oh UBS UBS Financial Services Inc. Account Number & Check here if this document applies to multiple accounts. Letter of Authorization for Duplicate Recipient of Tax Records This letter authorizes UBS Financial Services Inc. to send a copy of your tax form for the below accounts) to the following Account Number Account Number Account Number interested party(ies). Such authorization will continue for ten years unless terminated by UBS Financial Services Inc. or until you notify UBS Financial Services inc. in writing of your decision oo Oe - ES to terminate the mailing of your tax reports to the parties below Account Number Account Number Account Number Be advised that the service only pertains to your form 1099, TO99R or 1099Q. If you are eligible to receive a different tax Account Number Account Number Account Number 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 Laura - a __Barooshian First Name Mid Last Name Address Line 1 Address Line 2 City —— ~ State Zip Email Address Phone fcr: shislaine Maxwell x x Account Owner First Name Last Name Account Owner Signature Date 0206602695 " AC-DPT (Rev. 10/11} ©2071 UBS Financial Services Inc. All rights reserved. Member SIPC Page 1/1 CONFIDENTIAL UBSTERRAMARO0003243 EFTA00238622