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Get 871 Insurance Form

: Annuity Service Center 1050 N. Western Street Amarillo, TX 79106-7011 1. PERSONAL INFORMATION Owner: Annuitant (if different from owner): Address: City/State/Zip: Joint Owner: Social Security Number: Phone: 2. CONTRACT/POLICIES TO BE TRANSFERRED Account/Contract No. Company Address The above contract(s) is enclosed misplaced Phone 3. TYPE OF WITHDRAWAL Total withdrawal FROM Annuities Partial Withdrawal Life Insurance 4. SOURCE OF TRANSFER (For D.

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