Certificate Gift of Stock Form
Including Third Party Release and Irrevocale Stock or Bond Power
February 22, 2005

View the document (pdf)

Please complete this form if you are interested in donating securities in certificate form.

Please complete this form if you are interested in donating securities in certificate form.  This form should be returned to Perry Seiffert Investment Management.  Please do not send your certificate by mail but call 301-951-1588 or 888-889-7897 to arrange for your security to be picked up in person.