Individual Retirement Account (Ira) Distribution Request Form (Page 4 of 4) in pdf

VII. TAX WITHHOLDING ELECTION

A. Federal Withholding

Federal income tax will be withheld at the rate of 10% from any distribution, subject to the IRS withholding rules, unless you elect or have previously elected out

of withholding. Tax will be withheld on the gross amount of the payment even though you may be receiving amounts that are not subject to withholding

because they are excluded from gross income. This withholding procedure may result in excess withholding on the payments. If you elect to have no federal

taxes withheld from your distribution, or if you do not have enough federal income tax withheld from your distribution, you may be responsible for payment of

estimated tax. You may incur penalties under the estimated tax rules if your withholding and estimated tax payments are not sufficient. If you are completing

this form, your below election will remain in effect until such time as you make a different election in writing to the Custodian.

Please select one of the following:

I elect TO NOT have federal income tax withheld. (This option is only available for accounts registered with an address in the United States.)

Withhold 10% federal income tax

Withhold________% federal income tax (must be more than 10%)

B. State Withholding

Your state of residence will determine your state income tax withholding requirements, if any. Those states with mandatory withholding may require state

income tax to be withheld from payments if federal income taxes are withheld or may mandate a fixed amount regardless of your federal tax election. Voluntary

states let individuals determine whether they want state taxes withheld. Some states have no income tax on retirement payments. Please consult with a tax

advisor or your state's tax authority for additional information on your state requirements.

I elect TO NOT have state income tax withheld from my retirement account distributions (only for residents of states that do not require mandatory

state tax withholding).

I elect TO have the following dollar amount or percentage from my retirement account distribution withheld for state income taxes (for residents of

states that allow voluntary state tax withholding). $ ________________ or ________________ %

VIII. PARTICIPANT AUTHORIZATION

I certify that I am the individual authorized to make these elections and that all information provided is true and accurate. I further certify that the Custodian, the

Third Avenue Funds, or any agent of either of them has given no tax or legal advice to me, and that all decisions regarding the elections made on this form are my

own. The Custodian is hereby authorized and directed to distribute funds from my account in the manner requested. The Custodian may conclusively rely on this

certification and authorization without further investigation or inquiry. I expressly assume responsibility for any adverse consequences which may arise from the

election(s) and agree that the Custodian, Third Avenue Funds, and their agents shall in no way be responsible, and shall be indemnified and held harmless, for any tax,

legal or other consequences of the election(s) made on this form.

Participant’s Signature*:

Date:

*Beneficiary’s Signature for inheritance liquidations.

Please review the Third Avenue Funds prospectus for Medallion Signature Guarantee stamp requirements.

Mail to the following:

First Class Mail:

Overnight Mail:

Third Avenue Funds

P.O. Box 9802

4400 Computer Drive

Providence, RI 02940-5215