Inherited IRA Distribution Application

INHERITED IRA DISTRIBUTION APPLICATION

Account Information

Custodian Name:

Deceased IRA Owner

Date of Death:

Beneficiary (Requestor)

Daytime Phone:    Email:

Beneficiary Type

Primary Beneficiary
Contingent Beneficiary
Surviving Spouse
Trust / Estate / Other Entity

Distribution Election

Select one distribution method (mark all applicable selections that you request; additional documentation may be required for some elections):

Lump-sum distribution of entire account balance
Partial distribution Amount: $

Periodic distributions
Frequency:   Amount or basis:

Trustee-to-Trustee transfer to an inherited IRA (direct transfer to another custodian)
Receiving institution name:

Rollover to surviving spouse's IRA

Required Minimum Distribution (RMD) Election

The beneficiary elects (select one):

Life expectancy method (attach calculations and date of first distribution)
First distribution date:

Five-year rule (distributions completed by end of fifth year following death)

Payment Instructions

Payment method (select one):

Check mailed to address on file
Check mailed to alternate address:

ACH deposit to bank account

Routing Number:   Account Number:   Account Type:

Wire transfer (fees may apply)

Tax Withholding Election

Federal tax withholding (check one):
Do not withhold federal income tax
Withhold federal income tax at the rate of

State tax withholding (if applicable):

Required Documentation Checklist

The following items must accompany this application (check items provided):

Certified copy of death certificate
Proof of beneficiary status (trust instrument, will, court documents, or beneficiary designation)
Government-issued photo ID for beneficiary
Medallion signature guarantee (if required by custodian)

Fees and Processing

Applicant acknowledges that distribution requests may be subject to processing fees, account closing fees, or wire fees as set by the custodian. Fees will be deducted from the account unless otherwise agreed in writing. Distribution processing may require up to 30 calendar days from receipt of a complete application and all required documentation.

Certifications and Authorization

By signing below, I certify, under penalty of perjury, that I am the person identified above and that the information provided is true, correct and complete. I acknowledge that I have received no tax advice from the custodian and that I am responsible for determining the tax consequences and for reporting distributions. I authorize the custodian to process the distribution(s) requested, to rely on the documentation provided, and to withhold taxes in accordance with my elections above. I agree to indemnify and hold the custodian harmless for any losses, liabilities or costs arising from reliance on this application, including processing payments in accordance with the payment instructions provided.

Acknowledgement of Notices

I acknowledge that distributions from an inherited IRA may be subject to federal and state income taxes and, if applicable, an additional early distribution penalty unless an exception applies. I understand that my election regarding the method and timing of distributions is irrevocable once processed and may affect required minimum distribution calculations and beneficiary designations.

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