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Get Apple Request For Settlement Of Account Form

Participant Signature Date Return this completed Request for Settlement of Account Form plus the certified copy of the death certificate if applicable directly to Mail MidAmerica Administrative Solutions Attn APPLE 211 East Main Street Suite 100 Lakeland FL 33801 or Fax 863-688-4200 PLEASE NOTE You MUST complete the attached W-9 in order for your distribution to be processed. APPLERMDRSAForm2013.

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