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Get the free TRADITIONAL_IRA_TRUST_APP_FORM_2300-T.pdf. Member Dental Claim Form - CareFirst

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TRADITIONAL IRA TRUST APPLICATION PACKET (FORM 2300-T) Please Print or Type QUID (Credit Union will complete) IRA Owner s Name (First, Initial, Last) — IRA Owner s Social Security Number
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A traditional IRA trust account form for dental claims submitted by members.
Members of the traditional IRA trust who have dental expenses to claim.
The form must be completed with all relevant information regarding the dental expenses being claimed.
The purpose is to document and claim dental expenses incurred by members of the traditional IRA trust.
Information about the dental expenses, including the date of service, the provider, and the cost.
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