Registration Instructions. This part must be completed with respect to all shares purchased. If shares are to be registered in more than one manner, complete as many Subscription Agreements as there are registrations, or attach separate sheets providing all of the information required below with respect to each registration, and indicating the number of shares subject to each registration. -------------------------------------------------------------------------------- (Name) -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- (Address, including Street, City, County, State and ZIP Code) Taxpayer identification or Social Security Number: __________________________ Manner in which securities are to be owned: [_] Individual [_] Tenants in Common [_] Joint Tenants [_] Retirement Account (Trustee signature and authorization required) [_] Uniform Transfer to Minors [_] Other _______________________ (for example, corporation, trust or estate. If shares are purchased for a trust, the date of the trust agreements and trust title must be included).
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Registration Instructions. This part must be completed with respect to all shares purchased. If shares are to be registered in more than one manner, complete as many Subscription Agreements as there are registrations, or attach separate sheets providing all of the information required below with respect to each registration, and indicating the number of shares subject to each registration. -------------------------------------------------------------------------------- (Name) -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- (Address, including Street, City, County, State and ZIP Code) Taxpayer identification or Social Security Number: __________________________ Manner in which securities are to be owned: [_] / / Individual [_] / / Tenants in Common [_] / / Joint Tenants [_] / / Retirement Account (Trustee signature and authorization required) [_] / / Uniform Transfer to Minors [_] / / Other _______________________ (for example, corporation, trust or estate. If shares are purchased for a trust, the date of the trust agreements and trust title must be included).
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Sources: Subscription Agreement (Indian River Banking Company)
Registration Instructions. This part must be completed with respect to all shares purchased. If shares subscribed for are to be registered in more than one manner, complete as many Subscription Agreements as there are registrations, or attach separate sheets providing all of the information required below with respect to each registration, and indicating the number of shares subject to each registration. -------------------------------------------------------------------------------- (Name) -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- (Address, including Street, City, County, State and ZIP Code) Taxpayer identification or Social Security Number: __________________________ Manner in which securities are to be owned: [_] Individual [_] Tenants |_|Individual |_|Tenants in Common [_] Joint |_|Joint Tenants [_] Retirement |_|Retirement Account (Trustee signature and authorization required) [_] Uniform |_|Uniform Transfer to Minors [_] Other |_|Other _______________________ (for example, corporation, trust or estate. If shares are purchased for a trust, the date of the trust agreements and trust title must be included).
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