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Get IRA/Qualified Plan Distribution Request PDF - Evermore Global ...

Last four digits) CITY Date of Birth STATE ZIP CODE Daytime Phone I request a distribution from my Retirement Account as indicated above. I understand that it is my responsibility to determine that amounts distributed from my account shall be made in compliance with all Internal Revenue Service (IRS) regulations, including required minimum distribution rules and the death benefit rules, as applicable. We suggest that you contact your tax consultant to review which of the following choices.

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