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Get HSA Distribution Request Form

- - - *Day Telephone *Mailing Address *City *State *Zip Code Updates or changes to your profile can be made by logging into your account at www.discoverybenefits.com Step 2: Distribution Information *Requested Amount: Select one of the following: Normal Disability Prohibited Transaction Excess Contribution Removal Transfer Transfer Check Payable to: Mail Check to: Death (a copy of the death certificate is required) Is the distribution taken in the year of death (if you circle yes, ski.

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