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Form 30482 - Request for IRA/Roth ANNUITY Transfer or ...

Y (10/19)304821 Owner NameAmount to be moved:Plan Type:Outgoing ANNUITY Tax-Qualified Transfer , Exchange, Conversion or Direct Rollover from RiverSource Life Insurance CompanyTraditional IRA (including Rollover and SEP)Roth Contributory IRAS imple IRATax-Sheltered ANNUITY (TSA)Roth Conversion IRAI nherited (Beneficial) IRA Full (100%)Specific Amount $Withdraw total free amount without incurring surrender chargesWithdraw 10% free amountProduct TypeProduct NameCompany NameAccount You Are Moving Assets To continued on next NameFixed AnnuityVariable AnnuityMarket Value AnnuityFixed Index AnnuityImmediate AnnuityMutual Fund CDBrokerageOtherAdvisor/Agent NameRiverSource Life Insurance Company 70100 Ameriprise Financial Center Minneapolis, MN 55474 RiverSource Life Account You Are Moving Assets FromPart 1 Account You Are Moving Assets ToPart 2 2008 - 2019 RiverSource Life Insurance Company. All rights reserved. The distribution options available to you may be restricted by your employer's 403 (b) plan provisions.

Special Tax Notice for Plan Distributions. You should consult with a tax advisor prior to requesting this transaction. There will be no withholding on this request unless you elect withholding below. Direct Conversion from TSA to a Roth IRA DOC020530482 Page 2 of 5 If product is an annuity (Select one): Plan Type:

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Transcription of Form 30482 - Request for IRA/Roth ANNUITY Transfer or ...

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Form 30481 -Request for 1035 Exchange of Non-Qualified ...

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