Fillable Form 5305-R - Roth Individual Retirement Trust Account (Page 2 of 2) in pdf

Form 5305-R (Rev. 4-2017)

Page

Article VII

Notwithstanding any other articles which may be added or incorporated, the provisions of Articles I through IV and this sentence will

be controlling. Any additional articles inconsistent with section 408A, the related regulations, and other published guidance will be

invalid.

Article VIII

This agreement will be amended as necessary to comply with the provisions of the Code, the related regulations, and other

published guidance. Other amendments may be made with the consent of the persons whose signatures appear below.

Article IX

Article IX may be used for any additional provisions. If no other provisions will be added, draw a line through this space. If

provisions are added, they must comply with applicable requirements of state law and the Internal Revenue Code and may not imply

that they have been reviewed or pre-approved by the IRS.

Grantor’s signature

Date

Trustee’s signature

Date

Witness’ signature

Date

(Use only if signature of the grantor or the trustee is required to be witnessed.)

General Instructions

Article V. This article describes how

income. For more information on Roth

IRAs, including the required disclosures

distributions will be made from the Roth

Section references are to the Internal

the trustee must give the grantor, see

IRA after the grantor’s death. Elections

Revenue Code unless otherwise noted.

Pub. 590-A, Contributions to Individual

made pursuant to this article should be

Retirement Arrangements (IRAs), and

reviewed periodically to ensure they

Purpose of Form

Pub. 590-B, Distributions from Individual

correspond to the grantor’s intent. Under

Retirement Arrangements (IRAs).

paragraph 3 of Article V, the grantor’s

Form 5305-R is a model trust account

spouse is treated as the owner of the

agreement that meets the requirements

Definitions

Roth IRA upon the death of the grantor,

of section 408A. However, only Articles I

rather than as the beneficiary. If the

through VIII have been reviewed by the

Trustee. The trustee must be a bank or

spouse is to be treated as the

IRS. A Roth individual retirement

savings and loan association, as defined

beneficiary, and not the owner, an

account (Roth IRA) is established after

in section 408(n), or any person who has

overriding provision should be added to

the form is fully executed by both the

the approval of the IRS to act as trustee.

Article IX.

individual (grantor) and the trustee. This

Grantor. The grantor is the person who

account must be created in the United

Article IX. Article IX and any that follow

establishes the trust account.

States for the exclusive benefit of the

it may incorporate additional provisions

Specific Instructions

grantor and his or her beneficiaries.

that are agreed to by the grantor and

trustee to complete the agreement. They

Do not file Form 5305-R with the IRS.

Article I. The grantor may be subject to

may include, for example, definitions,

Instead, keep it with your records.

a 6% tax on excess contributions if

investment powers, voting rights,

Unlike contributions to traditional

(1) contributions to other individual

exculpatory provisions, amendment and

individual retirement arrangements,

retirement arrangements of the grantor

termination, removal of the trustee,

contributions to a Roth IRA are not

have been made for the same tax year,

trustee’s fees, state law requirements,

deductible from the grantor’s gross

(2) the grantor’s adjusted gross income

beginning date of distributions,

income; and distributions after 5 years

exceeds the applicable limits in Article II

accepting only cash, treatment of

that are made when the grantor is 59

for the tax year, or (3) the grantor’s and

excess contributions, prohibited

years of age or older or on account of

spouse’s compensation is less than the

transactions with the grantor, etc. Attach

death, disability, or the purchase of a

amount contributed by or on behalf of

additional pages if necessary.

home by a first-time homebuyer (limited

them for the tax year.

to $10,000), are not includible in gross

5305-R

Form

(Rev. 4-2017)

Form 5305-R - Roth Individual Retirement Trust Account Page 2

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