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Direct Registration Transaction Request

Mail to:
Shareowner Services Medtronic, Inc. PO Box 64874 St Paul MN 55164-0874



Visit or see reverse side for additional transaction requests.

Deposit Direct Registration Plan shares in my

Please change my address as indicated. All registered owners MUST sign on the back of this form. MANAN ATIT 812 CAMILLA IRVING TX 75039

You must submit your stock certificate(s). Do not endorse your certificates. Send the unsigned certificates and completed Transaction Request Form to Shareowner Services, 1110 Centre Pointe Curve, Suite 101, Mendota Heights, MN 55120-4100. We recommend that you use traceable mail and insure the package for 2% of the current market value.









Detach here. Forward top portion to the address shown above.

Direct Registration Account Statement

IMPORTANT: Retain this statement for your investment, tax and cost-basis records.
Visit anytime to access account information, obtain forms, and complete transactions. U.S. telephone number: 888-648-8154 Local and Outside U.S.: 651-450-4064

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Account Summary

Medtronic, Inc. Common Stock

Account # 4001928751
January 6, 2014

CUSIP Number:


Account Value
Market Value Date Market Value Price Total Market Value 01/06/14 $59.2200 $12,564.77

Share Balances
Direct Registration 1 Restricted/Pending 2 Partially Restricted 3 Unrestricted Certificate(s) Direct Purchase Plan Total Shares
Transaction or Settlement Date Transaction Type

0.000 0.000 0.000 0.000 212.000 0.171 212.171
Price per Share Gross Amount

Year-to-Date Amounts
Total Dividends Paid Service Charges Paid by You Commissions Paid by You Federal Tax Withheld Nonresident AlienTax Withheld State Tax Withheld
Service Charge Brokerage Commission Net Amount

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00

Number of Shares








212.000 -

The transaction(s) has been processed as instructed.

As required by Federal tax regulations, Wells Fargo Shareowner Services uses FIFO (First In First Out) as the default method of disposing of shares. To select any other method of disposition or specific tax lots, you must provide your instruction in writing and include the acquisition date and share amount.
Sale Fees: Batch - $10, Market - $25, Limit/Stop - $30, plus $0.10 per share commission. An additional $5 fee will be charged for direct deposit of sale proceeds. 1 Restricted/Pending shares are unavailable for sale, transfer or withdrawal, due to pending transactions or restricted status. 2 Partially Restricted shares are unavailable for transfer or withdrawal, but may be sold by contacting Wells Fargo Shareowner Services. ESPP Pricing 3 Unrestricted shares are available for sale, transfer or withdrawal.
Purchase Date The shares represented by this statement are fully paid and non-assessable. This statement is a record of addressee rights at the time of issuance. Delivery of this statement of itself conveys no rights to the recipient. This statement is neither a negotiable instrument nor a security. A full copy of any rights, privileges, restrictions, and conditions which may be attached to the securities covered by this statement can be obtained by writing to the Secretary of the Company.

Information (Per Share)

Purchase Price Discount Value

Market Value

03/31/13 06/30/13 09/30/13

$46.96 $51.47 $53.25

$39.92 $43.75 $45.27

$7.04 $7.72 $7.98



Medtronic, Inc. Common Stock MR01 4001928751

Transaction Request (continued)

1. Selling Shares: Check the first box to sell all, or check one of the remaining boxes and enter "all" or the number of shares to sell. Sell ALL shares in my account. The Plan will terminate. No additional boxes should be checked. Sell Sell Direct Registration shares. Plan shares, terminate the Plan, and move remaining full
All Registered Owners must sign when submitting a transaction.

shares to Direct Registration. Sell Plan shares but do not terminate the Plan. Checking or Savings Account

Print Shareowner Name(s) Date

2. Direct deposit of sale proceeds*

ABA/Routing Number (include voided check or deposit slip)

U.S. Bank Account Number

* Sale proceeds from written requests will be issued by check for transactions exceeding $10,000.

How to Request a Transaction

Transactions can be requested easily online. Visit If you are a first time visitor, click Sign Up Now!, select Authentication ID and click I do not have my Authentication ID. Instructions to transfer shares, investment plan materials, and forms are available online without signing on to your account. With online account access you can securely and easily manage your account anytime, anywhere. Enroll in eDelivery to receive online statements Update your address Download forms and tax documents Request check replacements Buy or Sell Shares (Batch/Market/Limit/Stop Loss orders) Access account details: o Balances o Transaction history o Dividend payments o Market value and stock quotes

To request your transaction by mail, complete the request form above using these instructions. 1. Sell your shares through the mail: Complete the Transaction Request above by indicating the number of shares you wish to sell. Upon receipt of properly completed sales instructions, your shares will be sold as soon as possible within five business days. Sales requests received by mail will be placed as a Batch order. Market/Limit/Stop Loss orders are available through or by telephone. 2. Direct deposit of sale proceeds to a U.S. financial institution (optional): o Provide us your Account Type, ABA/Routing Number (begins with 0, 1, 2, or 3), and Bank Account Number. Note: The transaction form above and any correspondence should be sent to the PO Box shown on the front of this statement. The Direct Registration System (DRS) provides registered owners with the option of holding their assets on the books and records of the transfer agent in book-entry form. All requests will be executed in accordance with the terms and conditions defined in your plan documents and/or the Share Sale Program. Once a sale has been submitted to Shareowner Services, it cannot be modified or cancelled. You are unable to direct the time or price at which the shares will be sold. The share price may fall or rise during the period between a request for sale, its receipt by Shareowner Services, and the actual sale in the open market. This price risk is assumed by the shareowners. View investment plan documents at for details.

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Deposit requests must include a corresponding pre-printed voided check or savings deposit slip. Incomplete or inaccurate information will result in proceeds being delivered via check. Sale proceeds from written requests will be issued by check for transactions exceeding $10,000.

3. For direct deposit of sale proceeds to a financial institution outside of the U.S., complete your transaction on Visit Frequently Asked Questions and select International Direct Deposit to view a list of available countries.

To sell shares or obtain account information via the automated phone system, dial 888-648-8154 or 651-450-4064.

Please retain this statement for your investment, tax, and cost basis records.