RE: MLPF&S Retirement Account Number(s) („Retirement Account(s)” includes, but is not limited to, any one or more of the following account types: an… [603016]
1 Code 0891-CR Rev. 01/15
RE: MLPF&S Retirement Account Number(s)
("Retirement Account(s)" includes, but is not limited to, any one or more of the following account types:
an Individual Retirement Account (IRA), a Medical Savings Account (MSA), a Roth Individual Retirement Account
(RRA), a Merrill Lynch Basic sm Employee Pension (SEP) Account, a Merrill Lynch Simple Retirement Account (SRA), or a Merrill
Lynch Money Purchase Pension or Profit-sharing Plan Account, a Merrill Lynch Simplified 403(b)(7)-
Retirement Selector Account (RSA), whether presently opened or hereafter opened.)
I hereby constitute and appoint__________________________________________(whose signature appears below),
as my agent and attorney-in-fact, with power and authority to act for me and on my behalf in connection with my
Retirement Account(s) with MLPF&S for which MLPF&S is custodian, however designated, specifically conferring upon my
agent and attorney-in-fact those powers which I have designated below by initialing the corresponding space provided to
the left of each power that I wish to confer.
NOTE: You may revoke this power at any time by providing MLPF&S with written notice that all proxy
soliciting materials, annual reports and other related materials are to be sent directly to you and are no
longer to be sent to your investment adviser.
(c) (FEES) MLPF&S is hereby authorized, upon receipt of invoices or statements from the investment adviser
named above, to pay such amounts in connection with the above Retirement Account(s) to:
(b) (PROXY) to receive proxy soliciting materials, annual reports and other related materials and to vote proxies on
my behalf (or respond to requests for voting instructions) with respect to all securities and other assets held in my
Retirement Account(s). If this power is initialed, the undersigned hereby represents the following to MLPF&S: that the
investment adviser designated above is registered under the Investment Advisers Act of 1940 and that such adviser
exercises investment discretion over my Retirement Account(s) at MLPF&S pursuant to an advisory contract.
(a) (PURCHASES AND SALES) to effect purchases and sales, to subscribe for and to trade in all types of securities
including, but not limited to, stocks, bonds, options, limited partnership interests, trust units, investments, or other
securities, obtainable through MLPF&S and its affiliates, that are compatible with MLPF&S's administrative, regula-
tory and operational requirements pertaining to my Retirement Account(s) at MLPF&S, whether such securities or
investments are in negotiable form, issued or unissued, or are traded on a foreign exchange (including any foreign
currency transactions necessary to effect the trade); to receive statements of transactions made for my Retirement
Account(s); to approve and confirm the same, to receive any and all notices or demands with reference to my
Retirement Account(s); and to direct payment to other broker-dealers, banks and other financial service providers
for purchases or trades made at such other firms, for my Retirement Account(s) at MLPF&S.
INITIAL ONLY THOSE POWERS YOU WANT YOUR INVESTMENT ADVISER TO EXERCISE
Name of Investment Adviser __________________________________________________________________________
Address of Investment Adviser ________________________________________________________________________
TO: Merrill Lynch, Pierce, Fenner & Smith Incorporated (MLPF&S) and, if applicable, Merrill Lynch Life Agency Inc. (MLLA)
PART I:
If the agent and attorney-in-fact is a registered Investment Adviser, choose from the limited
powers listed below in this Part I:
Initial here (Do not make a mark);
CALIFORNIA
DURABLE POWER OF ATTORNEY FOR RETIREMENT ACCOUNTS
FOR WHICH MERRILL LYNCH IS CUSTODIAN
(This Power of Attorney does not pertain to or provide any authority to your agent and
attorney-in-fact to deal with your non-retirement accounts at MLPF&S.)
I agree that this Durable Power of Attorney shall be applied to the MLPF&S accounts that I have listed above and annuity contract(s)
and life insurance policy(ies) owned by me and linked to my account(s) at MLPF&S and that it may also be applied to any identically
titled account(s) that I establish at MLPF&S and/or identically titled annuity contract(s) and life insurance policy(ies) that I own and are
linked to my accounts at MLPF&S in the future, unless I notify you otherwise in writing.
2 Code 0891-CR Rev. 01/15
In connection with the above direction, I agree that the investment adviser's fees shall be paid first (a) from free
credit balances, if any, in my Retirement Account(s); and second, (b) from the liquidation or withdrawal (which the
client/principal hereby authorizes by his/her signature below) by MLPF&S of my shares of any money market funds
or balances in my Retirement Account(s) at MLPF&S. I further agree that MLPF&S shall be under no other duty or
obligation to pay the investment adviser's fee, that I shall be solely responsible for verifying the accuracy or
calculation of fees submitted for such payment, and that the investment adviser named above has been directed
to submit an invoice or statement for each payment of fees to me and to MLPF&S, stating the client's name, which
MLPF&S account number the fee is to be paid from, and the amount to be paid. This fee payment authorization
shall remain in full force and effect until terminated by one of the parties hereto, and such termination shall be effec-
tive upon receipt of written notice by MLPF&S. MLPF&S may terminate this fee payment arrangement at any time.
NOTE: If this paragraph (c) (FEES) has been initialed by the client/principal, the investment adviser/agent, by
signing below, makes the following representations to MLPF&S: That I/we have entered into an agreement with the
client/principal for investment advisory services which authorizes me/us to receive direct payment from the
client's/ principal's retirement account(s) at MLPF&S upon presentation of my/our invoice or statement to MLPF&S.
I/We acknowledge and agree to all of the foregoing terms and conditions of my/our client's above authorization
to MLPF&S, and I/we agree to hold MLPF&S harmless for amounts paid to me/us upon receipt of my/our invoice
or statement.
(a) (PURCHASES AND SALES) to effect purchases and sales, to subscribe for and to trade in all types of securities
including, but not limited to, stocks, bonds, options, limited partnership interests, trust units, investments, or other
securities obtainable through MLPF&S and its affiliates, that are compatible with MLPF&S's administrative, regula-
tory and operational requirements pertaining to my Retirement Account(s) at MLPF&S, whether such securities or
investments are in negotiable form, issued or unissued, or are traded on a foreign exchange (including any foreign
currency transactions necessary to effect the trade); to receive statements of transactions made for my Retirement
Account(s); to approve and confirm the same, to receive any and all notices or demands with reference to my Retirement Account(s); and to direct payments to other broker-dealers, banks and other financial service providers for
purchases or trades made at such other firms, for my Retirement Account(s) at MLPF&S.
INITIAL ONLY THOSE POWERS YOU WANT YOUR AGENT AND ATTORNEY-IN-FACT TO EXERCISE
(c) (BENEFICIARY DESIGNATIONS) to designate beneficiaries, or change existing beneficiary designations, in
accordance with the procedures outlined in the applicable account agreement(s) governing my Retirement
Account(s) at MLPF&S.
(d) (MAKE CONTRIBUTIONS) to make contributions to my Retirement Account(s) at MLPF&S, whether or not
tax deductible by me.
(b) (DISTRIBUTIONS/TRANSFERS TO/FOR ME) to instruct MLPF&S to distribute or transfer to me or for my benefit or a successor
custodian or trustee any and all cash, securities or other property held in my Retirement Account(s), regardless of the tax
consequences of any such distribution.
Initial here (Do not make a mark);
PART II: If the agent and attorney-in-fact is not a registered Investment Adviser, choose from the powers listed
below in this Part II:
(e) (LIFE INSURANCE POLICIES) to exercise all available ownership rights on my policy(ies), including, but not limited to, the
right to cancel or exchange the policy(ies), and receive the net cash surrender value or to choose one or more income plans on
canceling the policy(ies), to apply for and receive policy loans, to collaterally assign the policy(ies), to change the allocation
between and among the available investment options of the company in which the policy(ies) are funded, to change the
beneficiary and ownership designations of the policy(ies) and to make inquiries and receive information as to the cash value
and death benefit of the policy(ies). To receive funds from, elect options under or continue any life insurance policy for which I
am named a beneficiary that is linked to or held in any account at MLPF&S.
(f) (ANNUITIES) to exercise all available ownership rights under my contract(s), including, but not limited to, the right to select or
change an annuitant, the annuity date, the annuity option or the allocation between and among the available investment
options, to cancel or exchange the contract(s) and receive the net value, to make withdrawals from the contract(s), to
collaterally assign the contract(s), to make or change the beneficiary designations or ownership designations of the contract(s),
to exercise all available benefits and/or riders, and to make inquiries and receive all information as to the cash value and death
benefit of the contract. To receive funds from, elect options under or continue any annuity contract for which I am named a
beneficiary that is linked to or held in any account at MLPF&S.
3 Code 0891-CR Rev. 01/15
I have inquired as to whether or not my agent and attorney-in-fact is registered (or is otherwise exempt from registration)
with the Securities and Exchange Commission under the Investment Advisers Act of 1940 and with the appropriate state
authority of my state of residence, where such registration would be required. In addition, I have investigated the business
experience, qualifications and reputation of my agent and attorney-in-fact and am satisfied with the experience,
qualifications and reputation of my agent and attorney-in-fact.
If I have appointed two or more agents and attorneys-in-fact, I hereby authorize each of them to act alone and with-
out the consent of the other agent or agents, with respect to the powers granted above. In addition, I hereby authorize
MLPF&S to restrict my Retirement Account(s) from further activity in the event the agents enter conflicting or inconsistent
instructions. I understand that my Retirement Account(s) at MLPF&S may remain restricted until written instructions are
received from me, the principal, or until joint written instructions are submitted by all of my agents .
MLPF&S accordingly is authorized and empowered to follow the instructions of my said agent and attorney-in-fact with
respect to the powers set forth and initialed above with respect to my Retirement Account(s) at MLPF&S provided such
instructions and transactions are permissible under the terms of my applicable Retirement Account(s) agreement(s) with
MLPF&S, and I hereby ratify and confirm any and all transactions, trades, or dealings effected in and for my Retirement
Account(s) by my agent and attorney-in-fact, and agree to indemnify MLPF&S, its affiliates, officers, agents and
employees, and hold them free and harmless from any loss, liability, or damage by reason of any such transaction, trade
or dealing; or by reason of any other matter or thing done by MLPF&S, its affiliates, officers, agents and employees, in and for my Retirement Account(s) pursuant to instructions received from my agent and attorney-in-fact.
This durable power of attorney, authorization and indemnity is in addition to (and in no way limits or restricts) any and all
rights which MLPF&S may have under any other agreement or agreements between MLPF&S and me, and shall inure
and continue in favor of MLPF&S, its successors (by merger, consolidation or otherwise) and assigns.
To induce any transfer agent or other third party to act, I hereby agree that any transfer agent or other third party receiving
a duly executed copy or facsimile of this Power of Attorney may act upon it, and that revocation or termination hereof shall
be ineffective as to such transfer agent or other third party, unless and until actual notice or knowledge of such revocation
or termination shall have been received by such transfer agent or other third party, and I for myself and for my heirs,
executors, legal representatives and assigns, hereby agree to indemnify and hold harmless any such transfer agent or
other third party from and against any and all claims that may arise against such transfer agent or other third party by
reason of such transfer agent or third party having relied on this Power of Attorney.
I have read carefully the provisions of this Power of Attorney and understand that it authorizes my agent and
attorney-in-fact to exercise all rights and powers set forth and initialed above with respect to my Retirement Account(s)
with MLPF&S, and I understand that anything my agent may do in the exercise of such rights and powers is fully binding
upon me.
I understand that MLPF&S has not provided any advice that this Durable Power of Attorney satisfies the requirements
under the laws of the state in which it is to be effective, and if there is anything about this Durable Power of Attorney that
I do not understand, I should consult with my attorney for an explanation.
This durable power of attorney, authorization and indemnity shall not be affected by my subsequent disability, incompe-
tence or incapacity, or by any lapse of time, and MLPF&S, its successors and assigns, shall be indemnified in relying
thereon, until MLPF&S shall receive written notice of revocation thereof, signed by me; or in the event of the termination
thereof by my death, until MLPF&S shall have received actual notice thereof, and such revocation or termination shall in
no way affect the validity of this power of attorney and my liability under the indemnity herein contained, with reference to
any transaction initiated by my agent and attorney-in-fact, prior to the actual receipt by MLPF&S of notice of such
revocation or termination, as above provided.
NOTE: IF THE CLIENT'S STATE OF RESIDENCE CHANGES AFTER THE CLIENT HAS EXECUTED THIS DURABLE POWER OF ATTORNEY,
THE CLIENT SHOULD CONSULT WITH HIS OR HER OWN LEGAL COUNSEL TO DETERMINE IF A NEW DURABLE POWER OF ATTORNEY SHOULD BE EXECUTED.
4 Code 0891-CR Rev. 01/15
NOTICE
This is an important legal document. Before executing this Durable Power of Attorney you should know these
important facts:
1. Since this is a Durable Power of Attorney, your agent's and attorney-in-fact's authority will continue notwithstanding your subsequent mental disability or incapacity. 2. You have the right to revoke or terminate this Durable Power of Attorney at any time and any such revocation or termination shall be effective upon receipt of written notice by MLPF&S and MLLA. 3. If you have initialed paragraph (c) under Part II of this Durable Power of Attorney, you have given your agent and attorney-in-fact the authority to choose who will receive the assets in your Retirement Account at your death. 4. The information provided in this Power of Attorney does not substitute for legal advice. If there is anything about this Power of Attorney you do not understand, you should consult with your own attorney. 5. The following notice is given pursuant to California Probate Code Section 4128:
NOTICE TO PERSON EXECUTING DURABLE POWER OF ATTORNEY
A Durable Power of Attorney is an important legal document. By signing the Durable Power of Attorney, you are
authorizing another person to act for you, the principal. Before you sign this Durable Power of Attorney, you should know these important facts: Your agent (attorney-in-fact) has no duty to act unless you and your agent agree otherwise in writing. This document gives your agent the powers to manage, dispose of, sell and convey your real and personal property, and to use your property as security if your agent borrows money on your behalf. This document does not give your agent the power to accept or receive any of your property, in trust or otherwise, as a gift, unless you specifically authorize the agent to accept or receive a gift.
Your agent will have the right to receive reasonable payment for services provided under this Durable Power of Attorney
unless you provide otherwise in this Power of Attorney.
The powers you give your agent will continue to exist for your entire lifetime, unless you state that the
Durable Power of
Attorney will last for a shorter period of time or unless you otherwise terminate the Durable Power of Attorney. The powers
you give your agent in this Durable Power of Attorney will continue to exist even if you can no longer make your own decisions respecting the management of your property.
You can amend or change this Durable Power of Attorney only by executing a new Durable Power of Attorney or by executing an amendment through the same formalities as an original. You have the right to revoke or terminate this Durable Power of Attorney at any time, so long as you are competent. This Durable Power of Attorney must be dated and must be acknowledged before a notary public or signed by two witnesses. If it is signed by two witnesses, they must witness either (1) the signing of the Power of Attorney or (2) the principal's signing or acknowledgment of his or her signature. A Durable Power of Attorney that may affect real property should be acknowledged before a notary public so that it may easily be recorded. You should read this Durable Power of Attorney carefully. When effective, this Durable Power of Attorney will give your agent the right to deal with property that you now have or might acquire in the future. The Durable Power of Attorney is important to you. If you do not understand the Durable Power of Attorney, or any provision of it, then you should obtain the assistance of an attorney or other qualified person.
Dated this______________day of__________________________________, 20_______.
WITNESSES (If not notarized, two witnesses are required.
Witnesses must be adults. Agent may not act as a witness.)
_____________________________________________
Signature of Client/Principal
(2)_______________________________________________
Code 0891-CR (Rev. 02/09)
(1)_______________________________________________
_____________________________________________
Print Name of Client/Principal
ACKNOWLEDGEMENT
(If not witnessed by two witnesses, must be notarized.)
STATE OF CALIFORNIA
COUNTY OF ____________________________________)
NOTICE TO PERSON ACCEPTING THE APPOINTMENT AS ATTORNEY-IN-FACT
(From California Probate Code Section 4128)
By acting or agreeing to act as the agent (attorney-in-fact) under this Power of Attorney you assume the fiduciary
and other legal responsibilities of an agent. These responsibilities include:
1. The legal duty to act solely in the interest of the principal and to avoid conflicts of interest.
2. The legal duty to keep the principal's property separate and distinct from any other property owned or controlled by you. You may not transfer the principal's property to yourself without full and adequate consideration or accept a gift of the principal's property unless this Power of Attorney specifically authorizes you to transfer property to yourself or accept a gift of the principal's property. If you transfer the principal's property to yourself without specific authorization in the Power of Attorney, you may be prosecuted for fraud and/or embezzlement. If the principal is 65 years of age or older at the time that the property is transferred to you without authority, you may also be prosecuted for elder abuse under Penal Code Section 368. In addition to criminal prosecution, you may also be sued in civil court.
I have read the foregoing notice and I understand the legal and fiduciary duties that I assume by acting or agree-
ing to act as the agent (attorney-in-fact) under the terms of this Power of Attorney.
I hereby represent that I am familiar with and have reviewed the investment goals, guidelines and objectives of the principal;
and that I will invest consistently with his or her stated goals, guidelines and objectives.
____________________________________________
_________________________ _______________________
Signature of Agent
Agent's SSN/TIN Agent's Date of Birth
____________________________________________
___________________________________________________
Printed Name of Agent
Agent's Occupation
____________________________________________
_________________________________________________________
Date
Name of Agent's Employer (if any)
____________________________________________
____________________________________________________
Agent's Address
Agent's MLPF&S Account Number(s) (if any)
5 Code 0891-CR Rev. 01/15
(SEAL)
__________________________________________________
Signature
WITNESS my hand and official seal.
I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and
correct.
On ________________________________, before me, ________________________________________________________,
(Insert name and title of the officer) personally appeared___________________________________________________________________________________
who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or entity upon behalf of which the person(s) acted, executed the instrument.
A notary public or other officer completing this certificate
verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document.
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