NAME AND ADDRESS OF YOUR BROKERAGE HOUSE

DATE:

Re: Shares Transfer as a Charitable Gift

To (NAME OF YOUR FINANCIAL INSTITUTE):

This is my/our directive to make a charitable gift transfer from (YOUR ACCOUNT #) (YOUR NAME ON THE ACCOUNT) of (THE NUMBER OF SHARES AND DESCRIPTION OF THEM) free through DTC #0418 for the Account of Youth Law Center #240-06638-17 083).

NAME AND SIGNATURE