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MTX-001 Distribution Request Form A PDF
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Residents of all states except Alabama, Arkansas, Colorado, District of Columbia, Florida, Kentucky, Louisiana, Maine, Maryland, New Jersey, New Mexico, New York,
Ohio, Oklahoma, Pennsylvania, Rhode Island, Tennessee and Washington, please note: Any person who knowingly, and with intent to defraud any insurance company or other
person, files or submits an application or statement of claim containing any materially false or deceptive information, or conceals, for the purpose of misleading, information concerning
any fact material thereto, commits a fraudulent insurance act, which is a crime and may subject such person to criminal and civil penalties.
For Arkansas, Colorado, Kentucky, Louisiana, Maine, New Mexico, Ohio, Rhode Island, Tennessee residents only: Any person who, knowingly and with intent to injure,
defraud or deceive any insurance company or other person, files an application for insurance or statement of claim containing any materially false information or conceals for the
purpose of misleading, information concerning any fact material thereto commits a fraudulent insurance act, which is a crime and may subject such person to criminal and civil
penalties, fines, imprisonment, or a denial of insurance benefits.
For Alabama residents only: Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or who knowingly presents false information in an
application for insurance is guilty of a crime and may be subject to restitution fines or confinement in prison, or any combination thereof.
For District of Columbia residents only: WARNING: it is a crime to provide false or misleading information to an insurer for the purpose of defrauding the insurer or any other
person. Penalties include imprisonment and/or fines. In addition, an insurer may deny insurance benefits if false information materially related to a claim was provided by the applicant.
For Florida and New Jersey residents only: Any person who knowingly and with intent to injure, defraud, or deceive any insurer files a statement of claim or an application
containing any false, incomplete, or misleading information is guilty of a felony of the third degree.
For Maryland residents only: Any person who knowingly or willfully presents a false or fraudulent claim for payment of a loss or benefit or who knowingly or willfully presents false
information in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison.
For New York residents only: Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim
containing any materially false information, or conceals for the purpose of misleading, information concerning any fact material thereto, commits a fraudulent insurance act, which is a
crime and shall also be subject to civil penalty not to exceed five thousand dollars and the stated value of the claim for each such violation.
For Oklahoma and Pennsylvania residents only: Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or
statement of claim containing any materially false information or conceals for the purpose of misleading, information concerning any fact material thereto commits a fraudulent
insurance act, which is a crime and subjects such person to criminal and civil penalties.
For Washington residents only: Any person who knowingly presents a false or fraudulent claim for payment of a loss or knowingly makes a false statement in an application for
insurance may be guilty of a criminal offense under state law.
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Mutual funds in the Lincoln Alliance® program are sold by prospectus. An investor should carefully consider the investment objectives, risks, and charges and expenses of the investment
company before investing. The prospectus and, if available, the summary prospectus contain this and other important information and should be read carefully before investing or sending
money. Investment values will fluctuate with changes in market conditions, so that upon withdrawal, your investment may be worth more or less than the amount originally invested. For
prospectus, please contact your Lincoln professional.
The Lincoln Alliance® program includes certain services provided by Lincoln Financial Advisors Corp. (LFA), a broker-dealer (member FINRA) and an affiliate of Lincoln Financial Group,
1300 S. Clinton St., Fort Wayne, IN 46802. Unaffiliated broker-dealers also may provide services to customers.
There are restrictions on the amount that can be withdrawn from the Lincoln Fixed Account and Lincoln Stable Value Account in a 12-month period.
Transfers from the Lincoln Stable Value Account may be subject to a 90-day equity wash.
The Lincoln NY Fixed Annuity is a group fixed annuity contract issued by Lincoln Life & Annuity Company of New York, Syracuse, NY, 13202 on Form 28866NY 05/04. Guarantees for the
Lincoln NY Fixed Annuity are subject to the claims-paying ability of the issuer.
The Lincoln Stable Value Account is a group fixed annuity contract issued by Lincoln Life & Annuity Company of New York, Syracuse, NY, 13202 on Form AR 700 10/09. Guarantees for
the Lincoln Stable Value Account are subject to the claims-paying ability of the issuer.
The Lincoln Stable Value Account is a fixed annuity contract issued by The Lincoln National Life Insurance Company, Fort Wayne, IN 46802 on Forms 28866-SV20 05/04, 28866-SV90
05/04, AR 700 10/09 and state variations thereof. Guarantees for the Lincoln Stable Value Account are subject to the claims-paying ability of the issuer. Affiliates of Lincoln National
Corporation include, but are not limited to, The Lincoln National Life Insurance Company, Lincoln Life & Annuity Company of New York, and Lincoln Retirement Services Company, LLC.
Lincoln Financial Group® affiliates, their distributors, and their respective employees, representatives, and/or insurance agents do not provide tax, accounting, or legal advice. Any tax
statements contained herein were not intended or written to be used, and cannot be used for the purpose of avoiding U.S. federal, state or local tax penalties. Clients should consult their
own independent advisor as to any tax, accounting or legal statements made herein. We recommend that you consult a tax advisor regarding the distribution rules as they pertain to your
personal circumstances.
Lincoln Financial Group is the marketing name for Lincoln National Corporation and its affiliates. Affiliates are separately responsible for their own financial and contractual obligations.
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