Stock / Securities Transfer Instructions
40 Ryan Court, Suite 200 Monterey, California 93940
Securities Transfer Letter Date: __________________ Broker’s Name _____________________________________Brokerage Firm________________________________ Street address _________________________________________________________________________________ City ______________________________________ State ____________________Zip ________________________ Phone ___________________________________ Email ________________________________________________ Brokerage Account Name ___________________________Brokerage Account # ___________________________ Dear Broker: Effective ______________, please transfer __________ shares of _______________________________ ________ (date)
(number of shares)
(company name)
(ticker symbol)
From my account, referenced above, via the the following instruction: Merrill Lynch DTC: 5198 PO Box 22320 Carmel, California 93922 Attn: Akiye Takeshita 831-625-7051 For credit to: Community Hospital Foundation Account Number 252-04054 Tax ID # 94-2789696
This transfer represents an irrevocable charitable contribution to Community Hospital Foundation, as of this date, for the benefit of the _______________________________________________________________________________. (name of fund/project at Community Hospital)
Please notify Community Hospital Foundation on the day of the transfer as detailed below. Should there be any questions, you may contact me at __________________________________________________________________. (daytime phone number)
Thank you, ______________________________________ Signature ______________________________________ Name (Printed)
____________________________________________________ Street Address ____________________________________________________ City State Zip
Community Hospital Foundation 40 Ryan Court Suite 200, Monterey, California 93940 Phone: 831-625-4506 Fax: 831-625-4695 Email:
[email protected]