Stock Transfer Instructions Form - Diocese Of Des Moines (Page 3 of 3) in pdf

Stock Transfer Instructions Form - Diocese Of Des Moines Page 3

Irrevocable

Stock or Bond Power

If you hold the paper stock certificates to be transferred, the following form must be completed and sent to

the Diocese of Des Moines, 601 Grand Avenue, Des Moines, IA 50309.

FOR VALUE RECEIVED, the undersigned

Date:_________________________ Signature: _______________________________________

Signature: _______________________________________

does/ do hereby sell, assign or transfer to:

FOR OFFICE USE ONLY:

_____________________________________________________________________________

(Social Security or Taxpayer Identification)

IF STOCK: _______________ shares of the _______________ stock of _______________

represented by Certificate(s) No.(s) _______________ inclusive, standing in the name of the above

signed on the books of said Company.

IF BONDS: _______________ bonds of _______________ in the principal amount of

$ _______________ No.(s) _______________ inclusive, standing in the name of the above signed on

the books of said Company.

The above signed does/do hereby irrevocably constitute and appoint First Clearing, LLC attorney to

transfer the said stock or bond(s), as the case may be, on the books of said company, with full power of

substitution in the premises.

Sharing God’s Gifts Stock Transfer Instructions / Stock Transfer Instructions

Stock Transfer Instructions Form - Diocese Of Des Moines Page 3