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Notarized form for your file. Your signature on the Change of Beneficiary Form must be notarized at the time you sign it. Change of Beneficiary Form received without signature, date, or notarization is invalid. Please note that this completed and notarized Change of Beneficiary Form will designate who receives your Death Benefit. No changes will be made until a new completed and notarized form is received at the following address: DC 37 Health and Security Plan 125 Barclay Street, Room 811 New.

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