Mutual Fund Transfer

1 T. Rowe Price Account

Owner Name Social Security Number (SSN) T. Rowe Price Mutual Fund Name Allocation %
Patrick Johnston 024-28-4441 PRTXX - U.S. Treasury Money Fund 100 %

Joint Owner Name (if applicable) Phone %

(972) 439-1929 %
%
Inherited IRA Asset Transfer
Complete this section if the assets are coming from an Inherited IRA. %
Provide deceased IRA owner’s information: %
Name SSN
%
Total = 100%
 For more investments, check this box and attach a separate page.

2 Transfer Instructions
Delivering Institution Name* Phone Check Transferring Firm Account Type (only one applies):
Vanguard Brokerage Services (800) 662-2738 Taxable Account
 Individual  Joint  UGMA/UTMA
Mailing Address  Trust  Estate  Corporate or Other Entity
P.O. Box 1170
IRA
City State ZIP Code
 Traditional IRA  Traditional Inherited IRA  SEP-IRA
Valley Forge PA 19482  Rollover IRA  Roth Inherited IRA  Roth IRA
 SIMPLE IRA (only if at least two years since the first contribution was credited)
*Not applicable if transfer is from a T. Rowe Price SEP-IRA or SIMPLE IRA (Option D)

Required - Complete transfer option(s) below

A: Full Liquidation—Transfer From Account(s) Listed Below B: P

 artial Liquidation—Transfer Dollar Amount or Number of
Shares Listed Below
1. Investment Name Account Number/Plan ID 1. Investment Name Account Number/ Dollar Amount Number of Shares
Plan ID
VMFXX-Federal Money Mkt Fund
29724635

2. Investment Name Account Number/Plan ID 2. Investment Name Account Number/ Dollar Amount Number of Shares
Plan ID

3. Investment Name Account Number/Plan ID 3. Investment Name Account Number/ Dollar Amount Number of Shares
Plan ID

 For more investments, check this box and attach a separate page.
 For more investments, check this box and attach a separate page.

C: Certificate of Deposit (CD) D: Internal Transfer From a T. Rowe Price SEP-IRA or SIMPLE IRA
Only complete this section if the investment is a CD. Indicate in Amount column All Assets or Dollar Amount. Complete
Liquidation time frame: the allocation instructions in Section 1.
 Immediately. I agree to pay any early withdrawal fees.
1. Investment Name Plan ID Amount
 Upon maturity (mm/dd/yyyy)
NOTE: Liquidating a CD prior to maturity may result in an early
withdrawal penalty. In order to transfer at the maturity date, this 2. Investment Name Plan ID Amount
form must be received 15–30 days prior to maturity.

3. Investment Name Plan ID Amount

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