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T S ESTATE BEING SETTLED WITHOUT ADMINISTRATION OMB No. 1535-0118 Visit us on the Web at www.treasurydirect.gov IMPORTANT: Follow instructions in filling out this form. You should be aware that the making of any false, fictitious, or fraudulent claim or statement to the United States is a crime that is punishable by fine and/or imprisonment. PRINT IN INK OR TYPE ALL INFORMATION A person qualified by the Department of the Treasury to act as voluntary representative must use this form to requ.

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