UBS Financial Services Inc.
UBS Account Number
21 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 accountfs) 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
to terminate the mailing of your tax reports to the parties below Account Number Account Number Account Number
Be advised that the service only pertain to your form 1099,
1099R or 1099O. If you are eligible to receive a different tax Account Number Account !timber Account Number
report, this will not be sent to the below parties. Also be aware
that it 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 fax)
INTERESTED PARTY
Laura Barooshian
First Name Middle Name Last Name
Address Lire 1 Address Line 2
City State Zip
Email Address Phone
SI(7M -hislaine Maxwell X
-bikr Account Owner First Name Last Name Ar.(9:011 OM SRIid:We Date
0206602695
;Rev ion 11
titingENEENI
O2011 UBS F nanoal Services Inc. A I tights r sent d Memver s'" P 90 1/1
CONFIDENTIAL UBSTERRAMAR00003243
EFTA00238622