we acknowledge and egret that this account is and will be governed by the terms and conditions set forth in the iteMelat opening don:meets, including the Deposit Agreement and Disclosures and the Personal Schedule of Fees. I/we acknowledge the receipt of these documents. Uwe understand and agree that six Bank may change Mese documents at any time by adding new =MS, a ddeting or =ending existing tam. The Deposit Agreement includes a provision for jury tie! waver or reference to ajadicial referee. A Joint account with right of survivonhip is the property of each on...owner and payable to eithu CO-Owner or to the Wrviring co-owner(s) if a co-owner dies. By checking the box marked "ATM/Debit Card Requested?" Fyn hereby request an Automatic Teller Machine Cwd and/or a Debit Card. By signing below, line COO/Rata/ the ISSUanou of an ATM card and/or Debit Card to the other account holders indicated be/ow. By Wining below, liwe acknowledge sad agree that the signetore(s) will serve is verification for any transaction in connection with this account, and as the certification (Set forth below) of the taxpayer identification number (FIN). Substitute Font W-9 Certification — Under penalties of perjury, I certify that: (1) The number shown on this form Is the correct taxpayer Ides tlflatton number (or I am waiting Ibr a number to be issued tome): and (2) I am not subject to backup withholding because: (A) 1 am exempt from backup withholding, or (II) I have not been notified by the Internal Revenue Service (IRS) that I am subject to Stickupwithholding es g result of a failure to report all interest or dividends, 3r (C) the IRS has notified me that I am no longer stabJea to backup withholding] and (3) I aro a US citizen or other US person (Defined In the W-9 Instructions). Certification instruedons You must trots out Item 2 above if you bare beta notified by the IRS that you arc currently subject to backup withholding because you hare failed to report all Interest and dividends on your tax return, For real estate transactions, item 2 does not apply. For mortgage interest paid, sequisltion or abandonment of secured property, cancellation of debt, tOntribu dons to as individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the certification, but you mut provide your correct TLN. (Please refer to the IRS Instructions for Form W-9). The Internal Revenue Service does not require your consent to any provision of this document other than the certification requited to avoid backup withholding. K Nonresident Alien Status (If applicable) tf you end all of the joint owners of *It Nam an foreign persons, check bete and complete and sign she applicable Form(s) W-8, Tax TD Number RPt- Interest Oa Van% Printed Name Signature Date ATM/Debit Card Request? Cheek If Yu (Deo. Accts. Only) ?in 7 11 0 Ki 2. K K 3. K n 4. L...1 r K 5. ❑- K NNY 00-14.9295M 014014 n mut um EFTA00123688 Feb/252014 5:40:04 PM Account Number Bank of America 7186871266 4/28 mass NORTTI CAROLINA ONLY' JOINT OWNERSHIP TYPE. SaTIONt (VATS PROBATE CODE§439.NCOS gS3-I46.1) During the lifetime of the co-owners of the account, the Bank may pay the money in the account to, or on the order of, any person named on the account, Joint Accents can be with or without survivorship. With survivorship means upon the death of one joint owner, the money remaining in the account will belong to the surviving joint owner(s), and will not be inherited by the heirs of the deceased Joint owner er controlkd by the deceased owner's Without survivorship means if one of the owners dies, die deceased owner's ownership mteres: in the account passes es part of the owner's estate under the owner's will or by intestacy if there is no will. Joint Accouat Sun Ivorshlp Selection (Select One of the following options: all owners must sign end date): K Joint Account - With Survivorship/Tenants by Entireties (with Survivorship for Spouses) OR K Joint Account — Without Survivorship Clatter TaMrmetion Customer I AecountOvirer's Signature Dale Customer 2 Account Owner's Sinewy Date Customer 3 Account Owner's Signature Date Customer 4 Account Owner's Signature Date Customer 5 Account Owner's Siputure Date Custo Name US Inver License W/Phote Review Infounation Customer 2 Name. Review Information Customer 3 Name Review Inform/Ilion Customer 0 Name Review :nformetion Customer 9 Name Review :nformetion Bank Information Date Banking Center Name Associate's Name Associate's Phone Number 1/2014 CHURCH AVE AND OCEAN AVE Shaft Summers NNY 00-1e-9295M 01.2014 1011111111111111111111111111111IIIIIIIIIIIIIIIIIIII Faze 2 aft EFTA00123689