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Get IRS 5305-SA 2016

T Address of participant Name of custodian Do not file with the Internal Revenue Service Date of birth of participant Check if transfer SIMPLE IRA Check if amendment . . . Address or principal place of business of custodian . . The participant named above is establishing a savings incentive match plan for employees of small employers individual retirement account (SIMPLE IRA) under sections 408(a) and 408(p) to provide for his or her retirement and for the support of his or her bene.

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