ANNUITY DISTRIBUTION REQUEST - Marketing …

Lincoln Financial Group is the Marketing name for Lincoln National Corporation and its affiliates. page 1 of 3AN07301 4/12 The Lincoln National Life Insurance Company ( Company )Lincoln Life & ANNUITY Company of New York ( Company )Servicing Office: PO Box 2348, Fort Wayne IN 46801-2348 Fax Number 260 Address: Lincoln Financial Group, Inforce - IA1300 S Clinton St., Fort Wayne IN 46802-3506 ANNUITY 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 INFORMATIONC ontract Number _____Contract Owner s Name _____Issued by h The Lincoln National Life Insurance Company h Lincoln Life & ANNUITY Company of New YorkSocial Security Number (Last 4 digits) _____ Date of Birth _____Telephone Number Daytime _____ Evening _____IMPORTANT INFORMATIONd The information contained on this form is based on the Company s understanding of curr

Lincoln Financial Group is the marketing name for Lincoln National Corporation and its affiliates. Page 1 of 3 AN07301 4/12 The Lincoln National Life …

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