Eagle Ira Distribution Request Form
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2EAGLE IRA DISTRIBUTION REQUEST FORM
P. O. BOX 701 s Milwaukee WI 53201 s (800) 421-4184 s Fax (855) 394-8958 s
1. Account Information
q Traditional
q
q SIMPLE
q SEP
ROTH
Name (as it appears on your account registration)
Account Number
Social Security Number
Date of Birth
Daytime Phone
Street Address
City
State
Zip Code
2. Distribution Type (check one)
q
q
Premature Distribution. I am under age 59 1/2. I understand that I may be
Death (Attach Death Certificate and a completed IRA New Account Application
responsible for paying a 10% premature withdrawal penalty in addition to
for each beneficiary)
normal income tax for an early withdrawal. *To claim an exception from the
Date of Death
premature distribution penalty, you should file IRS Form 5329.
q
Options always available (whether death occurs before or after required
Normal Distribution / Required Minimum Distribution (RMD). I have
beginning date (RBD))
reached the age of 59 1/2.
q
Treat as Own - I elect to roll over or transfer the IRA plan balance into my
q
72(t) Substantially Equal Periodic Payments. One of a series of
own IRA. (Only available to sole spouse beneficiary.)
substantially equal payments qualifying for penalty exemption (as define in
q Establish a new account (attach Eagle IRA application)
Internal Revenue Code (IRC)72(t)). Please see your professional tax advisor
q Use my existing Eagle IRA ________________________
for guidance.
Options if death occurs before RBD
q
q
Timely Removal of Excess or Nondeductible Contribution, plus earnings,
5-Year Payments - I elect to deplete the IRA balance by December 31 of the
year containing the 5th anniversary of the IRA holder's death.
for year 20__ __.
q
Life Expectancy Payments - I elect to deplete the IRA by taking payments
q
Refund of Principal Amount of Excess Contribution After Tax Filing Date,
over my own life expectancy.
for year 20 __ __.
Option if death occurs on or after RBD
q
q
Transfer Due to Divorce or Separation. (Attach Court Order, Transfer
Continue Distributions - I elect to receive the required minimum distribution
Instructions and Spousal Consent)
under the applicable distribution period.
3. Distribution Instructions
Distribution Amount:
Fund Breakdown:
q Complete distribution of all funds.
q Calculate and distribute my Required Minimum Distribution (RMD).
Fund Name
Share Class
% or $
q
Distribute a portion of my account. $_________________.
Fund Name
Share Class
% or $
(please complete fund breakdown)
Fund Name
Share Class
% or $
Date
Frequency
Systematic Withdrawal (optional): Complete if you would like to receive your
q 5th
qMonthly
RMD or another amount periodically.
q 10th
qQuarterly
Beginning Date _____________________
q 20th
qSemi-Annually
q Annually
Delivery Instructions:
q Check to address of record
q
q
Overnight check to address of record:
Alternate payee and/or address. A medallion signature guarantee is also
$15 fee will apply
required in section 6 below.
q
q Credit my Eagle Account #:
Electronically to my bank
Name of Payee
(complete section 5 below)
Street Address
City
State
Zip Code
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11/2014
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