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IRA Distribution Form - BankDirect

IRA Distribution Formfor Traditional and SIMPLE IRAsWITHHOLDING ELECTIONIRA OWNER INFORMATIONSIGNATURESDISTRIBUTION REASONPAYMENT INSTRUCTIONSS ignature of Custodian/TrusteeDateI certify that I am the IRA owner, the beneficiary, or individual legally authorized to complete this form . I certify the accuracy of the informationset forth in this form , and I authorize this transaction. I understand the custodian/trustee may require the completion of additional documentsbefore processing any distributions. I understand that I am responsible for any consequences resulting from this Distribution including taxes andpenalties owed.

IRA Distribution Form for Traditional and SIMPLE IRAs WITHHOLDING ELECTION IRA OWNER INFORMATION SIGNATURES DISTRIBUTION REASON PAYMENT INSTRUCTIONS

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