### UBS Financial Services Inc.

Account Number 41236

11 Check here if this document app to multiple accounts

### Letter of Authorization for Duplicate Recipient of Tax Records

de «uver nial the sense ody perior in 1999, 1099R a 1099C I reserve adfleter tar leant this wil not be
sent the below paties Alia be aware han 1099A Il you are tigde

Interested Party Information (may select up to four)

### INTERESTED PARTY

| Alan                                            |                      |                      |      |
|-------------------------------------------------|----------------------|----------------------|------|
| First Name                                      | Middle Name          | Blecher<br>Last Name |      |
| 685 Third Avenue                                |                      |                      |      |
| Address Line 1                                  |                      | Address Line 2       |      |
| New York<br>City                                | NY<br>State          | 10017<br>Zip         |      |
| Ablecher@markspaneth.com<br>t inal Address<br>/ |                      | 2122013197<br>Phone  |      |
| Ghislaine<br>Account Owner First Name           | Maxwell<br>Last Name |                      | Oate |



At . Det Rev 10/111

Page 1/1