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Get United of Omaha Life Insurance Change of Ownership Form

_________ State_______  ZIP_________ Tax ID/Social Security No._________________________ ( ) Telephone______________________________________ (Attach the above information for any Co-Trustee) If the Current Owner is a Trust, please send a copy of the pages showing that the Trust has been executed and identifying the Trustee(s) and Successor Trustee(s). L6501_1212 Please see reverse side Authorized Signature: United of Omaha Life Insurance Company is not responsible for the sufficiency or .

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