Traditional/Roth IRA Plan
Beneciary Distribution Election Form
BANK OF AMERICA, N.A. (THE “BANK”)
1. DECEASED DEPOSITOR INFORMATION INFORMATION Depositor’s Name
Social Security Number
Date of Birth
Plan Number
Date of Death
Plan Type
Traditional IRA Roth IRA Bank of America, like all nancial institutions, is required by the USA PATRIOT ACT to obtain, verify, and record information that identies each beneciary of an IRA account with us. When you are a beneciary of an IRA account with us, we will ask you for your name, address and other information that will allow us to identify you. The information we gather is for your protection and the country’s against terrorist activity and illegal money laundering schemes.
2. BENEFICIARY INFORMATION Beneciary Name
Social Security Number
Daytime Telephone Number
Relationship to Depositor
Date of Birth
Physical Street Address, City, State, Zip
Source of Income:
Mailing Address (If different)
Employment
Investment
Inhe Inheri rita tanc nce e
Reti Retire reme ment nt/S /Soc ocia iall Secu Securi rity ty
Employer Name (If Employment Selected)
Country of Citizenship
Occupation (If Employment Selected)
Country of Residency
Non U.S. Citizen Required Information
Senior Political Figure and Politi cally Exposed Persons
Have you or any of your immediate family ever been elected, appointed or assumed any political position in a Nat Natio iona nal, l, Stat State, e, or Prov Provin inci cial al gove govern rnme ment nt? ? (Y/ (Y/N) N) If yes, yes, desc descri ribe be the the pos positi ition on..
# of Days Present in U.S. This Year
# of Days Present in the U.S. Last Year Year
# of Days Present in the U.S. During Previous Year Year
3. DISTRIBUTION INSTRUCTIONS BANK OF AMERICA RECOMMENDS YOU CONTACT YOUR TAX ADVISOR BEFORE MAKING YOUR ELECTION A beneciary beneciary of an IRA IRA Plan should should elect how to to receive the proceeds proceeds of the IRA IRA Plan no later than 09/30 of of the year following following the year of the IRA Plan Depositor’s death. Any separate beneciary accounts must be established by 12/31 of the year following the IRA Plan Depositor’s death. Available options depend on the age of the IRA Plan Depositor, Depositor, the relationship relationship of the beneciary beneciary to the IRA Depositor, Depositor, and the type of IRA Plan. SELECT ONLY ONE OF THE PAYMENT OPTIONS BELOW.
Life Expectancy Payments
I elect to receive my entire portion of the IRA Plan in a single lump sum payment. Deposit into my Bank of America Checking Savings Mail check to the address above. State I elect to receive my entire portion of the IRA Plan by taking payments over the longer of my own life expectancy or the remaining life expectancy of the deceased IRA Plan Depositor.
Specic Amount
I elect to receive my entire portion of the IRA Plan by taking payments of
Specic Term
I elect to receive my entire portion of th the IR IRA Plan by taking payments over
Lump Sum Distribution
Option A. Always Available
year
I elect to receive my entire portion of the IRA Plan by 12/31 of the year containing the 5 anniversary of the IRA Plan Depositor’s death. (Only available if the deceased IRA Plan Depositor was under the age of 70½ on the date of death ) th
5-Year Payout
Option B. Additional Options for Spouse Only
Spouse Spouse Treat Treat as Own
I am the spouse of the deceased IRA Plan Depositor and I elect to treat the assets of the IRA Plan as my own IRA.
Spousal Exception
I am the spouse of the deceased IRA Plan Depositor and I elect to delay taking distributions until the year my spouse would would have reached age 70½. Date:
NOTE: Under both options, additional amounts may be withdrawn at any time.
4. RMD PAYMENT INSTRUCTIONS You are responsible for t aking your annual Required Minimum Distribution (RMD) from the IRA Plan. The Bank willnot distribute your RMD unless you give the Bank timely written distribution instructions. The Specic Start Date is limit ed to any date between January 7 th and December 28 th. If date selected is a non-business day, the distribution will be processed on the rst business day foll owing the date.
Select One:
Monthly
Select One:
Mail Mail chec heck to to the the addr addres ess s abo abov ve.
Quarterly
Form 00-59-1289NSBW–Version 00-59-1289NSBW–Version 051712
Semi-Annually
Annually
Specic St Start Da Date
Depo Depos sit into into my Bank ank of of Ame Ameri ric ca
Chec hecking king
Savin avings gs
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
5. TAX WITHHOLDING WITHHOLDING ELECTION ELECTION Notice of Withholding Election: Distributions you receive from your Individual Retirement Account are subject to Federal income tax withholding and may be subject to State income tax withholding and/or Local income tax withholding based on your state and municipality of residence unless you elect not to have withholding apply.
You are liable for Federal, and applicable State and Local income taxes on the taxable portion of your distribution. If you elect not to have withholding apply to your distribution, or if you do not have enough tax withheld from your distribution, you may be responsible for payment of estimated taxes. You may also incur penalties under the estimated tax rules if your withholding and estimated tax payments are not sufcient. Withholding Election: You MUST indicate your withholding election below.
Complete if you are providing a U.S. Address: Federal Withholding: Important: Please note that if you do not make a withholding election, federal income tax will be automatically withheld from your distribution at a rate of 10%.
Do not withhold federal income tax from my distribution. Withhold federal income tax from my distribution (check one): At a rate of 10%
At a rate of
% (must be greater than 10%)
State Withholding: Important: State withholding may also be required in certain states when you elect federal income tax withholding. North Carolina residents are required to use form NC-4P (Withholding Certicate for Pension or Annuity Payments) for all North Carolina state withholding elections.
The minimum required for the state of
.
is
Do not withhold state income tax from my distribution.
Withhold state income tax for the state of
from my distribution at the rate of
%, or amount of $
.
%, or amou amount nt of $
.
Local Withholding: Important: Local withholding may also be required in certain states.
The minimum required for the municipality of
is
.
withhold local income tax from my distribution. Do not withhold With Withho hold ld local local inco income me tax tax for for the the muni munici cipa palility ty of
from from my distr distrib ibut utio ion n at the the rate rate of
Complete if you are providing a Foreign Address: Important: If you are a U.S. citizen or a Resident Alien with a foreign address, you may not waive the Federal withholding requirement and you must complete Form W-9. If you are a Non-Resident Alien, all IRA distributions are subject to a tax treaty rate or 30% tax withholding and you must complete Form W-8BEN. I am a U.S. Citizen or Resident Alien living abroad (check one) With ithhold hold:: At a rate rate of 10% At a rate rate of % (must be greater than 10%)
6. BENEFICIAR BENEFICIARY’S Y’S ACKNOWLEDGM ACKNOWLEDGMENT ENT I acknowledge that I have read and completed this Form. I further acknowledge that neither the Bank nor its agents or employees have made any
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Traditional/Roth IRA Plan
Beneciary Distribution Election Form
BANK OF AMERICA, N.A. (THE “BANK”)
Informational Sheet BANK OF AMERICA RECOMMENDS YOU CONTACT YOUR TAX ADVISOR BEFORE MAKING YOUR ELECTION
A beneciary of an IRA Plan should elect how to receive the proceeds of the IRA Plan no later than 09/30 of the year following the year of the IRA Plan Plan Depos Deposit itor’ or’s s death death.. Any Any separ separat ate e bene beneci ciary ary accoun accounts ts must must be esta establ blis ished hed by 12/31 12/31 of the the year year foll follow owing ing the the IRA IRA Plan Plan Depos Deposit itor’ or’s s death death.. Available options depend on the age of the IRA Plan Depositor, the relationship of the beneciary to the IRA Depositor, and the type of IRA Plan. Complete, sign and send the distribution form: To your Local Bank of America Banking Center Or, mail to the following address: Bank of America, N.A. Mail code: TX2-979-02-14 P.O. Box 619040 Dallas, TX 75261-9943
1. DECEASED DEPOSITOR INFORMATION INFORMATION Depositor’s Name — Enter the deceased person’s name Social Security Number — Enter the deceased person’s social security number Date of Birth — Enter the deceased person’s Date of Birth Plan Number — Enter the deceased person’s Plan Number that is being processed Date of Death — Enter the date of death for the account owner (deceased person Plan type — Select the plan t ype of the deceased account holder
2. BENEFICIARY INFORMATION INFORMATION Bank Bank of Amer Americ ica, a, like like all all nan nanci cial al insti institut tutio ions ns,, is requ requir ired ed by the the USA PATRIOT ACT to obta obtain in,, veri verify fy,, and and reco record rd infor informa mati tion on that that iden identi tie es s each each bene benec cia iary ry of an IRA IRA acco accoun untt with with us. us. When When you you are are a bene benec cia iary ry of an IRA IRA acco accoun untt with with us, us, we will will ask ask you you for for your your name name,, addr addres ess s and and othe other r info inform rmati ation on that that will will allo allow w us to iden identif tify y you. you. The The info inform rmati ation on we gathe gatherr is for your your prot protec ecti tion on and and the coun countr try’ y’s s agai agains nstt terro terrori rist st activ activit ity y and and illega illegall money money launde launderin ring g scheme schemes. s. Beneciary Name — Enter the name of the beneciary for the plan identied in the Plan Number section Social Security Number — Enter the Social Security Number for the beneciary listed in the Beneciary Name section. If the beneciary is an entity, enter the Employer Identication Number (EIN) Daytime Telephone Number — Enter the best contact number that you can be reach at during the day Date of Birth — Date of birth for the person listed in the Beneciary Name section. If the beneciary is an Entity, please list the Date of Birth for the decedent Relationship to the Depositor — Example, Daughter, Mother, or Father. If the beneciary is an Entity please leave this eld blank Physical Street Address, City, State, Zip — Enter the street address for the beneciary listed in the Beneciary Name section. Please note: This must be a physical address to comply with the USA Patriot ACT. Source of Income — Select the appropriate option from the list provided. If the beneciary is an Entity, please select Inheritance. Mailing Address — Complete only if different from the Physical Address listed. Employer Name — List the beneciary’s current employer Country of Citizenship — Enter the Country that the Beneciary is a citizen Country of Residency — Enter the Country the Beneciary resides in Occupation — Enter the Beneciary’s current occupation or job ONLY if employment was selected as Source of Income Non U. S. Citizen Required Information
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
3. DISTRIBUTI DISTRIBUTION ON INSTRUCTIONS INSTRUCTIONS Please ensure that you select only one of the payment options f rom the list. Selecting multiple options can delay the processing of your request.
Option A:
Lump Sum Distribution — Available to all beneciaries. This option would be a single lump sum payment of the funds directly to the beneciary Life Expectancy — Payments would be made over the life expectancy of the beneciary list in the Beneciary Name section Specic Amount — Payment amounts would be disbursed as specied by the beneciary (the beneciary will be responsible to ensure that their disbursement disbursement amount meets IRS requirements requirements) ** Specic Term — Payments will be disbursed over a specied term as elected by the beneciary (the beneciary will be responsible responsible to ensure that their disbursement amount meets IRS requirements) ** 5 -year Payout Payout — Payments Payments will be disbursed disbursed by 12/31 12/31 of the 5th year post the year of death of the IRA Plan holder**
Option B (Spousal Options):
Spouse Treat as Own — An IRA plan honoring the deceased depositor’s existing IRA Plan terms would be established for the spouse, and the account would be treated as their own. Spousal Exception — The spouse elects to delay taking distributions until the deceased account holder would have reached 70½ **Under these methods denoted above, additional amounts may be withdrawn at any time. Please note: If you selected any option except Lump Sum, please ensure Section 4 is completed (if applicable).
4. RMD PA PAYMENT INSTRUCTIONS The Beneciary is responsible for taking their annual Required Minimum Distribution (RMD) from the IRA Plan. The Specic Start Date is limited to any date between January 7 th and December 28 th. If date selected is a non-business day, the distribution will be processed on the rst business day following the date. Please review the options carefully and select the appropriate distribution for the beneciary.
5. TAX WITHHOLDING WITHHOLDING ELECTION ELECTION Distribu butio tions ns you you receiv receive e from from your your Indivi Individua duall Retir Retireme ement nt Accoun Accountt are subjec subjectt to Fede Federal ral income income tax Notice Notice of Withhold Withholding ing Election Election:: Distri with withho hold ldin ing g and and may may be subj subject ect to State State incom income e tax with withho hold ldin ing g and/ and/or or Local Local incom income e tax with withho hold ldin ing g base based d on your your state state and and muni munici cipa palility ty of resid residenc ence e unles unless s you elect elect not to have have withh withhold oldin ing g apply apply.. You are are liab liable le for for Fede Federa ral, l, and and appl applic icab able le State State and and Loca Locall incom income e taxes taxes on the the taxab taxable le porti portion on of your your dist distri ribu buti tion on.. If you you elec electt not not to have have with withho hold ldin ing g appl apply y to your your dist distri ribu buti tion on,, or if you you do not not have have enou enough gh tax with withhe held ld from from your your dist distri ribu buti tion on,, you you may may be resp respon onsi sibl ble e for for paym paymen entt of esti estima mate ted d taxes taxes.. You may may also also incu incurr pena penalt ltie ies s unde underr the the esti estima mate ted d tax rule rules s if your your with withho hold ldin ing g and and esti estima mate ted d tax tax paym paymen ents ts are are not not sufc sufcie ient nt.. You You MUST indicate indicate your withholding withholding election on on the form provided. provided. Federal Withholding: Withholding: Important: Please note that if you do not make a withholding election, federal income tax will be automatically withheld from your distribution at a rate of 10%. State Withholding: Withholding: Important: State withholding may also be required in certain states when you elect federal income tax withholding. Note that North Carolina residents must use Form NC-4P (Withholding Certicate for Pension or Annuity Payments) to elect or waive North Carolina state withholding. Local Withholding: Withholding: Important: Local withholding may also be required in certain states. Complete denoted section if you are providing a Foreign Address:
