ARKANSAS STATE TREASURY MONEY MANAGEMENT TRUST

Please complete this form and return to the Arkansas State Treasury's Office via email. Email: MMTrust@artreasury.gov Contact: STMMT Administrator (501-682-1419)

Please complete this form to transfer funds from one STMMT Account into another STMMT Account.

Participant Name: ____________

Request Date: ____ Transaction Date: ______

Participant's Phone Number: ____________

Participant's Email: ____________

Transfer Amount: ____________

To STMMT Account #: ____________

From (Other STMMT Account Name): ____________

From STMMT Account #: ____________

Authorized by:

Signature

Title

Please Print Name

Date

FOR TRUST USE ONLY

Ticket #______

Correspondent

Bank Name____________

Bank T/R #____ Account Balance______

Correspondent Bank T/R#____________