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Fillable Rollover Certification Form - FirstBank

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Rollover Certification 529 Plan Administrator Information FirstBank 10403 West Colfax Avenue Lakewood, CO 80215 (303) 232-2000 529 PLAN ACCOUNT IDENTIFICATION (ACCOUNT OWNER'S SOCIAL SECURITY NUMBER) Designated Beneficiary Information BENEFICIARY NAME (FIRST, MIDDLE INITIAL, LAST) DATE OF BIRTH SOCIAL SECURITY OR TAX ID NUMBER ADDRESS NUMBER AND STREET ADDRESS CONTINUED CITY, STATE, ZIP CODE HOME PHONE CELL...
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