EFTA01298730.pdf

AUTHORIZATION OF POWER OF ATTORNEY
For Natural/Individual Persons For Brokerage Accounts and/or retirement accounts with DBSI
This Authoritation/Power of Attorney constitutes a non-durable limited power ofa ttorney, designed to
give a person or persons designated by you either limited authority over your Account(s) or IV full
authority over your Account(s) as set forth below.
NOTE: UNDER NEW YORK LAW, THE FOLLOWING DISCLOSURE IS REQUIRED TO BE INCLUDED,
VERBATIM, IN EVERY POWER OF ATTORNEY.
CAUTION TO THE PRINCIPAL: Your Power of Attorney is an important document As the "Principal: You
give the person whom you choose (your "agent") authority to spend your money and sell or dispose of your
property during your lifetime without telling ye u. You do not lose your authority to act even though you have
given your agent siniar authority. When your agent exercises this authority, he or she must act according
to any instructions you have provided or, when there are .no specific instructions, in your best Interest
"Important Information for the Agent" at the end of this document describes your agent's responsibilities.
Your agent can act on your behalf only after signabil the Power of Attooney before a notary public.
You can request information from your agent at any time. If you are revoking a prior Power of Attorney by
executing this Power of Attorney, you should provide written notice of the revocation to your prior agent's/
and to the financial institutions where your accounts ere located. You can revolts or terminate your Power
of Attorney at any time for any reason as long as you are of sound mind. If you are no longer of sound mind,
a court can remove an agent for acting improperly. Your agent cannot maim health care decisions for you.
You may execute a "Health Care Proxy" to do this. The law governing Powers of Attorney is contained in the
New York General Obligations Lew, Article 5, Title 15. This law is available at a law bray, or online through
the New York State Senate or Assembly wehsites, www.seriate.state.ny.us or www.assembly.state,ny.us.
If there is anythin.g in this document that you do not understand, you should consult with your lawyer.
AUTHORITY .
The gu dersig Principal (the "Undersigned" or 'Principal") hereby appoints:
u.if (y- Or v'_tk 1€ Ken as the Undersigned's *geniis) and attorneys)
imfact (" t(sr) to act INDIVIISUALLY with respect to any and all accounts, if applicable (see below) in the
Undersigned's name rAmount(s)1, held individually or jointly (provided that all joint account holders have
executers this faun) with DRS', as well as inthvidual retirement accounts bold for the benefit of the Undersigned
("IRAs"), with the authority to direct DBSI to buy, sell (including short sales) and othemise transact in any
security, including but not limited to stocks, bonds, mutual fund shares, limited partnership interests, call end put
options (covered and uncovered), on margin or otherwise, and any instrument. agreement or contract (elating
to same, on margin or otherwise, or enter into futures, options on futures and forward contracts, interest rate,
currency equity or commodity swap transactions, deposit accounts at finandal instihrtione and direct co indirect
interests in securities, deposit insournents or contracts where all or part of the return is calculated by reference
to changes in. among other things, the value of securities, commodities, currencies, interest rates. property of
any description or indices, in each case in accordance with ()BSI's terms and conditions for the Undersigned's
account, account type, and risk and in the Undersigned's names, or numbetts, on rink books. Agents) must
exercise the authority granted herein pursuant to the Undersigned's instructions, or otherwise for purposes
which the Agent(s) reasonably deems to be in the Undersigned's best interest. By giving this authority, the
Undersigned authorizes Agent(s) to make inquiries on the Aozourit(s), inchiging requesting information about
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account transactions. balances and holdings,
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The Undersigned try signing below contras that he/she Ms teed the contents of this Power of Attorney
and understands same, and has executed this Power of Attorney of his/her own tree will and has received
advice about the effect of this Power of Attorney from his/her advisers as he/she has deemed necessary or
advisable.
In witness whereof, the Undersigned has executed this AuttOriz, ion/Power of Atto
Date: 10.47/ Signature: / I
,
Print Name: r
• (the "Undersigned")
TO BE EFFECTIVE FOR JOINT ACCOUNT(S), ALL ACCOUNT FOLDERS MUST SIGN:
In witness whereof, the Undersigned has executed this Authorization/Power of Attorney.
Date: Signature:
Print Name:
(the "Undersigned")
This section intentionally left blank.
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gy SIGNING gum CUEN T ACXNOWLEDGES THAT: il ) CLIENT 4AS RECEIVED, READ AND AGREES TO Mt TERMS AND CONDITIONS OF THIS '
ACCOUNT AGREEMENT, INCLUDING THE APPENDIX WHICH CONTAINS IMPORTANT INFORNIA710tt AND TA 11* INFORMATION CONTAINED IN THIS
ACCOUNT APPLICATION IS AccuRATE,
CLIENT ACKNOWLEDGES THAT THIS ACCOUNT AGREEMENT CONTAINS A PRE-DISPUTE ANIMATION CLAUSE AT SECTION IR, PAGES, AND Cleft
AGREES TO TERMS (ALL ACCOUNT AGREEMENT SIGNATORIES M UST IlvniALJ,
4192KHENI —
THE INTERNAL REVENUE SERVICE DOES NOT REQUIRE CLIENT'S CONSENT TOMMY PROVISION OF THIS COCuMEHT EITHER THAN THE CERTIFICATIDM
REOUiRED TO AVOID BACKUP WITHHOLDING, AND, IF APPLICABLE, THE CERTIFICATION REWIRED TO ESTABLISH CLIENTS STATUS AS A HO-NU.&
PERSON AND MAN A REDUCED RATE OF WiTHICLOI NG.
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Important into:mason for EAI SA employee bay* pion Serer U.S. Osperovierk al Labor regulations require OBSI to disclose los responsive pan /lc notify
catein Women, In corneWon with the =vices that DES provides to a plan, to assist the fiducery ifvaluating the reasonableness ofOBSI's tervices end
rested canonisation. The disclosure is svafable mare. at Mtp./Nmerrysm.rb.cornfrenarteilerVeristrkdosum_pm.html. By signing below. you asknorMige
met you ere a thmisry respartsitta lot tie prawnm ent of OBSI's earners tolls On, you have read the tlistiosure end yOti understand the Socloswit.
Inilkildual or joint saccitmt (IF THIS IS A.)31VT ACCOUNT. ALL ACCOUNT OWNERS MUST SIGN):
CONFIRMATION OF TAX AND COMPUANCE RESPONSIBILITIES
Client astranyledges having rids remonntiity to hid arry taxobligations and any other rciatiatory moonlit:9 duties applicable in arty relevant i Suit:Sons Het
they visa In conneaJon oath assets, inoNne or trareraCdCM In Mars scommtle) arid bunnest wiattonahlp with DITSI.
1:NEC:KAI= BELOW ONLY IF CLIENTS DO NOT WANT JOINT TENANTS VVITH FUGHTS OF SURVIVORSHIP OR TENANTS BY THE ENTIRETIES.
CLIENTS SPECIFY INSTEAD:
Il Tenants in common: or
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CONFIRMATION OF TAX AND COMPLIANCE INDPONSMILTTIES
Client adowneedges having sol e rosponsatatty to t, A any Tex °Skein and any otter mgt./atm reporting duties applicable to et any relavart prisdmicim
that may ate if commotion with assets, income or transactions in Clerr's accountir.) and buslrea reladmr.hip with Dn. Funhamore, Client COfffliffl Vol 0tO I
Necessary insommtion (to the brat of Cases inmate* end capeNlitimi b made naive no Ian thaw =nu* to the Swint beneficial OWIlar(*. miliaria,.
baneficiaritieal. permeris1. at. to enable MST persordal to Titre any wasmalve tax obligations that may seise for such perscnall In comb:Son With Cita*:
plains reauonsro %so yes.
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