Form Sf2033 - Coverdell Esa Distribution Request 2014
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Coverdell ESA Distribution Request
ESA ACCOUNT HOLDER INFORMATION
Account Number
Name (Please Print)
Home Address
Street
Date of Birth
City
State
ZIP Plus 4
Social Security Number of Recipient
Name of Responsible Individual
AMOUNT OF DISTRIBUTION
Check appropriate boxes
1.
PARTIAL DISTRIBUTION
TOTAL DISTRIBUTION
2.
CASH: Please distribute $_________________ from my Coverdell ESA and
b. Journal to Scottrade non-IRA Account #____________________________
a. Mail me a check
(if alternate payee please
complete alternate payee form)
c. Wire Funds $25.00 Fee Applies
Please also complete Scottrade form SF3675, Authorization to Wire Funds
SECURITIES: Please distribute _________________ shares of __________________________________
to Scottrade Account # _______________________________________________________
Note: Securities cannot be mailed to you.
FREQUENCY OF DISTRIBUTION
ONE TIME
One time distributions are processed within 2-3 business days.
MONTHLY*
Starting Date _____/_____/_____
QUARTERLY*
Starting Date _____/_____/_____
*Monthly and Quarterly distributions are processed on the 5th of the month. If the 5th falls on a weekend or holiday
the distribution will be processed on the following business day.
REASON FOR DISTRIBUTION
Please select only one choice
Qualified Education Expenses
Disability
Death
Removal of Excess (Please attach Excess Removal Form)
Non-Qualified Distribution
PLEASE SIGN THIS SECTION - Required
I hereby certify that I am the party authorized to make these elections regarding this account, and that no tax advice was
given to me by Scottrade. All decisions regarding this withdrawal are my own. I expressly assume the responsibility for
any adverse consequences which may arise from the election(s), and agree that the Custodian shall in no way be responsible.
X
Signature of Responsible Individual
Date
*SF2033*
For Scottrade Use Only
Received
Authorized Signature of Custodian
Date
SF2033/7-14
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