Ira/qualified Plan Distribution Request Form (Sample) (Page 2 of 4) in pdf

Distribution Instructions

One-Time Distribution



I wish to liquidate my entire account.



I wish to make a one-time distribution of $___________or _______ shares, and the distribution should be paid out immediately.



I wish to convert $_____________ or ________ shares to my existing or new Roth IRA account # ________________.



Check this box if a new Roth IRA account needs to be established.



I wish to recharacterize $______________of my conversion dated _________ or my contribution for tax-year _______.



I wish to withdraw the excess contribution of $________ made for the tax year ______ and any earnings attributable to such contribution

(select one box below).*



I wish to have my excess contribution and my earnings distributed to my address of record.



I wish to have my excess contribution and any earnings applied to my IRA/Qualified Plan contribution for tax-year _________.



I wish to have my excess contribution applied to my IRA/Qualified Plan contribution for tax-year ________, and my earnings distributed

to my address of record.



I wish to have my excess contribution and any earnings applied to my Non-IRA account, Fund Number ___________, Account Number

____________ OR open a new Non-IRA account for distributions (a New Account Application must be attached).

*Earnings must remain in the account if the excess contribution is removed after October 15th following the year in which the contribution

was made.

Periodic Distributions*



I wish to take periodic distributions in the amount of $_____________.



Frequency:

M onthly

Q uarterly

S emi-Annually

A nnually

START DATE (MONTH,YEAR)

DAY(S) OF THE MONTH

*If you do not indicate a month and day for your periodic distribution(s), they will begin on or about the 5th day of the current month. If you

do not indicate a frequency, your distribution(s) will be made annually on December 5th.

Please list the amount you wish to take from each fund.

(The totals you enter here must match the amount you give in section B)

Dollar Amount

% of Total Distribution

All

 All

 Buffalo Discovery Fund

 All

 Buffalo Dividend Focus Fund

 Buffalo Emerging Opportunities Fund

 All

 Buffalo Flexible Income Fund

 All

 Buffalo Growth Fund

 All

 Buffalo High Yield Fund

 All

 Buffalo International Fund

 All

 Buffalo Large Cap Fund

 All

 Buffalo Mid Cap Fund

 All

 Buffalo Small Cap Fund

 All

Page 2 of 4

Ira/qualified Plan Distribution Request Form (Sample) Page 2

Related Articles

Related forms

Related Categories