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57(b) governmental employer plan. Fill in by hand using CAPITAL letters and black ink, or on screen (if electronic file). If you need more room for information or signatures, use a copy of the relevant page. Helpful To Know •  ou can only take a distribution if you meet one of the Y criteria for eligibility (see Section 3). If you are a beneficiary or qualified alternate payee, call Fidelity instead of using this form. •  orkplace retirement plan distributions may have tax W consequences.

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