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APPLICATION FOR DEFERRED ANNUITY * LIBERTY NATIONAL LIFE INSURANCE COMPANY ADMINISTRATIVE OFFICE: P.O. BOX 8080 * MCKINNEY, TX 750708080 Plan CodeAnnuitant Telephone No. Home Office Use Only ANNUITANT's

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Lann-ap 26008 - activated is a form used for reporting activated accounts.

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Any individual or business entity that has activated accounts is required to file lann-ap 26008.

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