SINGLE (living)

• signature (security or stock power) medallion stamped
• medallion stamped letter of instruction
• TIN for new shareholder

SINGLE (deceased)

• short certificate dated within 60 days
• affidavit of domicile (states domicile and location of stock at time of death)
• inheritance tax waiver required if value of securities are over $60,000 and live out of state
• signature of executor (security or stock power) medallion stamped
• medallion stamp letter of instruction
• TIN for new shareholder

JOINT (living)

• both signatures (security or stock power) medallion stamped
• medallion stamped letter of instruction signed by both
• TIN for new shareholder

JOINT (one deceased)

• original or certified copy of death certificate
• affidavit of domicile (states domicile and location of stock at time of death)
• inheritance tax waiver required if value of securities are over $60,000 and live out of state
• endorsement by survivor (security or stock power) medallion stamped
• medallion stamped letter of instruction
• TIN for new shareholder

JOINT (both deceased)

• short certificate for both dated within 60 days (or death certificate for first decedent and short certificate for second decedent)
• affidavit for domicile for both
• inheritance tax waiver required if value of securities are over $60,000 and live out of state
• signature of executor (security or stock power) medallion stamped
• medallion stamped letter of instruction
• TIN for new shareholder

TRANSFER TO MINOR

• certified copy of minor's birth certificate
• signature of minor (security or stock power) medallion stamped
• medallion stamped letter of instruction
• TIN for new shareholder

POWER OF ATTORNEY

• POA must include the wording "sell, assign or transfer"
• POA must have the certification that it is a true and correct copy
• POA must be dated within 30 days
• signature of POA (security or stock power) medallion stamped
• medallion stamped letter of instruction
• TIN for new shareholder

CORPORATION TRANSFER

• corporate resolution dated within 60 days
• corporate resolution must include the wording "sell, assign or transfer"
• signature of officer(s) authorized by the resolution (security or stock power) medallion stamped NOTE: officer who signs the resolution can never sign the security or stock power
• medallion stamped letter of instruction
• seal of corporation on resolution and security or stock power

For assistance regarding a change in registration of stock certificates, replacing lost certificates/dividend check, or an address change, please contact the transfer agent listed below.

Transfer Agent:
First Citizens National Bank
Attn: Gina Marie Boor
15 South Main Street
Mansfield, PA 16933
toll free: 1-800-326-9486
telephone: 570/662-2121
website: www.firstcitizensbank.com
e-mail: fcnb@firstcitizensbank.com