![ET-7355](https://etf.wi.gov/sites/default/files/styles/medium/public/pdfpreview/72546-et7355_0.png)
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Summary
Complete and return this form with your application.
This form is available to rollover separation benefits over $200. If you are applying for other lump-sum payments, including retirement or death benefits, please review the application materials you received from ETF.