Montgomery County Unforeseen Emergency Withdrawal Form (Page 5 of 5) in pdf

Montgomery County Unforeseen Emergency Withdrawal Form Page 5

Montgomery County 457(b) Plan

Unforeseen Emergency Withdrawal Rules



Residence Repair/Loss of Property

A copy of the cost estimate to repair damage to the primary

residence due to a casualty event described in IRS Publication

547 such as fire, flood, explosion, or storm.



Normal and regular maintenance, repairs, or remodeling

expenses are not unforeseen emergencies.



The repair bill/estimate must be dated within the past six

months.



Proof that the damage is not covered by insurance, such a

claim denial.

Other Events subject to Employer approval

Other non-budgetable, extraordinary unforeseeable emergency

may qualify such as:



A distribution for Other Events may or may

Spouse’s unemployment for an extended period of at least 3

not be approved.

months



IRS tax levy



Law suit judgment



Loss of automobile not covered by insurance



Unusual property tax or utility assessment

You must submit supporting documentation. The document must

be specific to this event and be dated within the last 60 days.

Fidelity Investments Institutional Operations Company, Inc. • 82 Devonshire Street., Boston, MA

643202.2.0

November 2013

Montgomery County Unforeseen Emergency Withdrawal Form Page 5