COIN BUY DIRECTION LETTER COVER SHEET On May 21, 2014, the United States District Court for the District of Utah entered an Order Clarifying Order Appointing Receiver, Freezing Assets, and Other Relief ("Clarifying Order") in Case No. 2014-cv-00309. Pursuant to the Clarifying Order, I am making a formal request that the Court-Appointed Receiver authorize certain transactions as evidenced by the attached Buy Direction Letter and related documents. By submitting this Buy Direction Letter and signing below, I hereby acknowledge that any assets acquired as a result of the requested transaction shall continue to remain subject to the terms of the Court’s Order Appointing Receiver, Freezing Assets, and Other Relief (“Receivership Order”). I also understand that the requested transaction may not be approved unless I maintain or reach a ratio of 20% cash to asset value following any reinvestments. I further acknowledge and agree that I may be required to liquidate this investment and/or some of my other self-directed investments to generate cash in the future if a Court approved Plan of Liquidation is implemented. Signed this ____ day of ___________, 2014. Account Name(s): ____________________________________________ Account Number(s): ____________________________________________ Signature: ____________________________________________ Address: ____________________________________________ ____________________________________________ Phone Number(s): ____________________________________________ E-mail(s): ____________________________________________ Please send this cover sheet, the attached Buy Direction Letter, and all other required documents to Diane Thompson, the Court-Appointed Receiver for American Pension Services, Inc., either via email at [email protected], via facsimile at (801) 208-7307, or via postal mail at 4168 W. 12600 S., Suite 300, Riverton, Utah 84096. Rev. 05.29.2014 COIN BUY DIRECTION LETTER 1. Account Owner Information : Account Owner Name: Email Address: Account Number: (4 or 5 digit) Fax Number: Primary Daytime Phone Number: 2. Dealer Information : Dealer Company Name : Representatives Name: Dealer Company Address: Dealer/Representative’s Phone Number: Dealer Fax Number: 3. Coin/ Metal Information: Troy OZ each Metal Type Description (e.g., U.S Silver Eagle, 1oz. . . ) Quantity Price per unit Total Price: $ $ $ $ $ $ $ $ $ $ $ $ Total: $ Special Instructions: 4. Coin Storage Information : Depository Name: Depository Phone Number: Depository Address: There are numerous depositories that specialize in storage and safekeeping of precious metals. I understand that the Custodian is not responsible for the actions of these depositories and hereby release and hold harmless Custodian/Administrator from any damage that I may incur with respect to my choice of depository and any activities or lack of activities on the part of said depository. 5. Title of Investment: When purchasing assets in a Self-Directed Retirement Plan, you MUST title the investment properly or the asset will not be accepted. Retirement Plan will be 100% owner and will be titled: “American Pension Services, Inc. Administrator for Account Owner’s Name , Account type #” Retirement Plan will be less than 100% owner and will be titled: “American Pension Services, Inc. Administrator for Account Owner’s Name , Account Type #, Percentage of Ownership%, Undivided Interest.” I have read and reviewed the information I have provided above: X Account Owner Initial Rev. 05.29.2014 Continue to page 2 Account Number: (4 or 5 digit) 6. Funding the Investment: Funds must be cleared and available in order to make an investment. Funds are further subject to requirements below. Funds are not cleared to invest until 7 business days after the deposit of a personal or business check. Funds from the deposit of a cashier’s check or money order are not cleared to invest for 3 business days. Bank wire funds are available immediately. Please Send $ By Check: (provide information below) OR By Wire $20 : (Complete Wire Request Form Attached) Make Check Payable To: Mail Check To: Address: City: State: Select Check Type Regular Check Cashier’s Check ($15) Zip Code: Select Mailing Option Overnight Mail (FedEx Charge) Certified Mail ($15) Overnight (FedEx Charge) (if no selection is made a regular check will be issued) (if no selection is made check will be mailed regular U.S. mail) I have read and approved all documents, and I agree with the terms. I understand that my account is self-directed and that American Pension Services, Inc., or any of its licensees, affiliates, or employees (collectively, “Administrator) and/or trustee or custodian does not review the merits, appropriateness and/or suitability of any investment in general, or in connection with my account in particular. I acknowledge that I have not requested the Administrator provide, and that the Administrator has not provided, any advice with respect to the investment directive set forth in this Buy Direction Letter, nor has the Administrator made any representations or recommendations or other statements regarding the parties with whom I now or in the future may be dealing. I understand that neither the Administrator nor trustee or custodian determine whether this investment is acceptable under the Employee Retirement Income Securities Act of 1974, as amended (“ERISA”), the Internal Revenue Code of 1986, as amended (the “Code”), or any other applicable federal, state, or local laws, including but not limited to securities laws. I understand that it is my responsibility to review any investments to ensure compliance with these requirements. I understand that no one at the Administrator has authority to agree to anything different than the above policy. I understand that neither the Administrator nor trustee or custodian is a “fiduciary” for my account as such term is defined in the Code, ERISA, or any applicable federal, state or local laws. I agree to release, indemnify, defend and hold the Administrator and trustee or custodian harmless from any claims arising out of this investment, including, but not limited to claims, demands, or causes of actions that an investment is not prudent, proper, diversified or otherwise in compliance with ERISA, the Code or any other applicable federal, state or local laws. I also understand and agree that the Administrator and/or trustee or custodian will not investigate, analyze, monitor, verify title to or otherwise evaluate any investment contemplated herein, or to obtain or maintain insurance coverage (whether liability, property or otherwise) with respect to any assets or investments purchased by me. The Administrator shall not be responsible to take any action should there be any default with regard to this investment. Such obligation to release, indemnify, defend and hold the Administrator and trustee and/or custodian harmless shall include but not be limited to necessary court costs, attorneys’ fees, or other expenses incurred to Administrator. I alone am responsible for the selection, due diligence, management, review and retention of all investments in my account. I am directing you as Administrator, in a passive capacity, to complete this transaction as specified above. I confirm that the decision to buy this asset is in accordance with the rules of my account and applicable law and I agree to hold harmless and without liability the Administrator and/or the trustee or custodian of my account. I have reviewed this transaction with my tax and legal advisors, and it does not constitute a Prohibited Transaction (as defined in section 4975 of the Code). IMPORTANT: PURSUANT TO THE COURT’S ORDER CLARIFYING ORDER APPOINTING RECEIVER, FREEZING ASSETS , AND OTHER RELIEF DATED MAY 21, 2014, BY SUBMITTING THIS BUY DIRECTION LETTER AND SIGNING BELOW, I HEREBY ACKNOWLEDGE THAT THE REQ UESTED TRANSACTION MAY NOT BE APPROVED UNLESS I MAINTAIN OR REACH A RATIO OF 20% CASH TO ASSET VALUE FOLLOWING ANY REINVESTMENTS . I FURTHER ACKNOWLEDGE AND AGREE THAT I MAY BE REQ UIRED TO LIQ UIDATE THIS INVESTMENT AND/ OR SOME OF MY OTHER INVESTMENTS TO GENERATE CASH IN THE FUTURE WHEN A COURT APPROVED PLAN OF LIQ UIDATION IS IMPLEMENTED. I declare that I have examined this document, including accompanying information, and to the best of my knowledge and belief, it is true, correct, and complete. X Account Owner’s Signature: ______________________________________ Date: _________________ By signing my name, I certify that I have read the above disclosures. Rev. 05.29.2014 Type Required Information(*), Print, Sign & Date, Send to APS With the Applicable Direction Letter WIRE REQUEST FORM Daily Outgoing Wire Cut-off is 4pm EST Date: *Amount (Numeric): $ *Amount (Alpha): TO: *Receiving Bank: *Bank Address: *ABA #: (9 digit number) BENEFICIARY INFORMATION: *Credit to: (Name on Bank Account) *Receiving Bank Account # *SSN or EIN of Payee: Further Credit To: Additional Reference: *Client Signature: X Date: *Print Name: APS Account # Authorized Personnel Complete Below Portion Please wire funds as requested above from American Pension Services, Inc. AUTHORIZED SIGNATURE: Diane A. Thompson, Receiver, APS Account: From: American Pension Services, Inc. Address: 4168 W. 12600 S. Suite 300 Riverton, UT 84096 Rev. 05.29.2014
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