Fill and Sign the Uniform Single Party or Multiple Party Account Form

CONTRACT FOR DEPOSIT UNIFORM SINGLE OR MULTIPLE-PARTY ACCOUNT FORM PARTIES(Name one or more parties): ______________________________________________________ _____________________________________________________________________________ OWNERSHIP (Select one and initial): ________ SINGLE-PARTY ACCOUNT ________ MULTIPLE-PARTY ACCOUNT Parties own the account in proportion to net contributions unless there is clear and convincing evidence of a different intent. RIGHTS AT DEATH (Select one and initial): ________ SINGLE-PARTY ACCOUNT At death of party, ownership passes as part of party's estate. ________ SINGLE-PARTY ACCOUNT WITH POD (PAY ON DEATH) DESIGNATION (Name one or more beneficiaries): _________________________________ _________________________________ At death of party, ownership passes to POD beneficiaries and is not part of party's estate. ________ MULTIPLE-PARTY ACCOUNT WITH RIGHT OF SURVIVORSHIP At death of party, ownership passes to surviving parties. ________ MULTIPLE-PARTY ACCOUNT WITH RIGHT OF SURVIVORSHIP AND POD (PAY ON DEATH) DESIGNATION (Name one or more beneficiaries): __________________________________ _________________________________ At death of last surviving party, ownership passes to POD beneficiaries and is not part of last surviving party's estate. ________ MULTIPLE-PARTY ACCOUNT WITHOUT RIGHT OF SURVIVORSHIP At death of party, deceased party's ownership passes as part of deceased party's estate. AGENCY (POWER OF ATTORNEY) DESIGNATION (Optional) Agents may make account transactions for parties but do not have ownership or rights at death unless named as POD beneficiaries. (To add agency designation to account, name one or more agents): __________________________________ __________________________________(Select one and initial): ________ AGENCY DESIGNATION SURVIVES DISABILITY OR INCAPACITY OF PARTIES ________ AGENCY DESIGNATION TERMINATES ON DISABILITY OR INCAPACITY OF PARTIES. DATED this the _______ day of ____________________, _______. ______________________________ Signature______________________________ Signature AK-02007 Code Sec. 13.33.204