No preview available
HomeMy WebLinkAboutResolutions - 2020.07.02 - 33395MISCELLANEOUS RESOLUTION #20232 July 2, 2020 BY: Commissioner Penny Luebs, Chairperson, Health, Safety and Human Services Committee IN RE: PUBLIC SERVICES — ANIMAL SHELTER AND PET ADOPTION CENTER— ACCEPTANCE OF GIFT TO THE OAKLAND COUNTY ANIMAL SHELTER AND PET ADOPTION CENTER To the Oakland County Board of Commissioners Chairperson, Ladies and Gentlemen WHEREAS in current times, many people have become more enlightened and concerned about the fate and welfare of animals that come into contact with public animal shelters; and WHEREAS in Oakland County, we are extremely fortunate to have compassionate residents and businesses that give generously to the Oakland County Animal Shelter and Pet Adoption Center's Legacy Fund and support its efforts to provide the highest quality service and humane treatment to the animals entrusted to the care of the Oakland County Animal Shelter and Pet Adoption Center; and WHEREAS Mr. Kenneth Earl Thweatt was a generous and compassionate resident of Oakland County; and WHEREAS Mr. Thweatt selected the Oakland County Animal Shelter and Pet Adoption Center as his beneficiary to his Roth IRA; and WHEREAS sadly Mr. Thweatt passed away on January 19, 2020 prompting InvestWise Financial to contact the Shelter to inform them of the donation from Mr. Thweatt's Roth IRA in the amount of approximately $12,376.11; and WHEREAS MR #83204 requires that gift donations with a value of $10,000 or more, with no match or other financial obligations to the County, be reviewed by the department's/division's liaison committee, acknowledged by the Board of Commissioners by signed resolution, accounted for in the appropriate departmental donation account, and recorded as a general fixed County asset. NOW THEREFORE BE IT RESOLVED that the Oakland County Board of Commissioners acknowledges the generous gift of $12,376.'11 donated by the late Mr. Kenneth Earl Thweatt and inherited by the Oakland County Animal Shelter and Pet Adoption Center. BE IT FURTHER RESOLVED that the donation will be accounted for in the Oakland County Animal Shelter and Pet Adoption Center's Legacy Fund. BE IT FURTHER RESOLVED that no budget amendment is required at this time. Chairperson, on behalf of the Health, Safety and Human Services Committee, I move the adoption of the foregoing resolution. Commissioner Penny Luebs, District 416 Chairperson,'!!cralth, Safety and Human Services Committee HEALTH, SAFETY AND HUMAN SERVICES COMMITTEE VOTE: Motion carried unanimously on a roll call vote with Miller absent. LT CAPITAL GROUP" AMERICAN PD Box 6007 FUNDS' IndianapolislN 46206 6007 CORI MARTIN CAMBRIDGE INVESTMENT RESEARCH INC 3883 TELEGRAPH RD STE 204 BLOOMFIELD MI 48302-1477 Re Account N CB«T CUST IRA EILEEN M MATTSON KENNETH EARLTHWE.ATT/BENE Dear Ms Martin' April 23, 2020 We have been informed the owner of the account referenced above has passed away. Please accept our condolences. To claim and/or distribute the assets in this account, please complete and return the enclosed forn-i(s) with a photocopy of the certified death certificate(s) and any applicable documents. If you have any questions, please contact your tax advisor, financial advisor or call us at(800) 421-4225, Monday through Friday between 8 am and 7 p.m. Eastern time. We look forward to assisting you. Cordially, Capital Group, home of American Funds Enclosures Organization needs to provide non -spousal Claim paperwork, either a government document 501 C'3 (tax-exempt org) or something that viliiv .; .'i i;;lY's Yt. i_ 01 llic 4)1'ganlzaiio1l. Also a ` orper'ate Ri,6`0 i.16!ffl that verifies the person that is signing (Corporate resolution or bylaws) the sco etary or someone other than the person signing needs to write that that the "Corporate Resolution is in lull lorce and cflect and is a true and C011-ect copy" DOG LAW OF 1919 (EXCEPA" f) Act 339 of 1919 2877 289a Animal control agency; establishment; employees; Jurisdiction; contents of animal control ordinance. Sec. 29a. The board of county commissioners by ordinance may establish an tannin control agency which shall employ at least I animal control officer. The board of county commissioners may assign the animal control agency to any existing county department. The printed conhol agency shall have jurisdiction to enforce this act in any city, village or lowaship which does oot have in animal control ordinance. The county's animal control ordinance shall provide for animal control programs, facilities, personnel and necessary expenses inaurod in animal control. The ordinance is subject to sections 6 and 30. liisoe,; Add 1972, Acr 349, Irnd. lift, pse. 9, 1977, Renclered Tuesday, April 28, 2020 Pere 1 Michigan Compiled Laws Complete Through PA 04 of 2020 rel Legislative Council, State of Michigan Courlesv .,f tft dtr1 g/iecb r(um.ou qov nit nY'•) Miscellaneous Resoluiiori 6565 March 7, 1974 BY: HEALTH COMMITTEE - Joseph R. Montante, M.D., Chairman IN RE: ANIMAL CONTROL DEPARTMENT TO'THE OAKLAND COUNTY HOARD OF COMMISSIONERS Mr. Chairman, Ladies and Gentlemen: WHEREAS, Act 349 of the Public Acts of 1972 provides that a county having an existing counfy department to conk -61 animal welfare may, by resolution, assign the duties of said department to an existing county department pursuant to said Act 349; and WHEREAS, the County of Oakland presently has in existence an Animal Welfare Department; and WHEREAS, it would appear that in assigning the jurisdiction of the animal control agency to a county department, that the county department's name should be chonged fiom Animal Welfare Division to ihe.Animal Control Department, NOW THEREFORE DE IT RESOLVED that the Animal Welfare Division hereafter be entitled and designated the Animal Control Department pursuant to the provisions of ,^� C. V0 of tlta Pu""Ic Aci3 cf 1972, The Health Committee, by Dr. Joseph R. Monlante, moves the adoption of the foregoing resolution. HEALTH COMMITTEE Joseph�R.r,Montonle, M.D., Chairman 3 nu F,s�rt:=&ic�r�rfic�:t raf ..t?rc.rrr�erros phaas and IRAs CAPITAL AMERICAN GROUPO FUNDS I a Guiding you through After you experience a loss, you're faced with many your claim options issues, including financial matters. That's why we've Put together this brochure — to explain your options as a beneficiary and to guide you through the process of claiming the money you've inherited. Your. options depend on two things: your relationship to the IRA (individual I etirement aCCO W11), or Ielirement plan account owner, arid the type of account you've inlie dtod_ I he beneficiary Information in this (.irochure applies to the following account types, IRAs Retirement plans • Traditional IRAs and Roth IRAs Prof r,sharing plana, 401(k)s and • SIMPLE IRAs money purchase plans • SEPs and SARSEPs • 403(b) custodial accounts • 457(b) goverrin- plans If at any time you have questions about how to proceed, please don't hesitate to toll our service center at (800) 421-4225 for assistance. Ifyou're outside the U.S., contact Your operator to call us collect at (949) 975-5000 between a.m. and 5 o no. Pacific. time, Monday through Fnday- The value of a A financial advisor can help you evaluate your situation as financial advisor you make decisions about the account you've inherited. In addition, a financial advisor can help you: • Understand the options available to you as a beneficiary • Review the potential tax implications of each option • Identify and complete the appropriate paperwork • Allocate your inherited assets to help you mop.-, your long-term financial goals If you don't have a financial advisor, we can help you find one in your area. For assistance, call (B00)421-9900 between 8 a.m. and 7 p.m.Easterir time, Monday. through Friday. You can learn more about American Funds at americanfunds.com. Investments are not FDIC -insured, nor are they deposits of or guaranteed by a bank or any other entity, so they may lose value. A number of rules and restrictions can affect the distribution of the money you inherit from an IRA or a retirement plan account. Those rules and restrictions are determined by your relationship to the person who left you the account, including whether or not you are the",.Icsi�,p�at<dh�•I,�-6�inry"(• •„t�•I�r (i. The designated beneficiary's age and the account owner's age at the time of death could also affect the distribution of the account. Start by deciding how you'd like to receive the money you've inherited: ® If you'd like to take multiple payments overtime, find the beneficiary type that best describes you from the three options below. Then go to the page(s) noted for information about your specific beneficiary claim options. • If you'd like to take a single lurnp-sum payment rather than multiple payments overtime, turn to page 7. 1'rn a Spoll5dl benE)kialy I paclrl 2 01, 1 I,,,,, ! 1 I,;'1, , I, I,,,'I I,, i„ •,;ro I I In �l rn.rnspc;t-Is�t x.neiicu,ry (page'I „'I,r r,.Ir"bbd n, �I,.n v -i. .,,•li , -: dl, li i 'II 6,„I. 'inn'- .I, if I I l i '.II !'In a bene`riciaiy of �,n "inheliir d IRA” I page `! I'ni a ti Usi belteficialy hagc 5 !ri. iii l• ,In.dl!:.-n [I 'ti Ill iiii[" ! n,r l.• , ,,.I] -, ih, Ill ,.- ,n rn 1, l I Dungy'! do it alone It's important that you fully understand your role as a beneficiary. The options discussed throughout this brochure can have serious tax consequences for you. This material is not intended to provide tax advice. Apart from discussing your options with your financial advisor, we strongly advise you to seek the assistance of a qualified tax consultant, estate attorney or accountant as you consider your options. _�. Not sure what beneficiary type you are? Ca 11usat(800)421-4225. I can take payments now or later =,-Iu'.LI C:'II, lu=Idly ui 1,4litl t{Ha strfP,e IJC:ue llciary Treat the IRA as our own rL:nllgdl"Ir lu-Ili±l,",� -',111,1„-Ili I_Illnli'r rl In- r:l i�. ,I 111. 5 1 n,l ^,I n'II_ II., 11I,I 1, 'I IIP','Li•.i''-. •.i •d1 IIP I, _ �I,e „ ,-I .,-Ii1',1. III I.I:I .11 .I Iq In. IIIInIc11r-. tlmnl ,ll -. , �.:: IIII II r. 11.:II:, I Ilyll ,,: ,,. I ; I , • ,.:I11.: ,11'I, I:..., I : � �('. _, I I - I I'L,IIr-Ivh:a'u,='I,, ,: , •ihe,:)lo Transfer the assets Into your own IRA FT:mail1w,y�,�:l , nl Iwill p:, ✓II 1 : IJ I- III( , II'll, --11 I -I Iii,- -,Jlv I I 9 I IIIS IL r -:Ili r, II ,I , _�: rn,ll tl,,.tlr„I I,411:•iu yuu, Ii 'n.'l afl I lln'n Jn. :I: 1111 .II vol .Ii qll :I-Ii1 is I t1 I •o,, 1 -„II, I:I Roll the assets into your own IRA Itrtn+.t vr,Ln _:pil�nl-,,I�;z�yvll l't I'm Iq II I.,r1lil n•I-In"II-rill„vl = 1_II.AI,I-'I I�-. :, Ill llv �Ilr",.Ibt. •-.';: iol l,�u.-.nll�d- I'll -I „I ,:Ly Ill: :ial-.=1i:h .111-n :.I.I 'r„Ilei, -i r Ii,d,l,l-III-II' L:I v : 111'1 :.., r,: -, dCrrl :- o:-: -; ud IIII v,lln,l l:',, I I',•I- .-:I,,. :Ilnln. 'tla_ .7 In,l:,l ::, - :I• ,III. -SII nl ll,dill I,!�It - I._I I I l I•:I II Li II'r, Lo l= �-Ivr II 'll, .I. 'I •III n ,'. Id IG!, 1 : II I 7:1' I:�•;In-nt5Dl, gnu ,.,r.nl l o tai.,- - ,u Treat yourself as the beneficiary* d l..lu no,w.n Lil. ,.II-,11•nI,.11II.. II', n: :, r1I - r.11t •fl �� 1"II.. -III gill; :r --�,h''i II- 1 : ll uii' -ill '1 1 11I , I :I, to I' -il' Il nivntriN al : I'u i-n,n miuru tdliv n. „nulll ,iI� II,v1,I '1711 .Ii Ill;r 51?, ILISI C'rn rarar: Of seaardfiytsBe> I:sesa�=ir.ieri�a�, If the beneficiary of the IRA Roll your portion of the assets Into your own IRA account is an estate and you, as I' 11:11: I I, II,::Ill :,I"i Ill: Iln,.:•;, 11,111, I1 I1, "11 -I,I III II':' -11; 1:b I,I:',.I:Ill the surviving spouse, are the sole IIn:I,.1111h„•.,.d, II,I;I I,I I;I1111-11 :'11hi-I,. ,!,I I I I II I': I= IIII•,, I I I I-•0 herieficlary of the estate, some Im: ILIFII 1, :, ,I �.:1 'p, q tlIY i', Wh, !I I,% [I 111 y11111 h 'I'- 11' of the options on this page may he available to you. Please consult Treatyourself as the beneficiary* a financial advisor to discuss ,1.11 I:III I_Il�rtr.I,I .,IIII ,111,1:.•- ,I„nil ,:Ill ..,la 'ii I -I' -iI II d�I,'1, youroptions.-11 -I n.'I,gI�.1 Ih=I-I,m 1” nli:111..111.,:11 III. I,r,-I 1.1 t11 II II-. 1�1 d1.11-., :��-L�,.1111 r,1 ,.I II� I,.-I„��I,n-�•II I�I�II•,Ird� -:I �I 11111• d'•11, .d - .I I _'' I:III ,1 II-:� 11 JII II L. I: � I :: ,,: 'u, I I -L,, I I i' 'I �mr' �:. I � :, .�n •III S Ci beneficiary of a retirement plan � II`I II ' Irib('T 1l l,. 11,',n, Ll -lav_ In Inln t -an IrT•n, •Ili I-dan nil blot,•, :'. 'I„i1 slllmld 'ngth Ill, erl,1-Ilnyt-r 21I it , Irn it ),)nlaI lvF t9 ii I, _mu i,dLo I,h ,ns may b, -ro,+il.11L= io ynu I Il,:_n nnw rlt-'I I'” Te .,he ll-:er %'. IJ I Vile ernlrl V,:-II,-ilnalq sl iIn .f In III pl,, Lin lir lalw .In: -I I=l Ith„ Ilni p - :t ill,-. u you {:..•:I�.:n; vT,nl �.I ,i i. -'n, I,'I ;ee wurh I can take payments now or later Vi:t thi N-ob 6a:oFaefi r;:+iv Roll the assets into your own retirement plan account . I . 1 : n l 11 lIn1„lt .uu 111 Id_I Ill -I1- -I 1 � 'I''' i- I In��l �d �.,. I, ,�I M1� I.I ,n b•„ nil h�.. : , I (I .1 ,it h, � I Treat you rself asthe beneficiary* „u I i 11111 nn1 I.: nl. 1-["h, lol ,Mlle ,Ill .11, ��. a.I Il d;,'1:6, 1 ILit ,,,.I.plrlltl Roll the assets into your own IRA IIIA , I . I, I, In_'; It : 'I 1.1,n 1 . ,L, I,f it I,. .II"' II'I IIL II L.1 •III ,rvl, l,„, 'IIIb ...... .- l,r l,Il .1, '.I .Ih ,��,Ir 11 r.i n,I ,.I Roll the assets into an IRA in your spouse's name* ill -Ilt 1 ,11''[111:\III, a .l-I.�-'�I„lea, lr;i,, gill I,1'r 1[ It nir, I.l lI t,LI-I11 np,.,yn,ly r„a ,II -I;-I l,vl :,LG'•” ' _.a I Ill �,. I I ,n- ,.n. i' f,, , nL. !m•'� „-III rl hI : I,I i:�tei".` uq tom" � ttlt rliho` ,7l YSi 49�k'8,f".b�¢f lxlneficiatR«.et hOli, Will ,LI Irl, : Roll your portion of the assets into your own retirement plan account 1,�1-: i� .�ll�.rl�l ,.nl , ISI I,I �.'I ,"la ,Ir�, ,a. �, �l l�ln �.,.,Io l,,l, ,nIm .I •, F9n_,. :,{in l,-��,Ir, ,-:IJI unpuL- 1• LI,le 'I �I1 ,I d,, I I11[1"]I.';' dI 'I it l,lnd . r1, -� [L lu.dll :li'Ll,I ill ,I "b, la r:.'I ,, I„ -IntL r,ill!, 11, Treat yourself as the beneficiary* Il jrllrl +Ic l�la ;.I>UUSH "" u,l--., un 11 iL I I d, 1 If the beneficiary of the retirement-I,I,.,I;��I 11 L-,.,n1�'��1 ��:, �.L �- „��'I, �,, ��„6�� ��"4,; plan account is an estate and you, I' 6 I„ : it I.' - as the surviving spouse, are the sole beneficiary of the estate, Roll the assets into your own IRA some of the options on this page I',Iilrnl r„'1 I L 111i11[ IL_ I I I. n.:','1'. .I I aL;I., 1L"P; it 'I, may he available to you. Please L" „ I, 'I,•L"III .II 'III II1,,,I .I consult a financial advisorto discuss your options. It Nonspousal beneficiary I am required to starttaking payments from an IRA or a retirement plan account Al_: l:: :(:: ,i-Iral �2neh,.i _Ily I' in II sf✓rt_ ke l'wtfir i'i 1"y ta!cw-,' ,if"holodk:8f'78v,7 „f in III or.I I -Iii errlc[r, IMai, „rrrunl. ,ou're not Ir" I lit reel l„.;I l„ I:nigir�l: I. Keep the assets in the IRA and begin taking withdrawals ,if I III I)r,_=y-ill-,r: ,Jl tri lhr I'11,„ n,-,I„I!, -.I-I, :I.:I:. 1,..In1 ,II ni'lll dI II-IIII'll,, :I, III �.bIII =dl IMl'I "Ving rl I, Y,- :)! ,�nl .r i, m: .ill1., :..III,, n�I��: I, , "I -, I :, 'h :,I- Ii. rilr�-:, I. II � 1 t:",IS IICII n:., :"[III .,,/,rto-.l'. iiM1 din :I-b'I1, IIL;: nlV.11, -I I__'n�I-,1: 91n "I -,rlI Illp_I I Ill "llitIV illm ,p-:rv�„Ird,1: ,.'nI' - ,I1': -itIIL,t-.-1 Of;11.,ns y„u 11 (ol13w ll"ir I_ IIII II rn,,!rlnr 11 _,. t ,nom 1 'I ,ill I-6 I let,' r-11)-1111 'rc lhr bci:elo:Ial ,r of ri:, P„`-, oI a 1 ::1 ',b i, "Intl, .oroJ ,, Ic"I' y-.nI Til,u r, 11.=s1t In Take a total distribution from the IRA over a five-year period I,unr! thm lel1, _:ucnt plan rn r;. i, 'I:.- rn. I ,, r, .I,I:ro-I^I I'. u1 :'.I ..n: 111, .: I,- .rely Erni l„» ell ot,Yv:n9 nlny I lI,i"n l I Ill III I" 1:.1 ipplr In y"ll) 1 JI t I,n ill [III, In:II': I it OI Ile i,n 1u 1.51 .. „u. ,,. .I „in,l f Le IIl. h,. ,,u'J hl,,=r: Roll the retirement plan account into a new "inherited IRA” 1 Wi III IF I,'I, { +,ill I III ap "t, Ylol Inrf­ n ,Ill 1111C,, ,I lnGn nud l�•n I -nI .. 14 :I In .r� �, � lo-ltdll,.,, Lu11; qiII,��n;„n.„lir,-TnINIIII „�.-114:uI-,p fit'+%{l.li d"r ',fl These abbreviations appear gi n ,,. ,', 1, III x'111 11'1'„ 1 ,I!:I1 1 1.,_F1 11, ,11 1 o- II,II, ill I,, I "1 1 1 frequently in this brochure and ; 1, ,,a I, I,I L 'III 11f IIIb I I n, ' I I I , 1,r 11 I 'I I_' c, .', . , 'I I 1 II, In other beneficiary documents HI III I';I' ,-� .,I li, ,-I ��,n1 ., 11.I ,li III IT, :Ii II I I II you'll read. The required beginning date (RBD) is the 11, IRS -specified date on which the IRA owner must start taking Take periodic payments from the plan required minimum distributions I�iu I. III1�, r1 III ., 1 ,I VIII .�- II !II. p �I IPI�Iy. n,�I, ., ., I' 1 rl- (Rlv1Ds)- specifically, April �IL.I �,rJ I„ „I. I, - , Io :I II bI `I ofthe calendar year following ""nl, ,��!I�..o- I,r:,s ''ISI ' the year in which the IRA owner Take a total distribution from the plan over a five-year period would have reached ago 70Yz. TIr I.'n,.Il 1r 'I'm ; I11 .Illi -.-.o. I -,h �1I 1 , "•- -''I'i Ii1 IL -n ial -II III 1 I ...11 I„ nI11, .I I.Iv" I ,n , ,: i!I�”: pl. i Trust beneficiary I am required to start taking payments as a trust beneficiary II;, I IPI tl-y II'l.,c Intal FlrrI Ill C', srale Brille ici aiy or ff fr+ of,lllolrirrl", So. ilror l7ci'm —1 ., `11v 1 ­il'.tll 1,-I I, "1 11`4VV iJyi ! 4 the 0 ii,l: III III 1 �1)P•11_ •Fu111Iuwhhc,i . 1 111 -';II!„- I,.I-', I II II' -,I ; :h A'L 11, I"I'IL At i,I 1,41n; 1n1, Ill pik"I 1 n-�oiIllt All II , Transfer the IRA or retire ment plan account assets into an IRA for the benefit Ill ol,-IJeIe•.I clo"liliprl It e,,16 of the trust ,Ilk ,""i1,11=I IIHI1119 I n1.t int- I,I -1n ,: II 11' •, Ill 1'" -I.1„ 11111 '•,11111 11-.1,•.111 ,Jill 1+","I 11111 l 'll�„''l " Y.,IIJIla1, L=I ,I,d1= I::�„ .,nil '�-• 1:-:u �l•li• I,11. IJ"1 'i,-1II1 i11 will -^Ill,[ Illi .rli If J, ,11i1 _ _ 1 ,. 1...11 .n.ii'[hIf, 'I. 11 11 IC-rn:o-m�al �L-, 1l,nllLw gene . iu Mantel b l a, Lq,,,I1 Ih•r ,Ji•all •'1r hr. •-,nIjII, 11,1x1-rl, im n,I,V, Ind Transferthe IRA or retirement plan account assets into IRAs for each o4 the Till, If if „n,h� I:n trust's beneficiaries 1x1 L Illy W If, _,I In th. trusl C 1„ I 11 I11 -, 1,[,r 111 r i , I 1 I.I illIll _ 1 1.1 1,1II II 11 1 111-•••I Jugumr.nL 1 ” 1 .CII I, 1"'IIJ`1 Ill..111,-, -u I - it1,- I I '11,,,, ,- _ 1•i�,l- •111111 II I I -p-i, r_ no-1,ul „11, 1..11l 1`ll•_,,I.1 1-wulr,l„Ilul„tlnt -�,�{hl i=l=�,i eft. ' Certifying the trust 11,1,1 .•m b_ -i11 -I P,', 1.I .Il 1.I ,- 'III, 1-I,^1.,11,1-wi .1 1, Jill U�lennlnv mph^hul Llf rullls r,I-.11•nl„rr 1lilim lh,„111',."1u,I ,r n -?11111) �., , n 1,db I1 -I •nl��hGr,Ii.,l 1n•n11 n.rL{i.J (v,�n „'f �.--.lln., ,T-, J-.,, rloy u., -LI L. Ir,l to a1, esielr- nl Itn I1•"vj - � i 11 11 11 1 dIll III-I':I > Transfer the IRA into an IRA for the benefit of the trust 1„1 l'n U , ,•I,1 11, 11 11, 111 1I 16n.1Ih,_!,hl' Hili -b1 I,•vyn,•�nr'- 11- 1 II Il,n 111 I1 ..1, 11.11.1.-111 If.111 ,tl,,I I_11,,I 1-d Transfer the IRA Into IRAs for each of the trust's beneficiaries .,1. 1. 1 11 1 11 - 1, 1,11111. u1� I�I•I ,-iI I��� 1111u` �,IuI 1111 Itr*_,..r 111 p.e <p• .-0ioI II ,- 11., 11 n , 1111 .'l 1. p1, 11, I �u u1-,1 ,Ill ', Inlpla I'm, 'i ISI ltlol,lI nl, n oration el, 111,'1 I Establish withdrawals from the retirement plan accountt I I t -I 1, u1 n'11 V, Spouses have more options than 1 1 111111 1 „ other benef lades. With a trust, the spouse has all of the options shown in the "Spousal beneficiary” sections of this brochure (pages 2 and 3), except for the "Treat the IRA as your own" option on page 2. A spouse who Is one of a trust's beneficiaries cannot reatthe IRA as their own. Information for the designated beneficiary ;,,CI --bio-, Cr! i --C neII";ierY I,a1 rlr_livit.-Inral \Is.l-!:.-,ugl'I an II?A. _n' i' d t:l!:e !t )) dII 3Crp L!I!I II l;' 1d'A. IIIt-ticq_,I_- l_"nallclaues, Lher.e , on utfly one, it ant desayl,. ted berohdaiy The Anynatc d benehraary's acre Is lased m deternvne the Un nr- Ir,din, ,vi vaincItpayrnents Il nust he taken Determining the designated beneficiary The designated beneficiary must be a living entity (with an age and life expectancy) determined as of September 30 of the year following the year of the original account owner's death. • One beneficiary it %01ma, date, came me perccm Aon bomikwly of do ,t s, -nano, An pal roan wil be..an;tdxwl the do'ni' ted benrt.:Iwn • Multiple beneficiaries II a, of +hon d.a„ tall „f rh, account bor:afi,-I o, i. e ar a!,eroils las Cpjposod to an -.I;t, of ch,:, tly), •kao the ei,-lau benk ion vnllbe ro nsu,lerod the Trust beneficiary If thr: Iruso i; quA l d led (yaa page S) ot, of Sep t"Ibe1 30 of th„ year [,,I IoawlnJ We yo oft, , a! roult a n er s dPalh, ood pwO e the only benelk iIy M tl,- I t1C t, yni'II be, n_ -Ria, Ed the =,.Igna Cal h-,Irehmary II tow T, nu-dU W h enannrn-., of Ih-IIu :t End all aw "nple fess oHpoc"I In an escaie oI .Ian ty), tho , tho AdoEt be, nali.I li y n con:Idr =:I th, Josrclnnt-r_i I',r_ue6cidl y, Estate or charity beneficiary An z<taie ,,, cl,al IrV Can nevy: ba considered a AvoclnateJ benehnaw because a in n'i a pm Eon And than. kw doesn't hare„ He oxpeu'r„ry If, an of Septa ober 30 of the yens 50 cal -�j the year of ik-acomaR ,,nek Wta Argy b,nteii nee , I$ an ee t=.le r r char dty, the a.O-IJ,t twill notha,<,-, de'signated "Was, TW Irrr.,ar-i The peyait pai iod used to dFt nndna the minimum mmountthat rnu-.t be Tater. each ; � al To avoid such n sMldT on t',L] Inu•.i arrange for the ostala of Varmy R: 'case It's pnrcion r,I ;he aro,I_nl poor to Septamber 30 of tha /. ,, fA ,Nawn we year nI me acro o a,mt"';. Nall Th,.des:9n2lid bVn $na: I My b:3 ectab"hed ante a nomp,won b,.neilciary ha, cashed Call Important factors to consider Bekof fol; nwkp alinal tit''_ISltil-Iil-y"n CIII v1- till( It 111811ierre- ;f lei` aI d few oil: t a int-neCitla6 that yorl liguhtwant to Lonader. Consul[ your 3ccu Aartt of a` diho[ldl guldni-I, e, Request minimum payments Yawd or yutu grdl,ad-ridl ii- ttlll3tn es A Ina, Lr In your be St interestto m,irhdl aw only tho rawnrt"'equal, d arnoums Ir order to w, In ."an any sinm L- the opP orli to g00 Toll: ,vnch your hnanod adasw oI qualfied l an ._en0tann alhotn tun icing y,orwthlat• K In rh_, leastarrow❑ that neyht be required Nuke, h:oweven that this olon,n a nut avmlatde fon A ne'ai c[al, types Create separate shares If mala are owl ogle ltenel'a add i, you -@n diode theWOW Into lapel an shales v, AM each hPnrficiar•y rale use tl'I eil oma Il is eq pec[a my to Oadete deo- RMDc Sostat'- laws roust be errand try December 31 of the year Fnllowmy the 1 i jla of au: Cunt C" JI, �[ , death. Please note that hweRn lei of a trust that III it on In A i plop w: eount cannot n cats Sepm ate e.harc;- Name a subsequent beneficiary T-maxnnnzr the ad,antorfes of uxome: tar cfeten On the event that you, as the orpmel ihwef min pass si,,ai bebn to the untio IRA al Ietuvin ant glair ecr:ount Is dMnbtlied Voll "an Iranian --obseguel't ,"I iii the anginal accr•nnt oiaun l dei nt•t name nr�e? Far c.r:rnlpla ct ssv yno t;Inng Rid D; sorer Ina fla n<pacnm� of 30 y^nr: fair y,>u pa« as an, On wx ye an Ihis notans t'cin sI l ,,qu ow beoehainry< dH rnnunm. tc: ,:nnt.l IU}tnLntna11_ oval •.be Ianamung d yells „i ;ruin la, er, po, tanc:, II tate IRP. am r ugmally dam ad 6t; ,tool Iret L.' fI.•Irarry .-mel you stll •seoauentl': ria In It. f ita ALL1411 I I,'o If you IP al:)riroo 'ne I.•-h,lf of an enty, your, nor ta n:nbl: to dt,lgueIr mirhton a l 'nem- h(Inrir, Review special rules for small business profit-sharing and money purchase plans (if applicable) Iron opQt , • .QV no pi Aa l rft'ne olu,i:rnd v+ni_I of tha rein am Pnl plan If I, rail vo.�i.nI 1,4,11 .mJ 1 h a sl n-", I'- hulut_I �I.a l., P .cI t[n:,I l-•ou,fit-n;r;, nit 11%11 We KrAmw a or W,. acr-.nuu un._ theI IRA or r.-4irernenLp sn!d lr ac spre rellcw-For . ° non-sf,r USA I-:onefI,jfm; n1u•:r Other tal,_ th-in part Ion of aid IF pant-, lu a ,mgla payrrn=nt ur have rhe, plea l oll the money uso.a l IRA In the of lFtpnel :nam? "Mns b nmv- rain :aha[ tted HRA! V156 nw As will Own he :I on it of the dongnated Lenehcov, Disclaim your rights to the account rVro may refuse to accept a porn,li c[ all of the If<4 or ratre•mwnr pl>n au.ount that ev an la [I a"' I>ecn p.t IIf s• It to 1-,u as a hcnefb racy- If you do this you mmt Prose a m'rlttun whom and o tupelo valid,lUc mw no lata than Sepmr-iLet 30 of tl-ne vest lollov/ing tn< m munt owner's Me of death. "on",O) voant to dloeso a'us oI;l inn if Von to his pl Intal V ILeuairclary so Thil ; utu Inhcntatl "aloum o"J yo io app ct>ntmcpsw I .ct-un[.lar y; bel"Oold ueslp•�ssbl; yow chddn n, of indchddran on t,thet odwidualsi-Avand ch5rla[mer ljpt. Ir. Maori all Stare and MCI al tin'uremen C, Talce a lump sum it you mash to vnthdl aw MUM M money at Ince, or l the arnrwnt e; tori small Fu alnc al pad mrzrdt I;, r-d:o sense, you or:n n.yuea a =Ingle une-limr payment o[ell the Iran," In the erg ount IPI t"WHO portion of any wrt6drawal Of omniarIn I Fos, lure I,x ts.< pot roses In view: ofcrus, are Pncour,yu , m total wan z 04 pro(e'sional hl -d 6:Inc rcowmeam f lm , n^.ay reri[.n to yo11-t, w1- dtaw we money In a vanes nl p vIonoms Instead of tal:nu_I, lu[n� sunt. Talk t,• the employee's I zr•-fit_ I ePly sente[tued for ntolo elih Imsrou.) Request more than the scheduled payments Ont e: ymNe oe< u,, a ps, nema xhn,±A. b" ro 1.'nn ays•, r/> -I 'till have=the c:ph,nn to torr-as[mi pny'n"Filts. ar evlthl h;) ti•eq File .rn-Ire• aM Jmnq . enol a m„ run it s tat at sur, tno f-ka,, road "Take a Worl, =nn(• caph your Pl{prth'ha,•,dla In( 1-1111[ >• ho I'll -,1 poeloent Ire ounl :-teat the I_hany. , ,lon't t:. atm On a.ldtlto I'll or: inbild; tor;ou The next steps If the beneficiary is ... A minor d In ,m, _II. -,I,'. III, I ii -.I, If I Ifi IlilI If I' d� II -II - Ir,l, An entity le InJ- I, ILIu v`I" r,o IIIIn 1I �I � II,.Iro .' JI ,rrll, Not identified by name nI II I. 11 11� I„ I, n''p Ildnl I,I; 'ill, i. II, II III I. d SII 'i l Ir, I. n'x An estate I, ni 1 I -e „l -:- Ill .'I 1 1 f,.I I ,IL Atrust Ilallll„ I, �, 'ung, l!. I. I, I' do : p' "'I,I I„ L, I'I If III : Ill cIrl�,lb ,II:.I I. If you didn't receive hooldet with this brochure, call us 4t(BOO) 421-4225. L-- - - --- ---- Things to remember Signature guarantee I: l .,I th' 1''1 L l., 1, „, 1 III -I Ir, lull= fitl ii I,I) I. 5L III - :I qI nl .i r.- 15 1 .Iya 9 IIS I VIS -<I it In !, IItI Illy :d'IIk,-���`.� h-„I,�I i\Ilu II Inic��id,l In/.-Inl�nh Death certificates II, -,,I iI I ",I I -, Il 111 ir. is 11 i n._ a, jpy' iL[, VII,-, -,_II III'I, ,111,i ,-iIII,-,I o I aJwl h<I 11, fl -d- ,1111 c.-1 idi, d'„,'111. I u,1 F, I ull,b'Ii y, Illlr �llll�, it lel "nlhI IIP -Il llei.•5!i_ III-n,..il. 1, q, ISIv.iILI-n. I�In-Ihe P.,ru Employer authorization (if the account was a retirement plan) I r ,-I npl� A. rd IIIx,'.(,'11111-r^;m-I mn.i -.I, in ..Irl „t,- it I,• 1, 1 1, C,,nt.� , I.., �'ITi I,;'".I' L -I i_h1, I=,,„, - -Id.11 l 1 I l II I rl o 1 ,.. I- ,gin d, „li�l-.va1\ I. :I ll,b Il,n 11 al , W.11\/f•1' Depending on the state of residence of the deceased, a tax waiver may be required in order for the assets to be daimcd. Contactyour estate attomey or a qualified tax consultant for more information. I Portfolio manager experience as of December 31, 2017, 2 Based on Class A share results for rolling periods through December 31, 2017 Per inds covered 'arc the shorter of the fund's lifetime or since the comp a table Lipper index inception date (except Capital Income Builder and SMALLCAP World Fund, for which Lite L.ipperaverage was used) Expenses differ for each share class, so results will vary. For current information and month-end results for Class Ashares and for all share classes, visit americantunds.com. ! On average, our management fees were in the lowest gmnlile 71% of the time, based on the 20 -year period ended December 31, 2017, versus comparable Lipper categories, excluding funds of funds. Past results are not predictive of results in future periods. Investors should carefully consider Investment olajectives, risks, charges and expenses. This and other important information is contained in the fund prospectuses and summary prospectuses, which can be obtained from a financial professional and should be read carefully before investing. All Capital Group trademarks mentioned are owned by The Capital Group Companies, Inc., an affiliated company or fund, All other company and product names et e thc- property of thei r respective companies, Securities offered through American Funds Distributors. [-jt.No RPGEBR-003-10180 CGD/8163-566200 © 2018 Capital Group. All rights aserved, CAPITAL AMERICAN State Tax Information GROUP' FUNDS` (Traditional, Roth, SEP, SARSEP, SIMPLE IRAs) Effective 02/21/20 • You may specify a percentage of dollar amount to be withheld for state Income tax by completing the appropriate section on the distribution form. Some states require a minimum percentage or Flat dollar amount. We will withhold at least the state -required minimum amount when such a minimum applies. • You may instruct us not to withhold state income taxes only when your state of residence allows such an election. State of residence State income tax withholding Information AL, AK, CO, FL, Hi, No state income tax will be withheld for residents of these states. ID, KY, MN, NV, NH, ND, OH, PA, SC, SO, TN, TX, WA, WY AZ, D.0 , GA, IL, IN, State income tax will be withheld only If you Instruct us to withhold it. See below for exceptions. LA, MD, MS, MO, MT, D.C.: 8.95% of the distribution amount is required 4 a total distribution Is taken. NE, NJ, NM, NY, RI, UT, VA, WV, Wt MS: 50% of the distribution amount is required if an early distribution is taken. IA, WE, MA, OK, VT State income tax withholding is required when federal withholding applies. See below for state -specific minimums and exceptions. • IA: 5% of the distribution amount • ME: 5% of the distribution amount • MA: 5% of the distribution amount • 015% of the distribution amount • VT: 30% of the federal withholding amount (If the distribution amount Is $200 or above) AR, CA, CT, DE, KS, State income tax withholding is required when federal withholding applies, unless you instruct us not Ml, NC, OR to withhold state income taxes. See below for stats -specific minimums and exceptions. • AR: 3% of the distribution amount at $200 or above • CA: 10% of the federal withholding amount • CT: 6.99% (whether or not federal withholding applies). To make a different withholding election, you must complete and attach Form CT-W4P. • DE: 5% of the distribution amount • KS: 5% of the distribution amount at $200 or above • MI: 4.25% of the distribution amount (whether or not federal withholding applies) To make a different withholding election, you must complete and attach Form MI W -4P. • NC: 4% of the distribution amount at $200 or above, To opt out or request an amount greater than the required amount, you must complete and attach a Form NC -4P. • OR: 8% of the distribution amount 1 of 2 CAPITAL AMERICAN GROU W FUNDS' Effective 02/21720 State Tax Inforination (4O3(b), 4O1(k), 457(b), MPP/PSP) You may specify a percentage or dollar amount to be withheld for state income tax by completing the appropriate section on the distribution form. Some states require a minimum percentage or flat dollar amount. We will withhold at least the state -required minimum amount when such a minimum applies, You may instruct us not to withhold state income taxes only when your state of residence allows such an election. State of residence State income tax withholding information AL, AK, CO, PL, HI, No state income tax will be withheld for residents of these slates. ID, KY, MN, NV, NH, ND, ON PA, SC, SD, TN, TX, WA, WY AZ, D.C., GA, IL, IN, State income tax will be withheld only if you instruct us to withhold It. See below for exceptions. LA, MS, MO, MT, NJ, ° D.C.: 8,95% of the distribution amount is required if a total distribution Is taken. NM, NY, RI, UT, WV, WI ° MS; 5% of the distribution amount is required if an early distribution Is taken. AR, IA, KS, ME, MD, State Income tax withholding is required when federal withholding applies. See below for state -specific MA, NE, NC, OIC, minimums and exceptions. VT, VA ERD = Eligible rollover distribution Non-ERD= Non -eligible rollover distribution ° Aft: 5% (for ERDs) or 3°% (for non-ERDs) of the distribution amount at $200 or above • IA: 5% of the distribution amount • KS: 5% of the distribution amount Is required at $200 or above for ERDs • ME: 5% of the distribution amount ° MD: 8% of the distribution amount is required when federal withholding is applied to ERDs ° MA: 5°%of the distribution amount • NE: 5"%of the distribution amount ° NC: 4% of the distribution amount Is required at $200 or above for ERDc 4% of the distribution amount is required at $200 or above for nomERDs. To opt out or request an amount greater than the required amount for a non-ERD, you must complete and attach a Form NC -4P. ° OK: 5% of the distribution amount is required for ERDs ° VT: 30% of the federal withholding amount (if the distribution amount Is $200 or above) ° VA: 4%of the distribution amount CA, C'f, DE, MI, OR State Income tax withholding is required when federal withholding applies, unless you instruct us not to withhold state income taxes. See below for stats -specific minimums and exceptions. • CA: 10% of the federal withholding amount • CT: 6.99% (whether or not federal withholding applies). To make a different withholding election, you must complete and attach Form CT-W4R DE: 5% of the distribution amount • :Ni: 4.25% of the distribution amount (whether or not federal withholding applies), to make a different withholding election, you must complete and attach Form MI W -4P OR: 8% of the distribution amount 2 of 2 U CAPITAL AMERICAN GROUP' FUNDS' IRA Nonspousal Beneficiary Claim (Traditional, Roth, SEP/SARSEP and SIMPLE IRAs) Pieasa consult your financial and tax advisors before completing this form. Use this form for Capital Bank and Trust Company"I (CB&T) accounts only. Carefully read the Information In the brochure titled "Understand Your Alternatives During This Time of Change:' Be aware of specific, dates that could impact your claim. If f Cit beneficiary is an entity, contact us to determine what supporting decnmoilte are required If the benefloary is a trust, you must complete and submit a Trust Beneficiary Claim form. If the beneficiary is an estate and the spouse Is the sole beneficiary of the estate, contact us at 1800) 421-4225, ° You will need a photocopy of the certified death certificate for the IRA owner and for any beneficiary who Is now deceased Depending on the state of residence of the deceased, a tax waiver may also be required. If the death occurred outside the United States or If the beneficiary is not a U.S. citizen, contact us for more Information at (800) 421-4225, ext. 71. wDeceased IRA owner irdorination Enter the information sell appears on the account .statement Please type orpnul clearly If'I J �I III Iii li�� SSN of deceased IRA owner Data of birth (moven yyyy) Date of death (mm/dd/yyyy) Kenneth E Thweatt First name of deceased IRA owner MI Led Account number Beneficiary information __.... - Complete A and C. Complete ti if applicable. A separate benegclary clalin form must be submitted for each beneficiary. A. Beneficiary details — Ptovide the beneficiary's personal information. If the beneficiary Is an entity or minor, the person signing on behalf of the beneficiary must also complete B. Oakland County Animal Control & Pet Adoption Him name of nonspousal beneficiary (if an entity, meant name of entity) MI Last 1200 N. Telegraph Rd Bldg 42 East Pontiac MI 48341 Residence address (physical address recu red —no P.O. boxes) city State zip Mailing address (If different from residence address) City Stale ZIP (248)858-1070 Email address' Daytime phone USA i Data of birth(mm/ddlyyyy) Country Of Citizenship +Your privacy is important to us. For information on our privacy policies, visit www.capitalgroup.com. 1. Attach a photocopy of the car hired death certificate(s)? 2. Attach a tax waiver, if required by your state? 3. Attach a Beneficiary Doclaration and Indemnification form, if required? 4. Obtain spousal consent, if required? 5. Sign in Section 9 and have your signature guaranteed, if requ'rede Continued on next page 5 1 of 8 CAFITAL AMERICAN IRA Nonspousal Beneficiary Claim GROUP' FUNDS (Traditional, Roth, SEP/SARSEP and SIMPLE IRAs) Beneficiary information (continued) B. Addition of details for an entity or parentllegal guard Ian for a minor beneficiary—If applicable, I,r:,vu.b_ ih w �nn,il nr i I w ;:: Is -;n .nji,kiq of ihr entl y or minor. If additional space is needed, attach a separate page. A ,I.,0,d n..... avx, trustee, parentllegal guardian of roquwetF ottwer MI Laat ' J�k caedr,ss(physeal address required-; no P.O.�roxes) Cly Feil, lip Mailing address (if different from residence address) City state Zip Do, l;nP phnnF SSn Date of birth (mmlddlyyyy) Country of clti±enship C. Beneficiary shares — If the account owner died without designating a beneficiary by name, you may also be required to complete a Beneficiary Declaration and Indemnification form in addition to the Intel motion requested bolow, ® I am the only beneficiary, and I am claiming 100% of the proceeds. ❑ I am one of beneficiaries, and I am claiming (Attach a separate page if more space Is needed,) First name MI Lasl First name MI Last % of the account. The other beneficiaries are listed below. __ __ Fust name MI Last Notes: o If you want payments to begin immediately, complete and submit an Inherited IRA Distribution Request. • Nonspousal beneficiaries must select a beneficiary distribution option by December 31 of the year following the IRA owner's death. You will need to notify American Funds when you want distributions to begin. • A new inherited IRA will be opened in your name; a separate account application Is not required. CAPITAL I AMERICAN CnROUP® I FUNDS® IRA Nonspousal Beneficiary Claim (Traditional, Roth, SEP/SARSEP and SIMPLE IRAs) Is, ,.-- . .r._.... .,,,..... .. ... .....,..,,1 .,.... .. Subsequent beneficiary designation W //encourage you to consult an advisor regarding the faXJaw and estate planning implications of your beneficiary, designation. All stated percentages usf be whole percentages fe.g, 33%, not 33.3%). If the percentages do not add up to 100%, each beneficiary's share will be based proportionately a the staled percenlages. When a percentage Is not indicated, the beneficlaries'shares will be divided equally. Note : • If the owner named subsequent beneficiaries, you may not alter the previous designation. • If the IRA was originally claimed by another beneficiary and you are subsequently claiming the remainder, you are not eligible to designate beneficiaries. • If the owner did NOT name subsequent beneficiaries, you may name your own below \\ Your spouse may need to sign in Section 8. If you wish to customize your designation or need more space, attach a separate page. - you narne a trust as beneficiary, provide the full legal name of the trusl. Example: "The Davis Family Trust: A. Primary B.eneitciary(ree)z,ifany desWnated Primary Beneflciary(ies) dies before 1 do, that beneficiary's share will be divided proportionately among the surviving Primary Beneficiaries unless btherwlse indicated. First and last name or trust name(print)Span N❑onspouse bust Date of irth or trust(mm/dd/yyyy) / Address City Stat ZIP SSNITIN 2. ❑ ❑ ❑ First and last name or trust name (prini) spouse Nonspo as Trust Data of birth or trust (mmlddlyyyy) Address City State ZIP SSN/TIN 3. ❑ ❑ ❑ First and last name or trust name (print) Spouse Non Dasa Trust Data of birth or trust(mmldd/yyyy) Address City tare ZIP SSN/TIN Important: Section 3-A must be completed prior to completing Sectio 3.8. B. Contingent Benefieiary(les)l It no Prlmary Beneficiary survives me, ay my benefits to the following Contingent Beneficiary{ios) If any designated Contingent Beneficiary(ies) dies before I do, that benefici ry's share will be divided proportionately among the surviving Contingent Beneficiaries unless otherwise Indicated. 1. Firstandlest name or trust name(print) Address City 2 First and last name or trust name (,rind ❑ [❑ Nonspouse Trust Date of birth or trust(mm/ddlyyyy) State ZIP SSN/TIN ❑ ❑ % Nonsecuse Trust Date of birth or trust (mmIt lyyyy) Address City State ~"ZI}"-------' S$N/TIN Note: If the subsequent beneficiaries pre -decease you or no beneficiary is designated at the time of your death, the proceeds of the inherited IRA account will go to your estate. r 3of8 CAPITAL AMERICAN GROUP I FUNDS° Financial advisor This section must be filled out completely by the financial advisor(s). IRA Nonspousal Beneficiary Claim (Traditional, Roth, SEP/SARSEP and SIMPLE IRAs) We authorize American Funds Service Company (AFS) to act as our agent for this account and agree to notify AFS of purchases made under a Statement of Intention or Rights of Accumulation. Kelly L. Boyd BFJ GWC (248)594-8110 Names) of advisor(a) Advlsor/team ID number Branch number Daytime phone 3883 Telegraph Rd. Suite 204 Bloomfield Hills MI 48302 Branch address City State ZIP Cambridge Investment Research X Name of broker-dealer firm (as It appears on the Selling Group Agreement) Signature of person authorized to sign for the broker-dealer Required Minimum Distribution (RMD) of deceased IRA owner If claiming in the year of death and the RMD for the deceased IRA owner has not been satisfied, it will be removed proportionately from your account at the time of claim. Any RMD will be sent by check to the beneficiary's address in Section 2 of this form The RMD will be assessed 10% federal Income tax withholding unless otherwise elected below. If your state requires withholding, CB&T will withhold the minimum state tax. ❑ DO NOT withhold taxes from the RMD. Reducing the sales charge on Class A shares only Rights of Accumulation (cumulative discount) While additional purchases may not be made into this account, the beneficiary, spouse and children under 21 or disabled adult children with ABLE accounts can aggregate accounts to reduce sales charges. Any share classes within these accounts will contribute toward a reduced sales charge. The Social Security or account numbers on these accounts are: Note: Purchases in the money market fund do not apply toward a Class A share Rights of Accumulation. Decline telephone and website exchanges and/or redemption privileges — optional Telephone and website exchange and redemption privileges will automatically be enabled on your account unless you decline below. To decline these privileges, read the individual statements and check the applicable box(es). Note: If either option Is declined, no one associated with this account, including your financial advisor, will be able to request exchanges or redemptions by telephone or via the website. Requests would need to be submitted In writing. Exchanges: I DO NOT want the option of using the telephone and website exchange privilege. ❑ Redemptions: I DO NOT want the option of using the telephone and website redemption privilege. ❑ Spousal consent to beneficiary designation — if required if you are married to the beneficiary named In Section 2, snobs crabs designated a Primary Beneficlary(les) other than you, please consult your financial advisor about the state -law and tax -law Implications of this beneficiary designation, including the need for your consent. I am the spouse of the beneficiary named in Section 2, and I expressly consent to the beneficiary(ies) designated in Section 3 or attached. X Name of spouse (print) Signature of spouse Date (mmNulyyyy) This document may not be signed using Adobe Acrobat Reader's "fill and sign" feature. 4 of CAPITAL I AMERICAN GROUP' I FUNDS` Authorization and signature guarantee IRA Nonspousal Beneficiary Claim (Traditional, Roth, SEP/SARSFP and SIMPLE IRAs) I certify that the information I am providing Is accurate, and I will notify CB&T of any changes. I acknowledge that I nm completing this document as a nonspousal beneficiary. I am aware of the RM6 rules and how they apply to me. I acknowledge that CB&T and its affiliates are not responsible for ensuring that I have compiled with these rules. I have received and road the American Funds Traditional or Roth IRA Disclosure Statement. I understand I am Inheriting the IRA as It exists, subject to the terms and conditions of the American Funds Traditional or Roth RHA Custodial Agroement currently In effect and as it may be updated from time to time, I understand that I and all shareholders at my address will receive one copy of fund documents (such as annual reports and proxy statements) unless I opt out by calling (800) 421.4225. 1 agree to the conditions of the telephone and website exchange/redemption authorization unless I have declined those privileges and agree to indemnify and hold harmless CB&T; any of Its affiliates or mutual hinds managed by such affiliates; and each of their respective directors; II llsteee; officers; employees; and agents for any loss, expense or cost arising from such Instructions once the telephone and webslle exchange and/or redemption privileges have been established. 1 certify, under penalty of perjury, that my Social Security number is correct. I authorize the registered representative assigned to my account to have access to my account and to act on my behalf with respect to my account, understand that the Informatinn on this form will be used to verify my Identity. For example, my identity may be verified through the use of a database maintained by a third party. If the ownership of the account Is being changed and CB&T is unable to verify my identity, I understand that it may need to take action, possibly Including closing my account and redeeming the shares at the current share price, and that such action may have tax consequences, including a tax penalty. I understand that CB&T reserves the right to require original documents or original certification of documents. I r° l4f r:+1 ,. 1 . , 1 , ;_ X 11, n.w op,�aer it^inft) t eInnaurr of Aerelltla, :, o, 11,enn,01iM,cd te act tri,. Ili i On 00"'If of Il,e heneficwy or untrly This document may not be signed using �dolae Acrobat Reader's "fill and sign" feaurre. A signature guarantee is required if the name of the beneficiary was not originally provided by the account owner. If required, a signature guarantee must be performed by a bank, savings association, credit union, member firm of a domestic stock exchange or the Financial Industry Regulatory Authority that Is an eligible guarantor institution. A notary public Is NOT an acceptable guarantor, The guarantee must be in the form of a stamp or a typewritten or handwritten guarantee that is accompanied by a raised corporate seal. nah; hnl,Wdn/VyYy) GUARANTOR: Stamp signature guarantee or medallion guarantee here. Note: A medallion guarantee Is acceptable In place of a signature guarantee. If a signature guarantee is 1401"required, you may fax this completed form to (888) 421-4371; othet'wise, mail it to the appropriate service center for your state using the maps below. Indiana Service Center American Funds Service Company P.O. Box 6164 Indianapolis, IN 46206-6164 Overnight mail address 12711 N. Meridian St, Carmel, IN 46032 9181 Fax(888)121-4371 Virginia Service Center American Funds Service Company F.O. Box 2560 Norfolk, VA 23501-2560 L fir" j% Overnight mail address 5300 Roon Hood Rd. * t.; Nor folk, VA 23513-2430 Fax(B88)421-437'1 If you have questions or require more information, contact your financial advisor or call American Funds Service Company at (300) 421-4225. 5 of t.0 CAPITAL AMERICAN Traditional or Roth IRA GROUP® FUNDS" Disclosure Statement The following is a brief summary of some of the financial and tax consequences of establishing a Traditional IRA or Roth IRA. The American Funds Traditional Individual Retirement Account ("Tradllianal IRA")IRoth Individual Retirement Account ("Roth IRA") Disclosure Statement If you did not receive this Disclosure Statement at least seven days before establishing your Iraollonal IRA andem Roth IRA, you may revoke your IRA. Your Traditional IRA and/or Roth IRA is established and accepted on the date you execute the American Funds Tradlffonai/Roth IRA Application. To revoke your Traditional IRA end/or Roth IRA, you must provide written notice of revocation within seven days shot your Account is established Written notice of revocation may be rnaiied to Capital Bank and Trust Company, P.O. Box 6007, Indianapolis, IN 46206-6007. The revocation will be considered given as of the postmark data. Upon revocation, the entire amount of your contribution will be returned to you without adjustment for administrative expenses or fluctuations In market value. I. Contributions to the Account 1. Limitation on Amount of Contribution. (a) Traditional IRAs. Contributions to the Traditional IRA may be either'7ollover" contributions or regular cash contributions. Rollover contributions, which may be of any amount, are contributions of eligible distributions from a §401(a) qualified retlrement plan, §403(b) plan, §457(b) government plan, SIMPLE IRA after two years, or distributions from another Traditional IRA. Rollover amounts can Include after-tax contributions made to the plans. To qualify for rollover treatment, you must make an appropriate election to treat the contribution as a rollover contribution. Money or property distributed to you must be rolled over within 60 days of your receipt. Eligible distributions from a §401(a) qualified retirement plan, §403(b) plan or §457(b) government plan may be directly rolled over to the Traditional I RA. Amounts, other than after-tax amounts, that had originally been rolled over into your Traditional IRA from an employer's retirement plan can again be roiled aver Into another employer's retirement plan that will accept such a rollover. Contributions that are not rollovers roust be made In cash and cannot exceed the maximum amount allowed under the Internal Revenue Code All or a portion of your contributions to a Traditional IRA may be tax deductible. This amount vanes depending on your modified adjusted grass Income ("MAGI") for the year You may contribute to a Traditional IRA even If the deduction forth. contribution Is reduced or eliminated as discussed in Section 2 of this Disclosure Statement It you designate the contribution as a nondeductible contribution on your Income tax return. If contributions are being made to your Traditional IRA under your employers SEP, the maximum annual contributor, limit to your Traditional IRA is the lesser of $56,000 for 2019 and $57,000 for 2020, or 25% of your compensation, In addlllon to any personal IRA contributions (Traditional and/or Roth). Personal contributions to a Traditional IRA are not allowed for the taxable year In which you reach age 70% or for any year thereafter. (b) Roth IRAs. Contributions to the Roth IRA may be "conversion," "rollover," or regular cash contributions. Conversion contributions, which may be of any amount, are contributions of distributions from a Traditional IRA, a SEP or a SIMPLE IRA, A MAGI limit does not apply to conversions Rollover contributions, which may be of any amount, are contributions of distributions from another Roth IRA, §401(a) qualified retirement plan, §403(11b) plan or §457(b) government plan. The MAGI limits specified under Section 3 do not apply to a Roth IRA established solely to receive Roth assets rolled over from a 401(k) cr403(b) plan. For both conversion contributlons and rollover contributions, money or property distributed to you must be rolled overwRI-In 60 days of tecelpt. Contributions, which are not conversions or roilovers, must be made In cash and cannot exceed the maximum amount allowed under the Intemal Revenue Code. This amount varies depending on your MAGI for the year. (c) All IRAs. Contributions, other than rollover or conversion contributions, to all of your Tradlhonal and/or Roth IRAs together cannot exceed $6,000 In 2019 and 2020, or 100% of your compensation If you are younger than 50. If you are 50 or older before the close of the taxable year to which the con0lbution applies, the maximum amount Is $7,000 for 2019 and 2020. You can make only one rollover from an IRA to another (or the same) IRA In any 12 -month period, regardless of the number at IRAs you ever The limit will apply by aggregating allot an Individual's IRAs, Including SEP and SIMPLE IRA. as well as Traditional and Roth IRAs, effectively treating them as one IRA for purposes of the limit A rollover from a Traditional IRA (Including SEP & SIMPLE IRAs) to a Roth IRA Is not subject to the one rollover per your limitation. The one rollover per year limitation also does not apply to a rollover to or fro n a qualified plan (and such a rollover is disregarded In applying the one rollover per year limitation to other roilovers), nor does It apply to trustee -to -trustee transfers. For more Information refer to IRS Announcements 2014-15 and 2014-32. td) Recombination of a Qualified Hurricane Distribution. If you received a qualified hurricane distribution from an eligible retirement plan, you may repay (In one at more contributions) the amount of the distribution to your IRA except for die following distributions: (a) payments received as a beneficiary (other than a spouse), (b) periodic payments for a period of 10 years or more, for your life or life expectancy, or for the joint lives or life expectancies of you and your beneficiary (other than from an IRA); and (c) required minimum distributions. You have three years from the date you received your retortion to make your repayment. Your repayment is treated as a rollover. (a) Inherited IRAs. An Inherited IRA Is an IRA that has been established to receive the distribution on behalf of a berieflclary who Is not the Account Owner's or plan particlpant's surviving spouse. Additional contributions or rollovers are not permitted to be made Into an inherited IRA. 6 of 2. Deductibility of Contributions to Traditional IRAs Cash contributions are deductible from gross Income (except as explained in the following paragraph), whether or not you Itemize your deductions, and must be claimed on Form 1040 or Form 1040A, The maximum amount deductible undera Traditional IRA Is the lesserof $6,000 for 2019 and 2020 ($7,000 It 50 or older), or 100% of compensation. "1 his amount Is Increased to $12,D00 for 2019 and 2020 ($14,000 if both you and your spouse are 50 or older), or 100% of compensation If contributions are made to your Tradition( IRA and the Traditional IRA of your spouse, but you must file a joint return. The maximum amount doduebble is reducod by amounts contributed to a Roth IRA other than conversion comrlbutions. For taxable years 2019 and 2020, If you are an active participant In a qualified retirement plan, a §403(a) or §403(b) plan, a SEP, a SIMPLE IRA or certain government plans, your contribution is not fully deductible d you are single with MAGI exceeding $64,000 for 2019 and $65,000 for 2020, or married filing jointly with MAGI exceeding $103,000 for 2019 and $104,000 for 2020. If you have income above these levels, the deductible amount is reduced at the rate of $600 for earn $1,000 of Income if single ($2,000 of Income If married), so that no deduction Is allowed If you are single with MAGI exceeding $74,000 for 2019 and $75,000 for 2020, or married filing jointly with MAGI exceeding $123,000 for 2019 and $124,000 for 2020. If this calculation results In a deductible amount of more than zero but less than $200, you will still be permitted to deduct $200. A married individual who Is not parbui pati r,0 in an employer-sponsored retirement plan, but whose spouse Is participating in one, will be able to make deductible IRA contributions. The deductibility of such contributions will be phased out for couples with MAGI between $193,000 and $203,000 for 2019 and $196,000 and $206,000 for 2020. Rollover contributions, If properly made, are not Included in your gross Income and, therefore, are not deductible. Eligibility to Make Roth Contributions The maximum amount that can be contributed to s Roth IRA is the lesser of $6,000 for 2019 and 2020 ($7,000 If 50 or older), or 100% of compensation. This amount Is Increased to $12,000 for 2019 and 2020 ($14,000 if both are 50 or older), or 100% of compensation If contributions are made to your Roth IRA and die Roth IRA of your spouse, but you must file a joint return. The maximum amount Is reduced by amounts contributed to a Traditional IRA other than rollover contributions. It you are single with MAGI that does not exceed $122,000 for 2019 and $124,000 for 2020, or married filing jointly with MAGI that does not exceed $193,000 for 2019 and $196,000 for 2020, you are eligible to make a full $6,000 CAPITAL AMERICAN GROUP' FUNDS° contribution for 2019 and 2020. If you have Income above these levels, the amount you may contribute to a Roth IRA is reduced on a pro rata basis, so that no contribution is allowed if you are single with MAGI exceeding $137,000 for 2019 and $139,000 for 2020, or married filing jointly with MAGI exceeding $203,000 for 2019 and $206,000 for 2020. If you are marded, filing separately, the phase-out range Is from $0 to $10,000 of MAGI. If this calculation results In a contribution amount of more than zero but less than $200, you will still be permitted to contribute $200. 4, Excess Contributions (a) Traditional IRAs. An excess contribution is generally the amount contributed to your Traditional and/or Roth IRAs that Is more than (a) your taxable compensation for the year or (b) $6,000 for 2019 and 2020 ($7,000 If 50 or older), whichever Is smaller. Contributions for the year you reach age 70'A and any year after that are also excess contributions. Such excess contributions will be subject to an annual 6% excise tax. However, this tax can be avoided if you withdraw your excess contributions plus any earnings on the excess on or before the due date, including extensions, for your federal tax return for the year In which the excess contribution Is made. The earnings that are withdrawn must bo Included In your income for the year the excess contributions were made and may also be subject to a 10% premature distribution penalty If you are under age 59'/x. (b) Roth IRAs — Contributions, If your contributions for any texahle year are groatorthan the maximum amount permitted based on your MAGI, the excess amount will be subject to an annual 6% excise tax. However, this tax can be avoided If you either withdraw or transfer to a Traditional IRA the amount of the excess contribution plus any earnings on the excess on or before the due date, Including extensions, far your federal tax return for the year in which the excess contribution was made. The earnings that are withdrawn must be included In your Income for the year the excess contributions were made and may also be subject to a 10% premature distribution penalty If you are under 591K, Recharacterization of Contributions Prior to your tax -f fing deadline, Including extensions, you may Instruct the Custodian to recharacterize a contribu0on made to a Traditional IRA as a contribution made to a Roth IRA, and a contribution made to a Roth IRA as a contribution made to a Tradihonel IRA. You may also Instruct the Custodian to recharacterize a conversion contribution prior to your tax -filing deadline, Including extensions. A subsequent reconversion following recharacterization may not occur earlier than (a) the first day of the calendar year following the calendar year of recharaclerizatlon, or (b) the and of the 30 -day period beginning on the date of recharactanzabon, whichever is later. 6. Investment of Contributions Under the terms of the Custodial Agreement, your contributions will be Invested by the Custodian, Capital Bank and Trust Company, or any successor, In accordance with your written Instructions or the written Instructions of your employer on your behalf If you are a participant In a payroll deduction plan with: (a) no Investment Instructions and contribution more than $10,000: If no fund is designated and the amount of the contribution, regular or rollover, is over $10,000, such contribution will be held unmvested (without liability to the Custodian for loss of Income or appreciation pending receipt of proper instructions) until investment instructions are received but for no more than three (3) business days. If Investment instructions are not received, the contribution will be invested in American Funds U.S. Government Money Market Follow on the third business day after receipt of the contribution. (h) no investment instructions and contribution $10,000 or lase: If no fund Is designated and the amount of the contribution, rag ular or rollover, Is $10,000 or less, the amount of the contribution will be Invested in the same proportion and In the same Fund or Funds In which the Iasi contribution, regular or rollover, was invested, provided such contribution was made within the last sixteen (16) months. If no contribution was made within the last sixteen (16) months, the contribution received without investment Instructions will be held uninvested (without liability to the Custodian for loss of income or appreciation pending receipt of proper Instructions) until Investment instructions are received but for no more than three (3) business days. if Investment Instructions are not received, the contribution will be Invested in American Funds U.S. Government Money Market Fund on the third business day after receipt of the contribution. (c) SEP/SARSEP contributions with no Investment instructions. If your contribution Is to a SEP or SARSEP and you fall to provide Investment Instructions, your SEP or SARSEP contribution will be Invested based on the Investment instructions provided by your employer. If you designate one or more of the American Funds but there Is he share class Indicated, the default will be A shares. No part of your Traditional and/or Roth IRA will be invested In life insurance contracts (d) Other investment Information. Any dividends or refund of premiums received from any annuity contract held In your Traditional IRA will be applied in the next year toward the payment of future annuity premiums or to purchase additional benefits. The Custodial Agreement provides that your entire Interest in the assets held in your Traditional and/or Roth IRA Is nonforallable at all times and that such assets will not be commingled with other property 7 of Traditional or Roth IRA Disclosure Statement 11. Distributions From the Account 1. Ta.. flon of Distributions (a) Traditional IRAs. Distributors from your Traditional IRA are taxed as ordinary Income except for the portion that equals all handeducfible contributions divided by the total withdrawals during the year plus the balance In all your Traditional IRAs at the end of the year plus any outstanding rollovers (amounts distributed from a Traditional IRA within 60 days of the end of the year, which are rolled over in the following year during the 60 -day rollover period). Premature distributions may be subject to a 10% penalty, (b) Roth IRAs. Distributions from your Roth IRA that are "qualified distributions" are not taxable. Qualified distributions are distributions road. from your Roth IRA more than five years after you establish your first Roth IRA If made after you reach age 59Y= or your death or disability, or If used for certain expenses to purchase a first-time home, Dislubutlons that are not qualified distributions will be excludable from your Income to the extent the amount of the distribution does not exceed the aggregate amount you contributed to your Roth IRA, Conversion amounts that you Included In Income may be subject to a 10% premature distribution penalty If removed from your Roth IRA within five years after making the conversion contribution to your Roth IRA Any distributions treated as taxable Income to you may be subject to a 10% premature distribution penalty, Penalty Tax on Premature Distributions Any dish ibullon (or in the case of a Roth conversion contribution, any distribution within Ove years of a conversion, to the extent such amount was included or Includable In income) made before you reach age 59% will be subject to a penalty of 10%ofthe taxable amount of the distribution, except for distributions made (a) In the case of death or disability (b) for the return of nondeductible or excess contributions from your Traditional IRA (c) for the return of excess contributions from your Roth IRA (d) as payments for certain catastrophic medical expenses (e) as payments made after an extended period of unemployment to cover health insurance premiums (f) as payments for certain expenses Incurred to purchase a first-time home up to a lifetime maximum of $10,000 (g) as payments far post -secondary education costs of your immediate family members and grandchildren or hd as payments made In substantially equal Installments which may be based on, but not limited to, the following methods. life expectancy, amortization (using a rate between 80% and 120% of the long-term applicable federal rate) or annuhizaton (using an acceptable mortality table Including, but not limited to, UP'84, '63 IAM, or Annuity 2000) 61 CAPITAL I AMERICAN GROUP® I FUNDS& (1) as payment In satisfaction of a levy under Code §6331 after December 31, 1999 (J) as payments taken due to certain catastrophic events In federally declared disaster wees Required Distributions From Traditional IRAs To begin receiving required distributions from your IRA, you must notify the Custodian in a form acceptable to the Custodian, Generally, a minimum distribution must be taken on account of each of your IRAs once you reach 7011, You must take your first distribution beginning April i (your "Required Batt thing Date") of the calendar year following the year in which you reach age 70'h Your distributlons can be taken over a period calculated on your life expectancy and that of a beneficiary assumed to be 10 years younger than you (the factors can be found In the IRS Uniform Lifetime table). If your sole Beneficiary is your spouse who is more than 10 years younger than you, you may use your spouse's actual age (the factors can be found in the IRS Joint Life and Last Survivor Expectancy table)to determine the payout period. If you have more than one IRA, other than a Roar IRA, a minimum must be separately delerm tried for each, but the total distribution can be taken from any one .,.ore IRAs. 4. Charitable Contributions From Traditional IRAs Ifyou are 701or older, you may satisfy all or a portion of your minimum distribution requirement by making lax -free distributions of Up to $100,000 per year directly from your Traditional IRA to certain charitable organizations. 5. Penalty Tax for Insufficient Distributions From Traditional IRAs If you take less than the required minimum dlst- bution atter you reach your Required Beginning Date, a 50% penalty tax on the difference between the amount required to be distributed and the amount actually distributed In ilial year will be assessed. The Internal Revenue Service can waive the 50% penalty tax if the insufficient distribution was due to reasonable error and steps are taken to correct the undedustribution. 6. Required Distributions From Rath IRAs No distributions are required to be made from your Roth IRA prior to your death. 7. Distributions Upon Your Death Your Beneficiaries may request distribution under the appropriate method or methods described below by filing a written claim with the Custodian (at Traditional IRAs. It you die after the Required Beginning Date, but before your entire Interest is distributed, the remaining portion of your Account may he distributed an the life expectanoy of your Beneficiary. (b) All IRAs. If you die before the Required Beginning Dale of your Traditional IRA, or at any time If your IRA Is a Roth IRA, the balance in your Account must be paid out as follows. (1) benefits may be paid out over the life expectancy of a nonspouse Designated Bonet clary, provided such benefits begin no later than December 31 of the year following the year of death or (11) benefits may be distributed to your surviving spouse over the life expectancy of the spouse, provided that the distributions start no later than December 31 of the year 1n which you would have reached age 701 and your surviving spouse Is the sole Beneficiary of the Account (iii) your spouse, as sole Beneficiary, may treat the Traditional and/or Roth IRA as his or her own by making a contribution or by notifying the Custodian or (iv) the entire balance must be distributed by December 31 of ilia year containing the fifth anniversary of your death Issuance of a Check Upon issuance of a check from the Account, no additional earnings will accrue m the Account with respect to the uncashed check. Earnings on uncashed chocks may accrue to the Custodian at a money market rate of return. Such earnings will accrue from the date upon which a check Is mailed, oma business day after the redemption or sale Is processed, until the dale upon which the check Is presented for payment. Estate and Gift Taxes Upon your death, the value of your Traditional andfor Roth IRA is subjectto federal estate taxes under §2039(a) of the Internal Revenue Code unless the Account Is left to a surviving spouse In a form that qualifies far the marital deduction. For gift -tax purposes, beneficiary designations will not be treated as gifts If they are revocable. In addition, contrau8ons to a Traditional and/m Roth IRA for a nonempioyed spouse wl It qualify for the annual exclusion as a present -interest gift. III. Tax Status of Custodial Account Tax -Exempt Status Generally, any contributions and earnings thereon held in your Traditional IRA are exempt from federal Income tax and will only be taxed when disli ibuted to you, unless the tay-exempt status of the Traditional IRA is revoked. Generally, any earnings in your Roth IRA are exempt from federal Income tax and will only be taxed when distributed to you In a nonqualified distribution, unless the tax-exempt status of the Roth IRA Is revoked. The Custodian of your Traditional and/ or Roth IRA has received a letter from the IRS approving the form of the Traditional and/or Roth IRA. Such approval Is a determination as to the IRA terms only and is not a determination of the merits of the Traditional and/or Roth IRA as an Investment. 9 of Traditional or Roth IRA Disclosure Statement 2. Los a of Exemption The tax-exempt status of the Traditional andfor Roth IRA will be revoked as of the beginning of the year In which you engage in any of the prohibited transactions listed in §4975(c) of the Internal Revenue Code, such as borrowing money from your IRA, selling property to your IRA or exchanging properly with your IRA. Generally, the fair market value of your Traditional IRA (excluding any nondeductible contributions) will be includable In your taxable Income in the year In which such prohibited transaction takes place and may also be subject to a 10% premature distribution penalty. In the case of a Roth IRA, to the extent the fair market value of your Roth IRA exceeds aggregate contributions made to your Roth IRA, such value will be Includable In your taxable Income In the year in which such prohibited transaction takes place and may also be subject to a 10% premature distribuflon penalty, In addition, the Traditional and/or Roth IRA will lose Its tax-exempt status if you use all or part of your Interest in the IRA as security for a loan. Any portion of the IRA used as security for a loan will be treated as a distribution in the year In which such use occurs. If you are under age 59Y, the amount of the loan may also be au bject to a 10% tax penalty as a premature distribution IV. Additional Tax Information For years In which excess contributions have been made to your Traditional and/or Roth IRA, of you received from your Account premature distributions or underdialributlons from your Traditional IRA after reaching age 701, you are required to file with the IRS Form 5329, Additional Taxes on Qualified Plans (Including IRAs) and Other Tax -Favored Accounts, along with your Individual tax return for that year. For years In which nondeductible contributions were made to your -Traditional IRA, Form 8686, Nondeductible IRAs, must be filed with your tax return. Form 8606 will also be used to keep track of your Roth IRA contributions and/or conversions. Further information about your Traditional and/or Roth IRA can be obtained from any district oflice of the IRS or at www.irs.gov, Consult Publication 590-A for Information on IRA contributions, and/or Publication 590-6 on IRA distributlons. V, Financial Information To calculate earnings on the Account, reinvested dividends and capital gain distributions are purchased at net asset value ("NI on the reinvestment date. The number of shams in the Account at the end of the period Is multiplied by the NAV per share at the end of the period to determine the ending value. The difference between the ending value and the initial Investment equals the earnings for the period. If $1,000 is invested In any fund other than American Funds U.S. Government Money Market Fund and a reduced sales charge is not available, the highest sales charge would be $57.50, or 5.75% of the contribution. See lho prospectus of each fund for further detalls. If $1,000 is invested in the money marketfund, no sales charge would be imposed In addition, there Is a fee for establishing the Account as well as an annual Custodial fee. The future growth results of your Investment in mutual fund shares cannot be guaranteed or projected, CAPITAL AMERICAN GROUP I FUNDS` Inherited IRA Distribution Request Important: If the amount owner passed away after December 31, 2019, the SECURE Act changed the distribution options available to nnnspousai beneficiaries, which are not yet reflected on this form. The distribution options listed in Section 2-A may not be applicable. Call Lw in discuss the options available to you. Use this form to request distributions from the Capital Bank and Trust Companys"' (CB&T) IRAs that you have inherited as a beneficiary. Information about you Please type or pont rleady Account number (it known) Oakland County Animal Control & Pet Adoption ( 248) 858-1070 net ua,ne MI Last Daytime phone 1200 N. -telegraph ted. Bldg 42 East Pontiac MI 483,11 7Jd res, City stat' Zip Citizenship status: LJ U,S. citizen ❑ U.S. resident alien ❑ Nonresident alien (Submit an IRS Faint N1-8BEN.) Distiribution options r` To req loot an RAID, complete A. to request a one-time payment, amuplete B. blokes: - Consult the "Understand Your Alini nafives During This Time of Change' brochure to evaluate your options, including guidelirip, s for Sort wi ed Minimum Distributions (RM Ds). Talk to your tax advisor before beginning distributions to ensure you are aware of any tax and penalty considerations. Dish ibufions are taken proportionately from each fund in your account. 1, -:'ou d'; .t.,i i. -,..n rn„oiler pagnt,:nts in J timely ivaunor, toe Ifr.5 will peusr4t, you with o Su"! i:,x nu "toy gnk,1111 you =houkl I'nva I i': tin iiIIt aid flat A. Request RMDs (Select one.) 'I. ❑ 1 am requesting RMDs using my defeat birth. (This option Is not available for an entity banefrciary.) 2. ❑ 1 am one of multiple beneficiaries, and I am required to tale RMDs based on the oldest beneficiary's date of birth' Onmlddlyyyy) 3. [-11 am requesting payments over a five-year period. If the account is a Traditional IRA, this option is only available if the account Owner passed away before the Required Beginning Date. 4. ❑ I am iegiresting RMDs using the original owner's date of birth and the account owner passed away after the Required Beginning Date. (This option Is Only available if the account Is a Traditional IRA.) Specify 46e frequency and statI date —required Note. 10 avoid delays in processing your request, provide complete instructions. All dishribUd011o will OCCUR annually unless ether wise Indicated: El Monthly ❑ Guar rally ❑ Semiannually Mahe the first distribution in (month) (year) Make distributions on (insert a date between the Gth and 28th) OR B. One-time distribution (Select one.) ❑ I rin requesting a liquidation of $ taken proportionately from each fund In my account X I am requesting a total liquidation. 1l41m CAPITAL'AMERICAN Inherited IRA CJROUFI" FUNDS' Distribution Recittest tl Payment options .e A slgna(me guarantee may W, required ROOPM rcrquaements m Section Y Select one of the three option;: hetow; A. CI Repurchase shares In laud in an American Funds non-reth Smear account. If opening a new account, an account appliration must be completed and attached; it Investing in an existing account, enter the number here P. ❑ Electronically deposit payments into my bank account, (Follow the instructions In Section 6. Payments will be delivered to your hank II�� within three (3) business days following the transaction date.) C. u Send a check (This option is available only for a one-time distribution.) Select one option below, 1, 1A To the address in Section t of this form 2. ❑ As a transfer to a custodian holding my inherited IRA 3, LI As a rollover to a custodian holding my IRA (This option is available to spousal beneficiaries only.) If requesting movement of assets to another custodian, provide the following Information' Plaine of IRA cuslodian Account number �p., HtlJiess City Siete ZIP - rederal income tax withholding If the Roth IRA owner did not meet the five-year holding requirement, a portion of the Roth IRA distribution may be taxable. Pedes al lame requires us to withhold income tax equal to l0% of the distribution unless you elect otherwise using the check boxes below Stato tax may also be required (see $action q). '(so may want more than 10% withheld because insufOciont withholding or undci payment of estimated taxes may result in IRS penalties. Taxes are withheld from the total amount requested. D DO No "r withhold federal (ayes f'otn' U & residence address is required to honor this request (no F.O. boxes). Resideuca ads, ass (Physical add resti required — no P.O. boxed coy ❑ Withhold federal taxes from the total distribution at the rale of _% (Must be 10% or gleaner) ,,t 4 Stale ZIP Internal Revenue Service Date: February 21, 2002 County of Oakland Payroll Division 1200 N Telegraph Rd Pontiac, MI 48341-1031 Dear Sir or Madam: Department of the Treasury P. D. Box 2508 Cincinnati, CH 45201 _ Person to Contact: Ms. Smith #31-07262 Customer Service Representative Toll Free Telephone Number: 8:00 a.m. to 0-30 p.m. EST 877-629-5500 Fax Number_ 513-263-3756 Employer Identification Number: $6-6004876 This is in response to your request for information concerning your organization s exemption from Federal income tax, As an instrumentality of a govemmental unit, your organization is not subject to Federal income tax under the provisions of Section 115(1) of the Intemal Revenue Code of 1954, which states in part 'Gross income does not include income carved from the exercise of any essential governmental function and accruing to a State or any political subdivision thereof .2 Because your organization is an instrumentality of a governmental unit, its income is not taxable as explained above. Contributions to instrumentalities are deductible under Section 170(c)(1) of the Code.' Your organization is not liable for the tax imposed under the Federal Unemployment l'ax Act (FUTA). If you have any questions, please call us at the telephone number shown in the heading of this letter. Sincerely. for John E. Ricketts, Director, TE/GE Customer Account Services CAPITAL AMERICAN Inherited IRA GROUP' FUNDS" Distribution Request Stato ifficome tax inelthholding If your stere requires withholding or if the amount below Is less than the numml Irn for your state, GR&T will withhold at feast the minimum state +\ tax regal Floss of your election below. CB&T does not withhold slate taxes for all states. -I DO NOT withhold ❑ Wi(Ithold _ _% OR Note: To review the in of state withholding fol your state of residence, visit www,capitalgroup.coin and search for "state tax withholding," or speak with your tax consultant. Bank information h .r If you selected electronic: deliomt In Section 7, attach an unsigned, voided check below 7hn check you altach must be preplan ed with the bank name, regrstiabon,'arnsw number and account number Please do not staple. Read the signature guarantee requUemants in S"ban 7 LnpoI tan l: The be nk intoe mation you provide here will he kept on file for future ACII Iequests. You will I'eceive an acknowledgment as confirmation If you do not want if Information retained and available for future AC distribution requests, decline here u You may cancel the ACH option at any time online at www.capitalgroup.com or by calling us at (800) 421-4225, L.John Doer nPIF �r Bank accolmt registration 10m U rl1 r,ITFIF �} — -j N IEDru Jr s C__ _.I .It — —. n o DOLLARS nr ( Anytowii Bank I w Bank name 7 1�9999999991' 000000000011: ^a- Baak routing number Bank account number Note: In lieu of a voided check, you may submit a letter from your bank on the bank's letterhead providing the: • hank account registration • louring number • accouut number 3 nf4 MlcWgan Uepennleni of rrocavy 3372 (Rev, 119-1a) ItttfO!yan Saless and Use "Pax Certificate of Exernption INS '1'ITUCTIONS: DO NOT send to the Department of Treasury. Corlllicato must lie retained In the sellar -s records. This cerfincalo Is Invalid unless all toursecllons ale completed by the purchaser, SECTION 1: TYPE OF PURCHASE EIA, One- Tlrne Freiman C. Blanket Cerilfiade, Order or IOVelee Winner r Expiration Data (maximum of fouryears): E B, Blanket Cedhlcate. Recun'Ing Business Relallnns'hip the purchase) hereby Wous exemption ort the purchase of tangible personal property and selected services made from the vendor listed below. this cedihas [list this claim Is based upon the purchaser's proposed use of the Items at services, OR the status of the purchaser. Vendars Name oad Addrass SECTION 2: ITEMS COVERED [3Y'PHIS CERTIFICATE Chock one of the following: 1 a All Items purchased. 2. ❑ Limped to file following items, SECTION 3: 13ASIS FOR kXEIVIPTION CLAIM Clandr one of the following; I. ❑ For t ease, Enter Use Tax Registration NunlineC 2 Ful Resale at Retail, Enter Sales Tax License Number Thefollowing exemptions DO NOT require the purchaser to provide a number: 3 0 Agliculluial Production, Enter percentage: C FXI Church, Government Entity, Nonprofit School, or Nonprofit Hospital (Circle type of organization), 5 ❑ Cunlraclol Qnusl provide Michlgan Sales and Use Tax (tonlractor Ellg@flity Statement (Form 3520)), G, [] For Resale at Wholesale. 7.11�T Indusidel Processing. Enter percentage:_" 0 IJ Nonprofit Internal Revenue Code Section 501(c)(3) or 501(c)(4) Exempt organization. 0. `—I Nonploln Organization with an authorized teller issued by the Michigan Department of Treasury prior to June 1994, 10 I holing Slack purchasnd by an interstate Motor Canner, 'li,❑ Qualified Data Center 12,❑ Direct I°'ay -Authorized to pay use lax on qualified fmnsacllons directly to the Stale of Michigan under Account Num(bol' 13,0 Other (explaln)'. SECTION 4: CERTIFICATION I declare, undo) penally of perjury, That the information oo this cedlficale is True, that f have consulted the statutes, adinlnlstielivo rules and other sources of lmv applicable to my exonp sin, and tial 1 have exetclsed reasonable care In assuring that myclailn ofexemplion a valid under Michigan lane In lire event 04s clalm Is disallowed, I accept full responsibility for Ilia payment of tax, penalty and any accrued interest, including, lfnecessary, rennbmsentenf to Ilse Vander for tax and accrued Interest. nosiness Nam. Oakland County Compliance/Purchasing nuslness Addmss 2100 Pontiac Lake Ind. @miness ralophone Number (incloda area code) (248)858-051.1 S"'I.Wro and fill. 1 Type of Business (see codes on page 2) Government - 05 City, Stale, XIP Cede Waterford, MI 48328 Dina- (Print or Type) Pamela L. Weipert, Compliance Officer Data Sipnad CAPITAL I AMERICAN GROUP" FUNDS" Authorization arid signature cgn ' g ._ -..;uarantee Inherited IRA Distribution Request I certify that the intourrahon herein Is accurate, and I will notify CB&T of any changes. I direct CB&T to make distributions from the IRA on the basis of the information I have piowded. I am aware of the RNID rules and I acknowledge that CD&T and Its affiliates are riot responsible fa ensuring that I have complied with these rules. I agree to hold harmless CB&T and its affiliates for any claims, expenses or taxes including penalties and interest) incurred due to distributions made In accordance with this form. If I have agreed to allow American Funds to retain bank intormatioIA for future ACH requests, I authorize AFS, upon request via phono, fax, or any other means utilizing tolecomrnunica0ons, including wireless or any other type of communication lines by authorized persons with m,!xnnr rata acr.eunt information, to i) redeem fund shares from this account and deposit the proceeds into the bank accrnuri idenhfieri on this �*n( and/or 2) secure payments from the bank account into this account I authorize the hank to accept any such credit or dark to my „, At without responsibility for its correctness cnu,,,i r, r.i.:; ,,:f h- -- :I tnr,d wo...I Ad,,k,r Avc i h.-< Reerl, is " dill :,nil sign” traanrr:. A signature guarantee is required unless the redemption request GUARANTOR: is less than $125,000 and will be: Stamp signature yuan aides or medallion guarantee here. ° mailed to the address of record, as long as the address has not changed In the last 10 calendar days OR sent via ACH to a hank account on file, and there has not been a change to the bank information in the last 10 calendar days. The bank information must be associated with a redemption option on the account. OR reinvested into an existing or new American Funds accomtt for which the IRA beneficiary is an owner Note regarding RMDs sent via ACH; A signature guarantee Is required unless the inherited IRA account holler is included in rhe baul< account iegisumlon, and the request is received at least 10 calendar days prior to the first draft. If required, a signature guarantee most be performed by a bank, savings association, credit union, member firm of a domestic stock exchange or the Financial Industry Regulatory Authority that is an eligible guarantor institution. A notary public is NOT an acceptable guarantor. The guarantee must be in the form of a stamp or a typewritten or handwritten guarantee that Is accompanied by a raised corporate seal. Note: A medalhon guarantee is acceptable in place of a signature guarantee. If a signature guarantee is required, mail this completed form to the service center fot your state using the maps below. Otherwise, you may fax it to (888) 421-4371. hnliona tern,, tYubrr, American Funds Service Company P.O Box 6164 Ind,anapola, IN 46-'06-616,1 --I- Overnight mail address 12'11 Pt Meridian Si. Carmel, IN 46032 9181 Fax (888) <121-4371 Vi,niuio S, wire i ¢a L., American Funds Service Company Psi P.O. Bos' 2560 Norfolk, VA 23501-25n0 —c' Overnight mail address 53x10 Robui Hood RJ Norfol6. VA'135'13.2430 Fax (8H)421-43/1 II you have questions or require more information, contact your financial adviser or call American Funds Service Company at (800) 421-4225. 4 old CAPITAL I AMERICAN GROUP" ( FUNDS" Entity Beneficial Owners "n Owner information (continued) 4. Ext. SSN Data or birth tmmlddlyyyy) Daytime phone Name of owner Country or citizenship %, ownership * ��`•^�°"*�- Raside,ce or business address Y h/klcala Imss ra aired no P.O,oxes) qty State (P `� t ZIP - .4 ..., .. .. t • Control person/authorized person - - - This section must be completed, even if the control person/authorized person was previously Identified In Sect/ort 2. If the control personhhhhoozed person Is not a U. citlzen or if an SSN has nal been issued, contact us at (000) 421-4225, act, 71 for additional information. Provide Information for one Individual with significant responsibility for managing the entity, such as a chief executive officer, chief financial _ officer, managing member, general partner, president, vice president or treasurer. (248)858-1070 ext. JCId Data,, Hrtfi r Daytime phone Ilww or control pa,soucl,..ho,nz d o"t,", I in, of wnhol pc sonfamironzed Avon Country of eihzenship '1200 N Telegraph rd. Bldg 42 East Pontiac MI 48341 Residence or business address (physical address requieu—no P.O, boxes) City State ZIP 11 :.11 ..,I:_� .., ...... _.: ___:. L,.,. _ Ir, l Signature of control person/authorized personT-" 0 II I hereby certify, to the best of my knowledge, that the Information provided on this form is complete and correct. p ddud p,. r,,,,Wau,hui ¢ad Peron (pdnl) :I ,',s ! Idle "s"'-' i d:nnbol pa�sunf:uilhn, ¢i -d po�;nn , ...,n,.10,, rr .,o.. i. •ut, pv: ,.,cv,:7 A.4,h; as ob.,l ; dill m,d:ilnn"'. ,n!Ir_. 1 1 - tlnte luvu(Jd/v;^vvl Luliane 5?, t, p o <_o W nl Vi, Dial„ `wr ,lzo r.dLL,y American Funds Service Company American Funds Service Company PO Box 6001 ! Y' P.O Box 2280 Indianapolis, IN 46206-6007 - Norfolk, VA 23501-2280 Overnight net/ address I-- 'j Overnight mail address 111 12711 N. Mai,dian St. hI-Y7„i�A' 5300 Robin Hood Rd. Ca, mel, IN 46032-9181 ,1 �� Norfolk, VA 23513-2430 Fax(888)421-4351 Fax(888)421-4351 If you have questions or require more information, contact your financial advisor or oall American Funds Service Company at (800) 421=4225, ext 78. 2 of CAPITAL AMERICAN GROUP° FUNDSe Entity Beneficial Owners Investors opening an account for a legal entity — such as a corporation, organization, partnership, limited liability company or nonprofit— should complete and sign this form to provide or update beneficial owner information. Federal regulations require American Funds to obtain and verify this information. For the purposes of this form, the beneficial owners are 1) each Individual, If any, who owns, directly or indirectly, 25% or more of the equity interests of the entity, and 2) a single individual with significant responsibility for controlling, managing or directing the legal entity. Information provided on this document will be used to verify the beneficial owners' identities. For example, identities may be. verified through the use of a database maintained by a third party. If American Funds is unable to verify the individuals' identities, American Funds may need to take action, possibly including closing the account and rodeeming the shares at the current market price, and such action Cray have tax consequences, Including a tax penalty. If you are updating information on an existing account, you must provide all the information requested in Sections 2 and 3, even if you are only updating the information for one Individual. Entity an$c,rnaa400.�n ,�. Please type orpra t clearly. OkaInd County Animal Control & Pet Adoption Pull legal name of entity Account number (if applicable) 1200 N. Telegraph Rd. Bldg 42 East Pontiac: MI 483111 Physical address of entity (no P.O. boxes) City State ZIP Owner information r'' -- if any om er is not a U.S. citizen or has not been Issued an SSN, contact us at (000) 42 1.4225, ext, 71 for additional mforrnatlon. Provide Information for each individual, If any, who, dh ectly or Indirectly, through any contract, arrangement, understanding, relationship or otherwise, owns 25% or more of the equity interests of the entity. r .b,�d this Lox If no individual owns 25% or more of the equity Interests of the entity. 1, SSN Date a( birth (mmiddlyyyy) Name at owns, Country of citizenship Residence or business address (physical address required —no P.O, boxes) City 2. SSN Date of birth (mmlddlyyyyl Name of owner Country of citizenship Radiative m business address (physical address required — no P.O. boxes) City 3. SSN Date of birth (mmlddiyyyy) Name of owner Country of citizenship Residence or business address (physical address required — no P.O, boxes) 1 of 2 City Ext Daytime phone 'Y. ownership state Z11 Ext. Daytime phone %ownership state ZIP Ext. Daytime phone %ownership Stat. zip Continued on next page 1 NMIONAL UrE INSURANCE COMPAI`d" Clntms Adrmutsnaimn April 15,2_020 Kelly Boyd 388,3 'i'elegraph Ped ;ice 201 Bloornfichl, D/II 48302 `A L3ci.;eased: l%ennetlt 1'fiveatt Policy No.: Clear Kelly Boyd: Wo are eorry to hear about the death of Kenneth Thweatt and wish to extend our condolences. Based on the infolnnation provided, we have established a claim for the following: P ka TA ra;i?er Named Beneficiary Preselected Benefit Option Oakland Cc Animal Cutr1 & Pet Adptn Please be aware that it is very important that you provide its with the contact information for tete beneficiary(its) listed above. If this information is not received, it may delay our processing of the claim. In addition, unclaimed funds will be repotted to the state as required by law. Ploase be advised that any scheduled distributions vvill cease and any un-Casllerl payments, issued in the deraased's name, have been slopped, in order to process the claim promptly, please return to its the following: Claim Form n1,ur rRt G�csc,lt!tiot! 11i H1,1rdx; Final Certified Death Certificate Once we. receive this information, we will process the claim as quickly as possible. Please be adviser, any documentation srtbtmmed to our office will not be returned. Sackwn National Life lnsmanco Company 1 Corporate way, Lansing, NII 43951 900/644-4565 Policy Nunnbm gilt A IS, 2020 If you have any questions or need additional iuformatiou, please contact our Service Center toll free at ILM/565-4995 3itrrerely, Laura Hanson VP, Policy Owner Services Enclosure: Claim Form Annuity Death Benefit Claim Form Y �$ � r • {[ryp §pp m. 1111 NVIIONl l 1111 Ph I I)ICICI t'u. 9l '. Homo Office: Lan Important Instructions for Prompt Settlement www.jackson.com • Use dark Ink only to complete this claim form. Print or type. • Claimant must sign, print name and date the claim form on page 7. m Include a certified copy of the finalized death certificate for the deceased with manner of passing. ® If the claimant is a Trustee, please provide a complete copy of the bust agreement, including all amendments and the Trust Tax Identification Number. • If the claimant is an Executor, Administrator, Guardian or other legal representative, please provide a certified copy of the court appointment. ® If the claimant is an Attorney -in -Pact on behalf of the beneficiary, include the Power of Attorney instrument. ® If any of the beneficiaries named in the Contract are deceased, please provide a copy of their death certificate. ® If the claimant is an ex-spouse, please provide a copy of the divorce decree and property settlement agreement. • If the claimant is a non-resident alien, please provide the W-8BEN form and Individual Taxpayer Identification Number. DECEASED INFORMATION (please print) Deceased's Name (First) (Middle) (Last) [Kenneth IEarl IThweatt Date of Birth (mm/dd/yyyy) Date of Death (mm/dd/yyyy) I1' Social Security Number of Deceased (IMPORTANT) (Other Name(s) by which Deceased was known Marital Status of the Deceased ❑ Married JZ Divorced ❑ Widowed ❑ Single Contract Number(s) for which you are claiming benefits 2 I _I CLAIMANT INFORMATION (please print) Claimant's Name (First) (Middle) (Last) L l _ Name of Non -natural Entity Claimant (if applicable) (Oakland County Animal Control & Pet Adoption Claimant's Physical Address (No P.O. Boxes) City 11200 N. Telegraph Bldg 42. East JIontiac Claimant's Mailing Address City Date of Birth (mm/dd/yyyy) Relationship to the Deceased Claimant's E -Mail Address Claimant's Social Security NuV US Citizen? ❑ Yes ❑ No Currently Residing In US? ❑ Yes ❑ No Do you wish to take the deceased's Required Minimum Distribution (RMD)? ❑ Yes ❑ No • If no dollar amount Is indicated, the RMD will be calculated for you. $1 Note: Please complete Notice of Withholding on page 3. This option may only be elected in conjunction with Options A, B, C, D or E. Page 1 of 8 Z11 42 03118 �r (..r ( R �J Tax iduntiticauun F Numhel State ZIP Code 1148341 1 State 11 ZIP Code 1F 1 Daytime Phone Number (including area code) 11(248) 858-1070 I US Citizen? ❑ Yes ❑ No Currently Residing In US? ❑ Yes ❑ No Do you wish to take the deceased's Required Minimum Distribution (RMD)? ❑ Yes ❑ No • If no dollar amount Is indicated, the RMD will be calculated for you. $1 Note: Please complete Notice of Withholding on page 3. This option may only be elected in conjunction with Options A, B, C, D or E. Page 1 of 8 Z11 42 03118 Please Select One of the Following Options (A, B, C, D or E), Then Sign and Date the Form. A. Lump -Sum Distribution, Beneficiary Access Account and 5 -Year Deferral Options— ifyouselect this option, you must also complete the "Notice of Withholding" section on page 3. Choose one of the Payment Options Below; (if no settlement option is selected, Jackson National Life Insurance Company° (Jackson`) will contact the beneficiary to seek an affirmative selection from the beneficiary.) 1. Lump -Sum © Please send me a check for my proceeds. ❑ Please wire my proceeds. I acknowledge there will be a $20.00 wire fee and have attached a copy of a voided check. 2. Beneficiary Access Account (BAA) ❑ Please establish an interest bearing BAA in my name for my proceeds and send me a book of checks for access to my money. 3. 5 -Year Deferral Option ❑ I elect to withdraw the Death Benefit within five years. I would like to withdraw $I I immediately and understand that I must submit the Annuity Partial or Full Liquidation Request, form X3101, to withdraw the remainder of the benefit. Please Note: this option Is not available for IRAs and other qualified plans it the deceased died after the RMD beginning date (generally April 1 after age 70th.) Jackson will make payment of annuity contract proceeds due you in a lump -sum. Except when contract proceeds are due corporations, partnerships, trusts, estates, minors, and beneficiaries resident In the stale of New York, if the proceeds due you are $5,000 or greater, you may request (above) that Jackson establish a BAA in your name that permits you to write checks to withdraw your money from the BAA. Money in a BAA remains in a Jackson general account until withdrawal. Jackson will pay you Interest on money in your BAA. Your BAA will not be FDIC -insured. Note: In order for any withdrawal to be treated as a direct exchange, transfer or rollover, you must submit the transferring company's Letter of Acceptance and required paperwork. Do you wish to advise us that this withdrawal will be treated as a direct exchange, transfer or rollover? ❑ Yes B. Spousal Continuation Option — It you select this option, you must also complete Section F, "Beneficiary Designation." ❑ As the spouse of the deceased, I elect to continue the Contract in my name. Note: If you choose this option you do not need to return the Contract to Jackson. If the contract has the IncomeAccelerator Lifetime Income Benefit (LIB), it will terminate automatically upon election of the Spousal Continuation Option unless you are a covered life under the LIB with joint option. If you are a covered life under the LIB with joint option, the LIB with joint option will remain in effect upon continuation of the Contract and may be terminated independently from the Contract to which it is attached only as allowed by the Termination of the LIB provision. If you are a covered life under the LIB with joint option, you may set or change the activation date by submitting a completed Activation Form (X4391). Please see Important Information on page 6 for more information regarding the ability to set, change or cancel the Activation Date. If the contract has the LifePay Lifetime Income Rider (LIR), you may elect to terminate the LIR benefit upon election of the Spousal Continuation Option. If you elect to terminate the LIR, a pro rata LIR Charge will be assessed for the period since the previous Indexed Option Anniversary, applicable charges will be stopped thereafter and no benefit will be available. If no election is made on the continuation date, the LIR will remain in effect and may be subsequently terminated independently from the Contract to which it is attached only as allowed by the Termination of the LIR provision. If you are a covered life under the joint benefit, the joint LIR remain in effect and may be subsequently terminated independently from the Contract to which it is attached only as allowed by the Termination of the LIR provision. ❑ I elect to continue the LIR. ❑ I elect to terminate LIR. dti Page 2 of 8 Z1142 03118 C. Systerriatle Withdrawal Option —ffyou select this option, you must also complete the"Notice of Withholding"section on page 3 and Section F, "Beneficiary Designation." To authorize direct deposit into your checking or savings account, please complete the "Direct Deposit" section on page 5. If you select an Irrevocable Systematic Withdrawal fISWI or Stretch IRA option, no indexed options will be available to you (if currently applicable), and Interest will be credited at a rate based on the current and guaranteed Interest rates Jarlemn credits on fixed annuity contracts it currently offers; that interest rate may be less than the rates Jackson credits to fire Fixed or Fixed Indexed Annuity. I choose to take distributions over my life expectancy using the following option; ❑ IRA: I choose to take distributions over my life expectancy (STRETCH IRA). While you must take a minimum amount each year to satisfy IRS requirements, additional amounts may be taken at any time. If elected, you may name a beneficiary. If you were to die prior to receiving all payments, your beneficiary(les) may continue any such distributions or take the current Contract Value as a lump -sum distribution. (This option may not be available on all products.) I'lon-Qualified Annuity: I choose to take distributions over my life expectancy (ISW). While VOL] must take a minimum amount each year to satisfy IRS requirements, additional amounts may be taken at any time. If elected, you may name a beneficiary. If you die prior to receiving all payments, your beneficiary must take the current Contract Value as a lump -sum distribution. (This option Inay not be available on all products.) IRA Spousal Stretch Deferral: I elect to defer stretch payments at this time. I understand in the future I most contact the Service Center for future distributions, Please select a Mode: ❑ Monthly ❑Quarterly ❑ Semi -Annually ❑ Annually Process the first payment as of (mm/dd/yyyy) I I . (Calendar days 29, 30, and 31 are not allowed.) If an initial payment date is not indicated, the first payment will begin 30 days after this form is received by the Claims Service Center. I"n'i-+°c' iii'd'lfriivJklilig ;f you have selected option A or C, or if you have requested to take fire deceased's BMD, you must nplete this section. '� � o7ln: Ta a ; will ho withheld if no Mcction is made Federal Tax Withholding The taxable portion of the distribution made to you will be subject to 10% (20% for eligible rollover distributions') federal income tax withholding unless you elect not to have withholding apply. L' Do not withhold federal income tax from my distribution. (If this box is checked, do not check box 2 or 3 below.) This option Is not available for an eligible rollover distribution from 403(b) contracts. If you elect not to have withholding apply to your withdrawals, or If you do not have enough withheld, you may be responsible for payment of estimated tax. You may incur penalties under the estimated tax rules If your withholding and estimated tax payments are not sufficient. 2. ❑ Withhold 10% (20% for eligible rollover distributions`) federal income tax from my distribution. 3. ❑ In addition to the instructions in No. 2 above, please withhold the following additional percentage: �� %. State Tax Withholding (Dopending on the laws in your state, state income tax withholding may be required. See "Important Information" section on page 8 for state withholding requirements.) 4. ® "Yes," please withhold the following percentage for state income taxes [___—J %. r "No," do not withhold state income tax. I tfeligible rollover distibution is any distribution of all or any podlon of the balance to the crodil of the Owner. However, such eligible rollover distribution i does not Include: (1) any distribution that is one of a series of substantially equal periodic payments (not less frequently than annually) made for the toe (or life expectancy) of the Owner or the joint lives (or joint life expectancies) of the Owner and the Owner's beneficiary, or for a specified period of ton (10) years or more; (2) any distribution required under Code Section 401(a)(9); (3) any hardship distribution; and (4) the portion of any distribution that is not included in gross Income. Page 3 of 8 21142 03/18 D. Benefit Continuation Option— if you select this option, you must also complete the "Notice of Withholding" section on page 6 and Section F, "Beneficiary Designation," To authorize direct deposit into your checking or savings account, please complete the "Direct Deposit' section on page 5. ❑ I elect to continue the periodic benefit checks the Annuitant was receiving. E. Income Option Election (Monthly Benefit Must Be $50 or More.) —if you select one of these options, you must also complete the "Notice of Withholding" section on page 6 and Section F, 'Beneficiary Designation.' To authorize direct deposit into your checking or savings account, please complete the "Direct Deposit" section an page 5. If an illustration is desired, please contact our office. ** ❑ Income Option A — (Life Only) Equal payment will be made to the annuitant as long as he or she is living. Benefits cease at the death of the annuitant. There is no right to select lump -sum payments for the annuitant and/or owner. ** ❑ income Option B — (Life, - Year Certain) A term of ten (10) or 20 years is available. However, a period -certain may not extend beyond the life expectancy of the annuitant. Equal payments will be made to the annuitant as long as he or she is living. DEATH BENEFIT: If the annuitant were to die prior to receiving the period -certain payments, any such unpaid payments shall be continued to the designated beneficiary. There Is no right to select lump -sum payments for the annuitant and/or owner. ❑ Income Option C — (L�] - Year Term Certain) A period of five through 60 years is available. However, a period -certain may not extend beyond the life expectancy of the annuitant. Equal payments will be made to the annuitant for the specified period of years. DEATH BENEFIT: If the annuitant were to die prior to having received all payments due under this Contract, payments shall be continued for the balance of the period to the beneficiary designated. There is no right to select lump -sum payments for the annuitant and/or owner. **Please send proof of age: either a copy of your birth certificate or a copy of your drivers license (or other identification provided by the state). Benefits will commence upon receipt of this paperwork in good order. Frequency of benefit payments: ❑ Monthly ❑ Quarterly ❑ Semi -Annually ❑ Annually 4 F >�'�: Page 4 of 8 21142 03/18 Direct Deposit - If you selected option C, D, or E, you may authorize direct deposit by completing this section. I hereby authorize Jackson to direct deposit into the checking or savings account identified below, until further notice, all contract payments due to the owner of the contract. If the contract is owned by a trust, I affirm that I am the current trustee of the trust and am authorized to make this request on behalf of the trust. This authorization will remain in effect until it is revoked in writing. I and/or the trust hereby release and agree to indemnify and hold Jackson harmless from any and all claims arising out of or in any way related to Jackson's actions in compliance with this authorization. I agree that Jackson will have no further liability with respect to any payments made in accordance with this authorization and may, at any time, discontinue my direct deposit and Issue checks to me requiring my personal endorsement. I, for myself, my heirs, executors, administrators, and assigns, do hereby consent and agree that any sums of money deposited to my account after my death shall be refunded to Jackson for distribution to the person or persons, if any, entitled to those sums under the terms of the contract. ❑ Checking Account (tape pre-printed voided check below) " ❑ Savings Account (provide letter from bank on institution's letterhead; letter must be signed and dated by a bank representative) " " Direct Deposit will not be established without receipt of a pre-printed voided check or letter from your bank. Please note: Contract payments will generate on the day they are due or the next business day and will be deposited into your account within 2-3 business days (receipt of funds may be delayed by a weekend or holiday). All payments from custodian owned contracts will be made payable to the Custodian for both direct deposits and checks. Do not staple. Do not attach a deposit slip or a starter check. Account Holder's Name(s) 245 Main St. Anywhere, USA 00000 Pay To The Order Of Dollars Your Financial Institution MM VO I D Name Y Street Address City, State, ZIP 1234 Your Transit Routing Number Your Account Number Your check number 2 Page 5 of 8 21142 03/18 Notice of Withholding — If you have selected option D or E, then you must complete this section. Annuity payments from income options are treated as wages for the purpose of income tax withholding, An annuity payment is one that is included in your income for tax purposes and that you receive In installments at regular intervals over a period of more than one full year from the starting date of the particular investment. The intervals can be annually, semi-annually, quarterly, or monthly. Unless you tell Jackson otherwise, tax must be withheld on annuity payments as if you are married and claiming three withholding allowances. For annuity payments, your withholding certificate stays in effect until you change or revoke it. Jackson must notify you each year of your right to elect to have no tax withheld or to revoke your election. If you elect not to have withholding apply to your withdrawals, or if you do not have enough withheld, you may be responsible for payment of estimated tax. You may incur penalties under the estimated tax rules if your withholding and estimated tax payments are not sufficient. Complete the following applicable lines: You may be able to avoid quarterly estimated tax payments by having enough tax withheld from your payments. [j i elect not to have state and federal Income tax withheld from my pension or annuity, ® I elect withholding from each periodic pension or annuity payment to be figured using the number of allowances and marital status shown (you may also designate an amount in the box at the right). Number of allowances: Marital Status: E] Single E] Married [—] Married, but withholding at higher single rate. I elect the following additional amount withheld from each pension or annuity payment. Note: For annuity payments, you cannot enter an amount here without entering the number (including zero) of allowances above, $I If your state of residence has state Income tax, you may elect to have taxes withheld using the same allowances and marital status as used for federal withholding. I elect to have state tax withheld. (Depending on the laws In your state, state income tax withholding may be required. She 'Important Information" section on page 8 for state withholding requirements.) ` F. Bkneficiary Designation — ff you have selected option A, B, C, Dor E, then you must complete this section. your beneticiary(ies). For additional beneficiaries, please attach additional name(s) and requested information on a }t, signed and dated. 1. ❑ Primak.ElPercentage of Death Benefit Beneficlarys Name (First ' p (Middle) (Last) --bate-ofBirth (mm/dd/yyyy) Social Security Number Non -Natural Entity Name Tex Identification Number Relationship to You __j I �I Address (number, street) city state Zip Code hone Number (Include area code) IN Page 6 of 8 21142 03/18 2. [] Primary Contingent El Percentage of Death Benefit ee_nriklmy's Name (First) (Middle) (Last) Date of birth (mm/dd/VwVf Social Security Number 1 II II Non -Natural Entity Name Tax Identification Numbor Relationship to You tAddress (number, street) 1City State np Code if PhoneNumber(include area code) 3. ❑ Primary ❑ Contingent ❑ Percentage of Death Benefit bonefinlary's Name tFlrst) (Middle) (Last) Date of Birth rnm/dd/yyyy) Social Security Number Non -Natural Entity Name Tax Identification Number Relationship to You II II Address (number, street) city___ tstatee ZIP Code Phone Number (Include area code) I IF- 11 1 Note: All Primary Beneficiary percentages must be in whole percentage numbers that total 100%. All Contingent Beneficiary percentages must also be in whole percentage numbers that total 100%. If no beneficiary is elected, your Estate will be recorded. Signature(:'s} The undersigned hereby makes claim to the undersigned's share of the death benefit proceeds of the above annuity Contract as beneficiary and agrees that the furnishing of this form or any of the forms supplemental thereto by the Company shall not constitute or be considered an admission by the Company that there was an annuity in force, nor shall it constitute or be considered a waiver of any of the Company's rights or defenses. THE INTERNAL REVENUE SERVICE DOES NOT REQUIRE YOUR CONSENT TO ANY PROVISION OF THIS DOCUMENT OTHER THAN THE CERTIFICATION REQUIRED TO AVOID BACKUP WITHHOLDING. Under penalties of perjury, f certify that: 1. The number shown on this form is my correct Taxpayer Identification Number. 2. I am not subject to backup withholding. k i .im a U.S, citizen or other U.S. person (including a U.S. resident alien). � :%of r.xempt from Foreign Account Tax Compliance Act (FATCA) reporting. 1 Kling below I acknowledge I have read all options available to me. Please note: ALL ELECTIONS ARE r ' ' CABLE, YOU MAY WISH TO CONTACT A TAX ADVISOR. rS to netwa Dale SlbeeJ (untldillYVYY) Cinlmanl^s Pinme (I h>q (IVh�UIa) wi lure of Witness Bate SIlned lrnm/dWyyyy) Willes>S Name(FrIp IMiddlu) (-0_���tl�.i 1 �---r_ ;C �I,C�L-1C,v � �`-. le (Lust) r. (I nsi) 4LfV Page 7 of 8 Z1142 03/18 Important Information- Please Read Carefully • The entire death benefit must be paid within five (5) years of the date of death unless you elect to have the death benefit payable under an Income Option or the Systematic Withdrawal Option. The death benefit payable under an Income Option or the Systematic Withdrawal Option must be paid over your lifetime or for a period not extending beyond your life expectancy. • For non-qualified funds, the first IRS -required withdrawal under the ISW and Income Option must occur within twelve months of the owner's death. For Lump -Sum Distributions, non-qualified funds must be completely withdrawn by the fifth anniversary of the date of death. • For qualified funds, the first IRS -required withdrawal for the Stretch IRA and Income Option must occur by December 31st of the year following the owner's death. For lump -sum distributions qualified funds must be completely withdrawn by December 31 following the fifth anniversary of the date of death. • If you wish to elect an Income Option or the Systematic Withdrawal Option you must do so within the 60 -day period beginning with the date Jackson receives proof of death. Please note: with these options your beneficiary will not receive any enhanced death benefit protections. • If a Continuation Option is selected for a JNL Target Select contract, the original allocation period will remain in effect. The Beneficiary will have the option to select a new allocation period upon renewal. • Please note: the following states do not have state income tax. We are not allowed to withhold state tax for these states: Alaska, Florida, Nevada, New Hampshire, South Dakota, Tennessee, Texas, Washington and Wyoming. The following states allow you to elect out of state withholding: California, Delaware, Oregon and Vermont. The state of Georgia allows you to elect out of state withholding on benefit payments only. • Please note: if you are a Michigan resident, we may be required to withhold state tax at the prevailing fixed percentage. • If you elect to have federal withholding, we are required to withhold for state purposes at the prevailing fixed percentage of the federal rate for the following states: Arkansas, California, Delaware, Georgia, Iowa, Maine, Massachusetts, Mississippi, Nebraska, North Carolina, Oklahoma, Oregon, Vermont and Virginia. • The 10% premature distribution penalty does not apply to distributions made to the beneficiary on or after the death of the original holder of the Contract. • Remember that there are penalties for not paying enough tax during the year, either through withholding or estimated tax payments. New retirees, especially, should see IRS Publication 505, Tax Withholding and Estimated Tax, which can be obtained by contacting the IRS. Publication 505 explains the estimated tax requirements and penalties in detail. You may be able to avoid quarterly estimated tax payments by having enough tax withheld from your payments. • Please note: if you continue a Contract with a LIB, you may set or change the Activation Date by completing the Activation Request Form (X4391). If an Activation Date has been set, you may change or cancel that date by notifying the Company at least 30 days prior to the selected Activation Date. If you do not notify the Company at least 30 days prior to the Activation Data, it cannot be changed or canceled. Mailing Address and Contact Information Jackson Claims Administration Regular Mail P.O. Box 30503, Lansing, MI 48909-8003 Overnight Mall 1 Corporate Way, Lansing, MI 48951 Customer Care 888-565-4995 (Wrh: 8:00 a.m, to 7:00 p.m. ET and Fri: am a.m. to 6.00 p.m. ET) Fax" 517-706-5513 Email customercare @lacksoncorn A fax cover page is not needed. If you have additional instructions to submit please complete Letter of Instruction (form X4250) Including owner and/or annuitant signature(s) as applicable. IR r Page 8 of 8 Z1142 03/18 Brooke =JACKS�)NLife Insurance CompanyO ft NATIONAL LIFE INSURANCE COMPANY Home Office. Lansing, Michigan Home Office: Lansing, Michigan www,jackson.com www.lackson.com Fraud Information Alabama residents, please note: Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or who knowingly presents false Information in an application for insurance Is guilty of a crime and may be subject to restitution fines or confinement in prison, or any combination thereof, Alaska, Arkansas, Delaware, Idaho, Indiana, Kentucky, Louisiana, Minnesota, Ohio, and Pennsylvania residents, please note: Any person who knowingly, and with intent to defraud any insurance company or other person, files an application for insurance or statement of claim containing any materially false information or conceals for the purpose of misleading, Information concerning any fact material thereto, commits a fraudulent Insurance act, which is a crime and subjects such person to criminal and civil penalties. Arizona residents, please note: For your protection Arizona law requires the following statement to appear on this form. Any person who knowingly presents a false or fraudulent claim for payment of a loss is subject to criminal and civil penalties. California Residents, please note: For your protection, California Law requires the following to appear on this form: Any person who knowingly presents a false or fraudulent claim for payment of a loss is guilty of a crime and may be subject to fines and confinement in state prison. Colorado residents, please note: It is unlawful to knowingly provide false, Incomplete, or misleading facts or information to an insurance company for the purpose of defrauding, or attempting to defraud, the company. Penalties may include imprisonment, fines, denial of insurance and civil damages. Any insurance company, or agent of an insurance company, who knowingly provides false, incomplete, or misleading facts or information to a policyholder or claimant for the purpose of defrauding or attempting to defraud the policyholder or claimant in regard to a settlement or award payable from insurance proceeds, shall be reported 10 the Colorado Division of Insurance within the Department of Regulatory Agencies. District of Columbia residents, please note: WARNING: It is a crime to provide false or misloading information to an insurer for the purpose of defrauding the insurer or any other person. Penalties include imprisonment and/or fines. In addition, an Insurer may deny insurance benefits, if false information materially related to a claim was provided by the applicant. Florida residents, please note: Any person who knowingly, and with intent to injure, defraud, or deceive any insurer, files a statement of claim or an application containing any false, incomplete, or misleading information is guilty of a felony of the third degree. Maine, Tennessee, Virginia and Washington residents, please note: It is a crime to knowingly provide false, incomplete or misleading information to an Insurance company for the purpose of defrauding the company. Penalties may include imprisonment, fines or a denial of insurance benefits. Maryland residents, please note: Any person who knowingly or willfully presents a false or fraudulent claim for payment of a loss or benefit or who knowingly or willfully presents false information in an application for insurance is guilty of a crime and may be subject to fines and confinement In prison. New Hampshire residents, please note: Any person who, with a purpose to injure, defraud or deceive any insurance company, files a statement of claim containing false, incomplete or misleading information is subject to prosecution and punishment for insurance fraud, as provided In RSA 638.20. New Jersey residents, please note: Any person who includes any false or misleading Information on an application for an insurance policy is subject to criminal and civil penalties. New Mexico and Rhode Island residents, please note: Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit, or knowingly presents false information in an application for insurance, is guilty of a crime and may be subject to civil fines and criminal penalties. Oklahoma residents, please note: Any person who knowingly, and with intent to injure, defraud, or deceive any insurer, makes any claim for the proceeds of an insurance contract containing any false, incomplete, or misleading information, is guilty of a felony. Oregon residents, please note: Any person who knowingly and with intent to deceive an insurer, makes a claim for the proceeds of an insurance policy containing materially false information, avoiding definite statements of guilt, is guilty of insurance fraud, not to conflict with the two-year limit on contestability. ri Page 1 of t Z800010/13 frust/Entity information and Suitability Form NAFE Please print pi closely m capital h4ters enu blocs ntln All mfoemefdn requestd is re rya it.d unl.ss ophonatIx mdlcated. _�.•.-'I Social Secret, number m•_.. l.,al.I •K• •. CLIC Tmde h'e, p -••, `.•••.. •. M1•_ -.._..,._,-... „«........... ...."Adve m code r B F B,.••• • .- 1 --ACCOUNT REGISTRATION Line l Oakland County Animal Control -- -__ _ Llne: tt Pet Adoption Center -_ _ Line a 2• ACCOUNT INFORMATION I NFS Pcidun9 'A�DIrecVOlher (prndup comp@nY'onhnGlelilaflormllhiubpahymoneymaneprrtlAMl- lsThis a (.arnbridgiaodvinal persunalof lanelg socunllet account? _ Yes IVNO A. Reglstralian Type Tlusl , G retool alma i 5 corporation Limited liability camnany I Bulledllal„Illy podmerlhlp padnmahlp I Non-profit rorpmatlon - Non- profit organnnllnn IJne¢olperaled nglamzalma Fatale lI Personal representaleve 6rrosimenl dub Denh/I-Inancml lnatilutten Chard,(FCCS scot is only) 1/;0hanlable donation adlmdual 529 Ownvl by ball u(i /e0L1 B. ITIMPershing Accounts Only Clearing account number (limn%n)gooed) I . Ddivoly iris is Payment IDVP)IRaC.Ipt venue payment iRVP) Alhom dwy ery mvioctiuns) 2 Coal bases Adler native Disposal Melt nds IAfilds) - Call balls ADM& we available For a list of ADM& and than definlhona, please see Feedon IG of the Client Agmarnant Chooalnu one of the ADM& will iese( the account d.faoll. Please consult your lax adviser for guidance on the use, of I oe i, methods. i Please speedy Alemative disposal method a Landed Liulmiily ParmersrriplPartnarship/Lunimd Liability Cumpony -laxed as -,C Coq) i Scarp '.1 Partnership I_ Sole Pfmcillelnr VNon Applicable 4 Cola'Gansarllon Account - Unless alherwis. nu ted below, bids, .,(a. In have any funds rlupuslfad far or [,,to In mindpatlon of steeurlires purchases, by ntmma anal dlsulbullm s ban Inveelmeme held Ia my/our Account, and any proceeds focal the sale of securities ('Cash Sweep Balance') auatmatically swept Into the deleult cash sweep program available to mall,& based ou nry/ow, Account reglsUa6on type Plans, sea Sol 22 of Ilia Client Agleonrent for infannahnn and disclosures (Ave, do out wish la have thin Cash Sweep Hnlaoce In mylour At wind swept enk, the default cash %veep program referenced @hove Allemalielly. Ilvre wish to have dry/our Cavil Sweep Balance wept here _ h. Smnding Ind"wic ns aV. agraa to the foimving Instructions being placed on retest Account onless Ilwe specify an alternative action through mylour &electrons uelow $ales - hold m Arsounl, Purchases - hind certificates In street name, Dividends and capital gains - minveel matual fund dividends and capital gams, pay oqudy dividends In crib and iavenp any Cash Sweep Balance In my Account Into t) the alternative cash sweep program specifimfy hated above or III the cW bolt rash sweep plogr-,vnl wrraspontlrng l,nlyGnn Acro om regrslmtmn type 8dnct Wa"i atom uplione bile, d you de•IIe to devl.le from Ilse Slari Iuralucbons above Sales Dividends and Capital Gatos Irrana/aoed pr Artois may daroull to Previous rnatna'Imns) Mutual funds Equities I told in arcoual Relnsesl Send "'da savacm vehe.le Pay income monthly (cnrnp(ule separate Iwm for Pay income optloni Nal all vim unbar, a,e ehy,l A,• fi.—t aesenr.nt P-1h."J Ln%IY %end maaell food air ... !mwn eodmn is a erAderl Int ,pen vs.tlmn av the adyour wI Nut a,lep•tHotdmq, C. Pershing Accounts Only Add to existing NoWfivadof - Client ID3 (4cnmvl evil nmy be p@eaJ Atli is P'a'^Jatl nun raR baa a aornplat, lurm rt nn till sh4mp la add s. cuunk by iSNI 3-TRUSTIFNI"IT Y INFORMATION Country oI Leyed Estabhshmo 1,t /chnosa nnej i✓Unilnd Stales I ,Other Cialdand County Animal Shelter TensivEntity nam. L.,I U.S Add, ass (regrured - no ('O Act 1200 N Telegraph Rd Bldg 42 East AUrhevl 1 A, I. I res& 2 Pontiac, lull 48341-1032 City, stale rep -- (248)858'1070 dullness plicae - - - Establishment date (.nrradd)yyyy) Malting Addrene faphonat- FJ, Bic, pelmdludl 1200 N Telegraph Rd Bldg 42 East Address I_- . Address 2 Pontiac, MI 48341-1032 City, stale, np ii address feptionall I ogres that Cambrldge may .11,10 cmlllTI Imhou; by email If I provide do entad oddness 1A-TRUSTEIiIAUTI-10 D SIGNER INFORMATION It there are nwre Inas Nm Ti Id -Arad, Additional Slgnrrs. Form r Enerrlpl payee code it any) Social Seconl Y numd', ar Fal,, ID Didh date ai I mtl dale r drddyYYYy) Mantel status F,In{Ile I Manned DOmastic pedne• VJloowed Glleenship IWudlo.. yo memred la""ale d0en, uurrreaNenlurine. of IJ3 tile's 1•✓rna me,"'a � U S cllrzml' Resldenl alien ;Nnn-residenl abau Counlr/ of ,.tiro poi ...ardent and non-reaolerJ ah,na only) LaidI L ,d eq Coad no PO Goll Audirryt ! (ydrbese2 City A'I. zip Mailing Addles (opnunal - PO Oct, p>rnutfedl Addo-is ` Address 7 CIA, state, z1p 46-ADD'L TRUSTEE/AUTHORIZED SIGNER INFORMATION If them are more than two ti usleeslauthonzed slrners, attach Additional Slyness Form Name (h A All, last) _ Social Security number nr fee ID C nampl payae conte (II any) (iirtti date or bunt dal, Pum laerl y) Marital status I Sidi !- elated Domestic partner I Widowed Citlzenshlp fy"-rdenmra reganeJ Inn roslJanl aIle.. nun-re;IJaw alien, m U S mbmn Way nbmm) U.S. adlzan 1 1 Rosident mien i I Non-resident alien - -- Cednlry of origin (tor'..'idem and noll-readeul effea, only) Log at U.S. Address (roqurrad- no P . Etoe) Evenin.INWide phanO i LmaA edwos (nphona0 I agree send cmYtmun¢;arune by omml A I provide an enrol adrtiess. USA PATRIOT Act Infra motion (required by federal law)„ fluv.., , Lrense1 1 Passport • Scale Issued Ill i- CAW, Alien regish aben ram - regmred for all rosdanr ahen> Non dncumenlm y- l In non -dor a eipeoq Wucadurw. Ad., ass 1 Admess 2 City, stale, zip _ _ _- Marling Address (oplional . PO ©Ov pemotled) AdJress 1 Address 2 City stale, zip DoytlloefVyorlt phone Eventri roma phone Caned arirlress (Optional) - 1 arose Plot Canlbddrn may scold r.omnluno alm e, by emell If I dimcle an added address. USA PATRIOT Act Interrelate (rarulrnd by federal law) - 1 Dover's license I i Pasepod 11 Stale Issued It) ! Other - Alien IaAe rabun card - r egatuad for all re.samni ahem Non dnuumentary -.eubleel to tion docummnlarypiucsidaoes ❑"rnuirnr niimbr:' SLde/cmdry Iseued Dnnimenl d,o iher G4u.am1' date le"a"od" i Odle Icdowl (inn✓ddr'WY) Reason ID Documentation Not Regulred, Dor anmllalinit ah early nn treat Cambodia, /Exa ipl or antity -..... •.._.- Employment Infommatlon for GusteelAuthei lead Signer 6upluyed �Soll employed Reload I Student - 44i,l emplOyadiNor aPppoablc Dc.rup,d.w pl pall-ont ooVed, apeer(V nafUrt; O(husrnusa) Name of ainpluYur . Employer addmss (,.I rod It onrplopad m sep-e ......It 1x10. 31a1c- 'If, .SlatetCuuntiv ls,oad f.)Puddon date (mmrodlyt tN) Date .'cued (nlnYadO'VYY) Rapson ID Documentation Not Regulred: I Documentation already on file a1 Combndge, I , Exempt or enlity EmPloyinent Informafiou for Additlonal TlosteetAuthorized Slgnm EmployedI (Sall -employed Retired !., SWdent Not ample yed/Nol applwable 0"apodn fit 3dif I splayed, specllp outdo, of btislness) Cama 'f nmPloy,r Fin,ii address pe.lun d It employed dr sell employed) City stale, dp - A 4A-TRUSTEEIAUTHORIZED SIGNER INFORMATION (CONT.) Affiliation Inform affair - Are you, your spouse, immediate family members or dependents' 1 Apolitical official? ` Yes ill If yas, please coach approprlate choma(s). I Elected official who has legal author lty to hire a professional for that affiliated goverriumm entity I Elected of clal who has appoinlmant authority. or can mlluenoe the hiring, of a flnanclal proresslonal for their affiliated government entity _I'to potential lnlluence to hire a financial professional for government entity 2 Employed by o, asm uft ed with the Issandlies industry (for example, a sole proprietor, partner, aglcor, modor, or branch manager of a broker-dealer firm) or a flnanaal regulatory agency? ,_j Yes FINRA IVN. Yes, RIA _-. You, sate or federal securities regulator Yes, broke, dealer or municipal sornalies dealer If this is a brokerage account toepable of trading mumclpal s'ocungesl and the account owner Is employed by a broker dealer or municipal securities dealer other than Cambridge Investment Research, Inc or is the spouse or miner child of such employee, please complete the Affiliated Persons Form and submit old this document J A director, 10 percent shareholder, or policy-making oPocor of a publicly traded company? I -I Yes, please list naive and symbol Of the company !VN. 4, A senior military, governmental, or poetical of i lel of a non -11.5 country? Yes, please Inst name of country, and complete politically Vigo Exposed Persons Form and word with this document 5 -TRUSTED CONTACT INFORMATION Trusted Conran, Inualumem, Is relined In Section 2.1 Name (firs, MI lase Addles. 0aatme(Wo4, phone EvemnglHume phone Email area ... 1) 4S-ADD'LTRU STE EIAUTHORIZED SIGNER INFO RMATION(CO Affiliation Information - Are you, your spouse, Inunediate family members or dopendenis', 1, A political af6cial? ,Yes _ _!No If yes, please check appropnote chome(s) 171 Elected offidal who has legal authority to hire a professional for their aKilialed government entlty ' Elected official who has appointment authority, or can Influence the hiring, of a flaancial professional for their, afoetal government unity He poteniml influence to hire a financial professional for government entity 2 Employed by or associated with the securities industry (tor example. a .In proprietor, partner. officer, director, or branch manager of a broker-dealer firm) or a financing regulatory agency', Yes, FINRA ', [he Yes, RIA Yes, slate or federal securities lagulemr Yes, bro6m-dealer or munlentil secuntime deals, If this is a brokerage account (capable of trading municipal seeme es) and the account owners employed by a broker dealer or munlapal securities dealer other than Cambadge Investment Research, Inc, or is the spouse or minor child of such employee, please complete the Affiliated Persons Farm and submit with this document, 3, Adirector, 10 percent shareholder, or policy-making officer of a publicly traded company? I Yes, please fist name and symbol of the company No 4, A;enlor military governmental, or political official of a non-U S. murbyt Yes, please list name of country and complete Politically No Exposed Persons Form and submit with this document Fandu naliF to pnmar idoml investor Dry, slate, tip e - FINANCIAL INFORMATION Ramer, to Trust or Entry _ Annual Income ' 11$20.000 [ , $20.000-$60.000 `_ $50,000-$100.000 1 5100,000-$200,000 [.I $200.000$500.000 _ j'$50moo Net Worth feef assets rnmus total I earisr its, excluding primary residence, but inchadi all otnerpersonal holdings '$00,000 Most$partly $ _ - .00 ;$h0, 000-51009001 ;5100000-$250,000 ,, j$250,0004500,000. ;9;500.000-$1 nulhon _$I—$�n1110o0 >$; million, must specify' S d10 Federal Tax Bracket- o Net Investable Assets $_ ____ . 00 (Sum o/all roveshea. assets, including oulside holdings, minus 6abtlihes, of, these assets) = 7 -RISK TOLERANCE AND PRIMARY INVESTMENT OBJECTIVE - Risk lulurenco and Investment Oblocuves are deemed In Sections 19 and 21 • planar select the one objective hi low that would bast describe the tisk tolerance and Investment objective for Ilia, registration type manor motor t(s) Conservative Moderate -conservative Moderato Moderate -aggressive Aggressive - Current Income Current income ,Current income high Current Income High Current Income High Cunenl hrenme - 'High Uurrent Income _' High Currant Income -_ Growth and Income I _,Growth and Income -Crowd, and Income "Growth and Inronre - Growth and Income . Growth I__ G myth Grow h Growth _IGrowlti Speculailon Bpecuiellon �'• I„i 1Jde y, .,L l "1, Fa.. rn „ ..n n i I,-. .n_ II • SECONDARY ILIVESTMENT OBJECTIVE b apprnpnar, please gated no to two senvld fry Inver erruc ubdecnves Ond annadd with any addl0onal mvesfioents ton Or regonallon type and/or uccouM(s) Those "'cares will allnm ler addlbneal Invedbnouls aulslde of the pmmno reactive rdendfald above nnsnmmg Biot the value M those ,nvestinenls do not move the onbra pud0.hn out of the nn,e sugpesiod by the pnnu f y,nveetmeni colorless Identified above Caffair, In, ,,a I High Carroll lnronne I Growth and lncnme Grown Speculation 9 -TIME HORIZON AND LIQUIDITY NEEDS Refers to Trust a, Entity _ Account Tome Hannan ' I U -d were I 4-j veam 1, 5 to years 110 v years Annual Expenses $ 00 (far un; ny ducal inal"do rnodgape narrowed; ,ant aorl-Ierm debts differ, cL: ) Estimated Special Ehpen Ses v 0 than" nnn-roeuan9 - an"ht vibrio real eedRe ""'hi hmmn remodel car powl"', filo, anon, on I Special Expenses Tina: Frame 0 y,nr, _ I I yeere 2 5 year; G+ years 10 - INVESTMENT EXPERIENCE Ula one radon., to sonih n,oramenr usablenes far each Investment category, I -stone 2 -Occasional 3 -Frequent 4-F-rdenswe stocks Bonds Options Cnmmndi les _ Real estate Mutual funds InswsnculAn labor RFI 6:Dpplo,f" _ _ - Other Fel/aura Ical "avant hastronbry holdings burned Cambridge For r5LIM"ae;aur,ellleb, please use cash V81UG If Ilam are no outside assets, star' Nona V NUlle slrniaa If - 00 Bunds £ _ ___._. .00 options CdndmdNnus $ an Real estate $_ 00 Marc.]ands $- 00 7. GO lw'coana,lit ng,bes 4. _ 00 REITIDPPILP ., 00 CasnBilnk products 1. u0 Unspeaned b ,00 Inlenal lands tr - _ -, 0h Other th VU 'I I - SIGNATURES II this amount s ewnud nr cnnlrolled by born than one I ... hadual orally, 'I" friars to all arsount owners Under par lllas of perjury, I dollfy Thal, (I l the number shown eel I,Ie lona u tiny r"i Iaxpaynr rtfentifIve0en molar nor I am welting a, a nu,nbe, to ba issued to me), and r2) 1 can flat sublact to backer withholding because I am aienlpt born backup wbl,huln,ng, 1, 1 have nal been noblled by Ore Internal Parabola Sotmce (IRS) that I am subject to Indudp vntbhuidmy as a result of o !aline to repod all Inrrvesl or fividonds or life IRS has nal,bed he Iasi I an, no Ian9er subject to backup wnhhaldrng: and (3) 1 and a U S. Aluvl or other U S. petioli and 14) rhe FAIOA code(al ente,se on Itis form (if any) Inncugtln9 flat I am emempl from FArCA repointing is roordcL I understand that If I have noun nollbad by the IRS that I are subjed to barkap withholding as a result ul Olvalenel or interest undercoating and I have not received a sono. from Ihr IRS adwslsg that hadelp withholding is terminated, I Must ',loss out ln,e 2 above is..eyl.ag below, I represent and Warrant that the edonnancn provided en as Lust/Cnllly Inlormahon end SoriaWlily Pram and On. identification presented to vanfy any Seurat is True _ind accoole I reps asenl pan I will unify Camundge In Willing irnmedialady if there Is any rnalanal Orange In the mformatlon I have provided and I aelmrnWedgn II'mt I have reserved, ,.ad, undorsdand and agree In be hound by drift an snap by all of Ihu temis and conddlons Sol loll'rn this'rrusUFnbdy Inbnm.tino and Swtamhly Foran led hug lhg 011ern Ag,aou.act wh,cb Is mcgrpanded Into tills TonalEnlily In(ormalinn end Sulldhi ily Form by reforunee. Cambridge slay use Ihlyd parties to penorin adnnrnslral.x maks on it, 1 -hall such as yrsp irallon of accounl app icaddras and rube, account forms I acknowledge that I am solody msponsdble for remeoarg my account dem m.aularmn for acwrar> and cowprobmuem By s,gnmg below, I authorize the sharing of my nonpublic personal iuforrnelfon In accordance with the Cambridge Privacy Policy (planar, sce the lust pages of the Client final eemend). I will contact the Career gr , Compliance Department by calling 800-777. iO80 if I do not want this Information shared with non-affitiatod thud parties. By adding below, I consent to rho review of email correspondence exchanged between me and my advisor, Such review is regained of Cambridge on sham to regulation, The Client Agwemest on the regarding pages nemof contain a pre -dispute binding arbitration and tliselusure aneumont In Snmiar 10 of the Client Agreement• and certain other provinces which may, substantially affect my rights. By signing below I acknowledge recent of Ihis pre-ddspute Loamy 'a I nun.1111 diflOosure agreement. By signing below, I aoltnowiudge (flat I have road the anile TrustlEnlity information and Suitability Form (page. 1-8), gry_uu Ltldno the Client Agrandent rouges 5.8). r+-' ,, 1 31,111, Fr,, Signature of additional lrusteciaulhorized signer Udie KC ll;ri_ Boyd BFJ , ,,,hof 1pnnl mann:/ Advsel rude Sgnam,a of odv,cor' Uel, Sapvrmsur arpreval p(.vpok,blvl Fiala Home office ephr vvat Data 'M{ "win ore Indicator, tlur I have if mowed the ibrstal"do ba) presented fry the above d on lid, and r.r n(y MaL to Iho best of my knowledge, the Identification 1s genuine and au hood mrd Truly n:pmsoub [be Warmly of my cliears), or I have relied hand lire non -documentary procedures_ Certification of Trustee - Direct TCIP it by c..npletad far FRUST ac(oegtt, ONLY, Please print, preferably in (aplal lotion and black alk. All infunnahon W(TIlood Is required unless nibb l Is mdw itcd, A, Trnsl information ++ )Ir/ I'll t 1, L� 11 l{.' BFJ FPeue Oakland County Anlrnal Sheller rrusi nvl nr Dala of bust pnn?rjl /y) I Manulon account anon ber (d eppheoMo) - Dlrei.l me ustr"vvm ac Seurat af aped 'able) Thene are In pill irtmtees Spaces the lollowmg critical hureac'S from- Tmstee nano rising insloa "sone (pang inspect parte IPnnO _ If thele is more than one Nutlet, please chock oral of the boxes below: TIIe Gilst Agter nmuA cxplicllly aulLonms Saco ct rho trustees to act Indlwdually without the approval of the pilot Unstees. The Ini rriucdag it,,, has the arnhunty It nt Spit orders and olltm In ell ,bi in om any ane till sten, acting .doge and such lriretpe may enecues any documents on behalf o(ILc Inst I 1 he gust Apronmenl Jne.6 sol authuu<e Ila b..st.e, to bcI Indtmdually on behalf of the thud tumuli B. Call fiileatlon of fnvoslmont powers Ta C.rohtdge lave,ga ual Ra.earcb, Inc Ilwe the tnISmi)(s), acknowledge than Uwe have mcse.atl and revu:wed Ihorrinity all.ucoum docernenlalion, agreements, and ask dlsclnsum loans fwc tho Imehae(sl hereby Salify that Me have the prnler unu el Inc trust and applicable law la 01 open all types of accounts, in cash ur margin, when, poled below, lPl a+`:est, minvasi and alter in In Ir aneacbo ls, both put Olives and sales, n all types of securities, unto ss road below', and (3) nppmnt fmanctul pool... mills to he bust, Pay such hnanuul PI ad. 11111,11, roasnna his cumpensa(Inn and live such linanmal professionals disinfectant powers la mveee ai coin vest tells( assets as spei llleAry burned to In wdile, Please seely, the types of sow litres or nccoune NOT suit their for 1eveshneut by this treat' lave, pie tlusleer, ), Johntly and sa'erally agree In mdemnds and hold females Gnmbndge Investment Research, Inc. !hair agents and employees, Iron any Hilarity (nal an, resull fmtn ,yann on this oenrheetbn whuu ppanuIn accounts oI effectors In"leaccen, of the type spenaied above, pursuant Io insduchana grven by the number of bu; ori l6od nbtvc PINS, hie• bo.,leo(s), i nduy that this bust Is still In lull ten.n end eflaet AS of tial clan'.,ipued holaw In'onsrdetalmn of yonr nCcephng ani or rnpte bust accounts for the hull dost,nbed hetero, thin rild"IdNien throe els) lomtly and severally w.irranl and siren thin nil u( Iiw Infonnapon connotes m Ills ollifiealmn is actor ale bnd'on.clly dulailo the terms of Ila bust idenllhrd above The Indemnification hereto shall Shrive le.rrurnallon nl Ihi. hurl or of Ifs ucuwnpsl levy, Iudhel warrant aril agree Thal Inns confection shall remain in ILII horse and ell mind such fine as you are n viand In wnling of any (herrye It, tri, mfornhatrna it ,uihmlly di sbnhed hereat- Uwe hereby caddy that the :hews information 1s coueet and that the undersigned are all of the current hbslees, In hie evenl there are any I...... ren�,hos noblest Ills cerhf rchno and the ofiginbl trust dorms IAar miller verify that this carhflcelion represents an amtmdurent to the nn9Wal hull tlpoum"tl or that Ova have taken all aahtnb rleeesaalY In 51, amend the original trust delwneol It tonloon w1d) III cerhflWilen, Date Gate IIID) IIr1I1IIII III11Ir1I1III I _ Troi name opting ,e'• � ,, o„i, Tnc'In. slgnalwe I cola. peme fpun7) Inrsce name (1)(111) aril Ace cipnalum Dale lattice srpnalule Date Gate IIID) IIr1I1IIII III11Ir1I1III I Py P7W" W 1'� s TI P`V %tO W, 4�1 1C STATE OF MY VIGA N LI, STATE OF MICHIGAN DITAKIM ENT OF I I UAL I I I AN 11 (ItrM A N SLARVWES STA I EFiI LNitNi HY,R CERTIFICATE OF DEATH I IJF(FNK\WSNAML (Fimt,MIddJCL.Ii) 2, 3. SFX K-ENKM'If EARLTHWEXIT male tj0a or After AJ BIRTHOROTPLEF(MANIE utlEo FOR PERSONAL PUNIFILS I'didi, 61, UNDLIK I YEAR 6 1 NAME _U1. a ')78 1 — 110085 w1amis DA YS til"1 7n Lo DEATH W) CIIY,VFLAGf OR fOvINSHIPOF DEATH �h, CN IN1Y OF DEATI I Ij Madison llejhls Onddand �u I IIRRFNT ItUNIMIVT SIA I I, Irl, COUNTY EV,10CALFIN OMBER Michigan Oakland IvIlldison Heights J_ n"-nv --tom 19 HFlTD FLACY 48071 Twp MiChiRID Royal Oak F I_NTIT[ u S ORIGIN IMLE) r li ,JI 6KjND( 014 It INDI:SIM I I MA S 14M\I�J%SP� 'I 61 IMPPRWRI, Middle, L.,t!) 11 N1011JERS'NANU BIFF(HUfLIKS1 NWtRIhD ffild,NI Raymond Lee Tl)%yeatt Sr Lillian St. Aubin 11n NIORNIANTSNWIF M, PPLAFTONSHTIV OIPFCFDFNI 2 1, NAII ]NO ADDRESS Apffl Anschno "POPW i] WY FuncrEl Repiesentalivc 25608 Dei, Madison Heights, Michigan 48071 NiF _rHoD OF DISPOSITION 21,1 PLA(hOl DISPO!,11ION ""A I ION—CII SOltllenl Michigan Services Royal Oak, michi Fall I NIORI QARY St IFFIRL A LNS1 L li LIKINSI NOMPIR ]I, SUHLIFe M. GLUID'HICI Hoperoft hmei a[ Home, 31145 JohL R: Road, MadisonI 45M`306158 }}Iclghls,Michigan48071 4=1, 17,11, IRTIFIFR 18A 4( HAI 0R1'RjqU&IF1) J'Sh PIR,NOUNI,FDI,EAnoN !s, OW VRONNWWItJIIII All I It l: Ccnrt4i ...... 11101LOFF)JAIM (13:15 Pm VJ Wd""I E,ol,mn. ... . .. . . ....... unkill 'l ,I I :l N11DICALEXAMINPIt Ill IIIACI 01 DFAI 11 Il IF HOSPILAI LJ F,,pwic NIDll(D Ir ONNACIED Dwc - - ------------------------------------- _FiT, 1 1 � i, 1'10L�s 12 NIEDIL'Al EXANIINEWStASL Ill NANIE (117 AITENDNt, PMSR IAN IF OIJWR THAN C [FIER F .'r i1 DA I F SiWIIED NUMBER jallutury 31,2020 14 N,WFANDADORPSIS 01 (FRIEMNO PHY$ICIAU L 3, Dnigovic, NID, Oakland County NTE, PLO N Telegraph Rd. Bldg 28E, Pontiac.Michig-an 4141-0439 RFGIqTRAR',SFGFIATURILFobt-ttary 00, 2020 I DATE Fit ED nno,........ Ancrioscleto(ic Cardiovascular Disease Yens I.. "All — ---- -- nue�, w, - �x n.", fi, E�, I "VIDI .­� . ... .. 6" ul 17 CC�F IF FINIAL), w PAIN 11. OTHER sJONIFICANT CONDITIONS ai,t6hm,ip Si deloh but nal izhIng III III� ulidert)nig cao,e 0 D, ,leen in F P, I I 1�11111, I tO D F A T H N. IZ Ms ANA �110111;� PEPI OBML�' -$rbl %LWV %U I l W!,Y FINDINGS AN'MIAVILS Ej 1 4-1.1 It 1 .111, Fill IS I () COWL 1, NON OF (L ALM 01, OFA 111 U4/GB/LUvu io:aa VpUglu" wV LVJ UUL MISCELLANEOUS RESOLUTION * 83204 July 14, 1983 BY: FINANCE COMMITTEE, DR. G. WILLIAM CADDELL, CHAIRPERSON IN RE: APPROVAL OF PROCEDURE FOR ACCEPTANCE OF A GIFT DONATION AND/OR GIFT ITEM FROM PRIVATE SOURCES TO THE OAKLAND COUNTY BOARD OF COMMISSIONERS Mr. Chairperson, Ladies and Gentlemen: WHEREAS Miscellaneous Resolution $8145, Approval of Revised Federal and State Grants Application Procedure, established written procedures for the application and the acceptance of Federal and State Grants; and WHEREAS private individuals and organizations periodically donate gifts in the .form of financial resources and/or capital equipment to Oakland County government that are important additions to the continuation and improvement of services and programs provided to Oakland County citizens; and WHEREAS the Finance Committee has requested and received from the Department of Management and Budget written procedures for recognition and acceptance of gifts from private donors, entitled Acceptance of a Gift Donation and/or Gift Item From Private Sources Procedure, copy of which is attached herein; and WHEREAS in such procedures it is recommended that gift donations be categorized, such that gifts with a value of $9,999.99 or less, with no match requirement or other financial implications to the County, be accepted administratively; and WHEREAS it is recommended that gift donations with a value of $10,000 or greater, with no match requirement or other financial implications to the County, be reviewed by the Department/Division Liaison Committee and acknowledged by the Hoard of Commissioners via signed resolution; and WHEREAS it is recommended that gift donations of any amount containing matching requirements or other financial implications to the County be formally approved by the Board of Commissioners through signed resolution; and WHEREAS it is further recommended that all gift donation amounts be accounted for in the appropriate departmental donation fund account (201) and gifts other than cash be recorded as general fixed County assets; and WHEREAS the Finance Committee has reviewed and recommends the adoption of the proposed Acceptance of A Gift Donation and/or Gift Item From Private Sources Procedure, NOW THEREFORE BE IT RESOLVED that, effective immediately, the Acceptance of a Gift Donation and/or Gift Item From Private Sources Procedure, as presented, be and are hereby adopted, The Finance Committee, by Dr. G. William Caddell, Chairperson, moves the adaption of the foregoing resolution. FINANCE COMMITTEE __- 04/20/2008 13:00 FAX 8581672 BOC OAKLAND COUNTY ACCEPTANCE OF A GIFT DONATION AND/OR GIFT ITEM FROM PRIVATE SOURCES PROCEDURE In recent years it has become an increasingly difficult challenge to fund County services and programs at prior year levels, and to establish new and innovative ones. Federal and State grant and revenue sharing monies have, in the past, provided County government with the opportunity .to meet community needs with services and programs that otherwise would not have been provided. Federal and State reductions, however, have caused this source of funding to decrease while community needs continue, Under these circumstances particularly, private gifts, whether in the form of cash and/or other types of valuables, become welcome and.important additional resources for continuing and improving upon the quality of County services and programs.. In recognition of this fact, as well as the uniqueness of this form of resource, procadures have been established wherein private gilts will be offirially acknowledged by the County and accepted. L Gift donation amounts and/or gift items shall be classlfi4eic' cording io one (1) of the following categoriasa _ A. Gifts with a valua of $9,999 or less, with no match requirement or other financial implication to the County. B. Gifts with a value of $10,000 or greater, with no match requirement or other financial implication to the County. C. Gifts with a value of any amount, with financial implication to the County. "Financial implication" shall be defined as any one-time, continuing, maintenance, and/or future, costs incurred by the County as a result of acceptance of a proposed gift donation amount and/or gift item. - - II. Gift donation amounts and/or gift items with a value of $9,999.99 or less, with no match requirement or other financial implication to the County, shall be U accepted and processed administratively through the County Executive Department of Management and Budget. The prospective Department/Division recipient shall list In writing, the gift donation amount and/or a brief description 'J of the gift Item, as well as it brief description of the purpose for whish donation is being made, and shall send the letter directly to the Department of Management and Budget, AccountlnR Division. Gift donation amounts shall be placed In the appropriate departme tfiat donation fund account (201) and records maintained in the Trial Balance/,Expenditure Fund Report within the Accounting Division. Gifts other than cash shall be recorded as general fixed County assets, III• Gift donation amounts and/or gift items with no match requirement or other , financial` implication to the County, but with a value of $10,000 or greater, shall be accepted and processed according to the following procedure: A. The prospective Department/Division recipient is to notify the Chairman of the Department/Division Liaison Committee in writing of a donor's derision to make a gift donation to the County. The letter shall identify the donor or, if desired, request anonymity of the donor-, list gift donation amount and/or a description of gift item; and contain a brief description of the purpose for which donation is being made. B. The Liaison Committee of the Board of Commissioners shall review .the letter to determine the acceptance decision and to recommend to the Board of Commissioners_ `After review a resolution shall be forwarded to the Board of Commissioners, The Board of Commissioners shall take final action on the gift donation resolution. . C. Gift donation amounts in this category shall be recorded and maintained in the appropriate departmental donation fund account (201) in the same manner as Item II above- Gifts other than cash shall be recorded in the same manner as Item 11 above. IV. Any gift donation amount and/or gift item with financial implications to the County, regardless of amount, shall be processed according to the following procedure: 14003 V4/GV/LUVq ;.).l'J rG 04010,4 pv4 A. The -irospective Department/Division recipient is to notify the Chah`ptrson at the Department/Division Liaison Committee in writing cf a donor's decision to make a gift donation to the County. The letter shall contain _ the same information listed in Item III, A above, B. The Liaison Committee of the Board of Commissioners shall review the letter, programmatic aspects of the prospective gift donation, other pertinent information and formulate a recommendation via resolution. The resolution shall be sent to the Board of Commissioners for referral to the Finance Committee. C. The Finance Committee of the Board of Commissioners shall review the resolution, determine financial implications to the County, write a fiscal note and return'to the Board of Commissioners, D. The Board of Commissioners shall take final action on the gift donation. The official acknowledgement and acceptance of any gift.donation amount - and/or gift item with financial implications to the County shall have approval by the Board of Commissioners in the form of a signed resolution. E. Any accepted gift donation amounts in this category shall be recorded and maintained in the appropriate departmental donation fund account Ml)'in the same manner as Item 11 shove. Gifts other than cash accepted in this category shall be recorded in the same manner as Item II above, V. In the event of a question as to dollar value amount of any gift item presented for acceptance, the Director of Management and Budget; through the Purchasing Division, Accounting Division and/or other appropriate information source shall determine and provide a dollar - value amount for any tangible gift item in question, VI. The "County Executive, Department of Management and Budget shall be responsible for all administrative actions necessary for the accounting of -aB gift donation amount and Item acceptances, These actions may include, but are not limited to, establishment of accounts, administrative procedures, eta. VB. Availability of documents relative to any gift donation amount and/or gift item shall remain the responsibility of the foliowingi Letter - Recipient Department or Division Receipt - Accounting Division Resolution - County Clerk ' Committee Minutes - Board of Commissioners The recipient Department/Division shall have ultimate responsibility for information relative to acceptance of any gift donation amount and/or gift item 1 within the Department/Division. VIII. A beginning - ending trial balance report shall be included as an addendum to the quarterly forecast report made to the Finance Committee of the Board of Commissioners. 44 VVL/UVL u Resolution #20232 July 2, 2020 Moved by Jackson seconded by Weipert the resolutions on the amended Consent Agenda be adopted (with accompanying reports being accepted). AYES: Hoffman, Jackson, Kochenderfer, Kowall, Kuhn, Long, Luebs, Markham, McGillivray, Middleton, Miller, Nelson, Powell, Quarles, Spisz, Taub, Weipert, Woodward, Zack, Gershenson. (20) NAYS: None. (0) A sufficient majority having voted in favor, the resolutions on the amended Consent Agenda were adopted (with accompanying reports being accepted). a, ( L' 1 HEREBY APPROVE THIS RESOLUTION CHIEF DEPUTY COUNTY EXECUTIVE ACTING PURSUANT TO MCL 45.559A (7) STATE OF MICHIGAN) COUNTY OF OAKLAND) I, Lisa Brown, Clerk of the County of Oakland, do hereby certify that the foregoing resolution is a true and accurate copy of a resolution adopted by the Oakland County Board of Commissioners on July 2, 2020, with the original record thereof now remaining in my office. In Testimony Whereof, I have hereunto set my hand and affixed the seal of the Circuit Court at Pontiac, Michigan this 2^d day of July, 2020. Lisa Brown, Oakland County