<SEC-DOCUMENT>0001140361-21-029446.txt : 20210826
<SEC-HEADER>0001140361-21-029446.hdr.sgml : 20210826
<ACCEPTANCE-DATETIME>20210826140510
ACCESSION NUMBER:		0001140361-21-029446
CONFORMED SUBMISSION TYPE:	POS AM
PUBLIC DOCUMENT COUNT:		2
FILED AS OF DATE:		20210826
DATE AS OF CHANGE:		20210826

FILER:

	COMPANY DATA:	
		COMPANY CONFORMED NAME:			FARMERS & MERCHANTS BANCORP INC
		CENTRAL INDEX KEY:			0000792966
		STANDARD INDUSTRIAL CLASSIFICATION:	SAVINGS INSTITUTION, FEDERALLY CHARTERED [6035]
		IRS NUMBER:				341469491
		STATE OF INCORPORATION:			OH
		FISCAL YEAR END:			1231

	FILING VALUES:
		FORM TYPE:		POS AM
		SEC ACT:		1933 Act
		SEC FILE NUMBER:	333-257767
		FILM NUMBER:		211211385

	BUSINESS ADDRESS:	
		STREET 1:		307-11 N DEFIANCE ST
		CITY:			ARCHBOLD
		STATE:			OH
		ZIP:			43502
		BUSINESS PHONE:		4194462501

	MAIL ADDRESS:	
		STREET 1:		307-11 NORTH DEFIANCE ST
		CITY:			ARCHBOLD
		STATE:			OH
		ZIP:			43502
</SEC-HEADER>
<DOCUMENT>
<TYPE>POS AM
<SEQUENCE>1
<FILENAME>ny20000091x2_posam.htm
<DESCRIPTION>POS AM
<TEXT>
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<div class="page" style="text-align: left; margin: auto; position: relative; width: 540pt;"><a name="ny20000091x2_posam_100-posam_pg1"><!--Anchor--></a><div class="page-content"><div class="block-main" style="width: 540pt; margin-left: 0pt;"><div class="h1" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; font-weight: bold; margin-top: 25pt; text-align: center;">As filed with the Securities and Exchange Commission on August&#160;26, 2021 </div><div class="regno" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; font-weight: bold; margin-top: 1pt; text-align: right;">Registration Statement No. 333-257767 </div></div></div><div class="block-frill" style="width: 540pt; margin-left: 0pt;"><div><div class="rule-full" style="height: 0pt; width: 100%; border-bottom: 2pt solid #000000; margin-top: 1pt; margin-bottom: 1pt; margin-left: auto; margin-right: auto;"> </div><div class="rule-full" style="height: 0pt; width: 100%; border-bottom: 1pt solid #000000; margin-bottom: 1pt; margin-left: auto; margin-right: auto; margin-top: 4pt;"> </div></div></div><div class="block-main" style="width: 540pt; margin-left: 0pt;"><div class="h1" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; font-weight: bold; margin-top: 6.75pt; text-align: center;">UNITED STATES <br></div><div class="h1" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; font-weight: bold; margin-top: 0pt; text-align: center;">SECURITIES AND EXCHANGE COMMISSION <br></div><div class="h1" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; font-weight: bold; margin-top: 0pt; text-align: center;">Washington, D.C. 20549 </div><div><div class="rule-full" style="height: 0pt; width: 100%; border-bottom: 1pt solid #000000; margin-bottom: 2pt; margin-left: auto; margin-right: auto; margin-top: 7pt;"> </div></div><div class="h1" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; font-weight: bold; margin-top: 9pt; text-align: center;">POST EFFECTIVE AMENDMENT NO. 1<br></div><div class="h1" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; font-weight: bold; margin-top: 0pt; text-align: center;">Filed pursuant to Rule 462(d)<br></div><div class="h1" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; font-weight: bold; margin-top: 0pt; text-align: center;">to <br></div><div class="h1" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; font-weight: bold; margin-top: 0pt; text-align: center;">FORM S-4<br></div><div class="h1" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; font-weight: bold; margin-top: 0pt; text-align: center;">REGISTRATION STATEMENT <br></div><div class="h1" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; font-weight: bold; margin-top: 0pt; text-align: center;"><font style="font-style: italic;">UNDER </font><br></div><div class="h1" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; font-weight: bold; margin-top: 0pt; text-align: center;"><font style="font-style: italic;">THE SECURITIES ACT OF 1933</font></div><div><div class="rule-full" style="height: 0pt; width: 100%; border-bottom: 1pt solid #000000; margin-bottom: 2pt; margin-left: auto; margin-right: auto; margin-top: 7pt;"> </div></div><div class="h1" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 14pt; font-weight: bold; margin-top: 9pt; text-align: center;">FARMERS &amp; MERCHANTS BANCORP, INC. <br></div><div class="h1" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 14pt; font-weight: bold; margin-top: 0pt; text-align: center;"><font style="font-size: 10pt;">(Exact name of registrant as specified in its charter)</font></div><div><div class="rule-full" style="height: 0pt; width: 100%; border-bottom: 1pt solid #000000; margin-bottom: 2pt; margin-left: auto; margin-right: auto; margin-top: 6pt;"> </div></div><table cellspacing="0" cellpadding="0" class="txttab" style="margin-top: 4pt; border-collapse: collapse; width: 540pt; margin-left: auto; margin-right: auto;"><tr><td style="width: 31.85%; text-align: center; vertical-align: top; padding-top: 6pt; padding-bottom: 2pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; font-weight: bold; margin-top: 0pt; text-align: center;">OHIO</div></td><td class="gutter" style="width: 1.11%; border-bottom: none; font-size: 2pt; padding-top: 6pt; padding-bottom: 2pt;">&#8203;</td><td class="gutter" style="width: 1.11%; border-bottom: none; font-size: 2pt; padding-top: 6pt; padding-bottom: 2pt;">&#8203;</td><td style="width: 31.85%; text-align: center; vertical-align: bottom; padding-top: 6pt; padding-bottom: 2pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; font-weight: bold; margin-top: 0pt; text-align: center;">6712</div></td><td class="gutter" style="width: 1.11%; border-bottom: none; font-size: 2pt; padding-top: 6pt; padding-bottom: 2pt;">&#8203;</td><td class="gutter" style="width: 1.11%; border-bottom: none; font-size: 2pt; padding-top: 6pt; padding-bottom: 2pt;">&#8203;</td><td style="width: 31.85%; text-align: center; vertical-align: bottom; padding-top: 6pt; padding-bottom: 2pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; font-weight: bold; margin-top: 0pt; text-align: center;">34-1469491</div></td></tr><tr><td style="width: 31.85%; text-align: center; vertical-align: top; padding-top: 2pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; font-weight: bold; margin-top: 0pt; text-align: center;">(State or other jurisdiction of<br></div><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; font-weight: bold; margin-top: 0pt; text-align: center;">incorporation or organization)</div></td><td class="gutter" style="width: 1.11%; border-bottom: none; font-size: 2pt; padding-top: 2pt; padding-bottom: 3pt;">&#8203;</td><td class="gutter" style="width: 1.11%; border-bottom: none; font-size: 2pt; padding-top: 2pt; padding-bottom: 3pt;">&#8203;</td><td style="width: 31.85%; text-align: center; vertical-align: bottom; padding-top: 2pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; font-weight: bold; margin-top: 0pt; text-align: center;">(Primary Standard Industrial<br></div><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; font-weight: bold; margin-top: 0pt; text-align: center;">Classification Code Number)</div></td><td class="gutter" style="width: 1.11%; border-bottom: none; font-size: 2pt; padding-top: 2pt; padding-bottom: 3pt;">&#8203;</td><td class="gutter" style="width: 1.11%; border-bottom: none; font-size: 2pt; padding-top: 2pt; padding-bottom: 3pt;">&#8203;</td><td style="width: 31.85%; text-align: center; vertical-align: bottom; padding-top: 2pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; font-weight: bold; margin-top: 0pt; text-align: center;">(I.R.S. Employer<br></div><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; font-weight: bold; margin-top: 0pt; text-align: center;">Identification No.)</div></td></tr></table><div class="h1" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; font-weight: bold; margin-top: 1pt; text-align: center;">307 N. Defiance Street <br></div><div class="h1" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; font-weight: bold; margin-top: 0pt; text-align: center;">Archbold, Ohio 43502 <br></div><div class="h1" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; font-weight: bold; margin-top: 0pt; text-align: center;">(419) 446-2501 <br></div><div class="h1" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; font-weight: bold; margin-top: 0pt; text-align: center;">(Address, including Zip Code, and telephone number, including area code, of registrant&#8217;s principal executive offices) </div><div><div class="rule-full" style="height: 0pt; width: 100%; border-bottom: 1pt solid #000000; margin-bottom: 2pt; margin-left: auto; margin-right: auto; margin-top: 7pt;"> </div></div><div class="h1" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; font-weight: bold; margin-top: 9pt; text-align: center;">Lars B. Eller <br></div><div class="h1" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; font-weight: bold; margin-top: 0pt; text-align: center;">President and Chief Executive Officer <br></div><div class="h1" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; font-weight: bold; margin-top: 0pt; text-align: center;">Farmers &amp; Merchants Bancorp, Inc. <br></div><div class="h1" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; font-weight: bold; margin-top: 0pt; text-align: center;">307 N. Defiance Street <br></div><div class="h1" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; font-weight: bold; margin-top: 0pt; text-align: center;">Archbold, Ohio 43502 <br></div><div class="h1" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; font-weight: bold; margin-top: 0pt; text-align: center;">(419) 446-2501 <br></div><div class="h1" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; font-weight: bold; margin-top: 0pt; text-align: center;">(Name, address, including Zip Code, and telephone number, including area code, of agent for service) </div><div><div class="rule-full" style="height: 0pt; width: 100%; border-bottom: 1pt solid #000000; margin-bottom: 2pt; margin-left: auto; margin-right: auto; margin-top: 7pt;"> </div></div><div class="h3" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; font-style: italic; font-weight: bold; margin-top: 9.5pt; text-align: center;">With copies to: </div><table cellspacing="0" cellpadding="0" class="txttab" style="margin-top: 4pt; border-collapse: collapse; width: 540pt; margin-left: auto; margin-right: auto;"><tr><td style="width: 48.89%; text-align: center; vertical-align: top; padding-top: 6pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; font-weight: bold; margin-top: 0pt; text-align: center;">Thomas C. Blank, Esq.<br></div><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; font-weight: bold; margin-top: 0pt; text-align: center;">Martin D. Werner, Esq.<br></div><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; font-weight: bold; margin-top: 0pt; text-align: center;">Shumaker, Loop &amp; Kendrick, LLP<br></div><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; font-weight: bold; margin-top: 0pt; text-align: center;">1000 Jackson Street<br></div><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; font-weight: bold; margin-top: 0pt; text-align: center;">Toledo, Ohio 43604-5573<br></div><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; font-weight: bold; margin-top: 0pt; text-align: center;">(419) 241-9000</div></td><td class="gutter" style="width: 1.11%; border-bottom: none; font-size: 2pt; padding-top: 6pt; padding-bottom: 3pt;">&#8203;</td><td class="gutter" style="width: 1.11%; border-bottom: none; font-size: 2pt; padding-top: 6pt; padding-bottom: 3pt;">&#8203;</td><td style="width: 48.89%; text-align: center; vertical-align: bottom; padding-top: 6pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; font-weight: bold; margin-top: 0pt; text-align: center;">Kimberly J. Schaefer, Esq.<br></div><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; font-weight: bold; margin-top: 0pt; text-align: center;">Jeffrey E. Smith, Esq.<br></div><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; font-weight: bold; margin-top: 0pt; text-align: center;">Vorys, Sater, Seymour and Pease LLP<br></div><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; font-weight: bold; margin-top: 0pt; text-align: center;">301 East Fourth Street<br></div><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; font-weight: bold; margin-top: 0pt; text-align: center;">Suite 3500 Great American Tower<br></div><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; font-weight: bold; margin-top: 0pt; text-align: center;">Cincinnati, OH 45202<br></div><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; font-weight: bold; margin-top: 0pt; text-align: center;">(513) 723-4068</div></td></tr></table><div class="para" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; font-weight: bold; margin-top: 0pt; margin-left: 0pt; text-indent: 20pt; text-align: justify;">Approximate date of commencement of the proposed sale of the securities to the public:<font style="font-weight: normal;"> As soon as practicable after the effective </font><font style="font-weight: normal;">date of this Registration Statement and upon the effective time of the merger described in the accompanying proxy statement and prospectus. </font></div><div class="para" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 6pt; margin-left: 0pt; text-indent: 20pt; text-align: justify;">If the securities being registered on this Form are being offered in connection with the formation of a holding company and there is compliance with General Instruction G, check the following box. <font style="font-size: 1pt;">&#8201;</font>&#x2610; </div><div class="para" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 6pt; margin-left: 0pt; text-indent: 20pt; text-align: justify;">If this Form is filed to register additional securities for an offering pursuant to Rule 462(b) under the Securities Act, check the following box and list the Securities Act registration statement number of the earlier effective registration statement for the same offering. <font style="font-size: 1pt;">&#8201;</font>&#x2610; </div><div class="para" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 6pt; margin-left: 0pt; text-indent: 20pt; text-align: justify;">If this Form is a post-effective amendment filed pursuant to Rule 462(d) under the Securities Act, check the following box and list the Securities Act registration statement number of the earlier effective registration statement for the same offering. &#x2612; </div><div class="para" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 6pt; margin-left: 0pt; text-indent: 20pt; text-align: justify;">Indicate by check mark whether the registrant is a large accelerated filer, an accelerated filer, a non-accelerated filer or a smaller reporting company. See the definition of &#8220;large accelerated filer,&#8221; &#8220;accelerated filer&#8221; and &#8220;smaller reporting company&#8221; in Rule 12b-2 of the Exchange Act. </div><table cellspacing="0" cellpadding="0" class="txttab" style="margin-top: 4pt; border-collapse: collapse; width: 540pt; margin-left: auto; margin-right: auto;"><tr><td style="width: 17.78%; text-align: left; vertical-align: top; padding-top: 6pt; padding-bottom: 2pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">Large accelerated filer</div></td><td class="gutter" style="width: 1.11%; border-bottom: none; font-size: 2pt; padding-top: 6pt; padding-bottom: 2pt;">&#8203;</td><td class="gutter" style="width: 1.11%; border-bottom: none; font-size: 2pt; padding-top: 6pt; padding-bottom: 2pt;">&#8203;</td><td style="width: 52.22%; text-align: left; vertical-align: bottom; padding-top: 6pt; padding-bottom: 2pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 1pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">&#8201;<font style="font-size: 10pt;">&#x2610;</font></div></td><td class="gutter" style="width: 1.11%; border-bottom: none; font-size: 2pt; padding-top: 6pt; padding-bottom: 2pt;">&#8203;</td><td class="gutter" style="width: 1.11%; border-bottom: none; font-size: 2pt; padding-top: 6pt; padding-bottom: 2pt;">&#8203;</td><td style="width: 22.22%; text-align: left; vertical-align: bottom; padding-top: 6pt; padding-bottom: 2pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">Accelerated filer</div></td><td class="gutter" style="width: 1.11%; border-bottom: none; font-size: 2pt; padding-top: 6pt; padding-bottom: 2pt;">&#8203;</td><td class="gutter" style="width: 1.11%; border-bottom: none; font-size: 2pt; padding-top: 6pt; padding-bottom: 2pt;">&#8203;</td><td style="width: 1.11%; text-align: left; vertical-align: bottom; padding-top: 6pt; padding-bottom: 2pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 1pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">&#8201;<font style="font-size: 10pt;">&#x2610;</font></div></td></tr><tr><td style="width: 17.78%; text-align: left; vertical-align: top; padding-top: 2pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">Non-accelerated filer</div></td><td class="gutter" style="width: 1.11%; border-bottom: none; font-size: 2pt; padding-top: 2pt; padding-bottom: 3pt;">&#8203;</td><td class="gutter" style="width: 1.11%; border-bottom: none; font-size: 2pt; padding-top: 2pt; padding-bottom: 3pt;">&#8203;</td><td style="width: 52.22%; text-align: left; vertical-align: bottom; padding-top: 2pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 1pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">&#8201;<font style="font-size: 10pt;">&#x2610;</font><font style="font-size: 10pt;"> (Do not check if a smaller reporting company)</font></div></td><td class="gutter" style="width: 1.11%; border-bottom: none; font-size: 2pt; padding-top: 2pt; padding-bottom: 3pt;">&#8203;</td><td class="gutter" style="width: 1.11%; border-bottom: none; font-size: 2pt; padding-top: 2pt; padding-bottom: 3pt;">&#8203;</td><td style="width: 22.22%; text-align: left; vertical-align: bottom; padding-top: 2pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">Smaller reporting company</div></td><td class="gutter" style="width: 1.11%; border-bottom: none; font-size: 2pt; padding-top: 2pt; padding-bottom: 3pt;">&#8203;</td><td class="gutter" style="width: 1.11%; border-bottom: none; font-size: 2pt; padding-top: 2pt; padding-bottom: 3pt;">&#8203;</td><td style="width: 1.11%; text-align: left; vertical-align: bottom; padding-top: 2pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">&#x2612;</div></td></tr></table><div class="para" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; font-weight: bold; margin-top: 6pt; margin-left: 0pt; text-indent: 20pt; text-align: justify;">THIS POST-EFFECTIVE AMENDMENT TO S-4 REGISTRATION STATEMENT SHALL BECOME EFFECTIVE UPON FILING WITH THE SEC IN ACCORDANCE WITH RULE 462(d) UNDER THE SECURITIES ACT OF 1933.</div></div><div class="block-frill" style="width: 540pt; margin-top: 12pt; margin-left: 0pt;"><div><div class="rule-full" style="height: 0pt; width: 100%; border-bottom: 1pt solid #000000; margin-top: 1pt; margin-bottom: 1pt; margin-left: auto; margin-right: auto;"> </div><div class="rule-full" style="height: 0pt; width: 100%; border-bottom: 2pt solid #000000; margin-bottom: 1pt; margin-left: auto; margin-right: auto; margin-top: 4pt;"> </div></div></div></div>
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<div class="page" style="text-align: left; margin: auto; position: relative; width: 468pt;"><a name="ny20000091x2_posam_100-posam_pg2"><!--Anchor--></a><div class="page-content"><div class="block-main" style="width: 468pt; margin-left: 0pt;"><div class="h1" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; font-weight: bold; margin-top: 6.75pt; text-align: center;">EXPLANATORY NOTE </div><div class="para" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 6pt; margin-left: 0pt; text-indent: 20pt; text-align: justify;">This Post-Effective Amendment No. 1 to Form S-4 Registration Statement (this &#8220;Registration Statement&#8221;) is being filed pursuant to Rule 462(d) of the Securities Act of 1933, as amended, solely to add Exhibit 99.3 hereto to the Registration Statement on Form S-4 (Registration No. <font style="font-weight: bold;">333-257767</font>). </div></div></div></div>
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<div class="page" style="text-align: left; margin: auto; position: relative; width: 468pt;"><a name="ny20000091x2_posam_100-posam_pg3"><!--Anchor--></a><div class="page-content"><div class="block-main" style="width: 468pt; margin-left: 0pt;"><div class="h1" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; font-weight: bold; margin-top: 6.75pt; text-align: center;">PART II <br></div><div class="h1" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; font-weight: bold; margin-top: 0pt; text-align: center;">INFORMATION NOT REQUIRED IN PROSPECTUS </div><div class="h3" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; font-style: italic; font-weight: bold; margin-top: 19.5pt; margin-left: 0pt; text-align: left;">Item 21. Exhibits and Financial Statement Schedules. </div><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 6pt; margin-left: 0pt; text-align: justify;">(a) The following Exhibits are being filed as part of this Registration Statement except those which are incorporated by reference: </div><table cellspacing="0" cellpadding="0" class="txttab" style="margin-top: 4pt; border-collapse: collapse; width: 468pt; margin-left: auto; margin-right: auto;"><tr class="header"><td style="width: 7.69%; text-align: left; vertical-align: bottom; border-bottom: 1pt solid #000000; padding-top: 6pt; padding-bottom: 4.25pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 8pt; font-weight: bold; margin-top: 0pt; margin-left: 0pt; text-align: left;">Exhibit <br></div><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 8pt; font-weight: bold; margin-top: 0pt; margin-left: 0pt; text-align: left;">No.</div></td><td class="gutter" style="width: 1.28%; font-size: 2pt; padding-top: 6pt; padding-bottom: 4.25pt; border-bottom: 1px solid #ffffff;">&#8203;</td><td class="gutter" style="width: 1.28%; font-size: 2pt; padding-top: 6pt; padding-bottom: 4.25pt; border-bottom: 1px solid #ffffff;">&#8203;</td><td style="width: 89.74%; text-align: center; vertical-align: bottom; border-bottom: 1pt solid #000000; padding-top: 6pt; padding-bottom: 4.25pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 8pt; font-weight: bold; margin-top: 0pt; text-align: center;">Description of Exhibit</div></td></tr><tr><td style="width: 7.69%; text-align: left; vertical-align: top; padding-top: 4.25pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;"><a href="https://www.sec.gov/Archives/edgar/data/792966/000119312521218520/d200634ds4a.htm#toc200634_69">2.1</a></div></td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 4.25pt; padding-bottom: 3pt;">&#8203;</td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 4.25pt; padding-bottom: 3pt;">&#8203;</td><td style="width: 89.74%; text-align: left; vertical-align: top; padding-top: 4.25pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">Agreement and Plan of Reorganization and Merger, dated as of May&#160;4, 2021 by and between Farmers &amp; Merchants Bancorp, Inc., The Farmers &amp; Merchants State Bank and Perpetual Federal Savings Bank of Urbana (attached as Annex&#160;A to the proxy statement and prospectus contained in this Registration Statement) **</div></td></tr><tr><td style="width: 7.69%; text-align: left; vertical-align: top; padding-top: 3pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt;">&#160;</div></td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 3pt;">&#8203;</td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 3pt;">&#8203;</td><td style="width: 89.74%; text-align: left; vertical-align: top; padding-top: 3pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt;">&#160;</div></td></tr><tr><td style="width: 7.69%; text-align: left; vertical-align: top; padding-top: 3pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;"><a href="https://www.sec.gov/Archives/edgar/data/792966/000119312517318709/d447990dex31.htm">3.1</a></div></td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 3pt;">&#8203;</td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 3pt;">&#8203;</td><td style="width: 89.74%; text-align: left; vertical-align: top; padding-top: 3pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">Farmers &amp; Merchants Bancorp, Inc. 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font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;"><a href="https://www.sec.gov/Archives/edgar/data/792966/000119312517235925/d422994dex32.htm">3.2</a></div></td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 3pt;">&#8203;</td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 3pt;">&#8203;</td><td style="width: 89.74%; text-align: left; vertical-align: top; padding-top: 3pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">Code of Regulations of Farmers &amp; Merchants Bancorp, Inc., as amended (incorporated by reference to Exhibit 3.2 of F&amp;M&#8217;s Form 10-Q filed on July&#160;26, 2017)</div></td></tr><tr><td style="width: 7.69%; text-align: left; vertical-align: top; padding-top: 3pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt;">&#160;</div></td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 3pt;">&#8203;</td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 3pt;">&#8203;</td><td style="width: 89.74%; text-align: left; vertical-align: top; padding-top: 3pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt;">&#160;</div></td></tr><tr><td style="width: 7.69%; text-align: left; vertical-align: top; padding-top: 3pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;"><a href="https://www.sec.gov/Archives/edgar/data/792966/000119312521210853/d200634dex51.htm">5.1</a></div></td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 3pt;">&#8203;</td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 3pt;">&#8203;</td><td style="width: 89.74%; text-align: left; vertical-align: top; padding-top: 3pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">Opinion of Shumaker, Loop &amp; Kendrick, LLP (legality) **</div></td></tr><tr><td style="width: 7.69%; text-align: left; vertical-align: top; padding-top: 3pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt;">&#160;</div></td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 3pt;">&#8203;</td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 3pt;">&#8203;</td><td style="width: 89.74%; text-align: left; vertical-align: top; padding-top: 3pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt;">&#160;</div></td></tr><tr><td style="width: 7.69%; text-align: left; vertical-align: top; padding-top: 3pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;"><a href="https://www.sec.gov/Archives/edgar/data/792966/000119312521210853/d200634dex81.htm">8.1</a></div></td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 3pt;">&#8203;</td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 3pt;">&#8203;</td><td style="width: 89.74%; text-align: left; vertical-align: top; padding-top: 3pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">Opinion of Shumaker, Loop &amp; Kendrick, LLP (tax matters) **</div></td></tr><tr><td style="width: 7.69%; text-align: left; vertical-align: top; padding-top: 3pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt;">&#160;</div></td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 3pt;">&#8203;</td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 3pt;">&#8203;</td><td style="width: 89.74%; text-align: left; vertical-align: top; padding-top: 3pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt;">&#160;</div></td></tr><tr><td style="width: 7.69%; text-align: left; vertical-align: top; padding-top: 3pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;"><a href="https://www.sec.gov/Archives/edgar/data/792966/000119312521210853/d200634dex82.htm">8.2</a></div></td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 3pt;">&#8203;</td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 3pt;">&#8203;</td><td style="width: 89.74%; text-align: left; vertical-align: top; padding-top: 3pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">Opinion of Vorys, Sater, Seymour and Pease LLP (tax matters) **</div></td></tr><tr><td style="width: 7.69%; text-align: left; vertical-align: top; padding-top: 3pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt;">&#160;</div></td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 3pt;">&#8203;</td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 3pt;">&#8203;</td><td style="width: 89.74%; text-align: left; vertical-align: top; padding-top: 3pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt;">&#160;</div></td></tr><tr><td style="width: 7.69%; text-align: left; vertical-align: top; padding-top: 3pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;"><a href="https://www.sec.gov/Archives/edgar/data/792966/000119312521218520/d200634ds4a.htm#toc200634_69">10.1</a></div></td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 3pt;">&#8203;</td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 3pt;">&#8203;</td><td style="width: 89.74%; text-align: left; vertical-align: top; padding-top: 3pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">Voting Agreement (attached as Annex&#160;A to the proxy statement and prospectus contained in this Registration Statement) **</div></td></tr><tr><td style="width: 7.69%; text-align: left; vertical-align: top; padding-top: 3pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt;">&#160;</div></td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 3pt;">&#8203;</td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 3pt;">&#8203;</td><td style="width: 89.74%; text-align: left; vertical-align: top; padding-top: 3pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt;">&#160;</div></td></tr><tr><td style="width: 7.69%; text-align: left; vertical-align: top; padding-top: 3pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;"><a href="https://www.sec.gov/Archives/edgar/data/792966/000156459021007929/fmao-ex21_8.htm">21.1</a></div></td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 3pt;">&#8203;</td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 3pt;">&#8203;</td><td style="width: 89.74%; text-align: left; vertical-align: top; padding-top: 3pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">Subsidiaries of Farmers &amp; Merchants Bancorp, Inc. (incorporated by reference to Exhibit 21 of registrant&#8217;s Annual Report on Form 10-K filed on February&#160;28, 2021)</div></td></tr><tr><td style="width: 7.69%; text-align: left; vertical-align: top; padding-top: 3pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt;">&#160;</div></td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 3pt;">&#8203;</td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 3pt;">&#8203;</td><td style="width: 89.74%; text-align: left; vertical-align: top; padding-top: 3pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt;">&#160;</div></td></tr><tr><td style="width: 7.69%; text-align: left; vertical-align: top; padding-top: 3pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;"><a href="https://www.sec.gov/Archives/edgar/data/0000792966/000119312521210853/d200634dex231.htm">23.1</a></div></td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 3pt;">&#8203;</td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 3pt;">&#8203;</td><td style="width: 89.74%; text-align: left; vertical-align: top; padding-top: 3pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">Consent of Crowe LLP **</div></td></tr><tr><td style="width: 7.69%; text-align: left; vertical-align: top; padding-top: 3pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt;">&#160;</div></td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 3pt;">&#8203;</td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 3pt;">&#8203;</td><td style="width: 89.74%; text-align: left; vertical-align: top; padding-top: 3pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt;">&#160;</div></td></tr><tr><td style="width: 7.69%; text-align: left; vertical-align: top; padding-top: 3pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;"><a href="https://www.sec.gov/Archives/edgar/data/0000792966/000119312521210853/d200634dex232.htm">23.2</a></div></td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 3pt;">&#8203;</td><td class="gutter" style="width: 1.28%; 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<div class="page" style="text-align: left; margin: auto; position: relative; width: 468pt;"><a name="ny20000091x2_posam_100-posam_pg4"><!--Anchor--></a><div class="page-content"><div class="block-main" style="width: 468pt; margin-left: 0pt;"><div class="h1" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; font-weight: bold; margin-top: 6.75pt; text-align: center;">SIGNATURES</div><div class="para" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 6pt; margin-left: 0pt; text-indent: 20pt; text-align: justify;">Pursuant to the requirements of the Securities Act of 1933, the Registrant has duly caused this Registration Statement to be signed on its behalf by the undersigned, thereunto duly authorized, in the City of Archbold, State of Ohio, as of the 26th day of August, 2021. </div><table cellspacing="0" cellpadding="0" class="txttab" style="margin-top: 4pt; border-collapse: collapse; width: 468pt; margin-left: auto; margin-right: auto;"><tr><td style="width: 51.28%; text-align: left; vertical-align: top; padding-top: 6pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt;">&#160;</div></td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 6pt; padding-bottom: 3pt;">&#8203;</td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 6pt; padding-bottom: 3pt;">&#8203;</td><td colspan="4" style="width: 46.15%; text-align: left; vertical-align: bottom; padding-top: 6pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">FARMERS &amp; MERCHANTS BANCORP, INC.</div></td></tr><tr><td style="width: 51.28%; text-align: left; vertical-align: top; padding-top: 3pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt;">&#160;</div></td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 3pt;">&#8203;</td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 3pt;">&#8203;</td><td style="width: 2.56%; text-align: left; vertical-align: bottom; padding-top: 3pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt;">&#160;</div></td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 3pt;">&#8203;</td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 3pt;">&#8203;</td><td style="width: 41.03%; text-align: left; vertical-align: bottom; padding-top: 3pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt;">&#160;</div></td></tr><tr><td style="width: 51.28%; text-align: left; vertical-align: top; padding-top: 3pt; padding-bottom: 4.25pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt;">&#160;</div></td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 4.25pt;">&#8203;</td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 4.25pt;">&#8203;</td><td style="width: 2.56%; text-align: left; vertical-align: bottom; padding-top: 3pt; padding-bottom: 4.25pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">By:</div></td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 4.25pt;">&#8203;</td><td class="gutter" style="width: 1.28%; font-size: 2pt; padding-top: 3pt; padding-bottom: 4.25pt; border-bottom: 1px solid #ffffff;">&#8203;</td><td style="width: 41.03%; text-align: left; vertical-align: bottom; border-bottom: 1pt solid #000000; padding-top: 3pt; padding-bottom: 4.25pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">/s/ Lars B. 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Planson</div></td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3.75pt; padding-bottom: 2.5pt;">&#8203;</td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3.75pt; padding-bottom: 2.5pt;">&#8203;</td><td style="width: 48.72%; text-align: left; vertical-align: bottom; padding-top: 3.75pt; padding-bottom: 2.5pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">Director</div></td></tr><tr><td style="width: 48.72%; text-align: left; vertical-align: top; padding-top: 2.5pt; padding-bottom: 2.5pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt;">&#160;</div></td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 2.5pt; padding-bottom: 2.5pt;">&#8203;</td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 2.5pt; padding-bottom: 2.5pt;">&#8203;</td><td style="width: 48.72%; text-align: left; vertical-align: bottom; padding-top: 2.5pt; padding-bottom: 2.5pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt;">&#160;</div></td></tr><tr><td style="width: 48.72%; text-align: left; vertical-align: top; border-bottom: 1pt solid #000000; padding-top: 2.5pt; padding-bottom: 3.75pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">/s/ Kevin J. Sauder* </div></td><td class="gutter" style="width: 1.28%; font-size: 2pt; padding-top: 2.5pt; padding-bottom: 3.75pt; border-bottom: 1px solid #ffffff;">&#8203;</td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 2.5pt; padding-bottom: 3.75pt;">&#8203;</td><td style="width: 48.72%; text-align: left; vertical-align: bottom; padding-top: 2.5pt; padding-bottom: 3.75pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt;">&#160;</div></td></tr><tr><td style="width: 48.72%; text-align: left; vertical-align: top; padding-top: 3.75pt; padding-bottom: 2.5pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">Kevin J. Sauder</div></td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3.75pt; padding-bottom: 2.5pt;">&#8203;</td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3.75pt; padding-bottom: 2.5pt;">&#8203;</td><td style="width: 48.72%; text-align: left; vertical-align: bottom; padding-top: 3.75pt; padding-bottom: 2.5pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">Director</div></td></tr><tr><td style="width: 48.72%; text-align: left; vertical-align: top; padding-top: 2.5pt; padding-bottom: 2.5pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt;">&#160;</div></td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 2.5pt; padding-bottom: 2.5pt;">&#8203;</td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 2.5pt; padding-bottom: 2.5pt;">&#8203;</td><td style="width: 48.72%; text-align: left; vertical-align: bottom; padding-top: 2.5pt; padding-bottom: 2.5pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt;">&#160;</div></td></tr><tr><td style="width: 48.72%; text-align: left; vertical-align: top; border-bottom: 1pt solid #000000; padding-top: 2.5pt; padding-bottom: 3.75pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">/s/ Frank R. Simon* </div></td><td class="gutter" style="width: 1.28%; font-size: 2pt; padding-top: 2.5pt; padding-bottom: 3.75pt; border-bottom: 1px solid #ffffff;">&#8203;</td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 2.5pt; padding-bottom: 3.75pt;">&#8203;</td><td style="width: 48.72%; text-align: left; vertical-align: bottom; padding-top: 2.5pt; padding-bottom: 3.75pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt;">&#160;</div></td></tr><tr><td style="width: 48.72%; text-align: left; vertical-align: top; padding-top: 3.75pt; padding-bottom: 2.5pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">Frank R. Simon</div></td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3.75pt; padding-bottom: 2.5pt;">&#8203;</td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3.75pt; padding-bottom: 2.5pt;">&#8203;</td><td style="width: 48.72%; text-align: left; vertical-align: bottom; padding-top: 3.75pt; padding-bottom: 2.5pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">Director</div></td></tr><tr><td style="width: 48.72%; text-align: left; vertical-align: top; padding-top: 2.5pt; padding-bottom: 2.5pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt;">&#160;</div></td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 2.5pt; padding-bottom: 2.5pt;">&#8203;</td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 2.5pt; padding-bottom: 2.5pt;">&#8203;</td><td style="width: 48.72%; text-align: left; vertical-align: bottom; padding-top: 2.5pt; padding-bottom: 2.5pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt;">&#160;</div></td></tr><tr><td style="width: 48.72%; text-align: left; vertical-align: top; border-bottom: 1pt solid #000000; padding-top: 2.5pt; padding-bottom: 3.75pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">/s/ K. Brad Stamm* </div></td><td class="gutter" style="width: 1.28%; font-size: 2pt; padding-top: 2.5pt; padding-bottom: 3.75pt; border-bottom: 1px solid #ffffff;">&#8203;</td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 2.5pt; padding-bottom: 3.75pt;">&#8203;</td><td style="width: 48.72%; text-align: left; vertical-align: bottom; padding-top: 2.5pt; padding-bottom: 3.75pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt;">&#160;</div></td></tr><tr><td style="width: 48.72%; text-align: left; vertical-align: top; padding-top: 3.75pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">K. Brad Stamm</div></td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3.75pt; padding-bottom: 3pt;">&#8203;</td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3.75pt; padding-bottom: 3pt;">&#8203;</td><td style="width: 48.72%; text-align: left; vertical-align: bottom; padding-top: 3.75pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">Director</div></td></tr></table><div><div class="rule-partial" style="height: 0pt; width: 72pt; border-bottom: 1pt solid #000000; margin-bottom: 1pt; margin-right: auto; margin-left: 0pt; margin-top: 13.25pt;"> </div></div><table border="0" cellpadding="0" cellspacing="0" style="margin-top: 3pt; margin-left: 0pt;"><tr><td style="width: 20pt; text-align: left; vertical-align: top;"><div style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 8pt;">*<br></div></td><td style="vertical-align: top;"><div style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 8pt; text-align: justify;">For each of the above directors pursuant to a power of attorney included on the &#8220;Signature&#8221; page of Form S-4 filed with the Commission on July&#160;8, 2021.</div></td></tr></table></div></div><div class="block-frill" style="width: 468pt; margin-top: 12pt; margin-left: 0pt;"><div class="unknown" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 9.47pt; text-align: center;">II-2<br></div></div></div>
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<TYPE>EX-99.3
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<DESCRIPTION>EXHIBIT 99.3
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<div class="page" style="text-align: left; margin: auto; position: relative; width: 468pt;"><a name="ny20000091x2_posam_400-ex99-3_pg1"><!--Anchor--></a><div class="page-content"><div class="block-main" style="width: 468pt; margin-left: 0pt;"><div class="h2" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; font-weight: bold; margin-top: 0pt; text-align: right;">Exhibit 99.3</div><div class="h1" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; font-weight: bold; margin-top: 19.5pt; text-align: center;">INSTRUCTIONS <br></div><div class="h1" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; font-weight: bold; margin-top: 0pt; text-align: center;">TO <br></div><div class="h1" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; font-weight: bold; margin-top: 0pt; text-align: center;">ELECTION FORM/LETTER OF TRANSMITTAL<br></div><div class="h1" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; font-weight: bold; margin-top: 0pt; text-align: center;">To Accompany Certificates Representing Shares of<br></div><div class="h1" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; font-weight: bold; margin-top: 0pt; text-align: center;">Perpetual Federal Savings Bank Common Stock</div><div class="h3" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; font-style: italic; font-weight: bold; margin-top: 7.5pt; margin-left: 20pt; text-align: left;">Please follow these instructions carefully when completing this Election Form/Letter of Transmittal.</div><table border="0" cellpadding="0" cellspacing="0" style="margin-top: 6pt; margin-left: 0pt;"><tr><td style="width: 20pt; text-align: left; vertical-align: top;"><div style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt;">1.<br></div></td><td style="vertical-align: top;"><div style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; text-align: justify;"><font style="font-weight: bold;">Time in which to Make an Election. </font>To be effective, a properly completed and executed Election Form/Letter of Transmittal (the &#8220;Election Form&#8221;), accompanied by the certificate(s) representing all of the holder&#8217;s shares of Perpetual Federal Savings Bank (&#8220;PFSB&#8221;) common stock and required additional documentation, must be received by Broadridge Corporate Issuer Solutions, the Exchange Agent, not later than <font style="font-weight: bold;">5:00 p.m., Eastern </font><font style="font-weight: bold;">Daylight Time, on September&#160;</font><font style="font-weight: bold;">24</font><font style="font-weight: bold;">, 2021 </font>(the &#8220;Election Deadline&#8221;). However, if the closing of the Merger is extended past October&#160;1, 2021, for any reason, the Election Deadline will be extended until up to three business days prior to the new anticipated closing date. In this event, Farmers &amp; Merchants Bancorp, Inc. (&#8220;F&amp;M&#8221;) will inform you of the new Election Deadline by the issuance of a press release filed with the Securities and Exchange Commission at least five business days prior to the new anticipated closing date.</div></td></tr></table><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 6pt; margin-left: 20pt; text-align: justify;">Each holder of PFSB common stock whose Election Form and certificates are not timely received (or who revoke their Election Form) will be considered a Non-Electing Shareholder. <font style="font-style: italic;">See Instruction 6 below.</font> </div><table border="0" cellpadding="0" cellspacing="0" style="margin-top: 6pt; margin-left: 0pt;"><tr><td style="width: 20pt; text-align: left; vertical-align: top;"><div style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt;">2.<br></div></td><td style="vertical-align: top;"><div style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; text-align: justify;"><font style="font-weight: bold;">Description of Certificates.</font> Insert in the box in Section 1 of the Election Form the certificate number(s) that you are surrendering and the number of shares of PFSB common stock represented by each certificate. If this certificate information is already provided in the box in Section 1, confirm the information provided and make any necessary corrections. If the space provided is insufficient, attach a separate sheet referencing Section 1 of the Election Form and listing this information. If you hold uncertificated/book entry shares, insert the number of such shares in the appropriate column. If you have shares represented by a certificate but the certificate has been lost, stolen or destroyed, see Instruction 12. </div></td></tr></table><table border="0" cellpadding="0" cellspacing="0" style="margin-top: 6pt; margin-left: 0pt;"><tr><td style="width: 20pt; text-align: left; vertical-align: top;"><div style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt;">3.<br></div></td><td style="vertical-align: top;"><div style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; text-align: justify;"><font style="font-weight: bold;">Election Options.</font> In Section 2 of the Election Form, indicate whether you would like to receive in exchange for your PFSB common stock: (a) all cash (in the amount of $41.20 for each share of PFSB common stock owned); (b) all shares of F&amp;M common stock (at the exchange ratio of 1.7766 F&amp;M shares for each share of PFSB common stock owned); (c) a mixture of cash (in the amount of $41.20 for each share of PFSB common stock) and F&amp;M common stock (at the exchange ratio of 1.7766 shares of F&amp;M common stock for each share of PFSB common stock); or (d) &#8220;No Election.&#8221; <font style="font-style: italic; font-weight: bold;">You may select only one of these election choices.</font> If you mark the box in Section 2 for the <font style="font-weight: bold;">Mixed Cash/Stock Election</font>, you <u>must</u> also indicate the whole number of your shares of PFSB common stock that you wish to exchange for cash and the whole number of your shares of PFSB common stock that you wish to exchange for shares of F&amp;M common stock.</div></td></tr></table><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 6pt; margin-left: 20pt; text-align: justify;">All elections made by PFSB shareholders will be subject to allocation and proration procedures set forth in the Merger Agreement so that 1,032,308 of the shares of PFSB common stock outstanding at the effective time of the Merger will be exchanged for F&amp;M common stock and the other 1,437,724 of the outstanding shares of PFSB common stock will be exchanged for cash. <font style="font-style: italic; font-weight: bold;">As a result, there is no assurance that you will receive the </font><font style="font-style: italic; font-weight: bold;">form of consideration that you elect to receive.</font> Please see Instruction 6 with respect to the failure to timely and properly submit the Election Form. Please see the Merger Agreement for information regarding how the allocation and proration procedures will be applied.</div><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 6pt; margin-left: 20pt; text-align: justify;">F&amp;M will not issue fractional shares, or certificates or script representing fractional shares, in the Merger. Instead, F&amp;M will pay to each holder of PFSB common stock who would otherwise be entitled to a fractional share of F&amp;M common stock (after taking into account all certificates representing PFSB common stock surrendered by such holder) an amount in cash, without interest, equal to the product of the fractional share of F&amp;M common stock multiplied by $41.20.</div><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; font-style: italic; font-weight: bold; margin-top: 6pt; margin-left: 20pt; text-align: justify;">None of F&amp;M, PFSB or the Exchange Agent makes any recommendation as to whether a holder should elect to receive cash, F&amp;M common stock, or a combination of cash and F&amp;M common stock in the Merger.</div><table border="0" cellpadding="0" cellspacing="0" style="margin-top: 6pt; margin-left: 0pt;"><tr><td style="width: 20pt; text-align: left; vertical-align: top;"><div style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt;">4.<br></div></td><td style="vertical-align: top;"><div style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; text-align: justify;"><font style="font-weight: bold;">Change or Revocation of Election</font>. A holder of PFSB common stock who has made an election may, at any time prior to the Election Deadline, (a) change the holder&#8217;s election by submitting a new Election Form in accordance with the procedures described herein that is received by the Exchange Agent prior to the Election </div></td></tr></table></div></div></div>
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<div class="page" style="text-align: left; margin: auto; position: relative; width: 468pt;"><a name="ny20000091x2_posam_400-ex99-3_pg2"><!--Anchor--></a><div class="page-content"><div class="block-main" style="width: 468pt; margin-left: 0pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 6.75pt; margin-left: 20pt; text-align: justify;">Deadline or (b) revoke the holder&#8217;s election and withdraw the certificate(s) representing the holder&#8217;s PFSB common stock deposited with the Exchange Agent by providing written notice that is received by the Exchange Agent by 5:00 p.m., Eastern Daylight Time, on the business day immediately prior to the Election Deadline.</div><table border="0" cellpadding="0" cellspacing="0" style="margin-top: 6pt; margin-left: 0pt;"><tr><td style="width: 20pt; text-align: left; vertical-align: top;"><div style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt;">5.<br></div></td><td style="vertical-align: top;"><div style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; text-align: justify;"><font style="font-weight: bold;">Joint Forms of Election</font>. Holders of PFSB common stock who make a joint election will be considered to be a single holder of such shares of PFSB common stock. A joint Election Form may be submitted only by persons submitting certificates registered in different forms of the same name (e.g., &#8220;John Doe&#8221; on one certificate and &#8220;J. Doe&#8221; on another certificate) or by persons who may be considered to own each other&#8217;s PFSB common stock by reason of the ownership attribution rules contained in Section 318(a) of the Internal Revenue Code of 1986, as amended. If the Election Form is submitted jointly, each record holder of PFSB common stock covered hereby must properly sign the Election Form in accordance with Instruction 7, attaching additional sheets if necessary. The signatures of such holders will be deemed to constitute a certification that the persons submitting the joint Election Form are eligible to do so.</div></td></tr></table><table border="0" cellpadding="0" cellspacing="0" style="margin-top: 6pt; margin-left: 0pt;"><tr><td style="width: 20pt; text-align: left; vertical-align: top;"><div style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt;">6.<br></div></td><td style="vertical-align: top;"><div style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; text-align: justify;"><font style="font-weight: bold;">Non-Electing Shares.</font> Holders of PFSB common stock who select <font style="font-weight: bold;">No Election</font> in Section 2 of the Election Form, or who fail to submit a properly completed and executed Election Form together with the certificate(s) representing their PFSB common stock by the Election Deadline, or who revoke their previously submitted Election Form and withdraw their certificates, will be deemed to have made a &#8220;non-election.&#8221; PFSB shareholders who are deemed to have made a non-election will receive in exchange for their PFSB common stock either all cash, all F&amp;M common stock, or any combination of cash and F&amp;M common stock as shall be determined in accordance with the terms of the Merger Agreement, subject to the payment of cash in lieu of the issuance of fractional shares of F&amp;M common stock. F&amp;M will allocate the merger consideration among all non-electing PFSB shareholders in the manner as set forth in the Merger Agreement. </div></td></tr></table><table border="0" cellpadding="0" cellspacing="0" style="margin-top: 6pt; margin-left: 0pt;"><tr><td style="width: 20pt; text-align: left; vertical-align: top;"><div style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt;">7.<br></div></td><td style="vertical-align: top;"><div style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; text-align: justify;"><font style="font-weight: bold;">Signatures.</font> The signature(s) on the Election Form should correspond exactly with the name(s) on the face of the certificate(s) unless the shares of PFSB common stock have been transferred by the registered holder(s), in which case the signature(s) on the Election Form should correspond exactly with the name of the last transferee endorsed on the certificate(s) or indicated on the stock power(s) accompanying the certificate(s). If the Election Form is signed by a person other than the registered owner of the certificate(s) listed in Section 1 of the Election Form, the certificate(s) must be endorsed or accompanied by appropriate stock power(s), in either case signed by the registered owner(s) corresponding with the name(s) set forth on the certificate(s), and the signature(s) appearing on such endorsement(s) or stock power(s) and on the Election Form must be guaranteed by a bank, broker or other financial institution that is a member of a securities transfer association approved medallion program, such as STAMP, SEMP or MSP. </div></td></tr></table><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 6pt; margin-left: 20pt; text-align: justify;">If the Election Form is signed by a trustee, executor, administrator, guardian, officer of a corporation, attorney-in-fact, or other person acting in a representative or fiduciary capacity, the person signing must give such person&#8217;s full title in such capacity, and the signature(s) on the Election Form must be guaranteed by a bank, broker or other financial institution that is a member of a securities transfer association approved medallion program, such as STAMP, SEMP or MSP. Appropriate evidence of authority to act in such representative or fiduciary capacity must be submitted to the Exchange Agent with the Election Form.</div><table border="0" cellpadding="0" cellspacing="0" style="margin-top: 6pt; margin-left: 0pt;"><tr><td style="width: 20pt; text-align: left; vertical-align: top;"><div style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt;">8.<br></div></td><td style="vertical-align: top;"><div style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; text-align: justify;"><font style="font-weight: bold;">Special Payment or Issuance Instructions.</font> Section 4 of the Election Form must be completed if checks or certificates representing F&amp;M common stock are to be payable to or registered in any name(s) other than the name(s) that appear on the certificate(s) representing the PFSB common stock being submitted with the Election Form. In addition, the certificate(s) submitted with the Election Form must be accompanied by appropriate signed stock power(s), and the signature(s) appearing on such stock power(s) and on the Election Form must be guaranteed by a bank, broker or other financial institution that is a member of a securities transfer association approved medallion program, such as STAMP, SEMP or MSP. It will be a condition to the issuance of any check or certificate representing F&amp;M common stock in any name(s) other than the name(s) in which the surrendered certificate for PFSB common stock is registered that the person(s) requesting the issuance of such check or certificate representing shares of F&amp;M common stock either pay to the Exchange Agent any transfer or other taxes required to be paid as a result of such issuance, or establish to the satisfaction of F&amp;M or the Exchange Agent that such taxes have been paid or are not applicable.</div></td></tr></table><table border="0" cellpadding="0" cellspacing="0" style="margin-top: 6pt; margin-left: 0pt;"><tr><td style="width: 20pt; text-align: left; vertical-align: top;"><div style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt;">9.<br></div></td><td style="vertical-align: top;"><div style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; text-align: justify;"><font style="font-weight: bold;">Special Delivery Instructions.</font> If checks or certificates representing F&amp;M common stock are to be delivered to a person other than the registered holder(s), or to the registered holder(s) at an address other than that appearing in Section 1 of the Election Form, please complete Section 5 of the Election Form. </div></td></tr></table></div></div></div>
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<div class="page" style="text-align: left; margin: auto; position: relative; width: 468pt;"><a name="ny20000091x2_posam_400-ex99-3_pg3"><!--Anchor--></a><div class="page-content"><div class="block-main" style="width: 468pt; margin-left: 0pt;"><table border="0" cellpadding="0" cellspacing="0" style="margin-top: 6.75pt; margin-left: 0pt;"><tr><td style="width: 20pt; text-align: left; vertical-align: top;"><div style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt;">10.<br></div></td><td style="vertical-align: top;"><div style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; text-align: justify;"><font style="font-weight: bold;">Method of Delivery</font>. The method of delivery of the Election Form and certificates representing PFSB common stock and all other required documents is at the option and sole risk of the holder. <font style="font-style: italic; font-weight: bold;">Delivery of any certificates </font><font style="font-style: italic; font-weight: bold;">will be effected, and risk of loss and title to the certificates will pass, only upon proper delivery of the </font><font style="font-style: italic; font-weight: bold;">certificates to the Exchange Agent.</font> If delivery is by mail, registered mail with return receipt requested, properly insured, or overnight delivery service is recommended.</div></td></tr></table><table border="0" cellpadding="0" cellspacing="0" style="margin-top: 6pt; margin-left: 0pt;"><tr><td style="width: 20pt; text-align: left; vertical-align: top;"><div style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt;">11.<br></div></td><td style="vertical-align: top;"><div style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; text-align: justify;"><font style="font-weight: bold;">Backup Withholding; Substitute Form W-9.</font> United States federal income tax laws generally require that each person surrendering certificates representing PFSB common stock to the Exchange Agent is required to provide to the Exchange Agent such person&#8217;s correct Taxpayer Identification Number (&#8220;TIN&#8221;), which, in the case of such a person who is an individual, is his or her social security number. If the holder is a nonresident alien or a foreign entity, other requirements (as described below) will apply. If the Exchange Agent is not provided with the correct TIN or an adequate basis for an exemption from backup withholding, such holder may be subject to a $50 penalty imposed by the IRS. In addition, failure to provide the Exchange Agent with the correct TIN or an adequate basis for an exemption from backup withholding may result in backup withholding (at a rate of 24%) on all payments made to the person or other payee. Backup withholding is not an additional federal income tax. Rather, the federal income tax liability of a person subject to backup withholding will be reduced by the amount of tax withheld. If withholding results in an overpayment of taxes, the tendering holder may be able to obtain a refund from the IRS if the requisite information is provided in a timely manner.</div></td></tr></table><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 6pt; margin-left: 20pt; text-align: justify;">Exempt holders of PFSB common stock are not subject to these backup withholding and reporting requirements. See the accompanying &#8220;<font style="font-weight: bold;">Guidelines for Certification of Taxpayer Identification Number on Substitute </font><font style="font-weight: bold;">Form W-9</font>&#8221; for additional instructions.</div><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 6pt; margin-left: 20pt; text-align: justify;">To prevent backup withholding, each holder of PFSB common stock that is a U.S. person (including a resident alien) must provide its correct TIN by completing the Substitute Form W-9 contained in the Election Form, certifying, under penalties of perjury, (a) that such holder is a U. S. person (including a resident alien); (b) that the TIN provided is correct (or that such holder is awaiting a TIN); (c) that such holder is not subject to backup withholding because (i)&#160;such holder is exempt from backup withholding, (ii)&#160;such holder has not been notified by the IRS that such holder is subject to backup withholding as a result of a prior failure to report all interest or dividends, or (iii)&#160;the IRS has notified such holder that such holder is no longer subject to backup withholding and (d) that the FATCA code entered on the Substitute Form W-9 (if any) indicating that te holder is exempt from FATCA reporting is correct. If the PFSB common stock is in more than one name or is not in the name of the actual owners, such holder should consult the &#8220;<font style="font-weight: bold;">Guidelines for Certification of Taxpayer Identification </font><font style="font-weight: bold;">Number on Substitute Form W-9</font>&#8221; for instructions on applying for a TIN and should write &#8220;Applied For&#8221; in the space reserved for the TIN, as shown on Substitute Form W-9. Note: Writing &#8220;Applied For&#8221; on the Substitute Form W-9 means that such holder has already applied for a TIN or that such holder intends to apply for one in the near future. Payments made to such holder will be subject to backup withholding if a TIN is not provided to the Exchange Agent by the time of the payment. </div><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 6pt; margin-left: 20pt; text-align: justify;">A holder that is a nonresident alien or a foreign entity must submit the appropriate completed IRS Form W-8 (generally IRS Form W-8BEN), Certificate of Foreign Status of Beneficial Owner for United States Tax Withholding and Reporting (Individuals) or IRS Form W-8BEN-E, Certificate of Status of Beneficial Owner for United States Tax Withholding and Reporting (Entities), as applicable to avoid backup withholding. The appropriate form may be obtained via the IRS website at www.irs.gov or by contacting the Exchange Agent at the address on the face of the Letter of Transmittal. </div><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 6pt; margin-left: 20pt; text-align: justify;">Payments of accrued and unpaid interest to a holder that is a nonresident alien or a foreign entity generally will be subject to 30% United States federal withholding tax unless such holder certifies its foreign status on an appropriate IRS Form W-8.</div><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; font-weight: bold; margin-top: 6pt; margin-left: 20pt; text-align: justify;">FAILURE TO COMPLETE SUBSTITUTE FORM W-9 OR APPLICABLE IRS FORM W-8 MAY RESULT IN WITHHOLDING OR BACKUP WITHHOLDING ON ANY PAYMENTS MADE TO YOU PURSUANT TO THE MERGER.<font style="font-weight: normal;"> </font></div><table border="0" cellpadding="0" cellspacing="0" style="margin-top: 6pt; margin-left: 0pt;"><tr><td style="width: 20pt; text-align: left; vertical-align: top;"><div style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt;">12.<br></div></td><td style="vertical-align: top;"><div style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; text-align: justify;"><font style="font-weight: bold;">Lost, Stolen or Destroyed Certificates.</font> If a certificate representing any of your shares of PFSB common stock has been lost, stolen or destroyed, contact the Exchange Agent immediately to obtain a form of Affidavit and instructions for completing the Affidavit and for providing a check for the posting of a surety bond. Failure to deliver a properly completed, signed and dated Election Form AND a properly completed, signed, dated and </div></td></tr></table></div></div></div>
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<div class="page" style="text-align: left; margin: auto; position: relative; width: 468pt;"><a name="ny20000091x2_posam_400-ex99-3_pg4"><!--Anchor--></a><div class="page-content"><div class="block-main" style="width: 468pt; margin-left: 0pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 6.75pt; margin-left: 20pt; text-align: justify;">notarized Affidavit with bond fee by the Election Deadline will be treated as a &#8220;non-election,&#8221; and no consideration properly payable under the Merger Agreement with respect to the shares of PFSB common stock represented by a lost, stolen or destroyed certificate will be paid until those documents are received by the Exchange Agent. </div><table border="0" cellpadding="0" cellspacing="0" style="margin-top: 6pt; margin-left: 0pt;"><tr><td style="width: 20pt; text-align: left; vertical-align: top;"><div style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt;">13.<br></div></td><td style="vertical-align: top;"><div style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; text-align: justify;"><font style="font-weight: bold;">Determinations.</font> All questions concerning this Election Form made by holders of PFSB common stock, including questions relating to the effectiveness of any elections or the computation of allocations, will be determined by F&amp;M or the Exchange Agent. The Exchange Agent shall have the right, in its sole and absolute discretion, to reject any and all Election Forms that are not in proper form or to waive any irregularities. Neither F&amp;M nor the Exchange Agent is under any obligation to inform any holder of PFSB common stock of any defect in any Election Form.</div></td></tr></table><table border="0" cellpadding="0" cellspacing="0" style="margin-top: 6pt; margin-left: 0pt;"><tr><td style="width: 20pt; text-align: left; vertical-align: top;"><div style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt;">14.<br></div></td><td style="vertical-align: top;"><div style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; text-align: justify;"><font style="font-weight: bold;">Trusts and Estates. </font>Any trust holding shares of PFSB common stock should submit, along with the Election Form, a copy of the trust document setting forth the name of the trustee and any successor trustee. Any estate holding shares of PFSB common stock should submit, along with this Election Form, a copy of the appointment papers and a copy of the death certificate. Any estate, trust, corporation or other organization holding PFSB common stock must also submit any other supporting documents evidencing the signing person&#8217;s authority to act on behalf of the trust, estate, corporation or other organization. </div></td></tr></table><table border="0" cellpadding="0" cellspacing="0" style="margin-top: 6pt; margin-left: 0pt;"><tr><td style="width: 20pt; text-align: left; vertical-align: top;"><div style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt;">15.<br></div></td><td style="vertical-align: top;"><div style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; text-align: justify;"><font style="font-weight: bold;">Questions. </font>If you have any questions regarding the Election Form, please contact the Exchange Agent at (855) 793-5068 between 9:00 a.m. and 6:00 p.m., Eastern Daylight Time, Monday through Friday. </div></td></tr></table><div class="h1" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; font-weight: bold; margin-top: 20.5pt; text-align: center;">ADDITIONAL INFORMATION ABOUT THE MERGER</div><div class="para" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 6pt; margin-left: 0pt; text-indent: 20pt; text-align: justify;">You are urged to read the Proxy Statement/Prospectus with respect to the Merger previously mailed to you as it contains important information. In addition, F&amp;M files reports, proxy statements and other information with the Securities and Exchange Commission under the Securities Exchange Act of 1934, as amended. You can access documents filed by F&amp;M without charge from the Securities and Exchange Commission&#8217;s website at: http://www.sec.gov. Filings by F&amp;M may also be obtained free of charge by requesting them from F&amp;M by writing to or calling F&amp;M at: </div><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 8.5pt; margin-left: 20pt; text-align: left;">Farmers &amp; Merchants Bancorp, Inc.<br></div><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 20pt; text-align: left;">307 N. Defiance Street<br></div><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 20pt; text-align: left;">Archbold, OH 43502<br></div><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 20pt; text-align: left;">Attention: Lydia A. Huber</div></div></div></div>
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<div class="page" style="text-align: left; margin: auto; position: relative; width: 468pt;"><a name="ny20000091x2_posam_400-ex99-3_pg5"><!--Anchor--></a><div class="page-content"><div class="block-main" style="width: 468pt; margin-left: 0pt;"><div class="h1" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; font-weight: bold; margin-top: 6.75pt; text-align: center;">ELECTION FORM/LETTER OF TRANSMITTAL<br></div><div class="h1" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; font-weight: bold; margin-top: 0pt; text-align: center;">To Accompany Certificates Representing Common Stock of <br></div><div class="h1" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; font-weight: bold; margin-top: 0pt; text-align: center;">Perpetual Federal Savings Bank</div><div class="para" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 6pt; margin-left: 0pt; text-indent: 20pt; text-align: justify;">This Election Form/Letter of Transmittal is sent to you in connection with the proposed merger (the&#160;&#8220;Merger&#8221;) of Perpetual Federal Savings Bank (&#8220;PFSB&#8221;) with and into The Farmers &amp; Merchants State Bank (&#8220;F&amp;M Bank&#8221;) pursuant to the Agreement and Plan of Reorganization and Merger, dated as of May&#160;4, 2021, (the &#8220;Merger Agreement&#8221;), by and between Farmers &amp; Merchants Bancorp, Inc. (&#8220;F&amp;M&#8221;), PFSB and F&amp;M Bank.</div><div class="para" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 6pt; margin-left: 0pt; text-indent: 20pt; text-align: justify;">Please return your Election Form/Letter of Transmittal, together with the certificate(s) representing your PFSB common shares, to Broadridge Corporate Issuer Solutions, the Exchange Agent, by mail, overnight courier or hand delivery to the address below:</div><table cellspacing="0" cellpadding="0" class="txttab" style="margin-top: 4pt; border-collapse: collapse; width: 468pt; margin-left: auto; margin-right: auto;"><tr><td style="width: 48.72%; text-align: left; vertical-align: top; padding-top: 6pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; font-style: italic; margin-top: 0pt; margin-left: 20pt; text-align: left;">If using UPS, FedEx, or Courier:</div></td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 6pt; padding-bottom: 3pt;">&#8203;</td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 6pt; padding-bottom: 3pt;">&#8203;</td><td style="width: 48.72%; text-align: left; vertical-align: bottom; padding-top: 6pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; font-style: italic; margin-top: 0pt; margin-left: 0pt; text-align: left;">If using USPS Service:<font style="font-style: normal;"> </font></div></td></tr><tr><td style="width: 48.72%; text-align: left; vertical-align: top; padding-top: 3pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt;">&#160;</div></td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 3pt;">&#8203;</td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 3pt;">&#8203;</td><td style="width: 48.72%; text-align: left; vertical-align: bottom; padding-top: 3pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt;">&#160;</div></td></tr><tr><td style="width: 48.72%; text-align: left; vertical-align: top; padding-top: 3pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 20pt; text-align: left;">Broadridge Inc. <br>Attn: BCIS IWS <br>51 Mercedes Way <br>Edgewood, NY 11717<br></div><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 20pt; text-align: left;">(855) 793-5068 (toll free) </div></td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 3pt;">&#8203;</td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 3pt;">&#8203;</td><td style="width: 48.72%; text-align: left; vertical-align: bottom; padding-top: 3pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">Broadridge Inc. <br></div><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">Attn: BCIS Re-Organization Dept. <br></div><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">P.O. Box 1317 <br></div><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">Brentwood, NY 11717-0718<br></div><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">(855) 793-5068 (toll free)</div></td></tr></table><div class="para" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; font-weight: bold; margin-top: 6pt; margin-left: 0pt; text-indent: 20pt; text-align: justify;">Please read carefully the accompanying Instructions before completing this Election Form/Letter of Transmittal. The Instructions contain important information about this Election Form/Letter of Transmittal and how to submit your certificates representing PFSB common stock.<font style="font-weight: normal;"> </font></div><div class="para" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; font-weight: bold; margin-top: 6pt; margin-left: 0pt; text-indent: 20pt; text-align: justify;">To make a valid election, your materials must be received by the Exchange Agent not later than 5:00&#160;p.m., Eastern Daylight Time, on September&#160;24, 2021 (the &#8220;Election Deadline&#8221;). However, if the closing of the Merger is extended past October&#160;1, 2021, for any reason, the Election Deadline will be extended until up to three business days prior to the new anticipated closing date. In this event, F&amp;M will inform you of the new Election Deadline by the issuance of a press release filed with the Securities and Exchange Commission at least five business days prior to the new anticipated closing date.</div><div class="para" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; font-weight: bold; margin-top: 6pt; margin-left: 0pt; text-indent: 20pt; text-align: justify;">If you have questions regarding this Election Form/Letter of Transmittal, please contact the Exchange Agent at (855) 793-5068, between 9:00 a.m. and 5:00 p.m., Eastern Daylight Time, Monday through Friday.</div><table cellspacing="0" cellpadding="0" class="txttab" style="margin-top: 4pt; border-collapse: collapse; width: 468pt; margin-left: auto; margin-right: auto; border-left: 1pt solid #000000; border-right: 1pt solid #000000; border-top: 1pt solid #000000;"><tr><td class="gutter" style="width: 0.64%; font-size: 2pt; border-bottom: 1pt solid #000000; padding-top: 6.5pt; padding-bottom: 3pt;">&#8203;</td><td style="width: 2.67%; text-align: left; vertical-align: top; border-bottom: 1pt solid #000000; padding-top: 6.5pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 1.75pt; text-align: left;">1</div></td><td class="gutter" style="width: 1.28%; font-size: 2pt; border-bottom: 1pt solid #000000; padding-top: 6.5pt; padding-bottom: 3pt;">&#8203;</td><td class="gutter" style="width: 1.28%; font-size: 2pt; border-bottom: 1pt solid #000000; padding-top: 6.5pt; padding-bottom: 3pt;">&#8203;</td><td style="width: 93.48%; text-align: left; vertical-align: bottom; border-bottom: 1pt solid #000000; padding-top: 6.5pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; font-weight: bold; margin-top: 0pt; margin-left: 0pt; text-align: left;">About You and Your PFSB Common Stock<font style="font-weight: normal;"> &#8212; See Instruction 2</font></div></td><td class="gutter" style="width: 0.64%; font-size: 2pt; border-bottom: 1pt solid #000000; padding-top: 6.5pt; padding-bottom: 3pt;">&#8203;</td></tr></table><table cellspacing="0" cellpadding="0" class="txttab" style="margin-top: 4pt; border-collapse: collapse; width: 468pt; margin-left: auto; margin-right: auto; border-left: 1pt solid #000000; border-right: 1pt solid #000000; border-top: 1pt solid #000000;"><tr class="header"><td class="gutter" style="width: 0.64%; font-size: 2pt; border-left: 1pt solid #000000; border-bottom: 1pt solid #000000; padding-top: 6.5pt; padding-bottom: 4.25pt;">&#8203;</td><td style="width: 38.57%; text-align: center; vertical-align: bottom; border-bottom: 1pt solid #000000; padding-top: 6.5pt; padding-bottom: 4.25pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 8pt; font-weight: bold; margin-top: 0pt; text-align: center;">Name and Address of Registered Owner(s)</div></td><td class="gutter" style="width: 1.28%; 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<div class="page" style="text-align: left; margin: auto; position: relative; width: 468pt;"><a name="ny20000091x2_posam_400-ex99-3_pg6"><!--Anchor--></a><div class="page-content"><div class="block-main" style="width: 468pt; margin-left: 0pt;"><table cellspacing="0" cellpadding="0" class="txttab" style="margin-top: 4pt; border-collapse: collapse; width: 468pt; margin-left: auto; margin-right: auto; border-left: 1pt solid #000000; border-right: 1pt solid #000000; border-top: 1pt solid #000000;"><tr><td class="gutter" style="width: 0.64%; font-size: 2pt; border-bottom: 1pt solid #000000; padding-top: 6.5pt; padding-bottom: 3pt;">&#8203;</td><td style="width: 2.67%; text-align: left; vertical-align: top; border-bottom: 1pt solid #000000; padding-top: 6.5pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 1.75pt; text-align: left;">2</div></td><td class="gutter" style="width: 1.28%; font-size: 2pt; border-bottom: 1pt solid #000000; padding-top: 6.5pt; padding-bottom: 3pt;">&#8203;</td><td class="gutter" style="width: 1.28%; font-size: 2pt; border-bottom: 1pt solid #000000; padding-top: 6.5pt; padding-bottom: 3pt;">&#8203;</td><td style="width: 93.48%; text-align: left; vertical-align: bottom; border-bottom: 1pt solid #000000; padding-top: 6.5pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">Election Choices &#8212; See Instructions 3 &#8211; 7</div></td><td class="gutter" style="width: 0.64%; font-size: 2pt; border-bottom: 1pt solid #000000; padding-top: 6.5pt; padding-bottom: 3pt;">&#8203;</td></tr></table><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; font-weight: bold; margin-top: 11.75pt; margin-left: 0pt; text-align: left;">Election Choices<font style="font-weight: normal;"> (select only one):</font></div><table cellspacing="0" cellpadding="0" class="txttab" style="margin-top: 4pt; border-collapse: collapse; width: 468pt; margin-left: auto; margin-right: auto;"><tr><td style="width: 1.07%; text-align: left; vertical-align: top; padding-top: 6pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 1pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">&#8201;<font style="font-size: 10pt;">&#x2610;</font></div></td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 6pt; padding-bottom: 3pt;">&#8203;</td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 6pt; padding-bottom: 3pt;">&#8203;</td><td style="width: 1.07%; text-align: left; vertical-align: top; padding-top: 6pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">1</div></td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 6pt; padding-bottom: 3pt;">&#8203;</td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 6pt; padding-bottom: 3pt;">&#8203;</td><td colspan="4" style="width: 92.74%; text-align: left; vertical-align: top; padding-top: 6pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">All Cash Election. Mark this box to elect to receive only cash, in the amount of $41.20* for each share of PFSB common stock, for all shares of PFSB common stock you own.</div></td></tr><tr><td style="width: 1.07%; text-align: left; vertical-align: top; padding-top: 3pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 1pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">&#8201;<font style="font-size: 10pt;">&#x2610;</font></div></td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 3pt;">&#8203;</td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 3pt;">&#8203;</td><td style="width: 1.07%; text-align: left; vertical-align: top; padding-top: 3pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">2</div></td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 3pt;">&#8203;</td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 3pt;">&#8203;</td><td colspan="4" style="width: 92.74%; text-align: left; vertical-align: top; padding-top: 3pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">All Stock Election. Mark this box to elect to receive only F&amp;M common stock, at the exchange ratio of 1.7766* shares of F&amp;M common stock for each share of PFSB common stock, for all shares of PFSB common stock you own.</div></td></tr><tr><td style="width: 1.07%; text-align: left; vertical-align: top; padding-top: 3pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 1pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">&#8201;<font style="font-size: 10pt;">&#x2610;</font></div></td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 3pt;">&#8203;</td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 3pt;">&#8203;</td><td style="width: 1.07%; text-align: left; vertical-align: top; padding-top: 3pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">3</div></td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 3pt;">&#8203;</td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 3pt;">&#8203;</td><td colspan="4" style="width: 92.74%; text-align: left; vertical-align: top; padding-top: 3pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">Mixed Cash/Stock Election. Mark this box to elect to receive a mixture of cash (in the amount of $41.20* for each share of PFSB common stock) and F&amp;M common stock (at the exchange ratio of 1.7766* share of F&amp;M common stock for each share of PFSB common stock). <font style="font-style: italic;">If you mark this box, you </font><font style="font-style: italic;"><u>must</u></font><font style="font-style: italic;"> also indicate below the whole number of your shares of PFSB common stock that you wish to </font><font style="font-style: italic;">exchange for cash and the whole number of your shares of PFSB common stock that you wish to </font><font style="font-style: italic;">exchange for F&amp;M common </font>stock<font style="font-style: italic;">. Do not write percentages, only whole numbers of shares.</font></div></td></tr><tr><td style="width: 1.07%; text-align: left; vertical-align: top; padding-top: 3pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt;">&#160;</div></td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 3pt;">&#8203;</td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 3pt;">&#8203;</td><td style="width: 1.07%; text-align: left; vertical-align: top; padding-top: 3pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt;">&#160;</div></td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 3pt;">&#8203;</td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 3pt;">&#8203;</td><td style="width: 58.97%; text-align: left; vertical-align: top; padding-top: 3pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt;">&#160;</div></td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 3pt;">&#8203;</td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 3pt;">&#8203;</td><td style="width: 31.2%; text-align: left; vertical-align: top; padding-top: 3pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt;">&#160;</div></td></tr><tr><td style="width: 1.07%; text-align: left; vertical-align: top; padding-top: 3pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt;">&#160;</div></td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 3pt;">&#8203;</td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 3pt;">&#8203;</td><td style="width: 1.07%; text-align: left; vertical-align: top; padding-top: 3pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt;">&#160;</div></td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 3pt;">&#8203;</td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 3pt;">&#8203;</td><td style="width: 58.97%; text-align: left; vertical-align: top; padding-top: 3pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">(a) Shares of PFSB common stock to be exchanged for <font style="font-style: italic;">cash</font>:</div></td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 3pt;">&#8203;</td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 3pt;">&#8203;</td><td style="width: 31.2%; text-align: left; vertical-align: top; padding-top: 3pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;"><u>&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;</u> <br></div><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">(whole numbers only) </div></td></tr><tr><td style="width: 1.07%; text-align: left; vertical-align: top; padding-top: 3pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt;">&#160;</div></td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 3pt;">&#8203;</td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 3pt;">&#8203;</td><td style="width: 1.07%; text-align: left; vertical-align: top; padding-top: 3pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt;">&#160;</div></td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 3pt;">&#8203;</td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 3pt;">&#8203;</td><td style="width: 58.97%; text-align: left; vertical-align: top; padding-top: 3pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt;">&#160;</div></td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 3pt;">&#8203;</td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 3pt;">&#8203;</td><td style="width: 31.2%; text-align: left; vertical-align: top; padding-top: 3pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt;">&#160;</div></td></tr><tr><td style="width: 1.07%; text-align: left; vertical-align: top; padding-top: 3pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt;">&#160;</div></td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 3pt;">&#8203;</td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 3pt;">&#8203;</td><td style="width: 1.07%; text-align: left; vertical-align: top; padding-top: 3pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt;">&#160;</div></td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 3pt;">&#8203;</td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 3pt;">&#8203;</td><td style="width: 58.97%; text-align: left; vertical-align: top; padding-top: 3pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">(b) Shares of PFSB common stock to be exchanged for F&amp;M<font style="font-style: italic;"> </font></div><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 14.99pt; text-align: left;"><font style="font-style: italic;">common stock</font>:</div></td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 3pt;">&#8203;</td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 3pt;">&#8203;</td><td style="width: 31.2%; text-align: left; vertical-align: top; padding-top: 3pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;"><u>&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;</u> <br></div><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">(whole numbers only)</div></td></tr><tr><td style="width: 1.07%; text-align: left; vertical-align: top; padding-top: 3pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt;">&#160;</div></td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 3pt;">&#8203;</td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 3pt;">&#8203;</td><td style="width: 1.07%; text-align: left; vertical-align: top; padding-top: 3pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt;">&#160;</div></td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 3pt;">&#8203;</td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 3pt;">&#8203;</td><td style="width: 58.97%; text-align: left; vertical-align: top; padding-top: 3pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt;">&#160;</div></td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 3pt;">&#8203;</td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 3pt;">&#8203;</td><td style="width: 31.2%; text-align: left; vertical-align: top; padding-top: 3pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt;">&#160;</div></td></tr><tr><td style="width: 1.07%; text-align: left; vertical-align: top; padding-top: 3pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt;">&#160;</div></td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 3pt;">&#8203;</td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 3pt;">&#8203;</td><td style="width: 1.07%; text-align: left; vertical-align: top; padding-top: 3pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt;">&#160;</div></td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 3pt;">&#8203;</td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 3pt;">&#8203;</td><td style="width: 58.97%; text-align: left; vertical-align: top; padding-top: 3pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">&#8195;&#8194;Total shares of PFSB common stock owned:</div></td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 3pt;">&#8203;</td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 3pt;">&#8203;</td><td style="width: 31.2%; text-align: left; vertical-align: top; padding-top: 3pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;"><u>&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;</u>#</div></td></tr><tr><td style="width: 1.07%; text-align: left; vertical-align: top; padding-top: 3pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt;">&#160;</div></td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 3pt;">&#8203;</td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 3pt;">&#8203;</td><td style="width: 1.07%; text-align: left; vertical-align: top; padding-top: 3pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt;">&#160;</div></td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 3pt;">&#8203;</td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 3pt;">&#8203;</td><td style="width: 58.97%; text-align: left; vertical-align: top; padding-top: 3pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt;">&#160;</div></td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 3pt;">&#8203;</td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 3pt;">&#8203;</td><td style="width: 31.2%; text-align: left; vertical-align: top; padding-top: 3pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt;">&#160;</div></td></tr><tr><td style="width: 1.07%; text-align: left; vertical-align: top; padding-top: 3pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt;">&#160;</div></td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 3pt;">&#8203;</td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 3pt;">&#8203;</td><td style="width: 1.07%; text-align: left; vertical-align: top; padding-top: 3pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt;">&#160;</div></td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 3pt;">&#8203;</td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 3pt;">&#8203;</td><td colspan="4" style="width: 92.74%; text-align: left; vertical-align: top; padding-top: 3pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; font-style: italic; font-weight: bold; margin-top: 0pt; margin-left: 59.99pt; text-indent: -59.99pt; text-align: left;"><u>#Important</u><font style="font-weight: normal;">:</font><font style="font-style: normal; font-weight: normal;">&#8195;</font>The sum of (a) and (b) <u>must</u> equal the total number of shares of PFSB common stock that you own (as listed in Section 1 above).<font style="font-style: normal; font-weight: normal;"> </font></div></td></tr><tr><td style="width: 1.07%; text-align: left; vertical-align: top; padding-top: 3pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt;">&#160;</div></td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 3pt;">&#8203;</td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 3pt;">&#8203;</td><td style="width: 1.07%; text-align: left; vertical-align: top; padding-top: 3pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt;">&#160;</div></td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 3pt;">&#8203;</td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 3pt;">&#8203;</td><td style="width: 58.97%; text-align: left; vertical-align: top; padding-top: 3pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt;">&#160;</div></td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 3pt;">&#8203;</td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 3pt;">&#8203;</td><td style="width: 31.2%; text-align: left; vertical-align: top; padding-top: 3pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt;">&#160;</div></td></tr><tr><td style="width: 1.07%; text-align: left; vertical-align: top; padding-top: 3pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 1pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">&#8201;<font style="font-size: 10pt;">&#x2610;</font></div></td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 3pt;">&#8203;</td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 3pt;">&#8203;</td><td style="width: 1.07%; text-align: left; vertical-align: top; padding-top: 3pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">4</div></td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 3pt;">&#8203;</td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 3pt;">&#8203;</td><td colspan="4" style="width: 92.74%; text-align: left; vertical-align: top; padding-top: 3pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">No Election. I/we make no election. I/we, the undersigned, acknowledge and understand that by making no election, the form of consideration that I/we will receive as a result of the Merger will be determined in accordance with the terms of the Merger Agreement.</div></td></tr></table><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; font-weight: bold; margin-top: 6pt; margin-left: 0pt; text-align: justify;">*NOTE: ALL ELECTIONS MADE BY PFSB SHAREHOLDERS WILL BE SUBJECT TO ALLOCATION AND PRORATION PROCEDURES SET FORTH IN THE MERGER AGREEMENT TO ENSURE THAT 1,032,308 OF THE SHARES OF PFSB COMMON STOCK OUTSTANDING AT THE EFFECTIVE TIME OF THE MERGER WILL BE EXCHANGED FOR SHARES OF F&amp;M COMMON STOCK AND 1,437,724 OF THE OUTSTANDING SHARES OF PFSB COMMON STOCK WILL BE EXCHANGED FOR CASH.</div><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; font-weight: bold; margin-top: 6pt; margin-left: 0pt; text-align: justify;">IMPORTANT: IF YOU DO NOT SELECT AN OPTION OR SELECT MORE THAN ONE, IT WILL BE ASSUMED THAT AS TO THESE SHARES YOU HAVE NO PREFERENCE AND THE SHARES WILL BE DESIGNATED NO ELECTION SHARES. IN ADDITION, YOUR ELECTION IS SUBJECT TO CERTAIN LIMITS AND ALLOCATION PROCEDURES SET FORTH IN THE MERGER AGREEMENT.</div><table cellspacing="0" cellpadding="0" class="txttab" style="margin-top: 4pt; border-collapse: collapse; width: 468pt; margin-left: auto; margin-right: auto; border-left: 1pt solid #000000; border-right: 1pt solid #000000; border-top: 1pt solid #000000;"><tr><td class="gutter" style="width: 0.64%; font-size: 2pt; border-bottom: 1pt solid #000000; padding-top: 6.5pt; padding-bottom: 3pt;">&#8203;</td><td style="width: 2.67%; text-align: left; vertical-align: top; border-bottom: 1pt solid #000000; padding-top: 6.5pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 1.75pt; text-align: left;">3</div></td><td class="gutter" style="width: 1.28%; font-size: 2pt; border-bottom: 1pt solid #000000; padding-top: 6.5pt; padding-bottom: 3pt;">&#8203;</td><td class="gutter" style="width: 1.28%; font-size: 2pt; border-bottom: 1pt solid #000000; padding-top: 6.5pt; padding-bottom: 3pt;">&#8203;</td><td style="width: 93.48%; text-align: left; vertical-align: bottom; border-bottom: 1pt solid #000000; padding-top: 6.5pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">Certification and Required Signatures &#8212; See Instruction 7</div></td><td class="gutter" style="width: 0.64%; font-size: 2pt; border-bottom: 1pt solid #000000; padding-top: 6.5pt; padding-bottom: 3pt;">&#8203;</td></tr></table><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 6pt; margin-left: 0pt; text-align: justify;">I/we, the undersigned, surrender to you for exchange the certificate(s) representing the PFSB common stock identified in Section 1 above. I/we agree, upon request, to execute and deliver any additional documents that F&amp;M or the Exchange Agent tells me/us are necessary or desirable to complete the exchange of my/our PFSB common stock. I/we understand and acknowledge that delivery will be effected, and risk of loss and title to my/our certificate(s) for PFSB common stock will pass, only upon proper delivery of those certificates to you, as Exchange Agent. I/we certify that I/we have reviewed the accompanying Instructions and have complied with all requirements stated therein. <font style="font-weight: bold;">I/we acknowledge that any election made in Section 2 above in connection with the Merger may </font><font style="font-weight: bold;">be subject to allocation and proration, as provided in the Merger Agreement. Therefore, I/we acknowledge that </font><font style="font-weight: bold;">I/we may receive a different form of consideration than I/we elected as a result of such allocation and </font><font style="font-weight: bold;">proration.</font> I/we hereby authorize the Exchange Agent to rely upon all representations, certifications and instructions accompanying this Election Form/Letter of Transmittal.</div></div></div></div>
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<div class="page" style="text-align: left; margin: auto; position: relative; width: 468pt;"><a name="ny20000091x2_posam_400-ex99-3_pg7"><!--Anchor--></a><div class="page-content"><div class="block-main" style="width: 468pt; margin-left: 0pt;"><div class="h2" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; font-weight: bold; margin-top: 6.75pt; margin-left: 0pt; text-align: left;">Required Signatures &#8212; all shareholders must sign below.</div><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 7.5pt; margin-left: 0pt; text-align: left;">x<u>&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;</u>&#8195;x<u>&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;</u></div><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; font-weight: bold; margin-top: 2.5pt; margin-left: 0pt; text-align: left;">&#8195;Signature of Shareholder&#8195;&#8195;&#8195;Date&#8195;&#8195;&#8195;&#8194;Signature of Shareholder <font style="font-style: italic;">(if joint account)</font>&#8195;&#8195;Date</div><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; font-weight: bold; margin-top: 8.5pt; margin-left: 0pt; text-align: left;">Daytime Phone Number<font style="font-weight: normal;"> </font><font style="font-weight: normal;"><u>(&#8195;)&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;</u></font><font style="font-weight: normal;">&#8195;</font>Title/Capacity, <font style="font-weight: normal;">if required</font><font style="font-weight: normal;"><u>&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;</u></font><font style="font-weight: normal;"> </font></div><table cellspacing="0" cellpadding="0" class="txttab" style="margin-top: 4pt; border-collapse: collapse; width: 468pt; margin-left: auto; margin-right: auto; border-left: 1pt solid #000000; border-right: 1pt solid #000000; border-top: 1pt solid #000000;"><tr><td class="gutter" style="width: 0.64%; font-size: 2pt; border-bottom: 1pt solid #000000; padding-top: 6.5pt; padding-bottom: 3pt;">&#8203;</td><td style="width: 2.67%; text-align: left; vertical-align: top; border-bottom: 1pt solid #000000; padding-top: 6.5pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 1.75pt; text-align: left;">4</div></td><td class="gutter" style="width: 1.28%; font-size: 2pt; border-bottom: 1pt solid #000000; padding-top: 6.5pt; padding-bottom: 3pt;">&#8203;</td><td class="gutter" style="width: 1.28%; font-size: 2pt; border-bottom: 1pt solid #000000; padding-top: 6.5pt; padding-bottom: 3pt;">&#8203;</td><td style="width: 93.48%; text-align: left; vertical-align: bottom; border-bottom: 1pt solid #000000; padding-top: 6.5pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">Special Payment or Issuance Instructions &#8212; See Instruction 8</div></td><td class="gutter" style="width: 0.64%; font-size: 2pt; border-bottom: 1pt solid #000000; padding-top: 6.5pt; padding-bottom: 3pt;">&#8203;</td></tr></table><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 6pt; margin-left: 0pt; text-align: justify;">Any shares of F&amp;M common stock and/or any check you receive in exchange for your PFSB common stock in the Merger will be issued in the name(s) printed in Section 1 above unless you indicate a different name(s) below. If you indicate a different name(s), your signature(s) and a guarantee by a member of a medallion program are required, and the Substitute Form W-9 attached to this Election Form/Letter of Transmittal <font style="font-weight: bold;">MUST be completed by the new </font><font style="font-weight: bold;">shareholder or payee</font>. Please refer to Instruction 8. </div><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 8.5pt; margin-left: 0pt; text-align: left;">Name<u>&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;</u></div><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 8.5pt; margin-left: 20pt; text-align: left;">&#8194;<u>&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;</u></div><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 8.5pt; margin-left: 0pt; text-align: left;">Address <u>&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;</u> </div><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 8.5pt; margin-left: 0pt; text-align: left;">City<u>&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;</u> State<u>&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;</u> Zip<u>&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;</u> </div><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 8.5pt; margin-left: 0pt; text-align: left;">x<u>&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;</u> <font style="font-weight: bold;">Place medallion</font><br></div><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;<font style="font-weight: bold;">signature guarantee here &#9658;</font></div><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 8.5pt; margin-left: 0pt; text-align: left;">x<u>&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;</u> <br></div><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;"><font style="font-weight: bold;">&#8195;Authorized signature(s)</font></div><table cellspacing="0" cellpadding="0" class="txttab" style="margin-top: 4pt; border-collapse: collapse; width: 468pt; margin-left: auto; margin-right: auto; border-left: 1pt solid #000000; border-right: 1pt solid #000000; border-top: 1pt solid #000000;"><tr><td class="gutter" style="width: 0.64%; font-size: 2pt; border-bottom: 1pt solid #000000; padding-top: 6.5pt; padding-bottom: 3pt;">&#8203;</td><td style="width: 2.67%; text-align: left; vertical-align: top; border-bottom: 1pt solid #000000; padding-top: 6.5pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 1.75pt; text-align: left;">5</div></td><td class="gutter" style="width: 1.28%; font-size: 2pt; border-bottom: 1pt solid #000000; padding-top: 6.5pt; padding-bottom: 3pt;">&#8203;</td><td class="gutter" style="width: 1.28%; font-size: 2pt; border-bottom: 1pt solid #000000; padding-top: 6.5pt; padding-bottom: 3pt;">&#8203;</td><td style="width: 93.48%; text-align: left; vertical-align: bottom; border-bottom: 1pt solid #000000; padding-top: 6.5pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">Special Delivery Instructions &#8212; See Instruction 9</div></td><td class="gutter" style="width: 0.64%; font-size: 2pt; border-bottom: 1pt solid #000000; padding-top: 6.5pt; padding-bottom: 3pt;">&#8203;</td></tr></table><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 6pt; margin-left: 0pt; text-align: justify;">F&amp;M common stock and/or a check will be mailed to the person and address shown in Section 1 (or the person and address in Section 4, if completed) unless you indicate a different mailing address below. If you indicate a different mailing address, your signature(s) and a guarantee by a member of a medallion program are required.</div><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 8.5pt; margin-left: 0pt; text-align: left;">Name<u>&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;</u> </div><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 8.5pt; margin-left: 0pt; text-align: left;">Address<u>&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;</u> </div><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 8.5pt; margin-left: 0pt; text-align: left;">City<u>&#8195;&#8195;&#8195;&#8195;&#8195;</u> State<u>&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;</u> Zip<u>&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;</u> </div><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 8.5pt; margin-left: 0pt; text-align: left;">x<u>&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;</u> </div><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 8.5pt; margin-left: 0pt; text-align: left;">x<u>&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;</u> <br></div><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;"><font style="font-weight: bold;">&#8195;Authorized signature(s)</font></div></div></div></div>
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<div class="page" style="text-align: left; margin: auto; position: relative; width: 468pt;"><a name="ny20000091x2_posam_400-ex99-3_pg8"><!--Anchor--></a><div class="page-content"><div class="block-main" style="width: 468pt; margin-left: 0pt;"><div class="h2" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; font-weight: bold; margin-top: 6.75pt; margin-left: 0pt; text-align: left;">PAYER&#8217;S NAME: FARMERS &amp; MERCHANTS BANCORP, INC.</div><table cellspacing="0" cellpadding="0" class="txttab" style="margin-top: 4pt; border-collapse: collapse; width: 468pt; margin-left: auto; margin-right: auto; border-left: 1pt solid #000000; border-right: 1pt solid #000000; border-top: 1pt solid #000000; border-bottom: 1pt solid #000000;"><tr><td class="gutter" rowspan="18" style="width: 1.28%; font-size: 2pt; border-left: 1pt solid #000000; border-bottom: 1pt solid #000000; padding-top: 6.5pt; padding-bottom: 2.75pt;">&#8203;</td><td rowspan="18" style="width: 15.49%; text-align: left; vertical-align: top; border-bottom: 1pt solid #000000; padding-top: 6.5pt; padding-bottom: 2.75pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10.5pt; font-weight: bold; margin-top: 0pt; margin-left: 3.25pt; text-align: left;">SUBSTITUTE <br></div><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10.5pt; font-weight: bold; margin-top: 0pt; margin-left: 3.28pt; text-align: left;">Form W-9<br></div><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10.5pt; font-weight: bold; margin-top: 0pt; margin-left: 3.28pt; text-align: left;">&#8195; <br></div><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10.5pt; font-weight: bold; margin-top: 0pt; margin-left: 3.28pt; text-align: left;">Department of the Treasury Internal Revenue Service<br></div><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10.5pt; font-weight: bold; margin-top: 0pt; margin-left: 3.28pt; text-align: left;">&#8195; <br></div><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10.5pt; font-weight: bold; margin-top: 0pt; margin-left: 3.28pt; text-align: left;">Payer&#8217;s Request for Taxpayer Identification Number (&#8220;TIN&#8221;) and Certification</div></td><td class="gutter" rowspan="18" style="width: 0.43%; font-size: 2pt; border-right: 1pt solid #000000; border-bottom: 1pt solid #000000; padding-top: 6.5pt; padding-bottom: 2.75pt;">&#8203;</td><td class="gutter" style="width: 0.43%; border-bottom: none; font-size: 2pt; padding-top: 6.5pt; padding-bottom: 2.75pt;">&#8203;</td><td colspan="4" style="width: 81.09%; text-align: left; vertical-align: top; padding-top: 6.5pt; padding-bottom: 2.75pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10.5pt; font-weight: bold; margin-top: 0pt; margin-left: 0pt; text-align: left;">Name (as shown on your income tax return). Name is required on this line; do not leave this line blank.</div></td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 6.5pt; padding-bottom: 2.75pt;">&#8203;</td></tr><tr><td class="gutter" style="width: 0.43%; border-bottom: none; font-size: 2pt; padding-top: 2.75pt; padding-bottom: 2.75pt;">&#8203;</td><td colspan="4" style="width: 81.09%; text-align: left; vertical-align: top; padding-top: 2.75pt; padding-bottom: 2.75pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10.5pt; margin-top: 0pt; margin-left: 0pt; text-align: left;"><font style="border-bottom: 1pt solid #000000;">&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;</font></div></td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 2.75pt; padding-bottom: 2.75pt;">&#8203;</td></tr><tr><td class="gutter" style="width: 0.43%; border-bottom: none; font-size: 2pt; padding-top: 2.75pt; padding-bottom: 1.5pt;">&#8203;</td><td colspan="4" style="width: 81.09%; text-align: left; vertical-align: top; padding-top: 2.75pt; padding-bottom: 1.5pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10.5pt; font-weight: bold; margin-top: 0pt; margin-left: 0pt; text-align: left;">Business Name/Disregarded Entity Name, if different from above</div></td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 2.75pt; padding-bottom: 1.5pt;">&#8203;</td></tr><tr><td class="gutter" style="width: 0.43%; border-bottom: none; font-size: 2pt; padding-top: 1.5pt; padding-bottom: 2.75pt;">&#8203;</td><td colspan="4" style="width: 81.09%; text-align: left; vertical-align: top; padding-top: 1.5pt; padding-bottom: 2.75pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10.5pt; margin-top: 0pt; margin-left: 0pt; text-align: left;"><font style="border-bottom: 1pt solid #000000;">&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;</font></div></td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 1.5pt; padding-bottom: 2.75pt;">&#8203;</td></tr><tr><td class="gutter" style="width: 0.43%; border-bottom: none; font-size: 2pt; padding-top: 2.75pt; padding-bottom: 1.5pt;">&#8203;</td><td colspan="4" style="width: 81.09%; text-align: left; vertical-align: top; padding-top: 2.75pt; padding-bottom: 1.5pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10.5pt; font-weight: bold; margin-top: 0pt; margin-left: 0pt; text-align: left;">Check appropriate box for federal tax classification; check only one of the following seven boxes:<font style="font-weight: normal;"> </font><br><font style="font-size: 1pt; font-weight: normal;">&#8201;</font><font style="font-weight: normal;">&#x2610;</font><font style="font-weight: normal;">&#8195;Individual/sole proprietor or single-member LLC </font><font style="font-size: 1pt; font-weight: normal;">&#8201;</font><font style="font-weight: normal;">&#x2610;</font><font style="font-weight: normal;">&#8195;C Corporation </font><br></div><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10.5pt; font-weight: bold; margin-top: 0pt; margin-left: 0pt; text-align: left;"><font style="font-size: 1pt; font-weight: normal;">&#8201;</font><font style="font-weight: normal;">&#x2610;</font><font style="font-weight: normal;">&#8195;S Corporation </font><font style="font-size: 1pt; font-weight: normal;">&#8201;</font><font style="font-weight: normal;">&#x2610;</font><font style="font-weight: normal;">&#8195;Partnership </font><font style="font-size: 1pt; font-weight: normal;">&#8201;</font><font style="font-weight: normal;">&#x2610;</font><font style="font-weight: normal;">&#8195;Trust/Estate </font><br></div><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10.5pt; font-weight: bold; margin-top: 0pt; margin-left: 20.08pt; text-indent: -20.08pt; text-align: left;"><font style="font-size: 1pt; font-weight: normal;">&#8201;</font><font style="font-weight: normal;">&#x2610;</font><font style="font-weight: normal;">&#8195;Limited liability company. Enter the tax </font><font style="font-size: 1pt; font-weight: normal;">&#8201;</font><font style="font-weight: normal;">&#x2610;</font><font style="font-weight: normal;">&#8195;Other</font><font style="font-weight: normal;"><u>&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;</u></font><font style="font-weight: normal;"> </font><br><font style="font-weight: normal;">classification (C = C corporation, </font><br><font style="font-weight: normal;">S = S corporation, P = partnership)</font><font style="font-weight: normal;"><u>&#8195;&#8195;&#8195;&#8195;&#8195;</u></font><br><font style="font-weight: normal;">&#8195;</font><br></div></td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 2.75pt; padding-bottom: 1.5pt;">&#8203;</td></tr><tr><td class="gutter" style="width: 0.43%; border-bottom: none; font-size: 2pt; padding-top: 1.5pt; padding-bottom: 1.5pt;">&#8203;</td><td colspan="4" style="width: 81.09%; text-align: left; vertical-align: top; padding-top: 1.5pt; padding-bottom: 1.5pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10.5pt; font-weight: bold; margin-top: 0pt; margin-left: 0pt; text-align: left;">Note.<font style="font-weight: normal;"> Check the appropriate box in the line above for the tax classification of the </font><font style="font-weight: normal;">single-member owner. Do not check LLC if the LLC is classified as a single-member </font><font style="font-weight: normal;">LLC that is disregarded from the owner unless the owner of the LLC is another LLC </font><font style="font-weight: normal;">that is not disregarded from the owner for U.S. federal tax purposes. Otherwise, a </font><font style="font-weight: normal;">single-member LLC that is disregarded from the owner should check the appropriate </font><font style="font-weight: normal;">box for the tax classification of its owner.</font></div></td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 1.5pt; padding-bottom: 1.5pt;">&#8203;</td></tr><tr><td class="gutter" style="width: 0.43%; border-bottom: none; font-size: 2pt; padding-top: 1.5pt; padding-bottom: 1.5pt;">&#8203;</td><td colspan="4" style="width: 81.09%; text-align: left; vertical-align: top; padding-top: 1.5pt; padding-bottom: 1.5pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10.5pt;">&#160;</div></td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 1.5pt; padding-bottom: 1.5pt;">&#8203;</td></tr><tr><td class="gutter" style="width: 0.43%; border-bottom: none; font-size: 2pt; padding-top: 1.5pt; padding-bottom: 1.5pt;">&#8203;</td><td colspan="4" style="width: 81.09%; text-align: left; vertical-align: top; padding-top: 1.5pt; padding-bottom: 1.5pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10.5pt; font-weight: bold; margin-top: 0pt; margin-left: 0pt; text-align: left;">Address</div></td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 1.5pt; padding-bottom: 1.5pt;">&#8203;</td></tr><tr><td class="gutter" style="width: 0.43%; border-bottom: none; font-size: 2pt; padding-top: 1.5pt; padding-bottom: 2.75pt;">&#8203;</td><td colspan="4" style="width: 81.09%; text-align: left; vertical-align: top; padding-top: 1.5pt; padding-bottom: 2.75pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10.5pt; margin-top: 0pt; margin-left: 0pt; text-align: left;"><font style="border-bottom: 1pt solid #000000;">&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;</font></div></td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 1.5pt; padding-bottom: 2.75pt;">&#8203;</td></tr><tr><td class="gutter" style="width: 0.43%; border-bottom: none; font-size: 2pt; padding-top: 2.75pt; padding-bottom: 1.5pt;">&#8203;</td><td colspan="4" style="width: 81.09%; text-align: left; vertical-align: top; padding-top: 2.75pt; padding-bottom: 1.5pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10.5pt; font-weight: bold; margin-top: 0pt; margin-left: 0pt; text-align: left;">City, state and ZIP code</div></td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 2.75pt; padding-bottom: 1.5pt;">&#8203;</td></tr><tr><td class="gutter" style="width: 0.43%; border-bottom: none; font-size: 2pt; padding-top: 1.5pt; padding-bottom: 2.75pt;">&#8203;</td><td colspan="4" style="width: 81.09%; text-align: left; vertical-align: top; padding-top: 1.5pt; padding-bottom: 2.75pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10.5pt; margin-top: 0pt; margin-left: 0pt; text-align: left;"><font style="border-bottom: 1pt solid #000000;">&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;</font></div></td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 1.5pt; padding-bottom: 2.75pt;">&#8203;</td></tr><tr><td class="gutter" style="width: 0.43%; font-size: 2pt; border-bottom: 1pt solid #000000; padding-top: 2.75pt; padding-bottom: 2.75pt;">&#8203;</td><td colspan="4" style="width: 81.09%; text-align: left; vertical-align: top; border-bottom: 1pt solid #000000; padding-top: 2.75pt; padding-bottom: 2.75pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10.5pt; font-weight: bold; margin-top: 0pt; margin-left: 0pt; text-align: left;">Exemptions (codes apply only to certain entities, not individuals: see W-9 Guidelines)<font style="font-weight: normal;"> </font><br></div><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10.5pt; font-weight: bold; margin-top: 0pt; margin-left: 0pt; text-align: left;"><font style="font-weight: normal;">Exempt payee code (if any) </font><font style="font-weight: normal;"><u>&#8195;&#8195;&#8195;</u></font><font style="font-weight: normal;"> </font><br></div><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10.5pt; font-weight: bold; margin-top: 0pt; margin-left: 0pt; text-align: left;"><font style="font-weight: normal;">Exemption from FATCA reporting code (if any)</font><font style="font-weight: normal;"><u>&#8195;&#8195;&#8195;</u></font></div></td><td class="gutter" style="width: 1.28%; font-size: 2pt; border-bottom: 1pt solid #000000; padding-top: 2.75pt; padding-bottom: 2.75pt;">&#8203;</td></tr><tr><td class="gutter" style="width: 0.43%; font-size: 2pt; border-bottom: 1pt solid #000000; padding-top: 2.75pt; padding-bottom: 2.75pt;">&#8203;</td><td style="width: 51.28%; text-align: left; vertical-align: top; border-bottom: 1pt solid #000000; padding-top: 2.75pt; padding-bottom: 2.75pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10.5pt; font-weight: bold; margin-top: 0pt; margin-left: 0pt; text-align: left;">Part 1 &#8212;<font style="font-weight: normal;"> Taxpayer Identification Number &#8212; Please </font><font style="font-weight: normal;">provide your TIN in the box at right and certify by </font><font style="font-weight: normal;">signing and dating below. If awaiting TIN, write </font><font style="font-weight: normal;">&#8220;Applied For.&#8221;</font></div></td><td class="gutter" style="width: 0.43%; font-size: 2pt; border-right: 1pt solid #000000; border-bottom: 1pt solid #000000; padding-top: 2.75pt; padding-bottom: 2.75pt;">&#8203;</td><td class="gutter" style="width: 0.43%; font-size: 2pt; border-bottom: 1pt solid #000000; padding-top: 2.75pt; padding-bottom: 2.75pt;">&#8203;</td><td style="width: 28.95%; text-align: left; vertical-align: top; border-bottom: 1pt solid #000000; padding-top: 2.75pt; padding-bottom: 2.75pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10.5pt; margin-top: 0pt; margin-left: 0pt; text-align: left;"><u>&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;</u> <br></div><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10.5pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">Social Security Number<br></div><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10.5pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">&#8195; <br></div><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10.5pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">OR <br></div><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10.5pt; margin-top: 0pt; margin-left: 0pt; text-align: left;"><u>&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;</u> <br></div><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10.5pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">Employer Identification Number</div></td><td class="gutter" style="width: 1.28%; font-size: 2pt; border-bottom: 1pt solid #000000; padding-top: 2.75pt; padding-bottom: 2.75pt;">&#8203;</td></tr><tr><td class="gutter" style="width: 0.43%; border-bottom: none; font-size: 2pt; padding-top: 2.75pt; padding-bottom: 1.5pt;">&#8203;</td><td colspan="4" style="width: 81.09%; text-align: left; vertical-align: top; padding-top: 2.75pt; padding-bottom: 1.5pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10.5pt; font-weight: bold; margin-top: 0pt; margin-left: 0pt; text-align: left;">PART 2 &#8212; Certification &#8212; Under penalties of perjury, I certify that:<font style="font-weight: normal;"> </font></div></td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 2.75pt; padding-bottom: 1.5pt;">&#8203;</td></tr><tr><td class="gutter" style="width: 0.43%; border-bottom: none; font-size: 2pt; padding-top: 1.5pt; padding-bottom: 1.5pt;">&#8203;</td><td colspan="4" style="width: 81.09%; text-align: left; vertical-align: top; padding-top: 1.5pt; padding-bottom: 1.5pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10.5pt; margin-top: 0pt; margin-left: 22.74pt; text-indent: -22.74pt; text-align: left;">(1)&#8195;The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me),<br></div><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10.5pt; margin-top: 0pt; margin-left: 22.74pt; text-indent: -22.74pt; text-align: left;">(2)&#8195;I am not subject to backup withholding because: (a) I am exempt from backup withholding, (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends or (c) the IRS has notified me that I am no longer subject to backup withholding,<br></div><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10.5pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">(3)&#8195;I am a U.S. citizen or other U.S. person (including a U.S. resident alien) and<br></div><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10.5pt; margin-top: 0pt; margin-left: 22.74pt; text-indent: -22.74pt; text-align: left;">(4)&#8195;The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.</div></td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 1.5pt; padding-bottom: 1.5pt;">&#8203;</td></tr><tr><td class="gutter" style="width: 0.43%; border-bottom: none; font-size: 2pt; padding-top: 1.5pt; padding-bottom: 1.5pt;">&#8203;</td><td colspan="4" style="width: 81.09%; text-align: left; vertical-align: top; padding-top: 1.5pt; padding-bottom: 1.5pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10.5pt;">&#160;</div></td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 1.5pt; padding-bottom: 1.5pt;">&#8203;</td></tr><tr><td class="gutter" style="width: 0.43%; border-bottom: none; font-size: 2pt; padding-top: 1.5pt; padding-bottom: 1.5pt;">&#8203;</td><td colspan="4" style="width: 81.09%; text-align: left; vertical-align: top; padding-top: 1.5pt; padding-bottom: 1.5pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10.5pt; margin-top: 0pt; margin-left: 0pt; text-align: left;"><u>Certification Instructions.</u> &#8212; You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. However, if after being notified by the IRS that you were subject to backup withholding you received another notification from the IRS stating that you are no longer subject to backup withholding, do not cross out item 2.</div></td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 1.5pt; padding-bottom: 1.5pt;">&#8203;</td></tr><tr><td class="gutter" style="width: 0.43%; font-size: 2pt; border-bottom: 1pt solid #000000; padding-top: 1.5pt; padding-bottom: 2.75pt;">&#8203;</td><td colspan="4" style="width: 81.09%; text-align: left; vertical-align: top; border-bottom: 1pt solid #000000; padding-top: 1.5pt; padding-bottom: 2.75pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10.5pt;">&#160;</div></td><td class="gutter" style="width: 1.28%; font-size: 2pt; border-bottom: 1pt solid #000000; padding-top: 1.5pt; padding-bottom: 2.75pt;">&#8203;</td></tr><tr><td class="gutter" rowspan="5" style="width: 1.28%; border-bottom: none; font-size: 2pt; border-left: 1pt solid #000000; padding-top: 2.75pt; padding-bottom: 1.5pt;">&#8203;</td><td rowspan="5" style="width: 15.49%; text-align: left; vertical-align: top; padding-top: 2.75pt; padding-bottom: 1.5pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10.5pt;">&#160;</div></td><td class="gutter" rowspan="5" style="width: 0.43%; border-bottom: none; font-size: 2pt; border-right: 1pt solid #000000; padding-top: 2.75pt; padding-bottom: 1.5pt;">&#8203;</td><td class="gutter" style="width: 0.43%; border-bottom: none; font-size: 2pt; padding-top: 2.75pt; padding-bottom: 1.5pt;">&#8203;</td><td colspan="4" style="width: 81.09%; text-align: left; vertical-align: top; padding-top: 2.75pt; padding-bottom: 1.5pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10.5pt;">&#160;</div></td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 2.75pt; padding-bottom: 1.5pt;">&#8203;</td></tr><tr><td class="gutter" style="width: 0.43%; border-bottom: none; font-size: 2pt; padding-top: 1.5pt; padding-bottom: 1.5pt;">&#8203;</td><td colspan="4" style="width: 81.09%; text-align: left; vertical-align: top; padding-top: 1.5pt; padding-bottom: 1.5pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10.5pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">The Internal Revenue Service does not require your consent to any provision of this document other than the certifications required to avoid backup withholding</div></td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 1.5pt; padding-bottom: 1.5pt;">&#8203;</td></tr><tr><td class="gutter" style="width: 0.43%; border-bottom: none; font-size: 2pt; padding-top: 1.5pt; padding-bottom: 1.5pt;">&#8203;</td><td colspan="4" style="width: 81.09%; text-align: left; vertical-align: top; padding-top: 1.5pt; padding-bottom: 1.5pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10.5pt;">&#160;</div></td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 1.5pt; padding-bottom: 1.5pt;">&#8203;</td></tr><tr><td class="gutter" style="width: 0.43%; border-bottom: none; font-size: 2pt; padding-top: 1.5pt; padding-bottom: 1.5pt;">&#8203;</td><td colspan="4" style="width: 81.09%; text-align: left; vertical-align: top; padding-top: 1.5pt; padding-bottom: 1.5pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10.5pt; font-weight: bold; margin-top: 0pt; margin-left: 0pt; text-align: left;">SIGNATURE<font style="font-weight: normal;"><u>&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;</u></font></div></td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 1.5pt; padding-bottom: 1.5pt;">&#8203;</td></tr><tr><td class="gutter" style="width: 0.43%; border-bottom: none; font-size: 2pt; padding-top: 1.5pt; padding-bottom: 3pt;">&#8203;</td><td colspan="4" style="width: 81.09%; text-align: left; vertical-align: top; padding-top: 1.5pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10.5pt; font-weight: bold; margin-top: 0pt; margin-left: 0pt; text-align: left;">DATE<font style="font-weight: normal;"><u>&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;</u></font></div></td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 1.5pt; padding-bottom: 3pt;">&#8203;</td></tr></table></div></div></div>
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<div class="page" style="text-align: left; margin: auto; position: relative; width: 468pt;"><a name="ny20000091x2_posam_400-ex99-3_pg9"><!--Anchor--></a><div class="page-content"><div class="block-main" style="width: 468pt; margin-left: 0pt;"><div style="padding: 6pt; border: 0.5pt solid #000000; margin-left: -6pt; margin-top: 4.5pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; width: 461.5pt; text-align: left; margin-left: 6.5pt;"><font style="font-weight: bold;">CERTIFICATE OF AWAITING TAXPAYER IDENTIFICATION NUMBER</font><br></div><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; width: 461.5pt; margin-top: 0pt; text-align: left; margin-left: 6.5pt;">&#8195; <br></div><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; width: 461.5pt; margin-top: 0pt; text-align: justify; margin-left: 6.5pt;">I certify under penalties of perjury that a taxpayer identification number has not been issued to me and either (1)&#160;I have mailed or delivered an application to receive a taxpayer identification number to the appropriate Internal Revenue Service Center or Social Security Administration Office or (2) I intend to mail or deliver an application in the near future. I understand that if I do not provide a taxpayer identification number by the time of payment, 24% of all reportable payments made to me will be withheld.<br></div><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; width: 461.5pt; margin-top: 0pt; text-align: left; margin-left: 6.5pt;">&#8195;<br></div><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; text-indent: 6.5pt; text-align: left; margin-left: 0pt;">Signature<u>&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;</u> Date<u>&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;&#8195;</u></div></div></div></div></div>
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<div class="page" style="text-align: left; margin: auto; position: relative; width: 468pt;"><a name="ny20000091x2_posam_400-ex99-3_pg10"><!--Anchor--></a><div class="page-content"><div class="block-main" style="width: 468pt; margin-left: 0pt;"><div class="h1" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; font-weight: bold; margin-top: 6.75pt; text-align: center;">GUIDELINES FOR CERTIFICATION OF TAXPAYER IDENTIFICATION <br></div><div class="h1" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; font-weight: bold; margin-top: 0pt; text-align: center;">NUMBER ON SUBSTITUTE FORM W-9 </div><div class="para" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; font-weight: bold; margin-top: 6pt; margin-left: 0pt; text-indent: 20pt; text-align: justify;">GUIDELINES FOR DETERMINING THE PROPER IDENTIFICATION NUMBER TO GIVE THE PAYER.<font style="font-weight: normal;"> &#8212; Social Security Numbers have nine digits separated by two hyphens: i.e., 000-00-0000. Employer </font><font style="font-weight: normal;">Identification Numbers have nine digits separated by only one hyphen: i.e., 00-0000000. The table below will help </font><font style="font-weight: normal;">determine the number to give the payer. All &#8220;section&#8221; references are to the Internal Revenue Code of 1986, as </font><font style="font-weight: normal;">amended. &#8220;IRS&#8221; is the Internal Revenue Service.</font></div><table cellspacing="0" cellpadding="0" class="txttab" style="margin-top: 4pt; border-collapse: collapse; width: 468pt; margin-left: auto; margin-right: auto;"><tr class="header"><td colspan="4" style="width: 52.56%; text-align: left; vertical-align: bottom; border-bottom: 1pt solid #000000; padding-top: 6pt; padding-bottom: 4pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 8pt; font-weight: bold; margin-top: 0pt; margin-left: 0pt; text-align: left;">For this type of account:</div></td><td class="gutter" style="width: 1.92%; font-size: 2pt; padding-top: 6pt; padding-bottom: 4pt; border-bottom: 1px solid #ffffff;">&#8203;</td><td class="gutter" style="width: 1.92%; font-size: 2pt; padding-top: 6pt; padding-bottom: 4pt; border-bottom: 1px solid #ffffff;">&#8203;</td><td style="width: 43.59%; text-align: left; vertical-align: bottom; border-bottom: 1pt solid #000000; padding-top: 6pt; padding-bottom: 4pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 8pt; font-weight: bold; margin-top: 0pt; margin-left: 0pt; text-align: left;">Give the SOCIAL SECURITY Number of:</div></td></tr><tr><td style="width: 2.56%; text-align: left; vertical-align: top; padding-top: 4pt; padding-bottom: 2.75pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">1.</div></td><td class="gutter" style="width: 1.92%; border-bottom: none; font-size: 2pt; padding-top: 4pt; padding-bottom: 2.75pt;">&#8203;</td><td class="gutter" style="width: 1.92%; border-bottom: none; font-size: 2pt; padding-top: 4pt; padding-bottom: 2.75pt;">&#8203;</td><td style="width: 46.15%; text-align: left; vertical-align: bottom; padding-top: 4pt; padding-bottom: 2.75pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">An individual&#8217;s account</div></td><td class="gutter" style="width: 1.92%; border-bottom: none; font-size: 2pt; padding-top: 4pt; padding-bottom: 2.75pt;">&#8203;</td><td class="gutter" style="width: 1.92%; border-bottom: none; font-size: 2pt; padding-top: 4pt; padding-bottom: 2.75pt;">&#8203;</td><td style="width: 43.59%; text-align: left; vertical-align: bottom; padding-top: 4pt; padding-bottom: 2.75pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">The individual</div></td></tr><tr><td style="width: 2.56%; text-align: left; vertical-align: top; padding-top: 2.75pt; padding-bottom: 2.75pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">2.</div></td><td class="gutter" style="width: 1.92%; border-bottom: none; font-size: 2pt; padding-top: 2.75pt; padding-bottom: 2.75pt;">&#8203;</td><td class="gutter" style="width: 1.92%; border-bottom: none; font-size: 2pt; padding-top: 2.75pt; padding-bottom: 2.75pt;">&#8203;</td><td style="width: 46.15%; text-align: left; vertical-align: bottom; padding-top: 2.75pt; padding-bottom: 2.75pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">Two or more individuals (joint account), other than an account maintained by a foreign financial institution</div></td><td class="gutter" style="width: 1.92%; border-bottom: none; font-size: 2pt; padding-top: 2.75pt; padding-bottom: 2.75pt;">&#8203;</td><td class="gutter" style="width: 1.92%; border-bottom: none; font-size: 2pt; padding-top: 2.75pt; padding-bottom: 2.75pt;">&#8203;</td><td style="width: 43.59%; text-align: left; vertical-align: top; padding-top: 2.75pt; padding-bottom: 2.75pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">The actual owner of the account or, if combined funds, any one of the individuals<sup style="vertical-align: text-top; line-height: 1; font-size: smaller;">(1)</sup></div></td></tr><tr><td style="width: 2.56%; text-align: left; vertical-align: top; padding-top: 2.75pt; padding-bottom: 2.75pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">3.</div></td><td class="gutter" style="width: 1.92%; border-bottom: none; font-size: 2pt; padding-top: 2.75pt; padding-bottom: 2.75pt;">&#8203;</td><td class="gutter" style="width: 1.92%; border-bottom: none; font-size: 2pt; padding-top: 2.75pt; padding-bottom: 2.75pt;">&#8203;</td><td style="width: 46.15%; text-align: left; vertical-align: bottom; padding-top: 2.75pt; padding-bottom: 2.75pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">Two or more individuals (joint account maintained by a foreign financial institution)</div></td><td class="gutter" style="width: 1.92%; border-bottom: none; font-size: 2pt; padding-top: 2.75pt; padding-bottom: 2.75pt;">&#8203;</td><td class="gutter" style="width: 1.92%; border-bottom: none; font-size: 2pt; padding-top: 2.75pt; padding-bottom: 2.75pt;">&#8203;</td><td style="width: 43.59%; text-align: left; vertical-align: top; padding-top: 2.75pt; padding-bottom: 2.75pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">Each holder of the account</div></td></tr><tr><td style="width: 2.56%; text-align: left; vertical-align: top; padding-top: 2.75pt; padding-bottom: 2.75pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">4.</div></td><td class="gutter" style="width: 1.92%; border-bottom: none; font-size: 2pt; padding-top: 2.75pt; padding-bottom: 2.75pt;">&#8203;</td><td class="gutter" style="width: 1.92%; border-bottom: none; font-size: 2pt; padding-top: 2.75pt; padding-bottom: 2.75pt;">&#8203;</td><td style="width: 46.15%; text-align: left; vertical-align: bottom; padding-top: 2.75pt; padding-bottom: 2.75pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">Custodian account of a minor (Uniform Gift to Minors Act)</div></td><td class="gutter" style="width: 1.92%; border-bottom: none; font-size: 2pt; padding-top: 2.75pt; padding-bottom: 2.75pt;">&#8203;</td><td class="gutter" style="width: 1.92%; border-bottom: none; font-size: 2pt; padding-top: 2.75pt; padding-bottom: 2.75pt;">&#8203;</td><td style="width: 43.59%; text-align: left; vertical-align: top; padding-top: 2.75pt; padding-bottom: 2.75pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">The minor<sup style="vertical-align: text-top; line-height: 1; font-size: smaller;">(2)</sup></div></td></tr><tr><td style="width: 2.56%; text-align: left; vertical-align: top; padding-top: 2.75pt; padding-bottom: 2.75pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">5.</div></td><td class="gutter" style="width: 1.92%; border-bottom: none; font-size: 2pt; padding-top: 2.75pt; padding-bottom: 2.75pt;">&#8203;</td><td class="gutter" style="width: 1.92%; border-bottom: none; font-size: 2pt; padding-top: 2.75pt; padding-bottom: 2.75pt;">&#8203;</td><td style="width: 46.15%; text-align: left; vertical-align: top; padding-top: 2.75pt; padding-bottom: 2.75pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">Adult and minor (joint account)</div></td><td class="gutter" style="width: 1.92%; border-bottom: none; font-size: 2pt; padding-top: 2.75pt; padding-bottom: 2.75pt;">&#8203;</td><td class="gutter" style="width: 1.92%; border-bottom: none; font-size: 2pt; padding-top: 2.75pt; padding-bottom: 2.75pt;">&#8203;</td><td style="width: 43.59%; text-align: left; vertical-align: top; padding-top: 2.75pt; padding-bottom: 2.75pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">The adult or, if the minor is the only contributor, the minor<sup style="vertical-align: text-top; line-height: 1; font-size: smaller;">(1)</sup></div></td></tr><tr><td style="width: 2.56%; text-align: left; vertical-align: top; padding-top: 2.75pt; padding-bottom: 2.75pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">6.</div></td><td class="gutter" style="width: 1.92%; border-bottom: none; font-size: 2pt; padding-top: 2.75pt; padding-bottom: 2.75pt;">&#8203;</td><td class="gutter" style="width: 1.92%; border-bottom: none; font-size: 2pt; padding-top: 2.75pt; padding-bottom: 2.75pt;">&#8203;</td><td style="width: 46.15%; text-align: left; vertical-align: bottom; padding-top: 2.75pt; padding-bottom: 2.75pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">Account in the name of guardian or committee for a designated ward, minor, or incompetent person</div></td><td class="gutter" style="width: 1.92%; border-bottom: none; font-size: 2pt; padding-top: 2.75pt; padding-bottom: 2.75pt;">&#8203;</td><td class="gutter" style="width: 1.92%; border-bottom: none; font-size: 2pt; padding-top: 2.75pt; padding-bottom: 2.75pt;">&#8203;</td><td style="width: 43.59%; text-align: left; vertical-align: top; padding-top: 2.75pt; padding-bottom: 2.75pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">The ward, minor, or incompetent person<sup style="vertical-align: text-top; line-height: 1; font-size: smaller;">(2)</sup></div></td></tr><tr><td style="width: 2.56%; text-align: left; vertical-align: top; padding-top: 2.75pt; padding-bottom: 2.75pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">7.</div></td><td class="gutter" style="width: 1.92%; border-bottom: none; font-size: 2pt; padding-top: 2.75pt; padding-bottom: 2.75pt;">&#8203;</td><td class="gutter" style="width: 1.92%; border-bottom: none; font-size: 2pt; padding-top: 2.75pt; padding-bottom: 2.75pt;">&#8203;</td><td style="width: 46.15%; text-align: left; vertical-align: bottom; padding-top: 2.75pt; padding-bottom: 2.75pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">&#8195;a. The usual revocable savings trust </div><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 10pt; text-align: left;">account(grantor is also trustee)</div></td><td class="gutter" style="width: 1.92%; border-bottom: none; font-size: 2pt; padding-top: 2.75pt; padding-bottom: 2.75pt;">&#8203;</td><td class="gutter" style="width: 1.92%; border-bottom: none; font-size: 2pt; padding-top: 2.75pt; padding-bottom: 2.75pt;">&#8203;</td><td style="width: 43.59%; text-align: left; vertical-align: top; padding-top: 2.75pt; padding-bottom: 2.75pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">The grantor-trustee<sup style="vertical-align: text-top; line-height: 1; font-size: smaller;">(1)</sup></div></td></tr><tr><td style="width: 2.56%; text-align: left; vertical-align: top; padding-top: 2.75pt; padding-bottom: 2.75pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt;">&#160;</div></td><td class="gutter" style="width: 1.92%; border-bottom: none; font-size: 2pt; padding-top: 2.75pt; padding-bottom: 2.75pt;">&#8203;</td><td class="gutter" style="width: 1.92%; border-bottom: none; font-size: 2pt; padding-top: 2.75pt; padding-bottom: 2.75pt;">&#8203;</td><td style="width: 46.15%; text-align: left; vertical-align: bottom; padding-top: 2.75pt; padding-bottom: 2.75pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">&#8195;b. So-called trust account that is not a legal or </div><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 10pt; text-align: left;">valid trust under State law</div></td><td class="gutter" style="width: 1.92%; border-bottom: none; font-size: 2pt; padding-top: 2.75pt; padding-bottom: 2.75pt;">&#8203;</td><td class="gutter" style="width: 1.92%; border-bottom: none; font-size: 2pt; padding-top: 2.75pt; padding-bottom: 2.75pt;">&#8203;</td><td style="width: 43.59%; text-align: left; vertical-align: top; padding-top: 2.75pt; padding-bottom: 2.75pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">The actual owner<sup style="vertical-align: text-top; line-height: 1; font-size: smaller;">(1)</sup></div></td></tr><tr><td style="width: 2.56%; text-align: left; vertical-align: top; padding-top: 2.75pt; padding-bottom: 2.75pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">8.</div></td><td class="gutter" style="width: 1.92%; border-bottom: none; font-size: 2pt; padding-top: 2.75pt; padding-bottom: 2.75pt;">&#8203;</td><td class="gutter" style="width: 1.92%; border-bottom: none; font-size: 2pt; padding-top: 2.75pt; padding-bottom: 2.75pt;">&#8203;</td><td style="width: 46.15%; text-align: left; vertical-align: bottom; padding-top: 2.75pt; padding-bottom: 2.75pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">Sole proprietorship or single member LLC account owned by an individual</div></td><td class="gutter" style="width: 1.92%; border-bottom: none; font-size: 2pt; padding-top: 2.75pt; padding-bottom: 2.75pt;">&#8203;</td><td class="gutter" style="width: 1.92%; border-bottom: none; font-size: 2pt; padding-top: 2.75pt; padding-bottom: 2.75pt;">&#8203;</td><td style="width: 43.59%; text-align: left; vertical-align: top; padding-top: 2.75pt; padding-bottom: 2.75pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">The Owner<sup style="vertical-align: text-top; line-height: 1; font-size: smaller;">(3)</sup></div></td></tr><tr><td style="width: 2.56%; text-align: left; vertical-align: top; padding-top: 2.75pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">9.</div></td><td class="gutter" style="width: 1.92%; border-bottom: none; font-size: 2pt; padding-top: 2.75pt; padding-bottom: 3pt;">&#8203;</td><td class="gutter" style="width: 1.92%; border-bottom: none; font-size: 2pt; padding-top: 2.75pt; padding-bottom: 3pt;">&#8203;</td><td style="width: 46.15%; text-align: left; vertical-align: bottom; padding-top: 2.75pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">Grantor trust filing under Optional Form 1099 Filing Method&#160;1 (see Regulations section&#160;1.671-4(b)(2)(i)(A)) </div></td><td class="gutter" style="width: 1.92%; border-bottom: none; font-size: 2pt; padding-top: 2.75pt; padding-bottom: 3pt;">&#8203;</td><td class="gutter" style="width: 1.92%; border-bottom: none; font-size: 2pt; padding-top: 2.75pt; padding-bottom: 3pt;">&#8203;</td><td style="width: 43.59%; text-align: left; vertical-align: top; padding-top: 2.75pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">The grantor*</div></td></tr></table><table cellspacing="0" cellpadding="0" class="txttab" style="margin-top: 4pt; border-collapse: collapse; width: 468pt; margin-left: auto; margin-right: auto;"><tr class="header"><td colspan="4" style="width: 52.56%; text-align: left; vertical-align: bottom; border-bottom: 1pt solid #000000; padding-top: 6pt; padding-bottom: 4pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 8pt; font-weight: bold; margin-top: 0pt; margin-left: 0pt; text-align: left;">For this type of account:</div></td><td class="gutter" style="width: 1.92%; font-size: 2pt; padding-top: 6pt; padding-bottom: 4pt; border-bottom: 1px solid #ffffff;">&#8203;</td><td class="gutter" style="width: 1.92%; font-size: 2pt; padding-top: 6pt; padding-bottom: 4pt; border-bottom: 1px solid #ffffff;">&#8203;</td><td style="width: 43.59%; text-align: center; vertical-align: bottom; border-bottom: 1pt solid #000000; padding-top: 6pt; padding-bottom: 4pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 8pt; font-weight: bold; margin-top: 0pt; text-align: center;">Give the EMPLOYER IDENTIFICATION Number of:</div></td></tr><tr><td style="width: 2.56%; text-align: left; vertical-align: top; padding-top: 4pt; padding-bottom: 2.75pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">9.</div></td><td class="gutter" style="width: 1.92%; border-bottom: none; font-size: 2pt; padding-top: 4pt; padding-bottom: 2.75pt;">&#8203;</td><td class="gutter" style="width: 1.92%; border-bottom: none; font-size: 2pt; padding-top: 4pt; padding-bottom: 2.75pt;">&#8203;</td><td style="width: 46.15%; text-align: left; vertical-align: bottom; padding-top: 4pt; padding-bottom: 2.75pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">A valid trust, estate or pension trust</div></td><td class="gutter" style="width: 1.92%; border-bottom: none; font-size: 2pt; padding-top: 4pt; padding-bottom: 2.75pt;">&#8203;</td><td class="gutter" style="width: 1.92%; border-bottom: none; font-size: 2pt; padding-top: 4pt; padding-bottom: 2.75pt;">&#8203;</td><td style="width: 43.59%; text-align: left; vertical-align: top; padding-top: 4pt; padding-bottom: 2.75pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">The legal entity<sup style="vertical-align: text-top; line-height: 1; font-size: smaller;">(4)</sup></div></td></tr><tr><td style="width: 2.56%; text-align: left; vertical-align: top; padding-top: 2.75pt; padding-bottom: 2.75pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">10.</div></td><td class="gutter" style="width: 1.92%; border-bottom: none; font-size: 2pt; padding-top: 2.75pt; padding-bottom: 2.75pt;">&#8203;</td><td class="gutter" style="width: 1.92%; border-bottom: none; font-size: 2pt; padding-top: 2.75pt; padding-bottom: 2.75pt;">&#8203;</td><td style="width: 46.15%; text-align: left; vertical-align: bottom; padding-top: 2.75pt; padding-bottom: 2.75pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">Corporation or LLC electing corporate status on Form 8832 account</div></td><td class="gutter" style="width: 1.92%; border-bottom: none; font-size: 2pt; padding-top: 2.75pt; padding-bottom: 2.75pt;">&#8203;</td><td class="gutter" style="width: 1.92%; border-bottom: none; font-size: 2pt; padding-top: 2.75pt; padding-bottom: 2.75pt;">&#8203;</td><td style="width: 43.59%; text-align: left; vertical-align: top; padding-top: 2.75pt; padding-bottom: 2.75pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">The corporation</div></td></tr><tr><td style="width: 2.56%; text-align: left; vertical-align: top; padding-top: 2.75pt; padding-bottom: 2.75pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">11.</div></td><td class="gutter" style="width: 1.92%; border-bottom: none; font-size: 2pt; padding-top: 2.75pt; padding-bottom: 2.75pt;">&#8203;</td><td class="gutter" style="width: 1.92%; border-bottom: none; font-size: 2pt; padding-top: 2.75pt; padding-bottom: 2.75pt;">&#8203;</td><td style="width: 46.15%; text-align: left; vertical-align: bottom; padding-top: 2.75pt; padding-bottom: 2.75pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">Association, club, religious, charitable, educational or other tax-exempt organization account</div></td><td class="gutter" style="width: 1.92%; border-bottom: none; font-size: 2pt; padding-top: 2.75pt; padding-bottom: 2.75pt;">&#8203;</td><td class="gutter" style="width: 1.92%; border-bottom: none; font-size: 2pt; padding-top: 2.75pt; padding-bottom: 2.75pt;">&#8203;</td><td style="width: 43.59%; text-align: left; vertical-align: top; padding-top: 2.75pt; padding-bottom: 2.75pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">The organization</div></td></tr><tr><td style="width: 2.56%; text-align: left; vertical-align: top; padding-top: 2.75pt; padding-bottom: 2.75pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">12.</div></td><td class="gutter" style="width: 1.92%; border-bottom: none; font-size: 2pt; padding-top: 2.75pt; padding-bottom: 2.75pt;">&#8203;</td><td class="gutter" style="width: 1.92%; border-bottom: none; font-size: 2pt; padding-top: 2.75pt; padding-bottom: 2.75pt;">&#8203;</td><td style="width: 46.15%; text-align: left; vertical-align: bottom; padding-top: 2.75pt; padding-bottom: 2.75pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">Partnership account held in the name of the business or multi-member LLC</div></td><td class="gutter" style="width: 1.92%; border-bottom: none; font-size: 2pt; padding-top: 2.75pt; padding-bottom: 2.75pt;">&#8203;</td><td class="gutter" style="width: 1.92%; border-bottom: none; font-size: 2pt; padding-top: 2.75pt; padding-bottom: 2.75pt;">&#8203;</td><td style="width: 43.59%; text-align: left; vertical-align: top; padding-top: 2.75pt; padding-bottom: 2.75pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">The partnership</div></td></tr><tr><td style="width: 2.56%; text-align: left; vertical-align: top; padding-top: 2.75pt; padding-bottom: 2.75pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">13.</div></td><td class="gutter" style="width: 1.92%; border-bottom: none; font-size: 2pt; padding-top: 2.75pt; padding-bottom: 2.75pt;">&#8203;</td><td class="gutter" style="width: 1.92%; border-bottom: none; font-size: 2pt; padding-top: 2.75pt; padding-bottom: 2.75pt;">&#8203;</td><td style="width: 46.15%; text-align: left; vertical-align: bottom; padding-top: 2.75pt; padding-bottom: 2.75pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">Disregarded entity not owned by an individual</div></td><td class="gutter" style="width: 1.92%; border-bottom: none; font-size: 2pt; padding-top: 2.75pt; padding-bottom: 2.75pt;">&#8203;</td><td class="gutter" style="width: 1.92%; border-bottom: none; font-size: 2pt; padding-top: 2.75pt; padding-bottom: 2.75pt;">&#8203;</td><td style="width: 43.59%; text-align: left; vertical-align: top; padding-top: 2.75pt; padding-bottom: 2.75pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">The owner</div></td></tr><tr><td style="width: 2.56%; text-align: left; vertical-align: top; padding-top: 2.75pt; padding-bottom: 2.75pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">14.</div></td><td class="gutter" style="width: 1.92%; border-bottom: none; font-size: 2pt; padding-top: 2.75pt; padding-bottom: 2.75pt;">&#8203;</td><td class="gutter" style="width: 1.92%; border-bottom: none; font-size: 2pt; padding-top: 2.75pt; padding-bottom: 2.75pt;">&#8203;</td><td style="width: 46.15%; text-align: left; vertical-align: bottom; padding-top: 2.75pt; padding-bottom: 2.75pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">A broker or registered nominee</div></td><td class="gutter" style="width: 1.92%; border-bottom: none; font-size: 2pt; padding-top: 2.75pt; padding-bottom: 2.75pt;">&#8203;</td><td class="gutter" style="width: 1.92%; border-bottom: none; font-size: 2pt; padding-top: 2.75pt; padding-bottom: 2.75pt;">&#8203;</td><td style="width: 43.59%; text-align: left; vertical-align: top; padding-top: 2.75pt; padding-bottom: 2.75pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">The broker or nominee</div></td></tr><tr><td style="width: 2.56%; text-align: left; vertical-align: top; padding-top: 2.75pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">15.</div></td><td class="gutter" style="width: 1.92%; border-bottom: none; font-size: 2pt; padding-top: 2.75pt; padding-bottom: 3pt;">&#8203;</td><td class="gutter" style="width: 1.92%; border-bottom: none; font-size: 2pt; padding-top: 2.75pt; padding-bottom: 3pt;">&#8203;</td><td style="width: 46.15%; text-align: left; vertical-align: bottom; padding-top: 2.75pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">Account with the Department of Agriculture in the name of a public entity (such as a State or local government, school district, or prison) that receives agricultural program payments</div></td><td class="gutter" style="width: 1.92%; border-bottom: none; font-size: 2pt; padding-top: 2.75pt; padding-bottom: 3pt;">&#8203;</td><td class="gutter" style="width: 1.92%; border-bottom: none; font-size: 2pt; padding-top: 2.75pt; padding-bottom: 3pt;">&#8203;</td><td style="width: 43.59%; text-align: left; vertical-align: top; padding-top: 2.75pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; margin-left: 0pt; text-align: left;">The public entity</div></td></tr></table><div><div class="rule-partial" style="height: 0pt; width: 72pt; border-bottom: 1pt solid #000000; margin-bottom: 1pt; margin-right: auto; margin-left: 0pt; margin-top: 7.25pt;"> </div></div><table border="0" cellpadding="0" cellspacing="0" style="margin-top: 3pt; margin-left: 0pt;"><tr><td style="width: 20pt; text-align: left; vertical-align: top;"><div style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 8pt;">(1)<br></div></td><td style="vertical-align: top;"><div style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 8pt; text-align: justify;">List first and circle the name of the person whose number you furnish. If only one person on a joint account has a social security number, that person&#8217;s number must be furnished. </div></td></tr></table><table border="0" cellpadding="0" cellspacing="0" style="margin-top: 3pt; margin-left: 0pt;"><tr><td style="width: 20pt; text-align: left; vertical-align: top;"><div style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 8pt;">(2)<br></div></td><td style="vertical-align: top;"><div style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 8pt; text-align: left;">Circle the ward&#8217;s, minor&#8217;s or incompetent person&#8217;s name and furnish such person&#8217;s social security number. </div></td></tr></table><table border="0" cellpadding="0" cellspacing="0" style="margin-top: 3pt; margin-left: 0pt;"><tr><td style="width: 20pt; text-align: left; vertical-align: top;"><div style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 8pt;">(3)<br></div></td><td style="vertical-align: top;"><div style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 8pt; text-align: justify;">You must show your individual name, but you may also enter your business or &#8220;doing business&#8221; name. You may use either your Social Security Number or Employer Identification Number. (if you have one). </div></td></tr></table><table border="0" cellpadding="0" cellspacing="0" style="margin-top: 3pt; margin-left: 0pt;"><tr><td style="width: 20pt; text-align: left; vertical-align: top;"><div style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 8pt;">(4)<br></div></td><td style="vertical-align: top;"><div style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 8pt; text-align: justify;">List first and circle the name of the legal trust, estate, or pension trust. Do not furnish the taxpayer identification number of the personal representative or trustee unless the legal entity itself is not designated in the account title. </div></td></tr></table><div class="ftnote" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 8pt; margin-top: 4.5pt; margin-left: 20pt; text-align: left;">NOTE: If no name is circled when there is more than one name, the number will be considered to be that of the first name listed. </div><table border="0" cellpadding="0" cellspacing="0" style="margin-top: 3pt; margin-left: 0pt;"><tr><td style="width: 20pt; text-align: left; vertical-align: top;"><div style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 8pt;">*<br></div></td><td style="vertical-align: top;"><div style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 8pt; text-align: left;"><font style="font-weight: bold;">NOTE:</font> Grantor also must provide a Form W-9 to trustee of trust. </div></td></tr></table></div></div></div>
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<div class="page" style="text-align: left; margin: auto; position: relative; width: 468pt;"><a name="ny20000091x2_posam_400-ex99-3_pg11"><!--Anchor--></a><div class="page-content"><div class="block-main" style="width: 468pt; margin-left: 0pt;"><div class="h2" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; font-weight: bold; margin-top: 6.75pt; margin-left: 0pt; text-align: left;">Purpose of Form</div><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 6pt; margin-left: 0pt; text-align: justify;">A person who is required to file an information return with the IRS must obtain your correct Taxpayer Identification Number (TIN) which may be your social security number (SSN), individual taxpayer identification number (ITIN), adoption taxpayer identification number (ATIN), or employer identification number (EIN), to report on an information return the amount paid to you, or other amount reportable on an information return. Examples of information returns include, but are not limited to, the following:</div><table border="0" cellpadding="0" cellspacing="0" style="margin-top: 6pt; margin-left: 20pt;"><tr><td style="width: 20pt; text-align: left; vertical-align: top;"><div style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt;">&#8226;</div></td><td style="vertical-align: top;"><div style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; text-align: left;">Form 1099-INT (interest earned or paid)</div></td></tr></table><table border="0" cellpadding="0" cellspacing="0" style="margin-top: 6pt; margin-left: 20pt;"><tr><td style="width: 20pt; text-align: left; vertical-align: top;"><div style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt;">&#8226;</div></td><td style="vertical-align: top;"><div style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; text-align: left;">Form 1099-DIV (dividends, including those from stocks or mutual funds)</div></td></tr></table><table border="0" cellpadding="0" cellspacing="0" style="margin-top: 6pt; margin-left: 20pt;"><tr><td style="width: 20pt; text-align: left; vertical-align: top;"><div style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt;">&#8226;</div></td><td style="vertical-align: top;"><div style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; text-align: left;">Form 1099-MISC (various types of income, prizes, awards, or gross proceeds)</div></td></tr></table><table border="0" cellpadding="0" cellspacing="0" style="margin-top: 6pt; margin-left: 20pt;"><tr><td style="width: 20pt; text-align: left; vertical-align: top;"><div style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt;">&#8226;</div></td><td style="vertical-align: top;"><div style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; text-align: left;">Form 1099-B (stock or mutual fund sales and certain other transactions by brokers)</div></td></tr></table><table border="0" cellpadding="0" cellspacing="0" style="margin-top: 6pt; margin-left: 20pt;"><tr><td style="width: 20pt; text-align: left; vertical-align: top;"><div style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt;">&#8226;</div></td><td style="vertical-align: top;"><div style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; text-align: left;">Form 1099-S (proceeds from real estate transactions)</div></td></tr></table><table border="0" cellpadding="0" cellspacing="0" style="margin-top: 6pt; margin-left: 20pt;"><tr><td style="width: 20pt; text-align: left; vertical-align: top;"><div style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt;">&#8226;</div></td><td style="vertical-align: top;"><div style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; text-align: left;">Form 1099-K (merchant card and third party network transactions)</div></td></tr></table><table border="0" cellpadding="0" cellspacing="0" style="margin-top: 6pt; margin-left: 20pt;"><tr><td style="width: 20pt; text-align: left; vertical-align: top;"><div style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt;">&#8226;</div></td><td style="vertical-align: top;"><div style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; text-align: left;">Form 1098 (home mortgage interest), 1098-E (student loan interest), 1098-T (tuition)</div></td></tr></table><table border="0" cellpadding="0" cellspacing="0" style="margin-top: 6pt; margin-left: 20pt;"><tr><td style="width: 20pt; text-align: left; vertical-align: top;"><div style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt;">&#8226;</div></td><td style="vertical-align: top;"><div style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; text-align: left;">Form 1099-C (canceled debt)</div></td></tr></table><table border="0" cellpadding="0" cellspacing="0" style="margin-top: 6pt; margin-left: 20pt;"><tr><td style="width: 20pt; text-align: left; vertical-align: top;"><div style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt;">&#8226;</div></td><td style="vertical-align: top;"><div style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; text-align: left;">Form 1099-A (acquisition or abandonment of secured property)</div></td></tr></table><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 6pt; margin-left: 0pt; text-align: justify;">If you are a U.S. person (including a resident alien), use Substitute Form W-9 to give your correct TIN to the requester (the person requesting your TIN). If you do not return Substitute Form W-9 to the requester with a TIN, you might be subject to backup withholding. By signing the filled-out form, you: (1) certify the TIN you are giving is correct (or you are waiting for a number to be issued), (2) (i)&#160;certify you are not subject to backup withholding or (ii)&#160;claim exemption from backup withholding if you are an exempt payee and (3) certify that the FATCA (Foreign Account Tax Compliance Act) code(s) entered on the Substitute Form W-9 (if any) indicating that you are exempt from the FATCA reporting, is correct. The TIN provided must match the name given on the Substitute Form W-9.</div><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; font-style: italic; font-weight: bold; margin-top: 6pt; margin-left: 0pt; text-align: justify;">Definition of a U.S. Person:<font style="font-style: normal; font-weight: normal;"> For federal tax purposes, you are considered a U.S. person if you are: (1) an individual </font><font style="font-style: normal; font-weight: normal;">who is a U.S. citizen or U.S. resident alien; (2) a partnership, corporation, company or association created or </font><font style="font-style: normal; font-weight: normal;">organized in the United States or under the laws of the United States; (3) an estate (other than a foreign estate); or </font><font style="font-style: normal; font-weight: normal;">(4) a domestic trust (as defined under Treasury Regulations section 301.7701-7).</font></div><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; font-style: italic; font-weight: bold; margin-top: 6pt; margin-left: 0pt; text-align: justify;">Special Rules for Partnerships:<font style="font-style: normal; font-weight: normal;"> Partnerships that conduct a trade or business in the United States are generally </font><font style="font-style: normal; font-weight: normal;">required to pay a withholding tax under section 1446 on any foreign partner&#8217;s share of effectively connected taxable </font><font style="font-style: normal; font-weight: normal;">income from such business and the portion of the gain (if any) on any disposition of an interest in such partnership. </font><font style="font-style: normal; font-weight: normal;">Further, in certain cases where a Substitute Form W-9 has not been received, the rules under section 1446 require a </font><font style="font-style: normal; font-weight: normal;">partnership to presume that a partner is a foreign person and pay the section 1446 withholding tax. Therefore, if you </font><font style="font-style: normal; font-weight: normal;">are a U.S. person that is a partner in a partnership conducting a trade or business in the United States, provide a </font><font style="font-style: normal; font-weight: normal;">Substitute Form W-9 to the partnership to establish your U.S. status and avoid section 1446 withholding on your share </font><font style="font-style: normal; font-weight: normal;">of partnership income or on the gain (if any) on the disposition of an interest in such partnership.</font></div><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 6pt; margin-left: 0pt; text-align: justify;">In the cases below, the following person must give Substitute Form W-9 to the partnership for purposes of establishing its U.S. status and avoiding withholding on its allocable share of net income from the partnership conducting a trade or business in the United States or the gain (if any) on any disposition of an interest in such partnership: (1) in the case of a disregarded entity with a U.S. owner, the U.S. owner of the disregarded entity and not the entity; (2) in the case of a grantor trust with a U.S. grantor or other U.S. owner, generally, the U.S.&#160;grantor or other U.S. owner of the grantor trust and not the trust; and (3) in the case of a U.S. trust (other than a grantor trust), the U.S. trust and not the beneficiaries of the trust. </div><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; font-style: italic; font-weight: bold; margin-top: 6pt; margin-left: 0pt; text-align: justify;">Foreign person. <font style="font-style: normal; font-weight: normal;">If you are a foreign person or the U.S. branch of a foreign bank that has elected to be treated as a </font><font style="font-style: normal; font-weight: normal;">U.S. person, do not use Substitute Form W-9. Instead, use the appropriate Form W-8 or Form 8233 (see IRS </font><font style="font-style: normal; font-weight: normal;">Publication 515, Withholding of Tax on Nonresident Aliens and Foreign Entities).</font></div><div class="h2" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; font-weight: bold; margin-top: 15pt; margin-left: 0pt; text-align: left;">OBTAINING A TAXPAYER IDENTIFICATION NUMBER </div><div class="para" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 6pt; margin-left: 0pt; text-indent: 20pt; text-align: justify;">If you do not have a taxpayer identification number or if you do not know your number, apply for one immediately. To apply for an SSN, obtain Form SS-5, Application for a Social Security Card, at the local office of </div></div></div></div>
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<div class="page" style="text-align: left; margin: auto; position: relative; width: 468pt;"><a name="ny20000091x2_posam_400-ex99-3_pg12"><!--Anchor--></a><div class="page-content"><div class="block-main" style="width: 468pt; margin-left: 0pt;"><div class="para" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 6.75pt; margin-left: 0pt; text-align: justify;">the Social Security Administration or get this form online at www.ssa.gov/online/ss-5.pdf. You may also get this form by calling 1-800-772-1213. You can apply for an EIN online by accessing the IRS website at www.irs.gov/businesses and clicking on Employer Identification Number (EIN) under Starting a Business. Use IRS Form W-7, Application for IRS Individual Taxpayer Identification Number, to apply for an ITIN, or IRS Form SS-4, Application for Employer Identification Number, to apply for an EIN. Go to www.irs.gov/Forms to view, download, or print Form W-7 and/or Form SS-4. Or, you can go to www.irs.gov/OrderForms to place an order and have Form W-7 and/or SS-4 mailed to you within 10 business days.</div><div class="para" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 6pt; margin-left: 0pt; text-indent: 20pt; text-align: justify;">If you do not have a TIN, apply for a TIN and write &#8220;Applied For&#8221; in Part 1 of Substitute Form W-9, sign and date both the form and the Certificate of Awaiting Taxpayer Identification Number set forth therein, and give it to the requester. For interest and dividend payments and certain payments made with respect to readily tradable instruments, you will generally have 60 days to get a TIN and give it to the requester. If the requester does not receive your TIN within 60 days, backup withholding, if applicable, will begin and continue until you furnish your TIN.</div><div class="para" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 6pt; margin-left: 0pt; text-indent: 20pt; text-align: justify;">Note: Writing &#8220;Applied For&#8221; on the Substitute W-9 means that you have already applied for a TIN OR that you intend to apply for one soon. As soon as you receive your TIN, complete another Substitute Form W-9, include your TIN, sign and date the form, and give it to the requester.</div><div class="h2" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; font-weight: bold; margin-top: 12pt; margin-left: 0pt; text-align: left;">EXEMPTIONS</div><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 6pt; margin-left: 0pt; text-align: justify;">If you are exempt from backup withholding and/or FATCA reporting, enter any exempt payee code and exemption from FATCA reporting code that may apply to you.</div><div class="para" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; font-style: italic; font-weight: bold; margin-top: 6pt; margin-left: 0pt; text-indent: 20pt; text-align: justify;">Backup Withholding.<font style="font-weight: normal;"> Payees generally exempt from backup withholding on payments by brokers include the </font><font style="font-weight: normal;">following: </font></div><table border="0" cellpadding="0" cellspacing="0" style="margin-top: 6pt; margin-left: 20pt;"><tr><td style="width: 20pt; text-align: left; vertical-align: top;"><div style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt;">&#8226;</div></td><td style="vertical-align: top;"><div style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; text-align: left;">A C corporation. </div></td></tr></table><table border="0" cellpadding="0" cellspacing="0" style="margin-top: 6pt; margin-left: 20pt;"><tr><td style="width: 20pt; text-align: left; vertical-align: top;"><div style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt;">&#8226;</div></td><td style="vertical-align: top;"><div style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; text-align: left;">A financial institution. </div></td></tr></table><table border="0" cellpadding="0" cellspacing="0" style="margin-top: 6pt; margin-left: 20pt;"><tr><td style="width: 20pt; text-align: left; vertical-align: top;"><div style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt;">&#8226;</div></td><td style="vertical-align: top;"><div style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; text-align: justify;">An organization exempt from a tax under Section 501(a) or an individual retirement plan or a custodial account under Section 403(b)(7) if the account satisfies the requirements of Section 401(F)(2). </div></td></tr></table><table border="0" cellpadding="0" cellspacing="0" style="margin-top: 6pt; margin-left: 20pt;"><tr><td style="width: 20pt; text-align: left; vertical-align: top;"><div style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt;">&#8226;</div></td><td style="vertical-align: top;"><div style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; text-align: left;">The United States or any agency or instrumentality thereof. </div></td></tr></table><table border="0" cellpadding="0" cellspacing="0" style="margin-top: 6pt; margin-left: 20pt;"><tr><td style="width: 20pt; text-align: left; vertical-align: top;"><div style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt;">&#8226;</div></td><td style="vertical-align: top;"><div style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; text-align: justify;">A State, the District of Columbia, a possession of the United States or any subdivision or instrumentality thereof. </div></td></tr></table><table border="0" cellpadding="0" cellspacing="0" style="margin-top: 6pt; margin-left: 20pt;"><tr><td style="width: 20pt; text-align: left; vertical-align: top;"><div style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt;">&#8226;</div></td><td style="vertical-align: top;"><div style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; text-align: justify;">A foreign government, a political subdivision of a foreign government or any agency or instrumentality thereof. </div></td></tr></table><table border="0" cellpadding="0" cellspacing="0" style="margin-top: 6pt; margin-left: 20pt;"><tr><td style="width: 20pt; text-align: left; vertical-align: top;"><div style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt;">&#8226;</div></td><td style="vertical-align: top;"><div style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; text-align: left;">An international organization or any agency or instrumentality thereof. </div></td></tr></table><table border="0" cellpadding="0" cellspacing="0" style="margin-top: 6pt; margin-left: 20pt;"><tr><td style="width: 20pt; text-align: left; vertical-align: top;"><div style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt;">&#8226;</div></td><td style="vertical-align: top;"><div style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; text-align: left;">A registered dealer in securities or commodities registered in the U.S. or a possession of the U.S.&#160;</div></td></tr></table><table border="0" cellpadding="0" cellspacing="0" style="margin-top: 6pt; margin-left: 20pt;"><tr><td style="width: 20pt; text-align: left; vertical-align: top;"><div style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt;">&#8226;</div></td><td style="vertical-align: top;"><div style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; text-align: left;">A real estate investment trust. </div></td></tr></table><table border="0" cellpadding="0" cellspacing="0" style="margin-top: 6pt; margin-left: 20pt;"><tr><td style="width: 20pt; text-align: left; vertical-align: top;"><div style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt;">&#8226;</div></td><td style="vertical-align: top;"><div style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; text-align: left;">A common trust fund operated by a bank under Section 584(a). </div></td></tr></table><table border="0" cellpadding="0" cellspacing="0" style="margin-top: 6pt; margin-left: 20pt;"><tr><td style="width: 20pt; text-align: left; vertical-align: top;"><div style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt;">&#8226;</div></td><td style="vertical-align: top;"><div style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; text-align: left;">An entity registered at all times under the Investment Company Act of 1940. </div></td></tr></table><table border="0" cellpadding="0" cellspacing="0" style="margin-top: 6pt; margin-left: 20pt;"><tr><td style="width: 20pt; text-align: left; vertical-align: top;"><div style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt;">&#8226;</div></td><td style="vertical-align: top;"><div style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; text-align: left;">A futures commission merchant registered with the Commodity Futures Trading Commission. </div></td></tr></table><table border="0" cellpadding="0" cellspacing="0" style="margin-top: 6pt; margin-left: 20pt;"><tr><td style="width: 20pt; text-align: left; vertical-align: top;"><div style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt;">&#8226;</div></td><td style="vertical-align: top;"><div style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; text-align: left;">A person registered under the Investment Advisors Act of 1940 who regularly acts as a broker. </div></td></tr></table><div class="para" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 6pt; margin-left: 0pt; text-indent: 20pt; text-align: justify;">Exempt payees described above should provide an IRS Form W-9 or the Substitute Form W-9 (or the appropriate IRS Form W-8 in the case of foreign persons) to avoid possible backup withholding. <font style="font-weight: bold;">PROVIDE THIS FORM TO </font><font style="font-weight: bold;">THE PAYER, FURNISH YOUR TAXPAYER IDENTIFICATION NUMBER, CHECK THE &#8220;EXEMPT </font><font style="font-weight: bold;">FROM BACKUP WITHHOLDING&#8221; BOX ON THE FORM, SIGN AND DATE THE FORM AND RETURN </font><font style="font-weight: bold;">IT TO THE PAYER.</font> </div><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; font-style: italic; font-weight: bold; margin-top: 6pt; margin-left: 0pt; text-align: justify;">Exemption from FATCA Reporting Code:<font style="font-style: normal; font-weight: normal;"> The following codes identify payees that are exempt from reporting under </font><font style="font-style: normal; font-weight: normal;">FATCA. These codes apply to persons submitting Substitute Form W-9 for accounts maintained outside of the United </font><font style="font-style: normal; font-weight: normal;">States by certain foreign financial institutions. Therefore, if you are only submitting Substitute Form W-9 for an </font><font style="font-style: normal; font-weight: normal;">account you hold in the United States, you may leave this field blank. Consult with the requester if you are uncertain </font><font style="font-style: normal; font-weight: normal;">if the financial institution is subject to these requirements.</font></div></div></div></div>
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<div class="page" style="text-align: left; margin: auto; position: relative; width: 468pt;"><a name="ny20000091x2_posam_400-ex99-3_pg13"><!--Anchor--></a><div class="page-content"><div class="block-main" style="width: 468pt; margin-left: 0pt;"><div class="para" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 6.75pt; margin-left: 0pt; text-indent: 20pt; text-align: justify;">A &#8211; An organization exempt from tax under section 501(a) or any individual retirement plan as defined in section&#160;7701(a)(37)</div><div class="para" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 8pt; margin-left: 0pt; text-indent: 20pt; text-align: left;">B &#8211; The United States or any of its agencies or instrumentalities</div><div class="para" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 6pt; margin-left: 0pt; text-indent: 20pt; text-align: justify;">C &#8211; A state, the District of Columbia, a U.S. commonwealth or possession, or any of their political subdivisions or instrumentalities</div><div class="para" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 6pt; margin-left: 0pt; text-indent: 20pt; text-align: justify;">D &#8211; A corporation the stock of which is regularly traded on one or more established securities markets, as described in Treasury Regulations section 1.1472-1(c)(1)(i)</div><div class="para" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 6pt; margin-left: 0pt; text-indent: 20pt; text-align: justify;">E &#8211; A corporation that is a member of the same expanded affiliated group as a corporation described in Treasury Regulations section 1.1472-1(c)(1)(i)</div><div class="para" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 6pt; margin-left: 0pt; text-indent: 20pt; text-align: justify;">F &#8211; A dealer in securities, commodities or derivative financial instruments (including notional principal contracts, futures, forwards and options) that is registered as such under the laws of the United States or any state</div><div class="para" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 8pt; margin-left: 0pt; text-indent: 20pt; text-align: left;">G &#8211; A real estate investment trust</div><div class="para" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 6pt; margin-left: 0pt; text-indent: 20pt; text-align: justify;">H &#8211; A regulated investment company as defined in section 851 or an entity registered at all times during the tax year under the Investment Company Act of 1940</div><div class="para" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 8pt; margin-left: 0pt; text-indent: 20pt; text-align: left;">I &#8211; A common trust fund as defined in section 584(a)</div><div class="para" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 8pt; margin-left: 0pt; text-indent: 20pt; text-align: left;">J &#8211; A bank as defined in section 581</div><div class="para" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 8pt; margin-left: 0pt; text-indent: 20pt; text-align: left;">K &#8211; A broker</div><div class="para" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 8pt; margin-left: 0pt; text-indent: 20pt; text-align: left;">L &#8211; A trust exempt from tax under section 664 or described in section 4947(a)(1)</div><div class="para" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 8pt; margin-left: 0pt; text-indent: 20pt; text-align: left;">M &#8211; A tax exempt trust under a section 403(b) plan or section 457(g) plan</div><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 6pt; margin-left: 0pt; text-align: justify;">Note. You may wish to consult with the requestor of this form to determine whether the FATCA code and/or exempt payee code should be completed.</div><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; font-weight: bold; margin-top: 6pt; margin-left: 0pt; text-align: justify;">PRIVACY ACT NOTICE.<font style="font-weight: normal;"> Section 6109 of the Internal Revenue Code requires you to give your correct TIN to persons </font><font style="font-weight: normal;">(including federal agencies) who are required to file information returns with the IRS to report interest, dividends and </font><font style="font-weight: normal;">certain other income paid to you, mortgage interest you paid, the acquisition or abandonment of secured property, </font><font style="font-weight: normal;">cancellation of debt, or contributions you made to an IRA or Archer MSA or HSA. The person collecting this form uses </font><font style="font-weight: normal;">the information on the form to file information returns with the IRS, reporting the above information. Routine uses of this </font><font style="font-weight: normal;">information include giving it to the Department of Justice for civil and criminal litigation and to cities, states, the District </font><font style="font-weight: normal;">of Columbia and U.S. commonwealths and possessions for use in administering their laws. The information also may be </font><font style="font-weight: normal;">disclosed to other countries under a treaty, to federal and state agencies to enforce civil and criminal laws, or to federal law </font><font style="font-weight: normal;">enforcement and intelligence agencies to combat terrorism. You must provide your TIN whether or not you are required </font><font style="font-weight: normal;">to file a tax return. Under section 3406 of the Internal Revenue Code, payers must generally withhold a percentage of </font><font style="font-weight: normal;">taxable interest, dividend, and certain other payments to a payee who does not give a TIN to the payer. Certain penalties </font><font style="font-weight: normal;">may also apply for providing false or fraudulent information.</font></div><div class="h2" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; font-weight: bold; margin-top: 12pt; margin-left: 0pt; text-align: left;">PENALTIES </div><table border="0" cellpadding="0" cellspacing="0" style="margin-top: 6pt; margin-left: 20pt;"><tr><td style="width: 20pt; text-align: left; vertical-align: top;"><div style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt;">(1)<br></div></td><td style="vertical-align: top;"><div style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; text-align: justify;"><font style="font-weight: bold;">PENALTY FOR FAILURE TO FURNISH TIN.</font> &#8212; If you fail to furnish your taxpayer identification number to a payer, you are subject to a penalty of $50 for each such failure unless your failure is due to reasonable cause and not to willful neglect. </div></td></tr></table><table border="0" cellpadding="0" cellspacing="0" style="margin-top: 6pt; margin-left: 20pt;"><tr><td style="width: 20pt; text-align: left; vertical-align: top;"><div style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt;">(2)<br></div></td><td style="vertical-align: top;"><div style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; text-align: justify;"><font style="font-weight: bold;">CIVIL PENALTY FOR FALSE INFORMATION WITH RESPECT TO WITHHOLDING.</font> &#8212; If you make a false statement with no reasonable basis that results in no imposition of backup withholding, you are subject to a penalty of $500. </div></td></tr></table><table border="0" cellpadding="0" cellspacing="0" style="margin-top: 6pt; margin-left: 20pt;"><tr><td style="width: 20pt; text-align: left; vertical-align: top;"><div style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt;">(3)<br></div></td><td style="vertical-align: top;"><div style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; text-align: justify;"><font style="font-weight: bold;">CRIMINAL PENALTY FOR FALSIFYING INFORMATION.</font> &#8212; Willfully falsifying certifications or affirmations may subject you to criminal penalties including fines and/or imprisonment. </div></td></tr></table><table border="0" cellpadding="0" cellspacing="0" style="margin-top: 6pt; margin-left: 20pt;"><tr><td style="width: 20pt; text-align: left; vertical-align: top;"><div style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt;">(4)<br></div></td><td style="vertical-align: top;"><div style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; text-align: justify;"><font style="font-weight: bold;">MISUSE OF TINS.</font> If the requester discloses or uses TINs in violation of federal law, the requester may be subject to civil and criminal penalties.</div></td></tr></table><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 6pt; margin-left: 0pt; text-align: justify;">FOR ADDITIONAL INFORMATION CONTACT YOUR TAX CONSULTANT OR THE INTERNAL REVENUE SERVICE. </div></div></div></div>
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<div class="page" style="text-align: left; margin: auto; position: relative; width: 468pt;"><a name="ny20000091x2_posam_400-ex99-3_pg14"><!--Anchor--></a><div class="page-content"><div class="block-main" style="width: 468pt; margin-left: 0pt;"><table cellspacing="0" cellpadding="0" class="txttab" style="margin-top: 4pt; border-collapse: collapse; width: 468pt; margin-left: auto; margin-right: auto;"><tr><td style="width: 48.72%; text-align: center; vertical-align: top; padding-top: 6pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; font-weight: bold; margin-top: 0pt; text-align: center;">FARMERS &amp; MERCHANTS BANCORP, INC.</div></td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 6pt; padding-bottom: 3pt;">&#8203;</td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 6pt; padding-bottom: 3pt;">&#8203;</td><td style="width: 48.72%; text-align: center; vertical-align: bottom; padding-top: 6pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; font-weight: bold; margin-top: 0pt; text-align: center;">PERPETUAL FEDERAL SAVINGS BANK OF URBANA</div></td></tr></table><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 9.25pt; text-align: center;">August&#160;27, 2021</div><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 8.5pt; margin-left: 0pt; text-align: left;">To the Shareholders of Perpetual Federal Savings Bank:</div><div class="para" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 6pt; margin-left: 0pt; text-indent: 20pt; text-align: justify;">As described in the Proxy Statement/Prospectus previously delivered to you, Farmers &amp; Merchants Bancorp, Inc. (&#8220;F&amp;M&#8221;), The Farmers &amp; Merchants State Bank (&#8220;F&amp;M Bank&#8221;) and Perpetual Federal Savings Bank (&#8220;PFSB&#8221;) have entered into an Agreement and Plan of Reorganization and Merger, dated as of May&#160;4, 2021, (the &#8220;Merger Agreement&#8221;), which provides for the merger of PFSB with and into F&amp;M Bank (the &#8220;Merger&#8221;). </div><div class="para" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 6pt; margin-left: 0pt; text-indent: 20pt; text-align: justify;">Upon the completion of the Merger, the shareholders of PFSB will be entitled to receive, in exchange for each share of PFSB common stock owned, either (a) $41.20 in cash, or (b) 1.7766 shares of F&amp;M common stock, subject to the election and allocation procedures set forth in the Merger Agreement. </div><div class="para" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 6pt; margin-left: 0pt; text-indent: 20pt; text-align: justify;">Pursuant to the Merger Agreement, the requests of the PFSB shareholders will be allocated, in accordance with the terms of the Merger Agreement, so that 1,032,308 of the shares of PFSB common stock outstanding at the effective time of the Merger will be exchanged for F&amp;M common stock and the remaining 1,437,724 outstanding shares of PFSB common stock will be exchanged for cash. For purposes of this allocation, shareholders of PFSB who exercise dissenters&#8217; rights will be treated as having elected to receive cash consideration for their PFSB common stock. <font style="font-weight: bold;">You should carefully read Section 1.5 of the Merger Agreement, which is attached to the Proxy </font><font style="font-weight: bold;">Statement/Prospectus and which sets forth in detail the manner in which the cash and stock consideration will </font><font style="font-weight: bold;">be allocated among the shareholders of PFSB.</font></div><div class="para" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 6pt; margin-left: 0pt; text-indent: 20pt; text-align: justify;">At this time, we are asking you to elect the form of consideration that you wish to receive in the Merger. Enclosed is an Election Form/Letter of Transmittal that must be completed and returned, together with the Certificate(s) representing your shares of PFSB common stock, to Broadridge Corporate Issuer Solutions, the Exchange Agent for the transaction. As more fully described in the Election Form/Letter of Transmittal, you may choose to receive in exchange for the shares of PFSB common stock that you own, either (a) all cash, (b) all F&amp;M common stock, or (c) a combination of cash and F&amp;M common stock. If you wish to make an election as to the type of consideration that you want to receive in the Merger, you should carefully review and follow the instructions contained in the enclosed Election Form/Letter of Transmittal. Please note that any election that you make will be subject to the allocation and proration procedures briefly mentioned above and set forth in detail in the Merger Agreement. As a result, there is no assurance that you will receive the form of consideration that you elect to receive. If you do not properly complete and return the enclosed Election Form/Letter of Transmittal, any PFSB common stock you hold will be subject to such allocation and proration procedures. </div><div class="para" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 6pt; margin-left: 0pt; text-indent: 20pt; text-align: justify;">Please review the enclosed materials carefully and return your completed Election Form/Letter of Transmittal. <font style="font-weight: bold;">In order to make a valid election regarding the form of consideration you wish to receive in the Merger, the </font><font style="font-weight: bold;">enclosed Election Form/Letter of Transmittal must be received by the Exchange Agent by 5:00 p.m., Eastern </font><font style="font-weight: bold;">Daylight Time, on September&#160;</font><font style="font-weight: bold;">24</font><font style="font-weight: bold;">, 2021 (the &#8220;Election Deadline&#8221;). However, if the closing of the Merger is </font><font style="font-weight: bold;">extended past the anticipated closing date of October&#160;1, 2021, for any reason, the Election Deadline will be </font><font style="font-weight: bold;">extended until up to three business days prior to the new anticipated closing date.</font> In this event, F&amp;M will inform you of the new Election Deadline by issuance of a press release, which will be filed with the Securities and Exchange Commission at least five business days prior to the anticipated closing date.</div><div class="para" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 6pt; margin-left: 0pt; text-indent: 20pt; text-align: justify;">We make no recommendation as to whether you should elect to receive F&amp;M common stock, cash, or a combination of F&amp;M common stock and cash. Each shareholder must make the shareholder&#8217;s own decision, bearing in mind the consideration received and the tax consequences of the election chosen.</div><div class="para" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; font-weight: bold; margin-top: 6pt; margin-left: 0pt; text-indent: 20pt; text-align: justify;">Please make sure that you submit the Certificate(s) representing your PFSB common stock with your Election Form/Letter of Transmittal.<font style="font-weight: normal;"> If the Exchange Agent does not receive a properly completed and executed </font><font style="font-weight: normal;">Election Form/Letter of Transmittal accompanied by your Certificate(s) (duly endorsed in blank or otherwise in a </font><font style="font-weight: normal;">form acceptable for transfer on the books of F&amp;M if the Election Form/Letter of Transmittal is not executed by the </font><font style="font-weight: normal;">person in whose name the shares are registered), and any other documentation required by the instructions to the </font></div></div></div></div>
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<div class="page" style="text-align: left; margin: auto; position: relative; width: 468pt;"><a name="ny20000091x2_posam_400-ex99-3_pg15"><!--Anchor--></a><div class="page-content"><div class="block-main" style="width: 468pt; margin-left: 0pt;"><div class="para" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 6.75pt; margin-left: 0pt; text-align: justify;">Election Form/Letter of Transmittal, your election will be deemed to be invalid and the form of consideration you will receive will be determined for you in accordance with the terms of the Merger Agreement. <font style="font-weight: bold;">In addition, if you </font><font style="font-weight: bold;">are representing a trust or an estate, see the instructions to the Election Form/Letter of Transmittal for </font><font style="font-weight: bold;">additional documentation that must be submitted.</font></div><div class="para" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 6pt; margin-left: 0pt; text-indent: 20pt; text-align: justify;">If you have any questions concerning the completion of the Election Form/Letter of Transmittal, please call the Exchange Agent at 855-793-5068 between 9:00 a.m. and 5:00 p.m., Eastern Time, Monday through Friday.</div><table cellspacing="0" cellpadding="0" class="txttab" style="margin-top: 4pt; border-collapse: collapse; width: 468pt; margin-left: auto; margin-right: auto;"><tr><td style="width: 48.72%; text-align: center; vertical-align: top; padding-top: 6pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; text-align: center;">Farmers &amp; Merchants Bancorp, Inc.</div></td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 6pt; padding-bottom: 3pt;">&#8203;</td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 6pt; padding-bottom: 3pt;">&#8203;</td><td style="width: 48.72%; text-align: center; vertical-align: bottom; padding-top: 6pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; margin-top: 0pt; text-align: center;">Perpetual Federal Savings Bank</div></td></tr><tr><td style="width: 48.72%; text-align: center; vertical-align: top; padding-top: 3pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt;">&#160;</div></td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 3pt;">&#8203;</td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 3pt;">&#8203;</td><td style="width: 48.72%; text-align: center; vertical-align: bottom; padding-top: 3pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt;">&#160;</div></td></tr><tr><td style="width: 48.72%; text-align: center; vertical-align: top; padding-top: 3pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt;">&#160;</div></td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 3pt;">&#8203;</td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 3pt;">&#8203;</td><td style="width: 48.72%; text-align: center; vertical-align: bottom; padding-top: 3pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt;">&#160;</div></td></tr><tr><td style="width: 48.72%; text-align: center; vertical-align: top; padding-top: 3pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; font-style: italic; margin-top: 0pt; text-align: center;">Lars B. Eller<font style="font-style: normal;"> </font><br></div><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; font-style: italic; margin-top: 0pt; text-align: center;"><font style="font-style: normal;">President and Chief Executive Officer </font><br></div><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; font-style: italic; margin-top: 0pt; text-align: center;"><font style="font-style: normal;">FARMERS &amp; MERCHANTS BANCORP, INC. </font></div></td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 3pt;">&#8203;</td><td class="gutter" style="width: 1.28%; border-bottom: none; font-size: 2pt; padding-top: 3pt; padding-bottom: 3pt;">&#8203;</td><td style="width: 48.72%; text-align: center; vertical-align: bottom; padding-top: 3pt; padding-bottom: 3pt;"><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; font-style: italic; margin-top: 0pt; text-align: center;">Michael R. Melvin<font style="font-style: normal;"> </font><br></div><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; font-style: italic; margin-top: 0pt; text-align: center;"><font style="font-style: normal;">President and Chief Executive Officer </font><br></div><div class="fpara" style="color: #000000; font-family: 'Times New Roman', Times, serif; font-size: 10pt; font-style: italic; margin-top: 0pt; text-align: center;"><font style="font-style: normal;">PERPETUAL FEDERAL SAVINGS BANK OF </font><font style="font-style: normal;">URBANA</font></div></td></tr></table></div></div></div>
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