KMHD Contribution Of Securities
2015-04-07
: Pdf Kmhd-Contribution-Of-Securities KMHD-Contribution-of-Securities support docs
Open the PDF directly: View PDF 
.
Page Count: 1
| Download | |
| Open PDF In Browser | View PDF |
Date: ______________________ Authorization for Contribution of Securities to KMHD PLEASE FILL OUT, FAX OR MAIL A COPY TO YOUR BROKER THEN FAX, MAIL OR EMAIL A COPY OF THIS FORM TO THE ADDRESS BELOW. Donor Name: _______________________________________________________________________ Address: __________________________________________________________________________ City, State, Zip Code: _______________________________________________________________ Phone: ________________________ E-mail: ____________________________________________ TO: Broker’s name: _______________________________________________________________ Brokerage firm: ________________________________________________________________ Address:______________________________________________________________________ City, State, Zip Code: __________________________________________________________ Fax: _________________________________________________________________________ REGARDING: Account Name: _______________________________________________________________ Account Number: _____________________________________________________________ INSTRUCTIONS: I hereby authorize and instruct you to transfer the following securities: Number of shares: ______________ Company Name: ___________________________ Via DTC from the above referenced account to: KMHD / Oregon Public Broadcasting Julie Arnzen, Leadership Giving c/o TD Ameritrade KMHD / Oregon Public Broadcasting DTC: 0188 503-977-7765, jarnzen@opb.org Account #: 875302770 7140 SW Macadam Ave., Portland OR 97219 OPB Tax ID: 93-0814638 CLIENT AUTHORIZATION: ___________________________________________ (Owner Name) ___________________________________________ (Joint Owner Name) ___________________________________________ (Owner Signature) ___________________________________________ (Joint Owner Signature) .................................................................................................................................................................................................................................................. FOR KMHD USE ONLY: Member # ___________________ SRC: ____________________________ Allocation: ______________________________ 12-13
Source Exif Data:
File Type : PDF File Type Extension : pdf MIME Type : application/pdf PDF Version : 1.6 Linearized : Yes Author : Julie Arnzen Company : OPB Create Date : 2013:12:23 17:13:07-08:00 Modify Date : 2014:12:18 10:25:18-08:00 Source Modified : D:20131224011135 Has XFA : No Tagged PDF : Yes XMP Toolkit : Adobe XMP Core 5.4-c005 78.147326, 2012/08/23-13:03:03 Metadata Date : 2014:12:18 10:25:18-08:00 Creator Tool : Acrobat PDFMaker 10.1 for Word Document ID : uuid:095f3d00-4b68-457d-9d56-00b98d5676fe Instance ID : uuid:527f37a0-28b3-4de8-b8e6-d0e528610f13 Subject : 2 Format : application/pdf Creator : Julie Arnzen Producer : Adobe PDF Library 10.0 Page Layout : OneColumn Page Count : 1EXIF Metadata provided by EXIF.tools