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Updated On[date-and-time]Received Date[Date]
Effective Date of Change[Date]Change Reason[field-value]
Approval Requested[True]Approval Status[Approved]
Status[Active]Updated By[User Name]
Annuity Type[field-value]Annuity Category[field-value]
Date Established[Date]End Date[Date]
Source of Funds[field-value]Annuity Value[Amount]
Recoupment By State[True] 

Institution Details

Institution Type[field-value] 

Institution Participant

Institution Participant[Full Name]

Comments

[Comments]