Fillable State Treasury Asset Reserve New Application Form (Ohio Department of Administrative Services OIT SDD)

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State Treasury Asset Reserve New Application Form (Ohio Department of Administrative Services OIT SDD)

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BROWSE OHIO DEPARTMENT OF ADMINISTRATIVE SERVICES OIT SDD (OH) FORMS

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02/2019
P
age 1
State Treasury Asset Reserve
New Application Form
All accounts must be opened in the name of the political
subdivision or the State and executed by an officer thereof.
If you need assistance in filling out this form, representatives
are available toll-free: 1-800-648-STAR (7827)
Make all checks payable to: STAR Ohio
I. ACCOUNT REGISTRATION The account should be registered as follows:
Name of Subdivision
Title of Account
Type of Subdivision
Attention Of Fed. ID# of Subdivision
Mailing Address County
Email
Telephone
Fax (if any)
Mail checks to: STAR Ohio
PO Box 46794
Cincinnati, OH 45246
Fax application to: 614-923-1149
Mail application to: STAR Ohio
PO Box 7177
Dublin, OH 43017
Email application to: info@starohio.com
II. WIRE REDEMPTION—See booklet for explanation. If this procedure is elected, redemption proceeds
may be sent only to the commercial bank listed below, for credit to your account. The participant hereby
authorizes STAR Ohio to honor telephonic or written instruction, without a signature guarantee, for
withdrawal requests received by STAR Ohio from the participant and believed by STAR Ohio to be
genuine. STAR Ohio’s Records of such instructions will be binding.
Please note: ABA/Routing numbers may vary depending on transaction type. Please verify information
below with your bank before submitting.
__________________________________________________________________________________________________________________________________________________
Name of Commercial Bank- ABA/Routing Number Account Number
__________________________________________________________________________________________________________________________________________________
Address of Bank City State Zip Code
ACH REDEMPTION—See booklet for explanation. If this procedure is elected, redemption proceeds
may be sent only to the commercial bank listed below, for credit to your account. The participant hereby
authorizes STAR Ohio to honor telephonic or written instruction, without a signature guarantee, for
withdrawal requests received by STAR Ohio from the participant and believed by STAR Ohio to be
genuine. STAR Ohio’s Records of such instructions will be binding.
Please note: ABA/Routing numbers may vary depending on transaction type. Please verify information
below with your bank before submitting.
__________________________________________________________________________________________________________________________________________________
Name of Commercial Bank- ABA/Routing Number Account Number
__________________________________________________________________________________________________________________________________________________
Address of Bank City State Zip Code
Check box
if desired
Check box
if desired
P
age 2
02/2019
III. SIGNATURE— By the execution of this Application, the undersigned represents and warrants that the participant has
full right, power and authority, to make the investment applied for pursuant to this Application, and the person or persons,
if any, signing on behalf of the participant represent and warrant that they are duly authorized to sign this Application and
to purchase or redeem investments in STAR Ohio on behalf of the participant.
The undersigned further acknowledges that I/we have received and reviewed the Informational Booklet describing STAR
Ohio, prepared by the State Treasurer’s Office and incorporated herein by reference, and I/we have been afforded the
opportunity to discuss STAR Ohio, the Informational Booklet and this Application with Public Funds Administrators, the
Co-Administrator of STAR Ohio, and that I/we have received such advice, legal and otherwise, as I/we have deemed
necessary, to make this application and to comprehend fully the information set forth in the Informational Booklet and
this Application. The undersigned appoints Huntington National Bank as agent of the participant to receive interest and
distributions for their automatic reinvestment.
Name of Participant Subdivision
Title of Account
Date Authorized Officer of Subdivision Signature Title
Date Authorized Officer of Subdivision Signature Title
I would like to receive electronic
statements only.
Check box
if desired
II. CHECK-WRITING REDEMPTION PROCEDURE—See booklet for explanation. We hereby request
Huntington National Bank to honor checks drawn by us on the account indicated above subject to
acceptance by STAR Ohio, with payment therefore to be made by withdrawing from our account without
a signature guarantee. Huntington National Bank does hereby reserve all their lawful rights for honoring
checks drawn by us and for effecting redemptions pursuant to the Check Writing Redemption Procedure.
We understand that this election does not create a checking or other bank account relationship between
ourselves and Huntington National Bank or STAR Ohio and that the relationship between us and Huntington
National Bank is that of participant-transfer agent. If the box is checked STAR Ohio will notify participants
as to the additional documentation needed to receive the Check Writing Redemption Procedure.
Check box
if desired
02/2019
P
age 3
By signing this document, I understand that this is the current and most up-to-date list of all authorized signers. This form will replace
any previous documentation received regarding authorized signers for both STAR Ohio and STAR Plus. If your STAR Ohio and STAR
Plus accounts should have different signers, contact Client Services at 800-648-7827.
Name of Participant Subdivision and Title of Account:_________________________________________________
The above referenced “Authorized Persons” subscribed and sworn their
afliation with named subdivision before me on this _______ day of
___________ , 20___ in the county of ______________State of Ohio.
STAR Ohio / STAR Plus
Authorized Signers
Certification
Account #_________________________________________
_________________________________________
_________________________________________
Federal ID# _______________________________________
Mail to: STAR Ohio Fax to: 614-923-1149
PO Box 7177
Dublin, OH 43017
Email to: info@STAROhio.com
_______________________________________________
Name of Certifying Officer of Subdivision
_______________________________________________
Signature
Title:
__________________________________________
Address: _______________________________________
Notary Public: __________________________________
My commission expires: __________________________
Effective Date:____________________
The following named persons are currently officers or other authorized signatories of the participant, and any one of them (“Authorized
Person(s)”) is/are currently authorized to act with full power to invest or redeem investments in STAR Ohio and/or STAR Plus for the
participant and to execute and deliver any instrument necessary to effectuate the authority hereby conferred:
___________________________ __________________________ ______________________ ____________________________
Name (printed) Signature Title Telephone Number
___________________________ __________________________ ______________________ ____________________________
Name (printed) Signature Title Telephone Number
___________________________ __________________________ ______________________ ____________________________
Name (printed) Signature Title Telephone Number
___________________________ __________________________ ______________________ ____________________________
Name (printed) Signature Title Telephone Number
Service Providers may, without inquiry, act only upon the instruction of ANY PERSON(S) purporting to be (an) Authorized Person(s)
as named in the Certification form last received by Service Providers. Service Providers shall not be liable for any claims expenses
(including legal fees), or losses resulting from Service Providers having acted upon any instruction reasonably believed genuine.
Online access. STAR Ohio and STAR Plus offer online access to your accounts. Users that require online access will receive separate
emails with a secure password and instructions on logging in to your accounts. The STAR Ohio username is first initial, last name in
all capital letters. The STAR Plus username is the email address provided for each user below. (Please note: Only authorized signers
can have Full Access to online accounts)Please provide the following information to obtain online access to your STAR Ohio and
STAR Plus accounts.
NOTE. Retain a copy of this document for your records. The document
is in full force and effect until another duly executed form is received by
Public Funds Administrators.
(Seal)
 Full Access  View Only
 Full Access  View Only
 Full Access  View Only
_______________________________ _____________________________________
Name (printed) Email
_______________________________ _____________________________________
Name (printed) Email
_______________________________ _____________________________________
Name (printed) Email
_______________________________ _____________________________________
Name (printed) Email
 Full Access  View Only
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State Treasury Asset Reserve New Application Form (Ohio Department of Administrative Services OIT SDD)

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Completed 21 July 2020

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