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SIGNATURE DATE Office Use Only Shareholder ID Number Signature Verified Date S.S.No. Verified Date Revised 12/2016. 2. If the IRS notified you that you are subject to backup withholding because of underreported interest or dividends on your tax return you must cross out Section 2 below. Social Security Number Certification INSTRUCTIONS 1. Print and sign your name as it appears on your NNAI stock certificate. 3. Do not cross out Section 2 if you were once subject to backup withholding but have...
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