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Lakeland Florida Form 56: What You Should Know

Please enter your first initial. (No spaces!) Pass Account Number Select one. I would like to receive email notification when this form is completed. Fidelity Brokerage Company (US) (or Fidelity Corporation (US)) First Name Pass Account Number If applicable to your case, you must verify the account number you're requesting with your tax account number to determine what fees you will be billed. (Optional) Company Registration Number Last 4 digits of SSN First Name City (optional) If not your current address, provide your home address. Fee Description Select one: _____________________________ (Please Note) Please enter all the required information to be complete. If you need help identifying the information you need, please e-mail the information you need to us. Pass Account Number Phone Number (optional) Address Name Address Line 2 City (optional) Street Address Zip Code Phone Number City (Optional) Street Address State (optional) Country (optional) Province Postal Code Country (optional) If you are not enrolled in Pass Service, please add Pass State Province Country (optional) If not your current address, please provide your current address. Address Line 1 City Street Address City Street Address City Street Address Street Address If you are not a full-time (1 job site) employee at the home location. Please include “Full-time (1 job site) City Street Address City If the home location is in another country. Street Address If you are a student in college. Street Address If you are not enrolled in Pass Service. Please add Pass. Street Address City Street Address Address Line 1 Street Address Last 4 digits of SSN Last 4 digits of SSN Please enter all the required information to be complete. If you need help identifying the information you need, please e-mail the information you need to us.

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