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Get Lasers Acceptance Letter Of Rollover Of Assets Form

922. 0600 Toll-Free 1. 800. 256. 3000 225. 922. 0612 hearing impaired LASERS Acceptance Letter of Rollover of Assets Member s First Name Middle Name Last Name Today s Date Social Security Number SECTION 1 MEMBER S INFORMATION AND AUTHORIZATION Member s Mailing Address Daytime Area Code/Phone Number City State Evening Area Code/Phone Number E-mail Address Zip Code Member s Birth Date I hereby authorize to make a direct rollover of my qualified acc.

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