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If delivering by express mail, courier,
or other expedited service:
Equiniti Trust Company, LLC
1110 Centre Pointe Curve Suite # 101 Mendota Heights, MN 55120 Attn: Onbase — Reorganization Department |
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By mail:
Equiniti Trust Company, LLC
Operations Center Attn: Onbase — Reorganization Department 1110 Centre Pointe Curve Suite # 101 Mendota Heights, MN 55120 |
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DESCRIPTION OF SHARES SURRENDERED
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Name(s) and Address(es) of Registered Owner(s)
(If blank, please fill in exactly as name(s) appear(s) on share certificate(s)) |
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Shares Surrendered
(attached additional list if necessary) |
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Certificated Shares**
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Certificate
Number(s)* |
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Total Number of
Shares Represented by Certificate(s)* |
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Number of
Shares Surrendered** |
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Book Entry
Shares Surrendered |
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DRIP shares
to be tendered |
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Total Shares
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Name of Tendering Institution:
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DTC Participant Number:
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Transaction Code Number:
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| Capacity (full title): |
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| Area Code and Telephone Number: |
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| Email Address: |
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| Social Security No.: |
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| Name of Firm: |
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| Authorized Signature: |
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| Area Code and Telephone Number: |
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If delivering by express mail, courier,
or other expedited service:
Equiniti Trust Company, LLC
1110 Centre Pointe Curve Suite # 101 Mendota Heights, MN 55120 Attn: Onbase — Reorganization Department |
| |
By mail:
Equiniti Trust Company, LLC
Operations Center Attn: Onbase — Reorganization Department 1110 Centre Pointe Curve Suite # 101 Mendota Heights, MN 55120 |
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