Transcription of CONTRIBUTION AND INVESTMENT SELECTION - Ascensus
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CONTRIBUTION AND INVESTMENT SELECTION - Ascensus
Page 1 of 26107 / 2414R (Rev. 3/2018) 2018 Ascensus , LLCCONTRIBUTION AND INVESTMENT SELECTIONPART 1. ROTH IRA OWNERName (First/MI/Last) _____Social Security Number _____Date of Birth _____ Phone _____Email Address _____Account Number_____ Suffix _____PART 2. ROTH IRA TRUSTEE OR CUSTODIANTo be completed by the Roth IRA trustee or custodianName _____Address Line 1 _____Address Line 2 _____City/State/ZIP _____Phone _____ Organization Number _____PART 3. CONTRIBUTION INFORMATIONC ontribution Amount _____ CONTRIBUTION Date _____ CONTRIBUTION TYPE (Select one) 1. Regular (Includes catch-up contributions) CONTRIBUTION for Tax Year _____ 2. Rollover (Distribution from a Roth IRA or eligible employer-sponsored retirement plan that is being deposited into this Roth IRA) By selecting this transaction, I irrevocably designate this CONTRIBUTION as a rollover.
Page 1 of 2 6107 / 2414R (Rev. 3/2018) ©2018 Ascensus, LLC CONTRIBUTION AND INVESTMENT SELECTION PART 1. ROTH IRA OWNER Name (First/MI/Last) _____ Social Security Number _____
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