0001193125-04-059209 Sample Contracts
Abraham Lincoln] [XX-0123456] Lincoln Life & Annuity Company of New York (A Stock Company) Home Office: 100 Madison Street, Suite 1860, Syracuse, New York 13202 Servicing Office: 1300 South Clinton Street, Fort Wayne, Indiana 46801-2348 ANNUITY...Annuity Contract • April 8th, 2004 • Lincoln Life & Annuity Variable Annuity Account H
Social Security number/TIN [_][_][_]-[_][_]-[_][_][_][_] ____________________________________________________________ Full legal name or trust name* Date of birth [_][_] [_][_] [_][_] [_] Male [_] Female Month Day Year...Variable Annuity Contract Application • April 8th, 2004 • Lincoln Life & Annuity Variable Annuity Account H