Transfer Requirements

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.

Shareholder Services

First Citizens Community Bank

Attn: Gina Marie Boor

15 South Main Street

Mansfield, PA 16933

toll free: 1-800-326-9486

phone: 570-662-2121

website: www.firstcitizensbank.com

e-mail: fccb@firstcitizensbank.com

Transfer Agent

Broadridge Corporate Issuer Solutions, Inc.

1717 Arch Street, Suite 1300

Philadelphia, PA 19103

phone: 215-553-5400

fax: 215-553-5402

website: www.broadridge.com

email: shareholder@broadridge.com