Common use of Acknowledgement and Signature Clause in Contracts

Acknowledgement and Signature. I understand that conversions from a Traditional IRA to a Roth IRA will be treated as a distribution and may be considered ordinary income for tax purposes. I have been advised to consult a tax professional and assume full responsibility for this conversion transaction and will not hold Computershare Trust Company, N.A. and its agents are not liable for any adverse consequences that may result. I understand that the resigning custodian will remit any income tax which has been withheld to the Internal Revenue Service on my behalf and I have made my election directly with them. I also understand that if I recharacterize, amounts previously withheld may only be refunded by the Internal Revenue Service. Amounts withheld may be subject to a 10% early withdrawal penalty in addition to income tax. By signing this IRA Transfer/Conversion Request Form, I certify that the information I have provided is true and correct. I authorize the current IRA Trustee/Custodian to transfer/convert the IRA assets as instructed above. I understand that I am responsible for ensuring I am eligible to authorize this transfer/conversion and I assume all responsibilities for any consequences that arise as a result of my actions. I agree to indemnify and hold the IRA Trustee/Custodian harmless from any consequences related to executing my directions. I have been advised to seek competent legal and tax advice, and have not been provided any such advice from the IRA Trustee/Custodian. Signature Date

Acknowledgement and Signature. I understand that conversions from a Traditional IRA to a Roth IRA Xxxx XXX will be treated as a distribution and may be considered ordinary income for tax purposes. I have been advised to consult a tax professional and assume full responsibility for this conversion transaction and will not hold Computershare Trust Company, N.A. and its agents are not liable for any adverse consequences that may result. I understand that the resigning custodian will remit any income tax which has been withheld to the Internal Revenue Service on my behalf and I have made my election directly with them. I also understand that if I recharacterize, amounts previously withheld may only be refunded by the Internal Revenue Service. Amounts withheld may be subject to a 10% early withdrawal penalty in addition to income tax. By signing this IRA Transfer/Conversion Request Form, I certify that the information I have provided is true and correct. I authorize the current IRA Trustee/Custodian to transfer/convert the IRA assets as instructed above. I understand that I am responsible for ensuring I am eligible to authorize this transfer/conversion and I assume all responsibilities for any consequences that arise as a result of my actions. I agree to indemnify and hold the IRA Trustee/Custodian harmless from any consequences related to executing my directions. I have been advised to seek competent legal and tax advice, and have not been provided any such advice from the IRA Trustee/Custodian. Signature Date