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Get Form 5305-r (rev. January 1998 )

Of birth of grantor Address of grantor DO NOT File with the Internal Revenue Service Social security number Check if Roth Conversion IRA Check if Amendment Name of trustee Address or principal place of business of trustee The grantor whose name appears 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 trustee named above has given the grantor t.

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