Escolar Documentos
Profissional Documentos
Cultura Documentos
1 Name of employer or plan sponsor 2 Employer identification number 3 Three-digit plan number
Here
Signature Date Title
For Privacy Act and Paperwork Reduction Act Notice, see page 2. Cat. No. 11835F Form 5309 (Rev. 12-2004)
3
I.R.S. SPECIFICATIONS TO BE REMOVED BEFORE PRINTING
INSTRUCTIONS TO PRINTERS
FORM 5309, PAGE 2 of 2
MARGINS: TOP 13mm (1⁄2 "), CENTER SIDES. PRINTS: HEAD TO HEAD
PAPER: WHITE, WRITING, SUB. 20 INK: BLACK
FLAT SIZE: 203mm (8") x 279mm (11")
PERFORATE: (NONE)
DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT