Nyce Ira Deposit Form
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1
2NEW YORK CITY EMPLOYEE IRA
Deposit Form
(888) IRA - NYCE (If Outside NYC)
(212) 306-7760
Please Print - Black Ink Preferred
Web site:
You must open a NYCE IRA account before a deposit of funds can be accepted. To establish a NYCE IRA account, go to .
To establish a NYCE Spousal IRA, complete a NYCE IRA Application. A separate deposit form is required for each account and each contribution.
1
IRA CONTRIBUTION RECORD
£ Apply to my Traditional NYCE IRA
£ Apply to my Roth NYCE IRA
:
:
:
amount
check number
date
/
/
$
Contributions to the NYCE IRA must be received by the NYCE IRA
(
):
this contribution applies to
enter tax year
Administrator prior to the tax filing deadline.
Points to remember:
•
Contributions for tax year 2016 may not exceed $5,500.
•
If you are or will be age 50 or over by the end of the tax year, you may make an additional contribution of up to $1,000.
•
You must state the tax year for which your contribution applies. If no year is indicated, it will apply to the current tax year.
•
Be certain that the check includes your name and the last four digits of your Social Security number.
•
Always mail your check with an IRA Deposit Form.
•
Use the address noted below when mailing in your contribution.
•
For additional forms please visit the Web site at nyc.gov/nyceira or call (212) 306-7760, or 1(888) IRA-NYCE if outside NYC, to order
forms through the automated voice response system.
•
Do not use this form if you are making a rollover contribution. Please complete a NYCE IRA Transfer/Rollover Form.
•
The City of New York, its custodian, and service providers are not responsible for determining or tracking your deductible and your
non-deductible contributions to the Traditional NYCE IRA, nor the cost basis (non-taxable contributions) to the Roth NYCE IRA.
2
PAYMENT INSTRUCTIONS
Make check payable to either the Traditional NYCE IRA or Roth NYCE IRA. Make sure the name and the last four digits of the account
owner’s Social Security number appear on the check. Mail (do not fax) this form and check to:
Regular Mail
Express Mail
Wire Instructions:
NYC Deferred Compensation Plan
NYC Deferred Compensation Plan
BNY Mellon, New York, NY
P.O. Box 392057
Attn: Box # 392057
ABA/Routing Number: 021000018
Pittsburgh, PA 15251-9057
500 Ross Street 154-0455
For credit to:
Pittsburgh, PA 15251-9057
NYC Deferred Compensation Plan/NYCEIRA
Account#: 8900623829
FBO: (Name of Account Owner)
Detach and mail bottom portion. Retain top portion for your records.
3
ACCOUNT OWNER INFORMATION
.
.
participant id or last 4 digits of ssn
date of birth
area code
home telephone no
area code
work telephone no
/
/
-
-
last name
first name
mi
-
.
apt no
home mailing address
number and street
£
check here if this is a new address
city
state
zip code
4
DEPOSIT INFORMATION
£ Apply to my Traditional NYCE IRA
£ Apply to my Roth NYCE IRA
Minimum Initial Deposit of $100 required
:
:
:
amount
check number
date
/
/
$
Contributions to the NYCE IRA must be received by the NYCE IRA
(
):
this contribution applies to
enter tax year
Administrator prior to the tax filing deadline.
5
ACCOUNT OWNERS SIGNATURE
/
/
:
:
signature
date
Office Use Only
initial
date
processed by
/
/
G:\DCP\IRA\FORMS\IRA_DEPOSIT_FORM.INDD 5K 6/2016
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