Form Db 4.33 - Tax Withholding Election - Federal And State Income Tax Withholding
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1
2DB 4.33
TAX WITHHOLDING ELECTION
Federal and State Income Tax Withholding
Name
Social Security No.
C
S
“A”
“B”
OMPLETE
ECTION
OR
BELOW
:
Name of Plan
Section A. RECURRING PAYMENTS – Federal and State Income Tax Withholding
Instructions: As a benefit recipient, the following withholding alternatives are available to you:
• By selecting No. 1 below, you may specify that you do not want any federal or state income tax deducted from your benefit .
• By selecting No 2 below, you may elect the “Allowances Claimed” section and completing the marital status and number
of allowances which will require the OkMRF system to determine the amount, if any, which must be withheld based
on federal and state withholding tables. If elected, the tax withholdings may or may not meet your required amounts.
• By selecting No. 3 below, you may elect to withhold a specified percentage or amount for federal and state income taxes.
In requesting the distribution of my funds from OkMRF, I designate the following withholding election.
This election will remain in effect until I submit another.
1. _______
I elect not to have Federal or State income tax withheld.
I wish to have OkMRF withhold from my monthly benefit the amount of federal and state income tax
2. _______
as determined in accordance with withholding tax tables and the allowances claimed below:
Single Married
Married –but withhold at higher Single Rate
_____ Number of withholding allowances/exemptions you want to claim.
3.
a. _______ I wish to have ____________ (% or $ amount) of Federal income tax withheld.
____ I wish to have ____________ (% or $ amount) of State income tax withheld.
b.
If you do not file a Tax Withholding Election form with OkMRF, we are required by law to assume that you are married and
are claiming 3 (three) allowances. We will automatically withhold federal and state income tax if your payment is large
enough to require withholdings.
Section B. ONE-TIME PAYMENTS – Federal and State Income Tax Withholding
Instructions: When receiving a total distribution from OkMRF, you may receive the payment in one of two methods:
•
The distribution can be made payable to you directly, in which case a mandatory 20% Federal tax withholding and
5% Oklahoma state tax withholding will occur. (The mandatory tax withholding only applies to the taxable portion
of your distribution.)
OR
•
You can direct OkMRF to roll over the distribution into an IRA or other qualified plan without taxes being withheld. You
will receive the non-taxable portion of the distribution payable to you even if you direct the taxable portion to a qualified
plan or IRA. Rollover checks will be payable to the rollover entity “For the Benefit of” and then your name. All
distributions are mailed directly to your address of record.
In requesting the distribution of my funds from OkMRF, I designate the following method of payment:
. I am aware of the mandatory 20% Federal and 5% Oklahoma
1.
_____ I
(
)
WANT THE CHECK
S
MADE PAYABLE TO ME
withholding * on the taxable portion of my distribution.
*(Withholding rate is 5% and is subject to change based on Oklahoma State withholding tables.)
If you’ve made a permanent move into a new state during the tax year, you may have to file two part-year state tax returns.
You may wish to consult with a professional tax advisor, before taking a payment from the Plan.
2. _______ I
T
IRA. (
IRA
WANT A DIRECT ROLLOVER TO A
RADITIONAL
YOU MUST SUBMIT A COPY OF YOUR
AGREEMENT FOR A
.)
DIRECT ROLLOVER
3. _______ I
Q
P
. (
WANT A DIRECT ROLLOVER TO A
UALIFIED
LAN
YOU MUST SUBMIT A COPY A RECENT PARTICIPANT
P
’
)
STATEMENT AND THE
LAN
S CONTACT INFORMATION
I have reviewed the information above and hereby submit this statement of preference regarding how my benefit distribution is
to be treated for purposes of federal and state income tax withholding.
Date
Participant’s Signature
Forms 2016
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