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HomeMy WebLinkAboutPaine Webber FI Ferry Dist SS#/TIN : Se~ect'~he type oi?:;nership:. ~ O rga'nlzafioni'Bu sine. ss Stnucture: EndowmenL type of Plan El P[ont Shad;,g E]Xvfeney Purchase , :L[4~l(k) LJSI]VIPLE 4~1 (k) .~ Char~er-S&L Bank ~fined Benefit LITarge[ Benefit ~ Charter-Savings Bank L_JEmployee Stock Ownership Plan (ESOp) ERISA Ptan$ must alsc~ complete the UBS F'e~eWebber Trustee Certification for ERISA Trus[s. ]~ there more than one Trdstee for this account?l'-]Y'es[-'l No Ifyes, specify flow , the~ complete the Accoudt OWnership information An .,o[ nt~llor~lnr ,: ~;3095 ltoute 25 D~ i~nco[~r~ted ~ U~mcorporafed 2)D For Profit ~ Not For ~oflt ;; ~0 BOX ~ ~ 79 P;u'liCilmnl Dlrn(:lod eRISA Plalm Only ,~ ii .' ' · : . · ., ., . . ' ,' 1~ s w/l ensure ha ~e pa~t c pant race yes a d~,~o~y et a rad~ conhrmat ons and statements. Middle Name: .est Name: SS#: (If teen-U.S, and no SS# specified) / ~tate: Finan~cia[ ~ormation (This information will be participant[fp~ a padicipant directed ERISA Ptan account. AnnUal ln~r~e: ~Liquid Assets: I Net ~oKh[ (exclusive of residence) Fiscal Year End: (indicate mon~) Inves~ent'~perience: (fe years) Equities __ Bonds __ Futures ~ Options-Buy ~ Options:Bell , , tGender: ~I [] Male [] Female El Widowed Self-Employed E]Student []Unemployed industry (i.e., Construction. Service, BUSiness Fax: experience are only required for options/futures accounts, ~ tTnahc a firms wh~re ether accounts are hek] : ! ' ~nciel Services Reference -Firm Name: :f'¢pncial Services R~ference - Firm Telephone Number: OAO-CL-BSA (BEV. 11/02) ©2002 UBS PaineWebber Inc. All Rights Reserved. Member SIPC. Principal Officer/Trustee Information Com~i~te t/ils s~cgo~ ~r' tbs Principal Officer f~r an Organize/ion/Business. Et.US~ ~!an truklee."~r'oth4r indMdua[ auffi~ri~d to gi~e investment or distribulion~ransfer instructions on zhe ac~unb Additional name~ ~n be added on page 5. 1 Officer/Trustee Name: Joshua Y. lto~ton 117-66-2894 Cfazenshie: e of Birth: (specffif)Z [1972 and Green Card~. (lf non-O.& and r~2 SSC¢ specified~ ~ (Home-Legal Residence) 26 Sterling Cove (63t..!.!:i/- /(,~ } j?_,?i~..1.?.~i.¢r~ ........ any Trustee or Director/Principal Officer. or any of his/her immediate family members, a Control Person of any publicly trad- (examples of Control ?arsons are Policy Making Officers, ; or 10% shareholders)2 :DYes ElNa - [f yes, speci~ cordpany securities firms or other financ~a! inst~u§ons (NYSE Rule 407~ es, please spec'r~ the, firm: ec any Trustee or DirectodPdncipal Officer. or any of ~mily members, an employee of UBS AG, its sub- UBS PaineWebberlnc., UBS Warburg LLC)? if yes, please specCy: EMogf~y~M~Er,~ por¢olio ~e~ J~,f~s~y Municipal Fund ~,;:Cal~fpr~i~t~u n~cipa~ RJnd } Ynves/ment ~pdons: [] New York Municioal Fund Tax-Free Fand U.S. Government Po~olio indicate the your name(s) exceeds 24,characters, iacJudJng spaces, please indicate de~ your nam~.(s) shaui~ appear Cnot exgeeding 24 characters~: so/d by prospectus only and other sweep documenfs. Tax*free and munici- Funds Transfer (EFT) Service ney electronically between Please refer ~o the Account information booklet h ResourceLine®. the toll-free tele- Please note: To b'ansfer your funds e enrolled in Orline.Ser~ices. Camelots theaccoun Electronic Funds Transfer Addendum on page 7. leck Writing f you would tike [o receive cheeks for your account, please enroll by check style: Walter~ [] 3-page business [] Other2 Initial order of wafts! checks is free. All other o~ders involve a fee. To order a different check style, please contact your branch office. the full name and address that you would like to appear on 3 Bill Pa3(~,pent Sorvico r-'¥oice ¢¢~.~nse ~ystem. Please note: To pay your bi,s online I eer~J~,iD o~line servi~s. ~mplete the Vendor/Payee J in~or~online. address for delivery of checks, if different from address on OAO*CL-BSA ('REV. 11102) ©2002 UBS PaineWebber Inc. All Rights Reserved. Member SIPC. Account Number I SS,~/TiN:F Basic Account Sweep Options - ERISA Plans Direct Deposit Please select a money market fund for sweep of uninvested cash if you ~ If you would llke to have your payroll or other recua[ng payments auto- ~ave not chosen any tJeair~ss Servlces Account BSA features, Your maficalb] depeaifed into your account, please check this box. mceant will automatically clefaLdt tp the Ratkemest Money Fund unless Complete:the Direct Deposit Application on page 9 and send it to the you select Cashfund~ below or elect nolte hayea sweep feature, employer, organization or financial instttutior~ making the deposit. UBS PaineWebber Cashfund* Ol~in,~ SerVices UBS Pain eW~bbe~,Re~tirem~ent Money Fund* ~ Check hem fer online access to account information, the latest L~ Check here if you do not w~nt ar0] sweep feature, research and market dale at no add,earl charge. Premier accounts UBS Pain'er/Ve6ber R~etirerneot Money Fund and UBS PaineWebber are enti~Jed to this, so.ice, including Bus[ness Sefvioss Ac¢ofint BSA, Cashfund,,fn~aresot~bypfosp~ctusonly. Resource Management Account® (RMA®). and Managed Aosounts_ Basic Acc~i,Sf- SWeep Options DUplicate i~you ,fl~, vei',~n°_~ ,h;°Se~t 'ar~; 'B'ushe~s Serv~pes Acc°uot 'BSA features y°ur -/,..JO~eckhe~.,effy~crWdefd~ii~edupr[catetradeconf[~mationsand ~ Check h:er~, f~ you dc- N~O~T want'U BS:Pai~eW~bber C~shfund. staterooms ~ent'~di~eaaI indiVtduals. Margin" ~]Oheck be~'etf yea ~lo not want margin, if your account will have margin, you are~require~i to answer th9 fcikiw~ng question: )~ youint~d te uno, ge in "patfem day trading" as defined by NYSE Ru1~431:- [] yes~] Ne ~arg~ /~,~? su~ble for al~,cfient& Please review UBS PatheWebber's Lean Disclosure Statement carefutty for inthrma ion on the risks thvo/vnd with ** "Da~lrao?~g" mee~s purcO~sing and selling or selling and purchasing the same security i~ the same day n a margin account. "Pagern day tradthg~ [~eriod~, 3aturr~. OI~e~;t[ve (select o~e): ~Ca~ita['~[~preciatfon- tnvestmenta seeking growth of principal rather than,the g~nera[ion of income, ,~Cu~'en~ ~acome ar~J Capital Appreciation - Investments seeking both the genera[ion of income and the growth of principal. .~i hi~i~ de' ,9~.e of [o~ of p~in¢lpa[. _JModerate ~Mo,,d~ra~~ Seeks poter,iia[ returns with a lower risk of loss of principal. "L~Ceaservative ~C~,.se~iye - Seeks,s~e~Qd~ies that are most ~kely to preserve pr ncipal w th Iow risk. the participant should complete this section. ' i§ ihe beneficial owners, trustees, power of attorneys ur other individuals wtth authority to effect transac~ ti~s,, ~ family members (including indaws) or close associates (persons they are "widely and publicly known" to maintain an ueaea i current or former senior non-U.S, politiCal official? E~Yes E~No If yes, please complete the following information: Poli!i?al official's Name Current or Forme¢ Position Relationship to Client(s) E~lnh~ritance - From whom; ~]Gifts - From whom: OAO-CL-BSA (REV. 11102) ©2002 UBS PaineWebber [nc_ Att Rights Reserved. Member SIPC. BY S GN NG BELOW, ACCOUNT HOLDER UNDERSTANDS. ACKNOWLEDGES AND AGREES: 1. that UBS PaineWebber does nol provide legal or tax advice: 2. ~at in accordance with ~e last pa~graph of the Maste[ Account Agreement entitled "Arbitration" the Account Holder agrees in advance to ar~trate an7 controversies which may ari~ wi~, among others, UBS PaineWebber i~ accor~nce w~h the terms outlined therein: loaned to UBS PaineWebber or to others; 4~ if no Business Se~[ces A~uni BSA ~atures have been sele~ed, the account w[)[ be opened as a tfe~ Of~e ~er A~o~t Agree~ 6. ~at ~S painewebber will qot supply the, A~punt Holder% nam¢ to i~ers of a~y ~ec~Oes he,.in the account so.~.~o~t ~o~ wllF not re~ve,ipfo~a~o~ regarding [h~e secarffi¢~ ~re~]~ fro~.the issuer, b~ r~he{ ~1 ~ceive i~o~a~on from U~S ~aineWeb~ in~ead,. ~n1¢~ A¢cou~ Holder 8ot~ UBS PaineWebber in ws~hg o~e~ise; 7. ~¢ fhe A~ognt Holder bas re~ived ~ read a copy Of the a~hed M~A~un'~A~re~e~ and a~[ees ~ be b~nd' by the terms and co~ditbns ~ntained there A (which ~rms and cp~dj~ons are , ..: . · ..... . UBS PaineWebber ~n ~¢ti~¢.~ any ma~l ~ ~nc~ng ~ose,~¢he ~nahdal situ~fon or .. t~- S~teme~ ~ C~ t Pr~ ~es~]M~ gt~t charge~ the ~ I P~ment aa~ ~le~onic ' '~ '" ~ ' ~.', ", '¢~.. ) ~'".', ' ' ' ('¢,9,' ," "'.':,.,'"""F'; ',': ' ' ....................... ' ..... """ ......... ,. -' ..?' .' . :,m:!. ':'i ' . . " ".'"' ..i" ' : . .. '!.' ! ' '' : '" x × X Additional Trustee/Party Signature Date PnntAgent N~me The pa~dcipanl of a participant directed ERISA p/an is reou"eC to sign above.) ~' )¢ ', IAgent Signature Date X X Branch Office Manager Temporary Aoorova~/Dafe Branch Office Manager Final Aoorovai/Dafe X Financial Advisor ~ }reval/Date s the FA reg stered in both the client's state of resMence and mailing address? E] Yss [] No ~ Init al Tradb What was th? initial transaction for this account? 1~ Buy [] Sell [] Deposit [] Transfer of Accounts ~. Security Name: How was the account obtained? ~l Walk-In El Referral: Interest/Dividends: UM~)nthly •Weekly E]HoldinAccount Account Sel~lrs: [~ Assets n Apcount l~ Equity DVP t~ Government DVP [] Transfer/Ship Security Symbol: Loan,Eligible: ~]Yes [] NO Value: $ Please Note, f the Account Holder, or their immediate family members; are affiliated with a securities firm or or financial ~asgtutfen (NYSE Rule 407) a letter of atdhorization from the firm specified must be obtained Shares: before ~he account can be opened, ~ BG~] F~] LGFI MLE] W9FI NB SweepFuDd: BankCode: Plan Cede: AssocCode; ¢lanaged Ac~J~unt Code: Fami~ of Account ~ode: Plan'Stmct~re: ~ (P)Pooled [] (NiNon-Pooled Plan Setup: [] (P)Padicipant [] (N)Non-Par[icipant If p an se up s P, enter employer s account numberF__ - -- UBS BASIC INVESTMENT ACCOUNT AGREEMENT Authodzation If Cbent did not choose any UBS PaineWebber SSA fea- tures o~ the ADI3bc~t]on. Client hereb, recuests that UBS PaineWebber open a Basic Investment Account i[~ Client'~ name. Clien[ understends lhat the r~quest to open ~he'Acc6unt is $05ject to ~e receipt of a signed Appt ca on and the epprova~ of UBS PaineWebber, Clm~ w~l auto- 5~9 Pia~ Account~, gBS PaineWebber m~y at any time wTth or w~out, cause~ in its sole discretion, termlnale this A~me~t and de~ver ~[iy property heJd in the A~COun~ to C [~nt~ $~bjec loIJBS Pa neWebber's rJgh s as descdbec/ A¢¢ouJ~ [~SA~) ~B~ Pai~W~bbe BSA% fi~'res are costo~enly ~!~ b~ ~rok~rag~ .rms ~nd any o~her 13U~N E~ S]~I~. ~,S~,~CC~OlJI~T ,B~A~GREEMENT I3 MAROI~ A~R~/IENT ClienTs acco~fs.~'Jth'OBS~t~§ber. Any such sams ~r~dr, oha4$ m¢y~ be,rr~4 ~a~t' ~ ~[neWeb~r's di ..... 9e~ Is usuNly ~a~d, ~a~t,b.au~on or private ~n account ~aclud- · ; · OAOq2L-BSA fREVA 1/02) ©2002 UBS PaineWebber l~c. All PJghts Reserved- Member $1PC. 15 ©2002 UBS PaineWebber Inc. AI~ Rights Reserved: Member S{PC. .F "..,. .~' ,' ',5~, · .:~ ~ iL~ OffiC~e¢~ S, O¢ er~p!oyets, ha:ye a be~e~cia[ inter?½ until ail m)~ ~,g r?~ ~ ec~l~F4~r v ~v ~ the death. ability; o ~l~b'm p~t e ~L~ ~ ~ f ~Clrent~ m )AO-CL-BSA (.REV. 11/02) ©2002 UBS PaineWebber ~c. A{[ Rig[~$ Reserved. Member SIPC. acknowledges tha UBS PaineWebber may rely upon UBS Pa2~_eW.~e'bber. U?S?~eWebbe_~ shal~clot~b.? C~en~ a~kr~ ~b~ t~e ~dce 9f a ,re/secr~t~sbow~ OAO-CL-J3SA REV.11/02) 17 ©2002 UBS PaineWebber Inc. All Rights Reserved. Member SIF~C. UBS PaineWebben CORPORATE RESOLUTIONS FULL ACCOUNT TITLE ~ ~% t~ishars Island Ferry Distric~ - - I, Eliz_a_~th A.__ ~_~ef~ille_ ~reby ~% t~t ~ am me~Town Clerk of the Town__o_f Southold ~ ...... ~N~mm~ s~n~ ~l~f DfficeD Si§nature o~ Of~cer) Item gLO0- #BMKT 3029 fRev. 11702] UBS PaineWebber~ ':_'~o~l~t:)Z~h~Certom- .fS~a_p~r~iBer, PO Box 1179, Southold, NY 11971-0959 #BMKT 3029 Rev. 1 t/02 Item #LO07 UBS PaineVdebber Additional Information Addendum Joshua Y.' Horton 26 Sterli_n~ Cove- 4 3~L~0~_72.~1 17-6_6-28_44 3535 Cedar Beac~ Road (~UsA E~Other Passmort/CMDULA and Green Carrie<ur non-lJ.S, a~d ~ $S~ sbecified~ E~JSA E~Olher ~sgecify):__ }~ome Address: ~ Co_de.Zi~ Code: #BMKT 3029 (Rev. I 1/02'~