Power of Attorney and Declaration of Representatives
before the Department of the Treasury
for the
Local 805 Pension and Retirement Plan

Applicant

The Board of Trustees of the Local 805 Pension and Retirement Fund
60 Broad Street

37th Floor

New York, NY 10004

Contact: Linda Kellner, Plan Manager

T: (212) 308-4200

F: (212) 308-4545

E: lkellner@savastaandco.com

Plan Number: 001

Plan EIN: 13-1917612

Applicant hereby appoints the following representative(s) as attorney(s)-in-fact to represent the
taxpayer before the Department of the Treasury and perform acts related to the attached application
dated February 23, 2018 for suspension of benefits under §432(e)(9) of the Internal Revenue Code
of 1986, as amended.

Representatives' information:

Craig A. Voelker

Principal and Senior Consulting Actuar
O'Sullivan Associates SREREITAE
1236 Brace Road, UnitE
Cherry Hill, NJ 08034

T: (856) 795-7777 x214

Fax: (856) 795-7779

E: evoelker@osullivanassociates.com

Enrolled Actuary No: 17-05537

Send copies of notices and communications to representative: YES.

With the exception of the acts described below, I authorize my representative(s) to receive and
inspect information, including confidential tax information and to perform acts that I can perform
with respect to the attached application dated February 23, 2018 for suspension of benefits under
§432(e)(9). For example, my representative(s) shall have the authority to sign any agreements,
consents, or similar documents.

Specific acts not authorized: None.


Date:_

Title: Union Trustee Title: Employer Trustee

Name: Lae: _ Name:__ =
Date:___ Date: =

Title: Union Trustee Title: Employer Trustee

Declaration of Representatives

Under penalties of perjury, by my signature below I declare that:
¢ Tam not currently suspended or disbarred from practice before the Internal Revenue
Service;
« Iam authorized to represent the Applicant for the matter(s) specified in this Power of
Attomey and Declaration of Representative; and
e Tam one of the following:
a) Attorney - a member in good standing of the bar of the highest court of the jurisdiction
shown below.
b) Certified Public Accountant — duly qualified to practice as a certified public accountant
in the jurisdiction shown below.
c) Enrolled Agent
d) Officer — a bona fide officer of the Applicant.
e) Full-Time Employee — a full-time employee of the Applicant
f) Enrolled Actuary — enrolled as an actuary by the Joint Board for the Enrollment of
Actuaries under 29 U.S.C. 1242 (the authority to practice before the Internal Revenue
Service is limited by section 10.3(d) of Circular 230).
g) Enrolled Retirement Plan Agent

Required information for Representative: Enrolled Actuary, Enrolled Actuary No 17-05537

Signature of Representative and Date:
Redacted by the U.S. Department of the



Signatures of Applicant and Date

Name: re Name}

a
Date : Date: Qa A, 20/8
Title: Union Trustee Title: Employer Trustee
Name: Name: —— —
Date: a Date:
Title: Union Trustee Title: Employer Trustee

Declaration of Representatives

Under penalties of perjury, by my signature below I declare that:
e Iam not currently suspended or disbarred from practice before the Internal Revenue
Service;
e Tam authorized to represent the Applicant for the matter(s) specified in this Power of
Attorney and Declaration of Representative; and
e Tam one of the following:
a) Attorney ~ a member in good standing of the bar of the highest court of the jurisdiction
shown below.
b) Certified Public Accountant — duly qualified to practice as a certified public accountant
in the jurisdiction shown below.
c) Enrolled Agent
d) Officer — a bona fide officer of the Applicant
e) Full-Time Employee — a full-time employee of the Applicant
f) Enrolled Actuary — enrolled as an actuary by the Joint Board for the Enrollment of
Actuaries under 29 U.S.C. 1242 (the authority to practice before the Internal Revenue
Service is limited by section 10.3(d) of Circular 230).
g) Enrolled Retirement Plan Agent

Required information for Representative: Enrolled Actuary, Enrolled Actuary No 17-05537

Signature of Representative and Date:
Redacted by the U.S. Department of the