IRA/ESA Automatic Contribution Cancellation

This form requires a notarized signature.

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Form Instructions

Please complete, print, sign, and notarize the form.

Mail to:
Star One Credit Union
Attn: IRA Services
P.O. Box 3643
Sunnyvale CA 94088-3643

Or fax to:
(408) 543-5203, Attn: IRA Services

Please complete a separate form for each IRA/ESA cancellation.

Learn more about Federal requirements, limitations, or policies in making annual contributions to your Traditional IRA or Roth IRA.

Your Information

Name

Member Number (Transfer from)

Contribution type

Payroll Allocation Savings Allocation

This cancellation request will take effect immediately. If I decide to restart the automatic contribution process, I understand a new automatic contribution form will need to be submitted.

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Member Signature

_________________________________________
Date

Star One Credit Union use only

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Processed By

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Date