Sit Mutual Funds Individual Retirement Account (Ira) Distribution Request Form printable pdf download

SIT M UTUAL F UNDS I NDIVIDUAL R ETIREMENT A CCOUNT ( IRA)

DISTRIBUTION R EQUEST F ORM

This f orm i s n ot i ntended f or r equired m inimum d istributions, t rustee t o t rustee t ransfers, r echaracterizations, o r c onversion r equests.

I. P ARTICIPANT I NFORMATION

– P lease p rint

Name:

Daytime T elephone: (

)

Address:

City:

State:

Zip C ode:

Social S ecurity N umber:

Date o f B irth:

Account N umber:

Complete t he f ollowing i f y ou a re a b eneficiary r equesting a f ull l iquidation o f t he i nherited p roceeds.

Beneficiary N ame:

Daytime T elephone: (

)

Social S ecurity N umber:

Date o f B irth:

II. T YPE O F A CCOUNT

T raditional / R ollover I RA

S EP I RA

R oth I RA -‐ ( Proceed t o S ection I II -‐ B o r C )

Note: F or t rustee t o t rustee t ransfers, p lease c omplete t he a ppropriate r eceiving c ustodian’s t rustee t o t rustee t ransfer f orm. T his f orm i s n ot i ntended t o f acilitate a

beneficiary/inherited IRA transfer due to death. For revocations, refer to the Traditional and Roth Individual Retirement Account (IRA) Combined Disclosure

Statement for instructions and information regarding your revocation rights. All required documentation must be received in good order before the distribution

request can be honored. All legal documents must be certified and a Medallion Signature Guarantee may be required. Please see the Participant Authorization

Section f or a n e xplanation o f t he M edallion S ignature G uarantee.

III. R EASON F OR D ISTRIBUTION

A. FROM A T RADITIONAL, R OLLOVER O R S EP I RA

The d istribution i s b eing m ade f or t he f ollowing r eason ( check o ne):

1 . Normal d istribution -‐ Y ou a re a ge 5 9½ o r o lder.

2 . Early (premature) distribution -‐ You are under age 59½, including distributions due to medical expenses, health insurance premiums, higher education

expenses, f irst t ime h omebuyer e xpenses, o r o ther r easons.

3 . Substantially e qual p eriodic p ayments w ithin t he m eaning o f s ection 7 2(t) o f t he I nternal R evenue C ode.

4 . Death/Beneficiary l iquidation -‐ I f y ou a re a b eneficiary, c ontact S hareholder S ervices r egarding a dditional d ocument r equirements.

5 . Permanent d isability -‐ Y ou c ertify t hat y ou a re d isabled w ithin t he m eaning o f s ection 7 2(m)(7) o f t he I nternal R evenue C ode.*

6 . Transfer i ncident d ue t o d ivorce o r l egal s eparation -‐ C ontact S hareholder S ervices r egarding a dditional d ocument r equirements.

7 . Removal o f e xcess -‐ Y ou m ust c omplete S ection I V ( Excess C ontribution E lection) i n i ts e ntirety.

8 . Direct r ollover t o a Q ualified P lan, 4 01(k), T SP o r 4 03(b) -‐ Y ou a re c ertifying t hat t he r eceiving c ustodian w ill a ccept t he I RA a ssets i ssued.

9 . Qualified R eservist D istribution

* For purposes of section 72(m)(7), an individual shall be considered to be disabled if he is unable to engage in any substantial gainful activity by reason of any

medically d eterminable p hysical o r m ental i mpairment w hich c an b e e xpected t o r esult i n d eath o r t o b e o f l ong-‐continued a nd i ndefinite d uration.

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IRAD2015

Sit Mutual Funds Individual Retirement Account (Ira) Distribution Request Form

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