Roth Conversion/recharacterization Request printable pdf download

Roth Conversion/recharacterization Request

ROTH CONVERSION/RECHARACTERIZATION REQUEST

Use this form to request a conversion of assets from Traditional IRAs, SEP IRAs, and SIMPLE IRAs to Roth IRAs,

or for a recharacterization of assets between a Roth IRA and a Traditional IRA, SEP IRA, or SIMPLE IRA.

PLEASE BE AWARE OF THE FOLLOWING WHEN COMPLETING THIS FORM:

Use of this form will result in a reportable event to the Internal Revenue Service (IRS)

and, if applicable, the tax authorities in your state.

The term “Traditional IRA,” as used in this request and its instructions, will include

Traditional IRAs, SEP IRAs, and SIMPLE IRAs, unless otherwise indicated.

Read the attached instructions prior to completing the form. If you need assistance, please

contact your investment professional.

If you wish to convert or recharacterize cash, you are responsible for ensuring that the funds

you request to be converted or recharacterized are available; this may require asking your

investment professional to sell securities in order to make the cash you are converting or

recharacterizing available.

You may convert your SIMPLE IRA to a Roth IRA only after you have participated in

the SIMPLE IRA for two years.

Please separate

instructions from the Roth Conversion/Recharacterization Request

the

prior to returning the form, and return the completed form to your investment

professional or financial organization.

Roth Conversion/recharacterization Request