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form Is Stie correct tax idealkason rwreber and (2) mot the Demmer is not Subject to baZkup vaihnoldng either because. (a) it has not been meted by the Internal Revenue Service (IRS) that it is subject ho wevrowing as a remit of failure to repot all interest or corwlarels. or (o) that the IRS has named Ole Depositor that an
l tii Wm Twee*" own 71.,.... 0 ono Enos., LI Mincer •Cwas.wonn Ortwt 0 .00 5c •••••••au eve. Ow AtXfin. • now". Onnos a v., Jame ••••••••• • Amato tate jai:in* oalot Elmo .141.1e1:10m nos.. valloeuna a• Den O.PriSke ../.•wM at 1,•••••••• CONFIDENTIAL FsteapR000466 SO NY_GM_000 13303
u with an updated year-end valuation in January 2018 This 2017 yearend value of your IRA (or the updated value, if applicable) will be furnished to the Internal Revenue Service. December 29 value $57,676.64 Beneficiaries you've named for this account The beneficiaries listed below reflect the information in our records a
endly account name: Imlay. IRA Account type: Indisodual Retirement Account Account number: Your /I sandal Advisor: SCOTT STACK MANILYLE CASRIEL Amato IS) Feb 7 Interest UBS BANK USA DEPOSIT ACCOUNT AS OF 07/0918 0.30 Total interest Total dividend and interest income Investment transactions
furnish Secured Party: a) a copy of Grantor's federal income tax return with all schedules attached thereto at the time such return is filed with the Internal Revenue Service and in any event within 120 days of the end of each calendar year: b) promptly, such additional financial and other information as Secured Party m
RESS ATTENTIONI Read the following statement before signing this application. This portion MUST be completed. A ape acisImen May IO any MOM in the Amato, MO/ IN °Munq te puns/tended by Na 2.511.0. vninonment 0 RIG Co* rap la sac tool) CERTIFICATION weE C E ROA.. III Thal Ins Pop swat • Omen by t
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