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Ection 408A of the Internal Revenue Code) Date of birth of depositor Do not file with the Internal Revenue Service Social security number Address of depositor Check if amendment Name of custodian Address or principal place of business of custodian The depositor named above is establishing a Roth individual retirement account (Roth IRA) under section 408A to provide for his or her retirement and for the support of his or her beneficiaries after death. The custodian named above has given.

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