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Nationwide` <br />is on your side <br />Nationwide Investment Advisors, LLC <br />Nationwide ProAccounto <br />Plan Sponsor Nationwide ProAccounte Program Termination Form <br />Instructions: Complete this form in its entirety only if you wish to terminate your plan's <br />participation the managed account program, Nationwide ProAccountO. If you have any questions, <br />please call 1-877-677-3678. Once we receive this form, we will process It and the ProAccount <br />program termination will be effective as soon as administratively feasible upon acceptance of this <br />notice by NIA. Once your plan's agreement has been terminated, a letter will be sent to each <br />participant enrolled in ProAccount, letting them know their retirement plan account is no longer <br />under management and they have full control over any investment changes going forward. <br />This form is being completed for the following plan types: <br />X) 457(b) ❑ 401(a) ❑ 401(k) ❑ 403(b) <br />09 By checking the box at the left and signing on the line below, i am acknowledging that i <br />no longer want to have Nationwide Investment Advisors, LLC offer its managed account <br />service on the plan stated below. I understand that all active ProAccount participants will <br />be terminated from ProAccount and sent a termination confirmation letter. All investments <br />will remain in their current allocations until participants proactively make changes. <br />Employer Name <br />Indian River County BOCC 457 <br />Employer Number <br />0036758001 <br />Employer Contact Name (Please Print) <br />Employer Contact Title (Please Print) <br />Employ r tact Signat Ier" <br />Date <br />Nationwide Ls`tmen t Advisors, LLC, an SEC -registered investment adviser, is the investment adviser for Nationwide <br />ProAccount®. Nationwide, Nationwide ProAccount, the Nationwide N and Eagle and Nationwide is on your side are <br />service marks of Nationwide Mutual Insurance Company. <br />NRN-1678AO (06/2017) <br />Nationwide investment Advisors, LLC - Nationwide ProAccount® <br />P.O. Box 182797 • Columbus, OH 43218-2797 <br />Ph: (888) 540-2896 • Fax: (877) 677-4329 <br />135 <br />