Individual Retirement Account (Ira) Distribution Request Form Page 3
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4V. DISTRIBUTION AMOUNT –
Complete sections A and B
A. Choose one:
Liquidate Entire Account
One-Time Partial Distribution of $_____________________________
Periodic Distributions - In the amount of $______________________
Monthly
Quarterly
Semi-Annual
Annual Installments
Substantially Equal Periodic Payments (Section 72(t) of the Internal Revenue Code) - In the amount of $_______________________ (or)
Calculate under the RMD method using
Uniform Lifetime Table
Single Life Table
Joint and Last Survivor Table*
*Beneficiary’s Name: _________________________________________________ Date of Birth: ________________
Distribute in a series of
Monthly
Quarterly
Semi-Annual
Annual Installments
B. Choose one:
Distribute proportionately across all funds, (or)
Distribute as indicated below:
Fund:______________________________________________________ Amount: $_________________________ or Percentage: ________%
Fund:______________________________________________________ Amount: $_________________________ or Percentage: ________%
Fund:______________________________________________________ Amount: $_________________________ or Percentage: ________%
Total Amount: $____________________
Total 100%
IMPORTANT CHANGES TO THE RULES GOVERNING INDIRECT (60-DAY) ROLLOVERS BETWEEN IRA ACCOUNTS
Beginning January 1, 2015, there will be a new restriction placed on indirect (60-day) IRA-to-IRA rollovers. An IRA participant will be allowed only one rollover across
all IRAs (Traditional, Rollover, Roth, SEP, SARSEP and SIMPLE IRAs) in aggregate that a taxpayer owns in any 12-month or 365-day period. As an alternative, a
participant can make an unlimited number of trustee-to-trustee transfers where the proceeds are delivered directly to the receiving financial institution, successor
custodian or trustee. For more information please visit the Internal Revenue Service’s web site using the search term “IRA One-Rollover-Per-Year Rule”,
“Announcement 2014-15 or “Announcement 2014-32”. You must contact the receiving institution to initiate a trustee-to-trustee transfer.
VI. MAILING INSTRUCTIONS
Mail to my address of record - (if you elected a Direct Rollover to a qualified plan or 403(b) you must complete the receiving custodian below*)
*Qualified Plan, 401(k), TSP or 403(b) Direct Rollover Deposit – Check will be made payable to the receiving custodian.
Type of plan receiving IRA assets:
401(k)
403(b)
TSP
457 plan
other employer sponsored qualified plan
*Receiving Custodian:
Account Number:
Street:
City:
State:
Zip:
*Transfer funds electronically via ACH (voided check required, if not on file)
(or)
*Mail check to:
*A Medallion Signature Guarantee (“MSG”)
Stamp is required if the banking instructions are
Name of Institution: _______________________________________________________________________
not already on file. An MSG may be obtained at
Address: ________________________________________________________________________________
your local bank or trust company, securities
broker/dealer, clearing agency or savings
________________________________________________________________________________________
association. The bank account must include your
name in the account registration.
Routing and Account Number: _______________________________________________________________
Purchase into my non-retirement account:
Application attached with investment instructions
(or)
Existing Account Number: ____________________________ Investment Fund(s): _________________________________________
Page 3 of 4
IRAD2015
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