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Fidelity re registration form... If you are transferring to an EXISTING Fidelity account C omplete the Fidelity Re-registration Form for Nonretirement Inherited Assets. Fidelity Re-registration for NonRetirement Inherited assets In order to complete the first step of moving the inherited assets you must transfer those assets to an account under your Social Security Number or tax ID number. In order to do that you may transfer the assets to an existing Fidelity nonretirement account or you may open a new Fidelity nonretirement account with your Social Security Number or tax ID. Complete all relevant sections sign in ink and return to Fidelity in the postage-paid envelope or mail to Fidelity Investments Account Re-registration Services P. O. Box 770001 Cincinnati OH 45277-0039. If using an overnight mail service please call us for additional instructions at 1-800-544-0003. All inheritors must complete this form in order for re-registration to be processed* CURRENT ACCOUNT INFORMATION The information regarding the decedent s Fidelity nonretirement account is required* TRANSFERRING TO YOUR FIDELITY ACCOUNT YOUR TRANSFER INSTRUCTIONS Detail how you would like the assets to be transferred* For partial transfer requests expressed in percentages use whole numbers i*e* 33 not 1 3. AUTHORIZATION TO RE-REGISTER ACCOUNT The signatures and documentation needed for the re-registration are indicated in the following instructions. For certain requests a signature guarantee may be required* Note If re-registering a Transfer on Death TOD account transfers will not be made until 30 days after the last owner s death. broker/dealer credit union if authorized under state law securities exchange or association clearing agency or savings association* A notary public cannot provide a signature guarantee and a notarization cannot be accepted in lieu of a signature guarantee. omplete the appropriate Fidelity nonretirement account application to receive your inherited assets. For a new account check the box provided and then complete the enclosed Fidelity nonretirement account application* QUESTIONS For more information 1-800-544-0003 or Fidelity. com INH-SURAPP-0313 453205. 5. 0 Print Reset Save for NONRETIREMENT Inherited Assets This form MUST be completed in order to initiate a change of registration for your inherited assets. If you have any questions visit us at Fidelity. com or call us at 1-800-544-0003 Monday through Friday between the hours of 8 00 a*m* and 6 30 p*m* ET. Decedent s Account number Name of Decedent Name of Additional Owner if any Daytime Phone Check here if the address for the decedent s original account should be updated to reflect a new address. Permanent address no P. O. boxes Street Address City State Zip Taking Possession of Account Assets MUST Check One If you do not have an existing Fidelity account you MUST establish a new Fidelity account. In order to take possession of the assets you must fill out the appropriate Fidelity nonretirement account application* If transferring to an existing Fidelity account please provide the account number.

Voter registration form wyando... as Voter Registration Form ,-. Please read instructions carefully. Please type or print clearly with blue or black ink. For further information, you may

Missouri voter registration fo... MISSOURI VOTER REGISTRATION APPLICATION TO BE FILLED OUT ON-LINE If filled out by hand, use pen and please print clearly. YOUR APPLICATION WILL BE CONFIRMED BY MAIL WITHIN SEVEN (7) BUSINESS DAYS

Az voters registration form Your completed voter registration form must contain your Arizona driver license or gonoperating identification license num- er. If you do not have either of these

Nj application registration fo... If we can be of further assistance please call 973-504-6351. New Jersey Is An Equal Opportunity Employer Printed on Recycled Paper and Recyclable 6/08 Initial Application for Registration for Dispenser/Prescriber P. O. Box 45045 Newark NJ 07101 New Jersey Controlled Dangerous Substances Act N.J.S.A. 24 21-1 et seq. O. Box 45045 Newark NJ 07101 973 504-6351 Controlled Dangerous Substance Registration Instruction sheet Enclosed is a Controlled Dangerous Substance C. D. S. application which you are required to submit pursuant to N.J.S.A. 24 21-1 et seq. Registration is required for every person who or firm that manufactures prescribes distributes dispenses or conducts research or analysis utilizing controlled dangerous substances. New Jersey Office of the Attorney General Division of Consumer Affairs Drug Control Unit 124 Halsey Street 3rd Floor P. O. Box 45045 Newark NJ 07101 973 504-6351 Controlled Dangerous Substance Registration Instruction sheet Enclosed is a Controlled Dangerous Substance C. D. S* application which you are required to submit pursuant to N*J*S*A. 24 21-1 et seq. Registration is required for every person who or firm that manufactures prescribes distributes dispenses or conducts research or analysis utilizing controlled dangerous substances. A New Jersey C. D. S* registration is issued only for a New Jersey location* Be sure to include a 20. 00 check or money order payable to State of New Jersey. It will take 4-6 weeks to process this application* Your C. D. S* registration will be mailed to the mailing address on file with your professional licensing board. Please note 1. If you have a current D. E*A. number in another state and plan to discontinue practice in that state you may transfer that D. E*A. number to New Jersey by providing the following to the Drug Enforcement Administration 80 Mulberry Street Newark New Jersey 07102 888-356-1071 www. deadiversion*usdoj. gov a* b. c* d. a copy of your New Jersey professional license or a verification letter from the licensing board a copy of your out-of-state D. E*A. registration and a letter requesting an address change to the same address that is on your New Jersey C. D. S* registration* A D. E*A. number is only valid in the state listed on the certificate. 2. If you plan to practice in both New Jersey and the state s where you currently hold a D. E*A. registration s you must also obtain a D. E*A. registration for New Jersey. Please contact the D. E*A. at the address indicated above and complete the New Jersey application* 3. In order to complete the attached application please note a* A dispenser/prescriber/ practitioner includes medical doctors doctors of osteopathy dentists optometrists veterinarians and podiatrists. A mid-level dispenser/prescriber/practitioner includes physician assistants advanced practice nurses and certified nurse midwives. Pharmacies must complete a separate application* b. Every person or firm handling controlled dangerous substances in New Jersey is required to have both a state and federal registration for that purpose.

Nj div mv form do11a New Jersey Motor Vehicle Commission Certified Information Unit P.O. Box 146 Trenton, New Jersey 08666-0146 609-292-4102 VEHICLE REGISTRATION APPLICATION REQUEST All requests for registration records

New jersey apiry registration... NEW JERSEY DEPARTMENT OF AGRICULTURE Division of Plant Industry P.O. Box 330, Trenton, NJ 08625-0330 Phone: (609) 292-5440, Fax: (609) 292-4710 APIARY REGISTRATION FORM OFFICE USE ONLY DATE: AIS#:

State of new jersey division o... DIVISION OF GAMING ENFORCEMENT VENDOR REGISTRATION FORM INSTRUCTIONS Please type all information and answer all questions completely. Respond 'None' or 'Does Not Apply,' if appropriate.

Omb 1513 0112 alcohol form OMB NO. 1513-0112 03/31/2012 DEPARTMENT OF THE TREASURY ALCOHOL AND TOBACCO TAX AND TRADE BUREAU TTB Alcohol Dealer Registration For Use On and After July 1 2008 Please read instructions carefully before completing this form SECTION 1 IDENTIFYING INFORMATION Complete all fields in section 1 to correctly identify your business NAME Last First Middle or CORPORATE NAME If Corporation EMPLOYER IDENTIFICATION NUMBER See Instructions MAILING ADDRESS ...

Registration form minnesota de... For Dept. of Health Use Only Fee Deposit # Deposit Date Initials Protecting, Maintaining and Improving the Health of Minnesotans REGISTRATION FORM SUPPLEMENTAL NURSING SERVICES AGENCY In accordance

Registration form housing with... For MDH Use Only Fee Deposit # Deposit Date Initials Protecting, Maintaining and Improving the Health of Minnesotans REGISTRATION FORM HOUSING WITH SERVICES ESTABLISHMENT In accordance with Minnesota

Alaska employer registration f... Alaska Department of Labor and Workforce Development Employment Security Division Employment Security Tax Juneau Registration 1111 W. 8th St., Room 203 PO Box 115509 Juneau, AK 99811 5509 (907) 465-2757

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