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Get Form 5305-R (Rev. January 2000). Roth Individual Retirement Trust Account

The Internal Revenue Code) Name of grantor Date of birth of grantor Social security number Address of grantor Check if Amendment Name of trustee Address or principal place of business of trustee The grantor whose name appears above is establishing a Roth individual retirement account (Roth IRA) under section 408A to provide for his or her retirement and for the support of his or her beneficiaries after death. The trustee named above has given the grantor the disclosure statement requi.

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