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American Century Life Insurance Company
9120 South Toledo Avenue
Tulsa, OKlahoma 74137
Office 918-712-7770
Fax 918-712-7773
Release of Assignment
Name of Insured
Policy Number
Date
I certify I am an authorized representative and hereby release this irrevocable assignment and all the benefits and proceeds provided by the policy number listed above.
Old Assignee
Address
City, State and Zip
Phone Number
Date
Signature
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