ANNUITY DISTRIBUTION REQUEST - Marketing …

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Lincoln Financial Group is the Marketing name for Lincoln National Corporation and its affiliates. Page 1 of 3AN07301 4/12The Lincoln National Life Insurance Company ( Company )Lincoln Life & ANNUITY Company of New York ( Company )Servicing Office: PO Box 2348, Fort Wayne IN 46801-2348Fax Number 260 Address: Lincoln Financial Group, Inforce - IA1300 S Clinton St., Fort Wayne IN 46802-3506ANNUITY DISTRIBUTION * REQUESTThis form should be used for the following markets: IRA/Roth/SEP/SARSEP/Non-QualifiedFor contracts** with the Lincoln Lifetime IncomeSM Edge living benefit riders, please use form AN10100 for CONTRACT INFORMATIONContract Number ________________________________________ ________________________________________ ____________Contract Owner s Name ________________________________________ __________________

Page 2 of 3 AN07301 4/12 *** Lincoln reserves the right to assess a fee; fees are subject to change. Variable Product Requests Only Dollar Amount/% Variable Subaccount

  Distribution, Request, Annuity, Annuity distribution request