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Get Application For Refund/Rollover Form (pdf) - Nebraska Public ...

Any after tax contributions will be sent to you unless you are rolling to a Roth IRA. COMBINATION REFUND / DIRECT ROLLOVER ROTH IRA PLAN I understand that 20 federal income tax withholding and 5 Nebraska state income tax withholding for Nebraska residents will apply to the refund portion of my distribution. Lump Sum Portion - Please refund OR of my acount directly to me and Rollover Portion - roll the remaining portion of my account to This form .

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