Zia Trust, Inc.- IRA Confirmation of Direction

CONFIRMATION OF DIRECTION

IF YOU ARE SUBMITTING THIS FORM VIA FAX, PLEASE CALL THE NUMBER BELOW TO CONFIRM THAT ZIA HAS RECEIVED YOUR REQUEST.

Phone: (505) 881-3338

Fax: (505) 217-0466
IRA Owner Name:*
Date:*

MonthDayYear
Zia Account Number (if known):
Zia Administrator:
Daytime Phone No.:*
E mail:*
example@example.com
The above named IRA Owner hereby authorizes Zia Trust, Inc. to execute the purchase/sale described below. This form must be completed by the Depositor when making purchases into or sales from Depositor’s IRA. Failure to properly complete this form may delay or prevent Zia Trust, Inc. from completing this transaction. Zia Trust, Inc. reserves the right to refuse to execute any direction in the event of inadequate information, insufficient funds, or for other reasons that Zia Trust, Inc. may deem unacceptable.
PART ONE

(To be used if the investment to be acquired or sold publicly traded.)
For STOCK sales or purchases, please complete the following:
Stock Name:
BUY or SELL?

BUYSELL
BUY: Number of Shares
BUY: Approximate $ worth of stock
SELL: Number of Shares
SELL: Approximate $ worth of stock
Specific Instructions (limit orders, etc.)
For FIXED INCOME ASSETS (bonds, treasuries, etc.) sales or purchases, please complete the following:
BUY or SELL?

BUYSELL
Bond Name:
Maturity range in years:
Target yield%
Approximate total value:$
For Mutual FUND sales or purchases, please complete the following:
PURCHASE or SELL?

PURCHASESELL
Name of Mutual Fund:
Approximate dollar value:$
Existing account number with mutual fund firm
(If no current account through Zia Trust, Inc., then contact us to determine if an account my be set up.)
PART TWO

PURCHASE AUTHORIZATION
(To be used if the investment to be acquired or sold is not publicly traded.)
Name of the Seller:
Is the Seller related to the IRA Owner?

YESNO
If yes, what is the relation?
If the Seller is an entity, does the IRA Owner and/or family have an ownership interest in the entity?

YESNO
If yes, then how much of the entity does the IRA Owner own and how much of the entity does each member of the IRA owner's family own?
Description of the asset being purchased:
Purchase price:$
If asset is real estate, will the IRA Owner of any member of the IRA Owner's family be using the real estate?
Is or will the IRA Owner also be investing non-IRA funds in the same asset?
Will the property be subject to a mortgage?

YESNO
For REAL ESTATE CONTRACTS, MORTGAGES, PROMISSORY NOTES and related purchases, please complete the following:
Type of Agreement:
Firm handling purchase:
Contact person:
Phone number:
Specifics:
Effective date of agreement:
Maturity date:
Interest rate:
Monthly payment:$
Paid by:
Agreement to be escrowed with:
Escrow company phone number:
Agreement secured by:
Ir purchase is discounted, indicate the face value of the agreement: $
For REAL ESTATE purchases, please complete the following:
Description:
Location:
Firm handled by:
Contact person/number:
For MISCELLANEOUS ASSETS, please complete the following:
Description:
Purchase value: $
Number of units:
Firm handled by:
Contact person:
Contact phone number:
SELL AUTHORIZATION
Name of the Purchaser:
Is purchaser related to the IRA Owner?

YESNO
If yes, then what is the relation?
If Purchaser is an entity, does the IRA Owner and/or family have an ownership interest in the entity?

YESNO
If yes, then how much of the entity does the IRA Owner own and how much of the entity does each member of the IRA owner's family own?
Description of the asset being sold:
Sale price: $
SPECIAL INSTRUCTIONS
Special Instructions
Please read below disclosures, and scroll to end to submit.
If the requested transaction involves the purchase/sale of a security, I direct that the institution placing the transaction be paid its standard fee/commission.
The undersigned IRA owner, in authorizing the sale/purchase of the above described asset, has been told to obtain independent professional advice as to the risks, tax, and legal consequences of entering into the transaction. The undersigned IRA owner further acknowledges that, pursuant to the Traditional Individual Retirement Account Agreement that the undersigned IRA owner has entered into with Zia Trust, Inc., Zia Trust, Inc.’s sole responsibility is to act as custodian of the assets and that the undersigned IRA owner holds Zia Trust, Inc., its officers, directors, and employees harmless from any claims by or against the IRA owner as a result of the transaction and indemnifies Zia Trust, Inc., its officers, directors, and employees for any damages, including attorney’s fees, that Zia Trust, Inc. may incur as a result of following the above instructions.
The undersigned IRA owner, in authorizing the sale/purchase of the above described asset, acknowledges and agrees that the IRA owner is solely responsible for the decision to sell/purchase the asset, that the IRA owner has not received any investment advice from Zia Trust, Inc. in regard to the sale/purchase of the asset, and that the IRA owner has been told to obtain independent, professional advice as to the risks, tax, and legal consequences of entering into this transaction.
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PART ONE

PART TWO

SELL AUTHORIZATION

SPECIAL INSTRUCTIONS

Please read below disclosures, and scroll to end to submit.