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Certification Signature Print Preparer s Name Phone Number Date Direct Deposit Information Response Required I am currently on Direct Deposit and wish to continue. Sign and date I decline Direct Deposit at this time. Sign and date Change in Direct Deposit Information Financial Institution Name Type Checking Cancel My Direct Deposit Savings Mail Code Account Number Will these payments be forwarded to a financial institution outside the United States Yes No I authorize the Texas Comptroller of Pu ...

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