Fillable Brokerage Account Application, Inherited Individual Retirement Account Forms (Page 4 of 4) in pdf

INHERITED INDIVIDUAL RETIREMENT ACCOUNT

DECEDENT'S INFORMATION

Mr.

Name

First

Middle

Last

Mrs.

Ms.

Social Security or Tax ID Number

Scottrade IRA Account Number (if applicable)

Date of Death

Type of IRA Held:

Traditional

SEP

Rollover

Roth

SIMPLE

Coverdell ESA

Note: The Inherited IRA you are opening will be the same as the decedent's type of IRA held except for SEP and Rollover which will be considered Traditional.

BENEFICIARY ACCOUNT HOLDER INFORMATION

Mr.

Name

First

Middle

Last

Mrs.

Ms.

Social Security or Tax ID Number

Phone

Date of Birth

Spouse

Non-Spouse

Trust - Provide a completed Trust Account Certification form.

Type of Beneficiary:

Estate - Provide a Letter of Court Appointment.

DESIGNATION OF BENEFICIARY(IES)

The following individual(s) or entity(ies) shall be my primary and/or contingent beneficiary(ies). If neither primary nor contingent is indicated, the individual or entity will be deemed to

be a primary beneficiary. If more than one primary beneficiary is designated and no distribution percentages are indicated, the beneficiaries will be deemed to own equal share percentages

in the IRA. Multiple contingent beneficiaries with no share percentage indicated will also be deemed to share equally. If any primary or contingent beneficiary dies before I do, his or her

interest and the interest of his or her heirs will terminate completely, and the percentage share of any remaining beneficiary(ies) will be increased on a pro rata basis. If no primary

beneficiary(ies) survives me, the contingent beneficiary(ies) will acquire the designated share of my IRA. If no beneficiaries are named, my estate will be my beneficiary. I understand that I

may change or add beneficiaries at any time by completing and delivering the proper form to the trustee or custodian. The trustee or custodian has provided no tax or legal advice to me

regarding my beneficiary designation.

I elect not to designate beneficiaries at this time and understand that I may designate beneficiaries at a later date.

Primary or

U.S. Social Security

Is this person

Name and Address

Date of Birth

Relationship

Contingent

Number (required)

a U.S. citizen?

Primary

Contingent

Primary

Contingent

Primary

Contingent

Primary

Contingent

SPOUSAL CONSENT

I am married

Must be completed by Beneficiary account holder:

I am not married

Must be completed by Spouse, if applicable.

This section should be reviewed if either the trust or the residence of the account holder is located in a community or marital property state and the account holder is married. Due to the

important tax consequences of giving up one’s community property interest, individuals signing this section should consult with a competent tax or legal advisor.

The undersigned hereby declares that he/she is the spouse of the account holder of this Inherited IRA; and, consents to any designation of beneficiaries made whatsoever and whensoever

by the account holder for this Inherited IRA. The undersigned also agrees not to make any claim against the beneficiary(ies) or against Scottrade, Inc. as a result of any distribution to said

beneficiary(ies) pursuant to this agreement. This consent shall apply to all assets in the account at the death of this Inherited IRA account holder. This consent shall be revocable by the

undersigned by executing a Letter of Authorization which is signed by the account holder and the spouse, and filing the same with Scottrade, Inc. prior to the account holder’s death.

I hereby give the account holder any interest I have in the funds or property deposited in this Inherited IRA and consent to the beneficiary designations(s) indicated above. I assume full

responsibility for any adverse consequences that may result. No tax or legal advice was given to me by Scottrade, Inc.

Signature of Spouse

Date

SIGNATURES

Important: Please read before signing: I have chosen to open an inherited IRA account. I understand that the tax laws surrounding this transaction may be complex depending on my

financial situation. Scottrade,Inc. advises consulting with a professional tax advisor or attorney before completing this transaction, and I am responsible for seeking the advice of a tax

professional prior to completing this transaction. I certify that no tax advice has been given to me by Scottrade Inc. I agree to hold Scottrade, Inc. harmless and indemnify Scottrade, Inc. for

any adverse consequences regarding this transaction. I also agree that I am responsible for any results of this transaction and beneficiary designation, including the appropriate treatment

under IRS Tax Codes, state law, and any other law, code, rule, regulation or statute. I expressly certify that I take complete responsibility for the investments.

Inherited IRA Account Holder's Signature

Date

Authorized Representative's Signature

Date

*SF2364*

SF2364/9-15