Ira Distribution Request Form - Greenspring Fund (Page 2 of 3) in pdf

Distribution Instructions

One-Time Distribution



I wish to liquidate my entire account.



I wish to make a one-time distribution of $___________or _______ shares, and the distribution should be paid out immediately.



I wish to convert $_____________ or ________ shares to my existing or new Roth IRA account # ________________.



Check this box if a new Roth IRA account needs to be established. An IRA Application must be included with this Form.



I wish to recharacterize $______________of my conversion dated _________ or my contribution for tax-year _______.



I wish to withdraw the excess contribution of $________ made for the tax year ______ and any earnings attributable to such contribution

(select one box below).*



I wish to have my excess contribution and my earnings distributed to my address of record.



I wish to have my excess contribution and any earnings applied to my IRA/Qualified Plan contribution for tax-year _________.



I wish to have my excess contribution applied to my IRA/Qualified Plan contribution for tax-year ________, and my earnings distributed

to my address of record.



I wish to have my excess contribution and any earnings applied to my Non-IRA account, Fund Number ___________, Account Number

____________ OR open a new Non-IRA account for distributions (a New Account Application must be attached).

*Earnings must remain in the account if the excess contribution is removed after October 15th following the year in which the contribution

was made.

Periodic Distributions*



I wish to take periodic distributions in the amount of $_____________.



Frequency:

M onthly

Q uarterly

S emi-Annually

A nnually

START DATE (MONTH,YEAR)

DAY(S) OF THE MONTH

*If you do not indicate a month and day for your periodic distribution(s), they will begin on or about the 5th day of the current month. If you

do not indicate a frequency, your distribution(s) will be made annually on December 5th.

Delivery Instructions



P lease send a check to the address of record currently on my account.



R egular Mail

O vernight Mail: A $15 fee will apply.



D eposit distribution proceeds directly into my existing Non-IRA account, Fund Number _______________, Account Number

______________, OR open a new Non-IRA account for distributions (a New Account Application must be attached).



ACH (Automated Clearing House): Electronic Funds Transfer to the bank instructions currently on my account. No fee applies. If you are

establishing or changing your bank instructions, please attach a voided check in Section 5. You must obtain a signature guarantee if establishing

or changing your bank instructions.



W ire Redemption: Wire distribution proceeds to the bank instructions currently on my account. A $15 wire fee applies. If you are establishing

or changing your bank instructions, please attach a voided check in Section 5. You must obtain a signature guarantee if establishing or changing

your bank instructions.



A lternate payee and/or address other than the address of record. You must obtain signature guarantee if having the redemption proceeds

payable to a third party or sent to an address that is currently not listed on the account.

Please complete the boxes below with the payee information.

NAME OF PAYEE

ADDRESS

CITY / STATE / ZIP

Page 2 of 3

Ira Distribution Request Form - Greenspring Fund Page 2

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