EFTA01268275.pdf

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Account Transfer Form
10 Amerltrade
Mail or Fax to:
PO Box 2760 • Omaha, NE 68103-2760
Fax: 000-400-0200 Receiving Firm DTC Clearing Number: 0188
Please use the Direct Registration System (DRS) Transfer Form TDA 100557 for transfer from a transfer agent.
Instructions: Attach a complete copy of your most recent statement, of the account you are requesting the transfer from,
(dated within 90 days) in order for the transfer to be processed. Please submit the completed form to TD Ameritrade Attn:
TO Ameritrade, PO Box 2760, Omaha, NE 68103-2760 or fax to RFA-468-6288. To submit the completed and signed form(s)
electronically through our secure Message Center, scan it, along with any other material you're sending. Then log in to your
account and go to Client Services > Message Center to write us. and attach the scanned document(s) to your message.
"if you are requesting to transfer from your Qualified Retirement Plan, please contact your plan administrator; this form may not be required.
It you are transtemng between two Ur Amentraoe accounts, please use tne Internal transfer corm. Please note you cannot use this fowl
to transfer from a standard checking account and/or sayings account from a banklcredit union. For IRAs, and Beneficiary IRAs where the
original owner woo 70% yon or older at death, plane attach a copy of your end of year statement to enable us fo calculate the required
minimum distribution for the account.
1. ACCOUNT INFORMATION 2. PLEASE PROVIDE INFORMATION ABOUT I HE
DELIVERING ACCOUNT
Your TD Ameritrade Account
(The registration of the account being transferred should match your (As Wetted in section 7 DOM registration and Tax Ms for the
TO Ameritrade account and the Tax ID for both the TO Ameritrade TO Ameritrade account end account being transferred should match.)
account and account being transferred.)
Account Number (Required): Account Number (Required):
(qtly one per form) (Only one per form)
Amount Reoidnatinnifitle. AccouN Registration/Title:
SOUTHERN FINANCIAL LLC SOUTHERN FINANCIAL LLC
bar: Social Sacurity/Tax ID Number.
te3 umhar Social Security/Tax ID Number:
(Secondary, It applicable) (Secondary, if applicable)
ConlrotOeivenna Ron Name (PeKtuire40:
Account Type (select one)
DEUTSCHE BANK PRIVATE WEALTH MANAGMENT
Olndividual - (Non IRA) El Traditional or Rollover IRA Contraajollvoting Ran Maroon:
DJoint El Roth IRA 345 PARK AVE 26TH FLOOR NY,NY10154
DTruet
CI Beneficiary IRA C floWhorl:
I:ICOVBUSineSS q Beneficiary Roth IRA
DUCMNUTMA CI
Qualified Flon (401k, 403B, PER oto.) Contre/Defivenno nrrn Lmo
O
I:IEState SIMPLE IRA
q 3EP IRA
00ther: Account Type (select one)
o
-(Non IRA) Traditional or Rollover IRA
0JOint CIRom
IRA
oTrual q Beneficiary IRA
I:Corp/Business q Beneficiary Roth IRA
OUGMANTMA q Qualified Plan (401k, 403D, P£R etc.)
oEstate
q SIMPLE IRA
o3EP
IRA
ElOther:
lf the registrations do not match, you may either establish a new account online at wwwtdameritrade.com or you must supply additional
documentation end oil delivering account owners must ego coot:on 4. For unlike talelregietratIon transte4 please call the transfer department
at 888-723-8504, option 4 for additional requirements. 'Please note if there are any issues with processing your transfer, we will communicate
that to you via your secure message center when you log in to your account.
11111ln MIMED HI
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From: "KOFAX PROD PROCESS"
Date: Mon, 25 Feb 2019 15:57:39 -0500
To:
Subject: ACAT transfer from DB //- messagelD=103743614 //- case ID=S8157869
Attachments: Attachment_20194566.zip, Attachment_20194567.zip
From Address:
Message ID: 103743614
Case ID: 58157869
Form Message
FULL NAME: Richard Kahn
ACCOUNT TITLE: SOUTHERN FINANCIAL LLC
USERID: 867730320z
ACCOUNT NUMBER: 867730320
User-Agent: Mozilla/5.0 (Macintosh; Intel Mac OS X 10.13; rv:65.0) Gecko/201C0101 Firefox/65.0
ENVIRONMENT: investameritradecom
attached are two forms with securities we would like to transfer from DB to TD. Thank you and please call me with
any questions.
[ Attachment I Type: application/pdf Name: TD_Bank_ACAT_transfer_fromDB_2-25-2019_I_of 2.pdg
[ Attachment 2 Type: application/pdf Name: TD_Bank_ACALtransfer_from_DB_245-2019_2 of 2.pdfj
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rD Amentrade Accr a 867 730320
3. TRANSFER INSTRUCTIONS-PLEASE COMPLETE ONLY ONE OF THE FOLLOWING SECTIONS (A,B, OR C)
A. BROKERAGE FIRM TRANSFER (Unless otherwise indicated, TO Ameritrade will transfer in Full)
['Full Transfer—To transfer entire account. check here and skip to Section 4.
['Partial Transfer—List specific security and/or cash amount below. If bonds are being transferred, please supply the CUSIP.
Only whole shares can be requested as fractional shares cannot be transferred. Please contact the delivering firm regarding your notion*.
Asset Description (CUSP or symbol) Quantity Asset Description (CUSIP or symbol) Quantity
(Partial Traersfeer Only) (Indicate rt of whole shares (Parkal Trans/0m Only) (Indicate 1 of 'shale shares
or 'AGO or ALL')
1. 04621XAK4 2,000,000 5. 30102RAA9 3,000,000
2. 172967J25 3,000,000 6.361860208 80,000
3. 172967341 79.000 7. A29866AB5 2.000.000
4. 17453BAW1 1,000,000 8. 46625HHA1 5,760,000
B. BANK/CREDIT UNION & ANNUITY TRANSFER
Transfer cash only. Unless otherwise indicated, all cash will be transferred. Banks, Annuity, and Trust Companies require Original
Client Signature. Please mall the Original form to complete the transfer request.
IRA Savings Accounts-Typically held with Bankleredit Union.
OTotal Transfer (Transfer entire account) ❑Wire
gees may aPPY/
['Partial Transfer (Transfer part of account) Portion to transfer $ 0 Check
Certificates of Deposit (CDs).
['Redeem my CD immediately.
l am aware of, and acknowledge, that 1a m responsible for any penalties that I may incur from any early withdrawal.
ORedeam my CD et maturity. Maturity Date:
Submit request at least 21days prior to maturity Please advise your bank not to roll over your CD to a new term.
Indicate in this section whether you wish fo liquidate the CD immediately or at maturity For any Investment instruments that have a renewal
deadline, maturity date, surrender charge pertodlwindow etc., paperwork must be received by TD Ameritrade in good order three weeks
prior to the firm deadine to allow for proper processing times. To liquidate a CD held in a non-retirement account, contact the bank or
credit union at which the assets are being held.
Annuity Transfer
['Transfer my Annuity
0 Full El Partial $
0 WIN
I have an annuity policy that I wish to transfer. Please redeem and terminate on my behalf q (fees mayamay)
n
I am aware of. and acknowledge. that I am responsible for any penalties that I may Incur from Check
any early withdrawal.
Select only one: Ufit/ate annuity in full or partial liquidation. If partial is selected. amount for partial must be included.
TO Ameritrade is not responsible (or the liming or execution of liquidations processed by the delivering firm.
C. MUTUAL FUND COMPANY TRANSFER
Check box for In-kind or Liquidation Transfer. Please list the Symbol or CUSIP for the Mutual Fund s) you wish to move.
Unless otherwise Indicated, TO Ameritrade will transfer shares in-kind. This section pertains only to shares of Mutual Funds held directly
vrith the fund company, for brokerage accounts containing Mutual Funds andAtc Stocks please complete the Brokerage Firm Transfer section
(bestial 3A, above).
'Proprietary Mutual Funds and all no-load Money Market funds cannot be transferred in-Idnd and must be liquidated.
Quantity Handing Gains & Dividends
Fund Name or Symbol Mutual Fund Account 4
(Incises a of shams or IM17 (Cheater ono) (Chock one if k:-kind)
• In-Kind ■ Reinvest
• Liquidate U Cash
Din-Kind CIPeinvest
0Liquidate °Cash
Ill In-Kind OReinvest
['Liquidate • ash
'If you are transferring more funds than will fit above, please include on attached list for the complete list of funds.
OWIre
'A statement MUST be included to ensure proper handling and processing of your Mutual Fund transfer (fees may apply)
' Unless othenvise indicated, I authorize the Transferor to achartate any non-transferable propnetary money market OCheCK
and mutual fund assets that are part of my account and to transfer the resulting credit balance to my account with
TO Ameritrade. If the fund is unable to be held by TDAmeritrede, I (please initial hare) authorize the Transferor
to liquidate and transfer as cash.
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TD Ameritraae Acct a 007-730320
Registration Difference
for unlike titled or type transfers, such as Individual to Joint. I authorize the transfer from account to account.
All parties on the delivering account must sign below. All TD Ameritrade parties must sign in sectica 6 for transfer authorization.
Xtalent signature: Date:
Xcam, signature: Uate:
Cana 31ggialtsie. Date:
5. ONE AND THE SAME LETTER (IF APPLICABLE)
If you are transferring an account, and the name(s) at TD Ameritrade do not exactly match but are stir one and the same person. please complete
this section. Tries section snout° De utilized rf your name has cnangeo due to one or more of me fottowIng: MaMage, Divorce, Name Spelling Error,
or any type of Name Change including Jr, Sr, etc. If last name difference, must supply legal documentation: that is, slate issued driver's license,
passport, or government ID. (Please specify account typos, such as Individual to Joint)
(please print name), am One and the Same as
(please print name) as shown on the delivwing firm account. (Please specify account typos, such as Individual to Joint)
Please sign name BOTH ways.
XSignature: XSignature:
6. TD AMERITRADE CLIENT AUTHORIZATION (REQUIRED)
All TD Ameritrade account holders (clients or trustees) as indicated by the account reeistration must skin this section.
Unless otherwise indicated in the instructions above, please transfer, in-kind, all assets into my account with TD Ameritrade. I understand that
the extent any assets in my account are not readily transferable, with a without any penalties, such assets may not be transferred within the time
frames required by applicable regulations. I understand I will be contacted by the carrying and/or receiving firm with regard to any assets that are not
transferable. I authorize the Transferor to deduct any outstanding fees due to transfer from the credit balance, or if the credit balance in the account
is insufficient to satisfy any outstanding fees. If certificates or other Instruments In my account are in your physical possession, I Instruct Traisfuiu, to
transfer them in good deliverable form, including affixing any necessary tax waivers, to enable the successor custodian to transfer them in its name
for the purpose of sale, when and as directed by me. I understand that upon receiving a copy of this transfer instruction, for a full arra, nt transfer
Transferor will freeze my account and cancel all open orders. i also understand That no new orders mayNvill be taken. I affirm that I have destroyed or
returned 10 the Transferor all credrt/debit cards and/or unused checks issued to me in connection with my account.
If this TD Ameritrade account is a qualified retirement account, I have amended the applicable plan to designate the successor custodian.
Aitematively, if this TD Ameritrade account is an Individual Retirement Account (IRA),
I have adopted an IRA plan so that it names the successor custodian. (Medallion Signature Guarantee - For TD Ameritrade Use Only)
XClient Signature: Date:
XCo-Owner's Signature: Date.
XCade-noes Signature: Dale
Co-Owner's Signature Data
7. LETTER OF ACCEPTANCE (FOR OFFICE USE ONLY)
The andth eig ned aganizarior agrees to serve as successor custodian for the account of the above-named individual, and as custodian, we agree to
accept assets being ben erred.
XRel7intative Signaler Dace: (Medallon Signature Guarantee - For TD Amer:Made Use Onty)
Z./25720/q
Reeresentathe Printed
For TD Amerltrede Cls6ring, . use only
Please be advised tha TD eritrade Clearing. Inc. is an 'Approved 403(b)(7)
Vnntine and/nr has ant ri into an Infnrinatinn Sharing Agreement with !ha Fmpinynr
for the above-captioned 403(b)(7) account. The Employer/Agent Signature above
hereby authorizes TO Ameritrade Clearing. Inc. to accept this exchange.
Investment Products: Not FDIC Insured ' No Bank Guarantee ' May Lose Value)
TD Ameritrade, Inc. and TD Ameritrade Clearing, Inc., members fINRNOInC. TD Ameritrade Is a trademark jointly owned by
TD Ameritrade IP Company, Inc. and The Toronto-Dominion Bank. 2018 TO Ameritrade.
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