UBS Financial Services Inc. UBS Account Number
UBS Financial Services Inc. UBS Account Number
❑ Check here if this document applies
to multiple accounts
Letter of Authorization for Duplicate Recipient of Tax Records
This letter authorizes 1)85 Financial Services Inc. to send a copy of your tax form for the below account(s) to the following interested paity(ies) Such authorization will continue for ten years unless terminated by UBS Financial Services Inc. or until you notify UBS Financial Services Inc in veiling of your decision to terminate the mailing of your tax reports to the parties below.
Be advised that the service only pertains to your form 1099, )099R or 1099Q. If you are eligible to receive a different tax report, this will not be sent to the below parties Also be aware that if you are a beneficiary on an account or a participant of a qualified plan, you are not eligible to enroll the account to send duplicate tax information to a third party
Interested Party Information (may select up to four)
INTERESTED PARTY
Alan
Fist Name
Address Line 1 Blether
Middle Name Last Name
Address tine 2
City State Zip
Email Address
islaine
Account Owner First Name
AC-DPT (Rev 10(1 I) Phone
0159495149
O2011 UBS Financial Services Inc. A I rights reserved. Member SIPC. Page if'',
CONFIDENTIAL UBSTERRAMAR00002180
EFTA00237759