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Exhibit 4.1 

 
Please follow these instructions carefully. Failure to do so may result in the rejection of your subscription. 	
	1. INVESTMENT INFORMATION

A minimum investment of $5,000 is required. A check for the full purchase price of the shares subscribed for should be made payable to “Wells Timberland REIT, Inc.” Only persons meeting the standards set forth under the “Suitability Standards” section of the Prospectus may purchase shares. Please indicate the state in which the sale was made if other than the state of residence. 
All additional investments must be for a minimum of $100. If additional investments in Wells Timberland REIT, Inc. (the “Company”) are made, the investor agrees to notify the participating broker/dealer (“Broker/Dealer”) or investment adviser named in Section 8 of the Subscription Agreement. 
Note: DUE TO ANTI-MONEY LAUNDERING CONSIDERATIONS, THE COMPANY WILL NOT ACCEPT CASH, THIRD-PARTY CHECKS, MONEY ORDERS, TRAVELER'S CHECKS, STARTER CHECKS, OR COUNTER CHECKS.
	
	2. TYPE OF OWNERSHIP

Please check the appropriate box to indicate the account type of subscribing investor.
In order to effect a Transfer on Death (TOD) account registration, a Designation of TOD Beneficiary Form must be completed and submitted with the Subscription Agreement.
	
	3. REGISTRATION AND CONTACT INFORMATION

USA PATRIOT Act Requirements
The U.S. Government, through its efforts to fight terrorism and money laundering, requires us to obtain information in Section 3. This information will be verified. If incomplete or inaccurate, this application may be rejected, and the settlement of your purchase will be delayed.
Please enter the exact name in which the Shares are to be held:
		
	•    
	Joint tenants with right of survivorship or tenants-in-common, include the names of both investors. 

		
	•    
	Partnerships or corporations, include the name of an individual to whom correspondence will be addressed.

		
	•    
	Trusts should include the Name and Tax Identification Number of the Trust. Also, please provide the Name(s), Social Security number(s), and Date(s) of Birth(s) of the Trustee(s).

All investors must complete the space provided for Social Security or Taxpayer Identification Number. By signing in Section 7, the investor is certifying that this number is correct. Enter the mailing address and telephone numbers of the registered owner of this investment. In the case of a qualified plan or trust, this will be the address of the trustee. The birth date of the registered owner(s) or trustee(s) is required unless the registered owner is a business entity. 	
	4. INSTITUTIONAL INFORMATION

If the investment is being made for an account held with a custodian, the custodian information should be entered here.  Fill in the Custodian Name, Address, Telephone Number, and Tax ID along with the Custodian Account Number. An authorized individual must sign the form approving the investment and include either the Custodian’s Signature Guarantee Stamp or a Corporate Resolution naming the authorized signer along with an example of their signature.
*CUSTODIAL ACCOUNTS: By signing the Subscription Agreement, the Custodian authorizes the investor to vote the number of shares of common stock of Wells Timberland REIT, Inc. that are beneficially owned by the investor as reflected in the records of Wells Timberland REIT, Inc. as of the applicable record date at any meeting of the stockholders of Wells Timberland REIT, Inc. This authorization shall remain in place until revoked in writing by the Custodian. Wells Timberland REIT, Inc. is hereby authorized to notify the investor of his or her right to vote consistent with this authorization.	
	5. ELECTRONIC DELIVERY ELECTION

We encourage you to reduce printing and mailing costs and to conserve natural resources by electing to receive electronic delivery of stockholder communications and statement notifications. By consenting below to electronically receive stockholder communications, including your account-specific information, you authorize Wells Timberland to either (i) e-mail stockholder communications to you directly or (ii) make them available on its Investor website at www.WellsTimberland.com and notify you by e-mail when such documents are available. 
You will not receive paper copies of these electronic materials unless specifically requested. 
The stockholder communications we may offer electronically include annual reports, proxy materials, and any other documents that may be required to be delivered under federal or state securities laws as well as account-specific information, such as quarterly account statements or tax information (“Account information”). In addition, by consenting to electronic access, you will be responsible for your customary Internet Service Provider charges (i.e., online fees) in connection with access to these materials. Account information may be accessed only via the Investor website as described in option (ii) in the above paragraph. Your consent will be effective until you revoke it. 
JOINT ACCOUNTS: If your Social Security number is the primary number on a joint account and you opt-in to electronic delivery, each consenting stockholder must have access to the e-mail account provided. 
Continued on next page
 

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	6. DISTRIBUTION INFORMATION

ONLY ONE OF THE OPTIONS MAY BE SELECTED. IF THIS SECTION IS NOT COMPLETED, DISTRIBUTIONS WILL BE PAID TO THE REGISTERED OWNER (OR CUSTODIAN, IF APPLICABLE). 
Please check the appropriate box to indicate to whom the distributions should be paid, in what form they should be paid, and the address of the individual(s) or institution receiving the distribution if distributions are to be paid to a third party. If no box is checked in this section, the funds will be paid to the registered owner (or custodian, if applicable). 
For a discussion of the Distribution Reinvestment Plan, please see the section of the Prospectus entitled “Description of Shares - Distribution Reinvestment Plan.” 
To receive your distributions via Electronic Funds Transfer, please check the highlighted box on the subscription document. 	
	7. SUBSCRIBER SIGNATURES

Please separately initial the representations where indicated. Note the higher suitability requirements described in the Prospectus and/or supplements for residents of certain states. Many states have restrictions on net worth and income requirements, and some states have restrictions on concentration in certain types of investments or concentrations of investments offered by the same sponsor. Please initial this only after you have discussed your specific state requirements with your financial representative. Except in the case of fiduciary accounts, the investor may not grant any person a power of attorney to make such representations on his or her behalf. Each investor must sign and date this section. If title is to be held jointly, all parties must sign. If the registered owner is a partnership, corporation, or trust, a general partner, officer, or trustee of the entity must sign.
Note: THESE SIGNATURES DO NOT HAVE TO BE NOTARIZED.	
	8. BROKER/DEALER OR REGISTERED INVESTMENT ADVISER (RIA) INFORMATION

Who must sign this section. If the investment is made through an investment adviser unaffiliated with a broker/dealer (“Registered Investment Adviser”), Section 8 must be signed by an authorized representative of the Registered Investment Adviser. Otherwise, this section must be signed by an authorized representative of the participating Broker/Dealer. 
Required Representations. By signing this section, the Broker/Dealer or Registered Investment Adviser represents that he has made every reasonable effort to determine that the purchase of shares in this offering is a suitable and appropriate investment for each investor based on information provided by the investor regarding the investor’s financial situation and investment objectives. In making this determination, the Broker/Dealer or Registered Investment Adviser ascertained that the prospective stockholder:
		
	•    
	meets the minimum income and net worth standards set forth in the Prospectus at “Suitability Standards”;

		
	•    
	can reasonably benefit from an investment in the shares based on the prospective stockholder’s overall investment objectives and portfolio structure;

		
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	is able to bear the economic risk of the investment based on the prospective stockholder's overall financial situation and has apparent understanding of:

		
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	the fundamental risks of the investment;

		
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	the risk that the stockholder may lose the entire investment;

		
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	the lack of liquidity of the shares;

		
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	the restrictions on transferability of the shares;

		
	•    
	the background and qualifications of Wells Timberland Management Organization, LLC and its affiliates; and

		
	•    
	the tax consequences of the investment.

Relevant information for this purpose will include at least the age, investment objectives, investment experience, income, net worth, financial situation, and other investments of the prospective stockholder, as well as any other pertinent factors. The Broker/Dealer or Registered Investment Adviser agrees to maintain records of the information used to determine that an investment in shares is suitable and appropriate for the stockholder for a period of six years.
In addition, the registered representative of a Broker/Dealer represents that he or she and the Broker/Dealer are duly licensed to offer the shares in the state where the investment was made and in the state of the investor’s address set forth in Section 3 of the Subscription Agreement. A Registered Investment Adviser represents that such adviser is either registered under the Investment Advisers Act of 1940 or exempt from registration.
Commission. Please provide the Representative Number Commission Code to prevent delays in processing. Also, Broker/Dealers should select only one commission rate. “Full commission” may not be selected if the investment is made through an investment adviser representative compensated on a fee-for-service basis in connection with the sale or if the purchase is for a Broker/Dealer, its retirement plan, or its representative (or the retirement plan or family members of its representative).
Note: The Subscription Agreement, together with a check for the full purchase price, should be delivered or mailed to one of the addresses noted at the top of the Subscription Agreement by the Broker/Dealer or Registered Investment Adviser, as applicable. Only original, completed copies of Subscription Agreements can be accepted. The Company cannot accept photocopied or otherwise duplicated Subscription Agreements. 
 
IF YOU NEED FURTHER ASSISTANCE IN COMPLETING THIS SUBSCRIPTION AGREEMENT, PLEASE CALL 800-557-4830.

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For additional questions or assistance, please call Client Services at 800-557-4830 or 770-243-8282. You also may contact us by e-mail at client.services@wellsref.com or visit our Web site at www.WellsTimberland.com.  
				
	  1.  Investment Information
	 
	 
	 2. Type of Ownership

	   o  I have an existing account at Wells. My Account Number is                                      
 
Investment Type (Please check one)
                  Dollar Amount $                             
    o    Initial Investment (Minimum $5,000)               In the event of a discrepancy between the
                  dollar amount indicated above and that of the
                  actual check(s) received, the check amount(s)
    o  Additional Investment (Minimum $100)             will govern.
 
State in which sale was made if other than state of residence                             
 
Method of Payment
 
    o  Check Enclosed      o  Wire      o  Transfer Request      o  Cheek Under Separate Cover
 
                (Check Under Separate Cover may delay the processing of your investment)
 
Please make check(s) payable to: Wells Timberland REIT, Inc.
 
	 
	 
	     o  Individual 
          o  Transfer on Death Requires “Designation of TOD Beneficiary Form” 
    o  Joint Tenants with Right of Survivorship
          o  Transfer on Death Requires “Designation of TOD Beneficiary Form”
    o  IRA                          Type                                                                                 
    o  Trust/Trust                                                                                                        
          Please specify Family, Living, Revocable, etc.
    o  UGMA                     State                                                                                
    o  UTMA                     State                                                                                
    o  Community Property
    o  Tenants-in-Common
    o  Qualified Plan          Type                                                                               
    o  Other                                                                                                                

	WE DO NOT ACCEPT Cash, Third-Party Checks, Money Orders, Traveler's Checks, Starter Checks, or Counter Checks, due to Anti-Money Laundering considerations.
	 
	 
	 

 
	
	  3.  Registration and Contact Information

	    o  Mr.      o  Mrs.      o  Ms.      o  M.D.      o  Ph.D.      o  D.D.S.      o  Other                                                                                       

 
							
	1st Registration
	Investor Name/Business Entity/Trust Name
	Social Security/Taxpayer ID Number
	 
	Birth Date

	 
	 
	 
	 
	 
	 
	 

	2nd Registration
	Investor Name/Trustee Name
	Social Security/Taxpayer ID Number
	 
	Birth Date

	 
	 
	 
	 
	 
	 
	 

	3rd Registration
	Investor Name/Trustee Name
	Social Security/Taxpayer ID Number
	 
	Birth Date

	 
	 
	 
	 
	 
	 
	 

	Investor Street Address (Required by USA PATRIOT Act)
	 
	City
	State
	 
	Zip

	 
	 
	 
	 
	 
	 
	 

	Investor Mailing Address (if different)
	 
	City
	State
	 
	Zip

	 
	 
	 
	 
	 
	 
	 

	Investor Home Telephone
	 
	Investor Business Telephone
	 
	 
	 

		
	 
	    o  U.S Citizen    o  Resident Alien - Country of Origin                                                    o  Nonresident Alien - Country of Origin                                                

A U.S. street address and a U.S. Social Security number or Taxpayer Identification Number are required to open an account. In addition, Nonresident Aliens also must supply IRS Form W-8BEN 
 
 
Continued on next page
 

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	  4.  Custodial Institution Information
	 
	 
	 

	 
	 
	 
	[Affix Signature Guarantee Stamp Here]

	Custodian Name
	 
	 
	 

	 
	 
	 
	 

	Custodian Address
	 
	City
	State
	Zip
	 
	 
	 

	 
	 
	 
	 

	Telephone
	 
	Custodian Tax ID
	 
	 
	 
	 
	 

	 
	 
	 
	 

	Custodian Account Number
	 
	 
	 

	 
	 
	 
	 

	Custodian Signature (Required)
*By signing above, Custodian makes the authorization described in Instruction No. 4 to this Subscription Agreement
	 
	 

	
	  5.  Electronic Delivery Election

We encourage you to reduce printing and mailing costs. Please review the accompanying instructions carefully and check the items below. 
		
	Would you like to receive stockholder communications electronically?
	    o  Yes          o  No        

	Would you like to receive your quarterly statement(s) online?
	    o  Yes          o  No        

	My e-mail address is                                                                                                                                                                        .

    Your e-mail address will be held in confidence and used only for matters relating to your Wells Timberland REIT investments. 
	
	  6. Dividend Information

If you elect to participate in the Distribution Reinvestment Plan, you must agree that if at any time you fail to meet the applicable income and net worth standards or you cannot make the other investor representations or warranties set forth in the then-current Prospectus or the Subscription Agreement relating to such investment, you will promptly notify Wells Timberland REIT in writing of that fact.
NOTE: If you have checked “IRA” in Section 2 and listed State Street Bank & Trust as custodian in Section 4, please disregard this section unless you are electing distribution reinvestment. If requesting an IRA trustee-to-trustee transfer, please complete the transfer paperwork of the accepting institution; Custodian’s Medallion Signature Guarantee stamp required. For all other options the State Street Bank & Trust IRA Distribution form is required.
ONLY ONE OF THE FOLLOWING OPTIONS MAY BE SELECTED. If this section is not completed, distributions will be paid to the registered owner (or custodian, if applicable) at the address above. 		
	o
	I prefer to participate in the Distribution Reinvestment Plan. (If selling commission is being waived, attach the Distribution Reinvestment Plan - Discounted Shares form.)

	o
	I prefer to receive a distribution check at the address of record for my account or, if applicable, the custodian of record as indicated in Section 4.

	o
	I prefer to receive my distributions via Electronic Funds Transfer into the following checking account:

 
							
	Institution Name
	 
	Account Name
	 
	Institution ABA Number
	 
	Account Number

 
										
	
	TERMS OF AGREEMENT: I/We authorize and direct Wells Timberland REIT to begin making electronic deposits into the checking account designated above or on the attached voided check. An automated deposit entry shall constitute my/our receipt for each transaction. This authority is to remain in force until Wells Timberland REIT has received written notification from me/us of its termination at such time and in such manner as to give Wells Timberland REIT reasonable time to act on it.
     
o   I prefer to have my distributions paid to a third party for the benefit of the registered owner at the following address (option not available if a      custodian is listed on the account):

	 
	 
	 
	 
	 
	 
	 
	 
	 

	Last Name/Third-Party Institution
	 
	First
	 
	  
	Middle
	  
	Telephone Number

	 
	 
	 
	 
	 
	 
	 
	 
	 

	Address
	  
	 
	  
	 
	  
	 
	  
	 

	 
	 
	 
	 
	 
	 
	 
	 
	 

	City
	  
	 
	  
	State
	  
	Zip
	  
	External Account Number

 	
	  7. Subscriber Signatures

Please separately initial each of the representations in (a) through (d) below, and the remaining representations as applicable. Except in the case of fiduciary accounts, you may not grant any person a power of attorney to make such representations on your behalf. In order to induce Wells Timberland REIT, Inc. (the “Company”) to accept this subscription, I hereby represent and warrant to you as follows: 

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	Primary
Investor
	  
	Joint Investor
	  
	Joint Investor
	  
	 

	 
	  
	 
	  
	 
	(a) I have received a final Prospectus and accept the conditions of the Wells Real Estate Funds Privacy Notice. I acknowledge that the Company will not complete a sale of shares to me until at least five business days after the date I have received a final prospectus. I will receive a written confirmation of purchase. If I choose to cancel the subscription by providing a written request to the Company that is received prior to completion of the sale, I am entitled to a refund of the subscription amount. If the Company rejects my subscription, I will receive a refund of my subscription amount automatically.

	 Initials
	  
	Initials
	  
	Initials

	 
	  
	 
	  
	 
	  
	 

	 
	  
	 
	  
	 
	 
(b) I have (1) a net worth (exclusive of home, home furnishings, and automobiles) of $250,000 or more; or (2) a net worth (as described above) of at least $70,000 and had during the last tax year or estimate that I will have during the current tax year a minimum of $70,000 gross annual income, or I meet the higher income and net worth requirements imposed by my state of primary residence as set forth in the Prospectus under “Suitability Standards.” I will not purchase additional Shares unless I meet these income and net worth requirements at the time of final purchase.

	 Initials
	  
	Initials
	  
	Initials

	 
	  
	 
	  
	 
	  
	 

	 
	  
	 
	  
	 
	 
(c) I acknowledge that the Shares are not liquid.
	 

	Initials
	  
	Initials
	  
	Initials
	  
	 

	 
	 
	 
	 

	 
	  
	 
	  
	 
	(d) I am purchasing the Shares for my own account. (Fiduciaries should make the representation if purchasing for the fiduciary account.)

	Initials
	  
	Initials
	  
	Initials

	 
	 
	 
	 

	 
	  
	 
	  
	 
	(e) If I am an Alabama investor, I must have either (1) net worth of at least $350,000 or (2) annual gross income of at least $70,000 and a minimum net worth of $100,000. In addition, I must have a liquid net worth of at least 10 times my investment in this program and in other similar programs. If I am an Alabama investor, I am not eligible to participate in the Company’s automatic investment plan.

	Initials
	  
	Initials
	  
	Initials

	 
	 
	 
	 

	 
	  
	 
	  
	 
	(f) If I am a California, Massachusetts, Ohio, or Oregon investor, in addition to the suitability standards in 7(b) above, my investment in the Company may not exceed 10% of my liquid net worth.

	Initials
	  
	Initials
	  
	Initials

	 
	 
	 
	 

	 
	  
	 
	  
	 
	(g) If I am an Iowa investor, I have either (1) a minimum annual gross income of $70,000 and a minimum net worth of $100,000 or (2) a minimum net worth of $350,000. Additionally, I may invest no more than 10% of my liquid net worth in the Company or its affiliated programs.

	Initials
	  
	Initials
	  
	Initials

	 
	 
	 
	 

	 
	  
	 
	  
	 
	(h) If I am a Kansas investor, in addition to the suitability requirements in 7(b) above, I understand that the state of Kansas recommends that my aggregate investment in the Company and similar direct participation investments should not exceed 10% of my liquid net worth, which is defined as that portion of net worth which consists of cash, cash equivalents, and readily marketable securities.

	Initials
	  
	Initials
	  
	Initials

	 
	 
	 
	 

	 
	  
	 
	  
	 
	(i) If I am a Kentucky investor, I have either (1) a minimum annual gross income o $85,000 and a minimum net worth of $85,000 or (2) a minimum net worth of $300,000. Additionally, my investment in the Company may not exceed 10% of my liquid net worth.

	Initials
	  
	Initials
	  
	Initials

	 
	 
	 
	 

	 
	  
	 
	  
	 
	(j) If I am a Michigan investor, in addition to the suitability requirements in 7(b) above, my aggregate investment in the Company and similar direct participation investments may not exceed 10% of my liquid net worth.

	Initials
	  
	Initials
	  
	Initials

	 
	 
	 
	 

	 
	  
	 
	  
	 
	(k) If I am a New Jersey investor, I must have either (1) a minimum annual gross income of $200,000 and a minimum net worth of $200,000 or (2) a minimum net worth of $500,000 exclusive of home, home furnishings, and automobiles. Additionally, I may invest no more than 10% of my liquid net worth in the Company and affiliated programs.

	Initials
	  
	Initials
	  
	Initials

	 
	 
	 
	 

	 
	  
	 
	  
	 
	(l) If I am a Pennsylvania investor, in addition to the suitability requirements of 7(b) above, I have a net worth of at least 10 times my investment in the Company.

	Initials
	  
	Initials
	  
	Initials

	 
	 
	 
	 

	 
	  
	 
	  
	 
	(m) If I am a Tennessee investor, I must have either (1) a minimum annual gross income of $150,000 and a minimum net worth of $150,000 or (2) a minimum net worth of $500,000, exclusive of home, home furnishings, and automobiles.

	 Initials
	  
	Initials
	  
	Initials

I declare that the information supplied above is true and correct and may be relied upon by Wells Timberland REIT, Inc. in connection with my investment in the Company.
If the investor signing below is acquiring the shares through an IRA or will otherwise beneficially hold the shares through a Custodian, investor authorizes Wells Timberland REIT, Inc. to receive (on behalf of the investor) authorization for the investor to act as proxy for Custodian. This authorization, coupled with the Custodian authorization described in Instruction No. 4 to this Subscription Agreement, are intended to permit the investor to vote his or her shares even though the investor is not the record holder of the shares.
The Company will send you confirmation of your purchase upon acceptance of your subscription.
Under penalty of perjury, by signing this Signature Page, I hereby certify that (a) I have provided herein my correct Social Security number or Taxpayer Identification Number; (b) I am not subject to backup withholding as a result of a failure to report all interest or dividends, or the Internal Revenue Service has notified me that I am no longer subject to backup withholding; and (c) I am a U.S. Citizen unless I have indicated otherwise in Section 3.
I acknowledge that I will not be admitted as a stockholder until my investment has been accepted. Depositing of my check alone does not constitute acceptance. The acceptance process includes, but is not limited to, reviewing the Subscription Agreement for completeness and signatures, conducting an Anti-Money Laundering check as required by the USA Patriot Act, and depositing of funds.
I represent that I am not a person with whom dealings by U.S. persons are, unless licensed, prohibited under any Executive Order or federal regulation administered by the U.S. Treasury Department’s Office of Foreign Assets Control.
The Internal Revenue Service does not require your consent to any provision of this document other than the certifications required to avoid backup withholding. 										
	 
	 
	 
	 
	 
	 
	 
	 
	 
	 

	Signature of Investor or Trustee
	 
	Date    
	 
	Signature of Joint Owner, if applicable
	  
	Date    
	  
	Signature of Joint Owner, if applicable
	Date    

PLEASE NOTE THAT THIS MUST BE SIGNED AND INITIALED BY TRUSTEE(S) IF A QUALIFIED PLAN. THIS APPLICATION WILL NOT BE PROCESSED IF ANY SIGNATURES OR INITIALS ARE MISSING. 

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	  8. Broker/Dealer or Registered Investment Adviser (RIA) Information

 												
	The Broker/Dealer or RIA must make the representations described in the instructions to this Agreement by signing below to complete the order.
	  
	 
	 
	 
	 
	 
	 

	 
BROKER/DEALER OR RIA
	  
	 
	 
	Broker/Dealer or RIA Firm Telephone Number

	 
	  
	 
	  
	IARD/CRD number (if applicable)                                                              

	Broker/Dealer or RIA Firm Name
	  
	Broker/Dealer Account Number (if applicable)

	 
	  
	 
	  
	 

	Authorized Signature (if necessary)                                                                    Date
	  
	 
	 
	IARD/CRD NUMBER
	REP. COMISSION CODE

	 
	 
	 
	 
	 
	 
	 
	 
	 
	 
	 
	 

	INDIVIDUAL REPRESENTATIVE(S)
	  
	 

	 
	 
	 
	 
	 
	 
	 
	 
	 
	 
	 
	 

	 

	Primary Representative Name
	  
	Telephone Number
	  
	E-mail Address
	  
	Split % (if applicable)        

	 
	 
	 
	 
	 
	 
	 
	 
	 
	 
	 
	 

	 

	Secondary Representative Name
	  
	Telephone Number
	  
	E-mail Address
	  
	Split % (if applicable)        

	 
	 
	 
	 
	 
	 
	 
	 
	 
	 
	 
	 

	 

	Tertiary Representative Name
	  
	Telephone Number
	  
	E-mail Address
	  
	Split % (if applicable)        

	 

	 
	 
	 
	 
	 
	 
	 
	 
	 
	 
	 
	 

	Firm Name (if different from Broker/Dealer or RIA name)                Office Address                                   City                            State                          Zip
	Office Telephone        

 
THIS SUBSCRIPTION WAS MADE AS FOLLOWS: 
 				
	 
	o
	  
	Through a participating Broker/Dealer - Indicate the one correct commission rate below.

	 
	 
	 
	 

	 
	 
	  
	__ (1) Full commission

	 
	 
	 
	 

	 
	 
	  
	__ (2) Waiver of selling commission; purchase through an investment adviser

	 
	 
	 
	 

	 
	 
	  
	__ (3) Waiver of selling commission; purchase is for participating Broker/Dealer or its retirement plan, or for a representative of participating Broker/Dealer or his or her retirement plan or family member(s)

	 
	 
	 
	 

	 
	o
	  
	Through a representative and RIA unaffiliated with a Broker/Dealer (Certification of Client Suitability Form must be attached).

 
I am aware of all of the Prospectus Supplements that constitute a part of the Prospectus as of this date. I have ensured that all such Prospectus Supplements were delivered to the investor, and applicable state suitability guidelines were reviewed, prior to the investor's completion of the Subscription Agreement. 
 
								
	Primary Representative Signature
	Date
	 
	Secondary Representative Signature
	Date
	  
	Tertiary Representative Signature
	Date

 
PLEASE NOTE THAT THIS SUBSCRIPTION AGREEMENT CANNOT BE PROCESSED WITHOUT THE SIGNATURES OF ALL REPRESENTATIVES LISTED ABOVE. 
 
			
	TMMPFORMP1012-1045
	  
	© 2011 Wells Real Estate Funds

6WebFilings | EDGAR view

 

EXHIBIT 4.3
 
WELLS TIMBERLAND REIT, INC.
AMENDED AND RESTATED SHARE REDEMPTION PLAN
 
The board of directors (the “Board”) of Wells Timberland REIT, Inc., a Maryland corporation (the “Company”), has adopted a Share Redemption Plan (the “SRP”), the terms and conditions of which are set forth below. Capitalized terms shall have the same meaning as set forth in the Company’s charter unless otherwise defined herein. 
 
1. Share Redemption. Subject to the terms and conditions of the Company’s credit agreements and the terms and conditions of this SRP, including the limitations on redemptions set forth in paragraph 3 and the procedures for redemption set forth in paragraph 4, the Company will redeem such number of shares of the Company’s Common Stock (the “Shares”) as requested by a stockholder or the authorized representative of a stockholder. Redemptions sought on the special terms identified in paragraph 5 do not require a one-year holding period and are subject only to the overall limitation that, during any calendar year, aggregate redemptions may not exceed 100% of the net proceeds from our distribution reinvestment plan during the calendar year and any additional amounts reserved for such purpose by the Company’s board of directors.
 
2. Redemption Price. The price at which the Company will redeem a Share depends on whether the redemption is sought within two years of a stockholder’s death, Qualifying Disability (as defined in paragraph 6) or qualification for federal assistance for confinement to a Long-Term Care Facility (as defined in paragraph 7). The redemption of a Share that is not sought within two years of a stockholder’s death, Qualifying Disability or qualification for federal assistance for confinement to a Long-Term Care Facility is referred to as an “Ordinary Redemption.”
 
a. The price that the Company will pay to redeem Shares pursuant to an Ordinary Redemption is as follows:
 
i. through the end of the period of one year after the Company completes its offering stage, the redemption price will be at an amount per share equal to 91% of the aggregate amount paid to the Company for all Shares owned by such stockholder, divided by all Shares owned; and 
 
ii. following a period of one year after the Company completes its offering stage, 95% of the per share value of Shares, as estimated by the Company’s advisor or other firm chosen for that purpose.
 
b. The price that the Company will pay to redeem Shares within two years of a stockholder’s death, Qualifying Disability or qualification for federal assistance for confinement to a Long-Term Care Facility (each such redemption, a “Special Redemption”) is as follows:
 
i. through the end of a period of one year after the Company completes its offering stage, the redemption price will be at an amount per share equal to 100% of the aggregate amount paid to the Company for all Shares owned by such stockholder, divided by all Shares owned; and
 
ii. following a period of one year after the Company completes its offering stage, 100% of the aggregate amount paid to the Company for all Shares owned by such stockholder, divided by all Shares owned, plus or minus (x) a valuation adjustment (the aggregate 

 

 

distributions per Share of any net sale proceeds from the sale of one or more of the Company’s assets) and, or, (y) any other special distributions so designated by the Board.
 
Notwithstanding the foregoing, during any period in which the Company is engaged in a public offering of Shares, the purchase price paid to redeem any Shares shall not exceed the then-current offering price.
 
The Company will view its offering stage as complete upon the termination of its last public equity offering prior to the listing of its shares on a national securities exchange. For purposes of the SRP, the Company will exclude from the definition of “public equity offering” certain issuances by it as described under the “ERISA Considerations — Annual Valuation” subsection of the Company’s prospectus. The Company will report the redemption price in the annual report and the three quarterly reports it is required to publicly file with the U.S. Securities and Exchange Commission.
 
3. Limitations on Redemption. Notwithstanding anything contained in this SRP to the contrary, the Company’s obligation to redeem Shares pursuant to paragraph 1 hereof is limited as follows.
 
a. The Company will not redeem any Share pursuant to this SRP that has been transferred for value by a stockholder. After a transfer for value, the transferee and all subsequent holders of the share are not eligible to participate in the SRP.
 
b. The Company will not make an Ordinary Redemption of a Share until such Share has been issued and outstanding for at least one year, provided that, if the Company is redeeming all of a stockholder’s Shares, then the Company will redeem Shares purchased by such stockholder pursuant to the Company’s  distribution reinvestment plan, even if such Shares have not been issued and outstanding for at least one year.
 
c. During any calendar year, the Company will not redeem in excess of 5% of the weighted-average number of shares outstanding during the prior calendar year.
 
d. The Company will not redeem Shares on any Redemption Date (as defined in paragraph 4 below) to the extent that such redemptions would cause the aggregate amount paid for redemptions since the beginning of the then-current calendar year to exceed the sum of (x) 100% of the net proceeds from the Company’s distribution reinvestment plan during such period and (y) any additional amount reserved for such purpose by the Board.
 
4. Procedures for Redemption. The Company will redeem Shares on the last business day of each month (each such date a “Redemption Date”). For a stockholder’s Shares to be eligible for redemption on a given Redemption Date, the Company must receive a written redemption request at least five business days before the Redemption Date. If the Company cannot repurchase all Shares presented for redemption in any month, then the Company will attempt to honor redemption requests on a pro rata basis, except that (i) if a pro rata redemption would result in a stockholder owning less than half of the minimum amount described the “Plan of Distribution — Minimum Purchase Requirements” subsection of the Company’s prospectus, then the Company would redeem all of such stockholder’s Shares; and (ii) if a pro rata redemption would result in a stockholder owning more than half but less than all of the applicable minimum amount, then the Company would not redeem any Shares that would reduce a stockholder’s ownership of Shares below the applicable minimum amount. 
 
If the Company does not completely satisfy a redemption request at month-end because the Company did not receive the request in time, or because of the restrictions on the number of Shares the Company may 

 

 

redeem under the SRP, then the Company will treat the unsatisfied portion of the redemption request as a request for redemption at the next Redemption Date, unless the redemption request is withdrawn. Any stockholder may withdraw a redemption request by sending written notice to the Company at the address set forth in paragraph 7, provided such notice is received before the Redemption Date.
 
5. Special Provisions upon Death, Qualifying Disability or Qualification for Federal Assistance for Confinement to a Long-Term Care Facility. 
 
Notwithstanding anything herein to the contrary, the Company will treat redemption requests sought pursuant to a Special Redemption differently than Ordinary Redemptions, as follows:
 
a. There is no requirement that Shares be issued and outstanding for at least one year before being redeemed;
 
b. The Special Redemption pricing terms set forth in paragraph 2.b. will apply.
 
c. The limitation on redemptions set forth in paragraph 3.b. will not apply.
 
d. A stockholder that is a trust may only redeem on the terms available in connection with a Special Redemption if the deceased or disabled was the sole beneficiary of the trust, or if the only other beneficiary of the trust was the spouse of the deceased or disabled.
 
6. Qualifying Disability Determinations. In order for a stockholder’s disability to entitle such stockholder to the Special Redemption terms described in paragraph 5 (a “Qualifying Disability”), (1) the stockholder must receive a determination of disability based upon a physical or mental condition or impairment arising after the date the stockholder acquired the Shares to be redeemed, and (2) such determination of disability must be made by the governmental agency responsible for reviewing the disability retirement benefits that the stockholder could be eligible to receive (the “Applicable Government Agency”). The Applicable Government Agencies are limited to the following: (i) if the stockholder paid Social Security taxes and, therefore, could be eligible to receive Social Security disability benefits, then the Applicable Governmental Agency is the Social Security Administration or the agency charged with responsibility for administering Social Security disability benefits at that time if other than the Social Security Administration; (ii) if the stockholder did not pay Social Security taxes and, therefore, could not be eligible to receive Social Security disability benefits, but the stockholder could be eligible to receive disability benefits under the Civil Service Retirement System (“CSRS”), then the Applicable Governmental Agency is the U.S. Office of Personnel Management or the agency charged with responsibility for administering CSRS benefits at that time if other than the Office of Personnel Management; or (iii) if the stockholder did not pay Social Security taxes and, therefore, could not be eligible to receive Social Security benefits but suffered a disability that resulted in the stockholder’s discharge from military service under conditions that were other than dishonorable and, therefore, could be eligible to receive military disability benefits, then the Applicable Governmental Agency is the Department of Veterans Affairs or the agency charged with the responsibility for administering military disability benefits at that time if other than the Department of Veterans Affairs. 
 
A disability determination by a governmental agency for purposes other than those listed above, including but not limited to worker’s compensation insurance, administration or enforcement of the Rehabilitation Act or Americans with Disabilities Act, or waiver of insurance premiums will not be considered a Qualifying Disability. Redemption requests following an award by the Applicable Governmental Agency of disability benefits must be accompanied by: (1) the investor’s initial application for disability benefits and (2) a Social Security Administration Notice of Award, a U.S. Office of Personnel Management determination of disability 

 

 

under CSRS, a Department of Veterans Affairs record of disability-related discharge or such other documentation issued by the Applicable Governmental Agency that the Company deems acceptable and that demonstrates an award of the disability benefits.
 
Because the following disabilities do not entitle a worker to Social Security disability benefits, they will not be considered Qualifying Disabilities, except in the limited circumstances when the investor is awarded disability benefits by the other Applicable Governmental Agencies described above:
 
a. disabilities occurring after the legal retirement age;
 
b. temporary disabilities; and
 
c. disabilities that do not render a worker incapable of performing substantial gainful activity.
 
7. Qualifying for Federal Assistance for Confinement to a Long-Term Care Facility.
 
With respect to the Special Redemption terms described in paragraph 5 sought in connection with a stockholder (or stockholder’s spouse) qualifying for federal assistance for confinement to a Long-Term Care Facility, a “Long-Term Care Facility” shall mean an institution that: (a) either (i) is, approved by Medicare as a provider of skilled nursing care,  or (ii) is licensed as a skilled nursing home by the state or territory in which it is located (it must be within the United States, Puerto Rico, or U.S. Virgin Islands); and (b) meets all of the following requirements: (i) its main function is to provide skilled, intermediate or custodial nursing care; (ii) it provides continuous room and board to three or more persons; (iii) it is supervised by a registered nurse or licensed practical nurse; (iv) it keeps daily medical records of all medication dispensed; and (v) its primary service is other than to provide housing for residents.
 
A stockholder seeking a Special Redemption of his or her Shares in order to qualify for federal assistance for confinement of the stockholder (or the stockholder's spouse) to a Long-Term Care Facility must submit:  (a) a written statement from a licensed physician certifying either (i) the continuous and continuing confinement of the stockholder (or the stockholder's spouse) to a Long-Term Care Facility beginning at any time in the last two years, or (ii) that the licensed physician has determined that the stockholder (or the stockholder's spouse) should be or is eligible to be indefinitely confined to a Long-Term Care Facility; and (b) evidence satisfactory to the Company in its sole discretion that the redemption of the Shares and complete or partial exhaustion of the redemption proceeds is necessary for the stockholder (or the stockholder's spouse) to meet the income or asset levels required by applicable state or federal assistance programs in order to qualify for state or federal assistance in paying for his or her Long-Term Care Facility. The Company may not effect a Special Redemption of Shares if the stockholder seeking redemption was confined to (or eligible to be confined to) a Long-Term Care Facility on the date he or she became a stockholder. If the Shares are not held by a natural person, or through a revocable grantor trust or an IRA or other retirement or profit sharing plan, then the right of redemption described in this paragraph 7 does not apply. 
 
8. Termination, Suspension or Amendment of the SRP by the Company. The Company may amend, suspend or terminate the SRP for any reason upon 30 days’ notice to the Company’s stockholders. The Company will notify stockholders of such developments (i) in the quarterly reports mentioned in Section 2. above or (ii) by means of a separate mailing, accompanied by disclosure in a current or periodic report under the Securities Exchange Act of 1934, as amended. During the current public offering, the Company will also include this information in a prospectus supplement or post-effective amendment to the registration statement, as then required under federal securities laws.
 

 

 

The SRP provides stockholders a limited ability to redeem Shares for cash until a secondary market develops for the Shares. If and when such a secondary market develops, the SRP will terminate automatically.
 
9. Address for Notice of Redemption Requests. Stockholders who desire to redeem their shares must provide written notice to Wells Investment Securities at 6200 The Corners Parkway, Norcross, Georgia 30092-3365, Attn: Client Services. 
 
10. Liability of the Company. The Company shall not be liable for any act done in good faith or for any good faith omission to act.
 
11. Governing Law. The SRP shall be governed by the laws of the State of Maryland.

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