Notice to Financial Institutions To Establish or Convert to an Interest on Lawyer Trust Account (“IOLTA”) INDIANA BAR (To be completed by lawyer/firm for each IOLTA account) FOUNDATION TO FINANCIAL INSTITUTION: ____________________________________________ FROM: ____________________________________________ Lawyer/Law Firm ____________________________________________ ____________________________________________ ____________________________________________ ____________________________________________ The undersigned is establishing an IOLTA account in compliance with the Indiana Rules of Professional Conduct, Rule 1.15 regulating lawyers. Under the IOLTA program you are authorized to open (if new), or change the status of my/our law firm’s existing trust account (Name on Account _____________________________________________Account Number__________________________________) to an interest-bearing checking account (negotiable order of withdrawal – “NOW”, or as the balance allows, a “SUPER NOW” – or similar type account). The establishment of NOW accounts for use in the IOLTA program by lawyers or law firms (including professional associations, corporations, and partnerships) has been approved by appropriate federal regulatory agencies. Copies of these rulings are available from the Indiana Bar Foundation (the “Foundation”) or the Indiana Supreme Court. The undersigned further authorizes you to disclose to the Foundation any and all information with respect to the IOLTA account being established by the undersigned as contemplated herein including, but not limited to, all information designated by Indiana Professional Conduct Rule 1.15 authorizing the establishment of IOLTA accounts and designating the Foundation as the recipient of the interest on all such accounts. The account should be/remain in my/our law firm’s name. However, financial institutions should designate the account with the tax identification number of the Foundation, which will receive all interest from the account. The tax identification number of the Foundation is 35-6032377. My/Our law firm’s tax identification number should not be used. The Indiana Supreme Court has ordered that interest on the IOLTA account, less reasonable service charges, must be remitted at least quarterly (monthly is preferred) to the Foundation. The Foundation is a not-for-profit corporation exempt from federal income tax. No 1099 forms are required for IOLTA Accounts (Internal Revenue Code 6049), and IOLTA accounts are not subject to back-up withholding. Further, no W-9 form Mailing is required (Treas. Reg. 35a.0000-1). If you have questions about how IOLTA accounts are set up, please contact the Foundation at (317) 269-2415 for assistance or for a complete IOLTA Handbook. BY (All IOLTA Account Signatories) Date: ______________________________________________ ____________________________________________________ ___________________________________________________ (Signature) (Signature) ____________________________________________________ ___________________________________________________ (Printed Name) (Printed Name) ____________________________________________________ ___________________________________________________ (Signature) (Signature) ____________________________________________________ ___________________________________________________ (Printed Name) (Printed Name) Attention Lawyers Please return this form to: Indiana Bar Foundation 230 East Ohio Street Indianapolis, IN 46204 Or Fax to: (317) 269-2420 American LegalNet, Inc. www.USCourtForms.com