Laserfiche WebLink
05/14/01 12:32 FAX PHIL BRETT ? LAW DIR Iin 007 <br />.`iVA1.1C <br />y *AeAmerieanCicmwlCumpnY <br />IIV lNTI'NESS WHEREOF, the parties have caused flhis Agreement to be executed.to be effective as of the date heceinabave. <br />EMPLOYFIt: <br />Name <br />By: <br />Signawte <br />, N$me end Titk <br />fIOME OFFICE: <br />TFIE VAttIABLE p?NNUITY LIFE <br />INSURANCE COMPAN-Y <br />By: <br />ARTICLE VI--E1ViPL(lYER P10TIGE OF WTTHHOLDING <br />(Sigrtarure required if itenc 43b was selected) <br />Notice is hereby given by the Employer that all disbursements under the above referenced PIan shall be made by <br />VALIC to Employer 9n aecordance with the annvity contract(s) entered iato between VALIC and rlie Employer undex <br />the Plan in such amounts and at such times as Emplayer spECiftes in writing to dALIC. VAI:IC is hereby released. <br />from the responsibiiity, if any, o#' withholding federal and staee income taxes from a11 disbuesements made to Employa <br />under the above referenced Plan• <br />EWLQYER: <br />Norite <br />Bx: <br />signatire <br />A1tTICLE VII - EMPLOYER NOTICE OF WI'I'HHOLDING <br />• (Signature required if etem 4.3c was selected) <br />Alotice is hereby given by the Bmployer that ail disbursements uniler tlie above refec+enced F'lan shall be made 6y <br />VALiC.to Employer in accordance with the annuity conmact(s) entered into hetween VALIC and the Employer under <br />the Plan in such amounu and at such tianes as Employer specifies in vdriting to VALIC. VALIC is hereby reteased, <br />from ahe responsibility, if any, of withtiolding federat and state incomc taxes from in-serviCe and lump sum termination <br />disbursements made to Employer undgr the above referensed Plar?. VALIC shall be respans'ible for wtthholding fed-, <br />eral and state income taxes f=om requ€red_dis@ributions as oudenea! in section 4.5 of the agreement. <br />EMPY.OYER: <br />Name <br />B.Y: <br />Signelurc <br /> <br />