Irrevocable Stock Or Bond Power printable pdf download

Office of the Treasurer

Securities Gifts Accounting & Administration

3451 Walnut Street, 427 Franklin Building

Philadelphia, PA 19104-6205

215-898-7254

Dear University of Pennsylvania Benefactor:

Thank you very much for making a gift of securities to the University of Pennsylvania.

If the physical stock certificate is registered in the donor’s name, please forward the following to Penn:

Mail in a certified (or Fedex/UPS) envelope:

Physical stock certificate without any endorsement or assignment

Mail in a separate, regular envelope:

Executed (signed) stock power endorsed in blank

Short letter from the donor to University stating purpose of the gift.

If the physical stock certificate has been re-registered in the University’s name, please forward the following to Penn:

Mail in a certified (or Fedex/UPS) envelope:

Physical Stock certificate without any endorsement or assignment.

Short letter from the donor to University stating purpose of the gift.

We will mail you these pre-addressed, pre-paid envelopes with the stock power. Contact Jean Suta at 215.898.7254.

IRREVOCABLE STOCK OR BOND POWER

For Value Received, the undersigned does (do) hereby sell, assign and transfer to ___________________________________

If Donating Stock,

______shares of the _____________________ stock of __________________________

Complete This Portion

represented by Certificate Number (s) ____________________________ inclusive,

standing in the name of the undersigned on the books of said Company.

If Donating Bonds,

Complete This Portion

___________bonds of ____________________________________________________

in the principal amount of $ __________ Number (s) _____________________________

inclusive, standing in the name of the undersigned on the books of said Company.

The Undersigned does (do) hereby irrevocably constitute and appoint _______________

________________________________________________________ attorney to transfer

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

power or substitution in the premises.

Important: The signature(s) to this power must correspond with the name(s) as written upon the face of the certificate(s) or

bond(s) in every particular without alteration.

_________________________________________________________________

Title Which Appears on Certificate

PERSON(S) EXECUTING THIS POWER SIGN(S) HERE

_________________________________________________________________

itle Which Appears on Certificate

PERSON(S) EXECUTING THIS POWER SIGN(S) HERE

____________________________________________________________

Dated

Irrevocable Stock Or Bond Power