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Wflains. org FAX 319 538-0268 Application for Membership and Individual Annuity SECTION A Annuitant 1. Sex 7. Marital Status 8. US Citizen M F M S Yes No home Maiden/Former 10. E-mail cell 12. Street Address City State Zip Code SECTION B Owner complete only if different than annuitant Annuitant must be Owner in qualified plans M F M S Yes No SECTION C Beneficiary ies Annuitant s Primary Beneficiary ies Print full names and addresses Relationship to Date of Birth SSN or Tax ID No....
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