Bmo Funds Ira Distribution Form
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4BMO FUNDS IRA DISTRIBUTION FORM
Traditional IRA, Roth IRA or SEP-IRA
For help with this application, or for more information, call us toll-free at 1-800-236-FUND(3863) or 414-287-8555.
IMPORTANT: Please be sure to complete all pages of this request.
1. Account Information
_______________________________________________________________________________________________________________
Account Number
_______________________________________________________________________________________________________________
Name
(first, middle initial, last)
______________________________________________________
______________________________________________________
Social Security Number
Birth Date
______________________________________________________
________________________
__________________________
Email Address
Daytime Phone
Evening Phone
2. Distribution Reason
Choose One:
o Normal Distribution. I am age 59 ½ or older.
o P remature Distribution. I am less than age 59 ½. I understand that I may be subject to a 10% penalty unless the distribution is rolled
over within 60 days of receipt to another IRA or retirement plan.
(Exceptions to the penalty may apply. Please consult a qualified tax advisor for
more information.)
o Disability. I am less than age 59 ½ and am permanently disabled. I have attached a copy of my valid Social Security Award Certificate.
o R equired Minimum Distribution for IRA Owner. I must begin receiving my RMD no later than the first required distribution date after
attaining age 70 ½.
The Custodian will calculate the minimum distribution amounts for your IRA based on the information supplied herein. The Custodian,
their agents and affiliates disclaim any liability with respect to the calculation of the required minimum distribution.
o Substantially Equal Periodic Payments [as defined by IRC Section 72(t)].
o Death. I am the beneficiary of the above-named IRA owner and I request a distribution. Please contact BMO Funds to verify what other
documentation is required.
______________________________________________________
__________________________________________________
Date of IRA Owner’s Death
Beneficiary’s Date of Birth
______________________________________________________
__________________________________________________
Beneficiary’s Name
Relationship
____________________________________________________________________________________________________________
Address
_____________________________________________________
______________________
________________________
City
State
Zip Code
______________________________________________________
__________________________________________________
SSN or TIN
Beneficiary’s Phone Number
o E xcess Contribution. I contributed an excess on __________ (date) for tax year ______ in the amount of $_______________.
This excess is being removed (check one):
o The same year in which the excess occurred — but before my tax due date
(attach IRA excess contribution worksheet)
o The year following the year the excess occurred — but before my tax due date
(attach IRA excess contribution worksheet)
o After my tax due date (less than age 59 ½)
o After my tax due date (age 59 ½ or older)
(6/14)
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