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CHAMPLAIN INVESTMENT PARTNERS Sections 14 and 6 must be read and completed for all applications. Section 5 is an optional service. Section 7 must be completed by SET Private Trust Company. If you
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Kansas CHAMPLAIN accountholder Roth NAMEPERCENT Householding nonresident 7th CSC-AP-003-0300 STATEZIP W-8 accountholders abovenamed DST SIGNATUREDATE BYDATE designating iii designates certifying Rollover referenced cashiers DESIGNATION adopts applicable S

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