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In the IRA assets, I hereby give to the IRA owner such interest in the assets held in this IRA and consent to the beneficiary designation set forth in this Application. Signature of Spouse Agent Name: Date Signature of Witness (if required) Date (Witness cannot be a beneficiary of this IRA) Referral Source Code: ITC: By entering this information, I understand that this Farm Bureau Agent has requested that Farm Bureau Bank, establish an account for me. Information perta.

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