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Fillable SIGN-UP FORM
Name

sf1199a

PRINT OR TYPE REPRESENTATIVE'S NAME. SIGNATURE OF REPRESENTATIVE. TELEPHONE NUMBER. DATE. STANDARD FORM 1199A. (Rev. 9/83). Prescribed by Treasury




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Kansas Missouri payee OPM cer 1199A benefitsagency tion NSN stitution tify plete agress Cir APO UMB annuitant OMB


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