Sample Transferor'S (Seller'S) Application For Transfer Form

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hibit A
ICON Capital
To:_
_________________
Transaction Reference Number:
___________________
(GENERAL PARTNER OR TRANSFER AGENT)[SEE INSTRUCTION 1])
(OPTIONAL-SEE INSTRUCTION 2
P.O. Box 219476
__
Kansas City, Mo 64121-9476
__
________
The transferor hereby makes application to transfer and assign, subject to the general partner's rights, to the transferee all
rights and interests, as set forth in the partnership below and for the transferee to succeed to such interest as a Substitute
Limited Partner, successor in interest or assignee.
X
FULL NAME OF PARTNERSHIP
Partnership ID Information:
X Quantity
Complete at least one of the following (see instruction 3) .
Must be Completed
Optional
Number of units
Number of units
CUSIP #_____________________________________
to be
to be held
NASD Symbol:________________________________
transferred
after transfer
Partnership Tax ID #:___________________________
Tax Shelter ID #:______________________________
_________
_________
X Registration Information
Indicate exactly as shown on partnership records (see instruction 4.)
Partnership interests are currently registered as follows:
NAME OF TRANSFEROR
Tax Identification Information
X
Complete applicable sections (see instruction 5)
____________________________________________
Social Security or Tax ID #:_________________________
ADDRESS OF RECORD
____________________________________________
____________________________________________
____________________________________________
Custodian/Trustee Tax ID #:________________________
____________________________________________
TELEPHONE
____________________________________________
____________________________________________
INVESTOR ID NUMBER-OPTIONAL (SEE INSTRUCTION 6)
California Residents: It is unlawful to consummate a sale or transfer of limited partnership interests or any interest therein, or to receive any
consideration therefore, without the prior written consent of the Commissioner of Corporations of the State of California, except as permitted by the
Commissioner's rules.
Broker/Dealer
(OPTIONAL)
____________________________________________
Registered Representative:__________________________________
NAME OF FIRM
____________________________________________
Telephone:______________________________________________
NAME AND NUMBER
____________________________________________
Client Account Number:___________________________________
ADDRESS
____________________________________________
Wire Code:____________________________________________________
OPTIONAL

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