IRA Distribution Form - BankDirect

1 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. I indemnify and hold the custodian/trustee harmless from any resulting liabilities. I acknowledge that the custodian/trustee cannotprovide me with legal advice, and I agree to consult with a tax or legal professional for of IRA Owner/BeneficiaryDateAccount TypeAccount Number(1)(2)(3)I elect distributions to be paid in thefollowing manner (select one):Date of DistributionAmount Requested$Penalties Charged(-)Administrative Fees(-)$Federal Income Tax Withheld(-)State Income Tax Withheld(-)Local Tax Withheld(-)$Earnings paid to date not already reported to IRAA dministration Provider (optional).

2 Includethis figure in the Amount Requested. $Does this Distribution close the IRA? YesNo(Complete for IRS Levy, Death, Transfer, Recharacterization, Direct Rollover, and QHSAFD transactions.)(1)of $.(2)I authorize automatic distributions of$onamonthlyannualquarterlyotherbasis, starting periodic distributions until Inotify you in writing otherwise.(3)(including transfers)Correction of Excess Contribution for Tax of excess $.In same year as excess contributionEarnings attributable to excess $.In year after excess contribution, but by my tax-filing duedate, including extensionsEarnings attributable to excess $.After my tax-filing due date, including extensionsRecharacterization of:Prior tax year regular contribution in the current yearCurrent tax year regular contribution in the current yearSIMPLE IRA Distribution During Two-Year Period(if younger than age 59 )Premature, no known exceptionPremature, exception applies (includes IRS Levy)DisabilityDeathProhibited TransactionRevocationNormalTransferTo my IRATo spouse's IRA due to death (only if sole beneficiary)To former spouse's IRA due to divorce or legal separationDirect Rollover to an employer-sponsored Eligible Retirement PlanQualified Health Savings Account Funding Distribution (QHSAFD)I electto have Federal income tax withheld from my IRA elect to have 10 percent Federal income tax withheld from my IRA want the followingdollar amount ($), orpercentage (%) withheld from each IRA elect to have $or% State income tax withheld from my IRA Distribution (if applicable).

3 The instructions to form W-4P (Withholding Certificate) are included in the Additional Information section of this IRASIMPLE IRAFormDepartment of the TreasuryInternal Revenue ServiceOMB No. 1545-0074W-4P(page 1 of 2)-1998, 2004 Wolters Kluwer Financial Services - Bankers Systems form IRA4/W4P-LAZ Rev. 1/1/2007*Select One. (For further information, see Additional Information included with this form .)Mail check to into myaccount at thisfinancial Amount PaidRecipient InformationImmediate DistributionPeriodic DistributionOther(See IRS form W-8 BEN if you are a foreign person.)notadditionaladditionalNAME, ADDRESS, CITY, STATE AND ZIPA. PAYMENT ELECTIONC. PAYMENT DETAILB. PAYMENT METHODBENEFICIARY DATE OF BIRTH (IF APPLICABLE)IRA ACCOUNT (PLAN) NUMBER (IF APPLICABLE)DAYTIME PHONE NUMBERTAXPAYER IDENTIFICATION NUMBER (TIN)/SSN (IF APPLICABLE)DAYTIME PHONE NUMBERSOCIAL SECURITY NUMBERTYPE OF IRA (SELECT ONE):IRA ACCOUNT (PLAN) NUMBERDATE OF DEATH (IF APPLICABLE)DATE OF BIRTHNAME, ADDRESS, CITY, STATE AND ZIPlllllllllllllllllllllllllllllllllll(c ompleted by financial organization)(amount subject to withholding)(if applicable)lll(page 2 of 2) Retirement , exception , no known Health Savings Account Funding Additional INFORMATIONR ecipient of Federal Income Payments 10% Not to Have Income Tax Your "No Withholding" ChoicePayments to Foreign Persons and Payments Outside the United is a Distribution taken by a beneficiary(ies) of a deceased IRAowner that is exempt from the premature- Distribution penalty Distribution for disability can avoid the 10 percentpremature- Distribution penalty tax if you are younger than age 59 andmeet the definition of disability under Internal Revenue Code (IRC)Section 72(m)(7).

4 Eligible retirement plans include qualifiedplans under IRC Section 401(a), which includes Section 401(k) plans, atax-sheltered annuity under IRC Section 403(b), or a deferredcompensation plan under IRC Section 457(b).An excess contribution occurs when thecontribution amount exceeds allowable limits or when an ineligibleindividual makes a contribution. For correction purposes, an IRA ownercan treat an unwanted contribution as an you are age 59 or older, you are not subject to a 10 percentpremature- Distribution penalty types of distributions areautomatically exempt from the 10 percent premature- Distribution penaltytax:If you are younger than age 59 , youmay be subject to a 10 percent premature- Distribution penalty tax unlessyou properly roll over the assets within 60 days (or 120 days in the case ofthe return of a first-time homebuyer Distribution ), or unless you meet anexception. The exceptions are for distributions used to pay for a:Violations of IRC Section 4975 due to improperinvestment or use of IRA assets could result in the IRA assets becomingfully taxable and subject to penalty is adistribution from a traditional IRA, not including a SEP or SIMPLE IRA,to the extent it is contributed to your health savings account.

5 The electionto make this Distribution is recharacterization is the method by which an IRAowner can redesignate the type of IRA contribution made for the may revoke your IRA on or before seven (7) days afterthe date of establishment. If you revoke a regular contribution, thedistribution is reported to the IRS as a correction of excess contribution inthe same year. If you revoke a rollover or transfer contribution, thedistribution is reported to the IRS as a normal Distribution if you are age59 or older, or as a premature Distribution no known exception, if youare younger than age 59 .Under Treasury Regulation Section (a)(9)-8,Q&A-3, a separate account in an IRA would be a separate portion of theIRA that reflects a beneficiary's separate interest in the IRA as of the dateof the owner's death. If separate accounting is not immediate upon an IRAowner's death, an IRA custodian/trustee should allocate the post-deathinvestment gains and losses for the period prior to the establishment ofseparate accounts on a reasonable and consistent pro rata basis among theseparate beneficiary transfer is the non-reportable movement of assets betweenIRAs of the same IRA Distribution form for Traditional and SIMPLE IRAs isdesigned to assist you in selecting your individual retirement account (IRA) Distribution reason and law or policies of the IRAcustodian/trustee may require additional documentation.

6 A separatedistribution form must be completed for each Distribution is in your best interest to seek the guidance of atax or legal professional before completing this document. Your first referenceshould be the IRA agreement and disclosure statement you received uponestablishing your IRA or amendments provided by your custodian/trustee. Formore information, refer to Internal Revenue Service (IRS) Publication 590,, IRS Publication 505,, instructions to your federal income taxreturn, your local IRS office, or the IRS's web site at general understanding of the following terms may be helpful incompleting your Distribution subsequently converted to a Roth Distribution made to satisfy an IRS based on an election to receive substantially equalperiodic payments for the greater of a five-year period or until youattain age 59 .Higher Education ExpenseFirst-Time Home PurchaseMedical ExpenseHealth Insurance PremiumQualified Reservist DistributionThe Recipient Information section must be completedfor a Distribution due to IRS levy, a death Distribution , a transfer to anothertraditional IRA, a transfer to a former spouse's traditional IRA due to divorceor legal separation, a transfer to a spouse's traditional IRA due to death (ifsole beneficiary), a recharacterization, a direct rollover to an eligibleretirement plan, or a qualified health savings account funding complete information regarding the individual or entity receiving , federal income taxwithholding applies to your IRA distributions.

7 The method and rate ofwithholding depends on (a) the type of Distribution you receive, (b) whetherthe Distribution is delivered outside the United States or its possessions, and(c) whether you (or your beneficiary after your death) are a nonresident alienindividual, a nonresident alien beneficiary, or a foreign estate. Qualifieddistributions from a Roth IRA are nontaxable and, therefore, not subject towithholding. Because your tax situation may change from year to year, youmay want to change your withholding election each year. You can change theamount to be withheld by using IRS form W-4P or an appropriate state may allow or require state income taxwithholding on any taxable local governing authority may allow or requirelocal income tax withholding on any taxable IRA funds cannot be rolled or transferred to atraditional IRA or converted to a Roth IRA within a two-year period thatbegins on the date of the initial contribution to your SIMPLE IRA funds transferred or distributed during the two-year periodare subject to an additional 25 percent excise from an IRAthat are payable on demand are treated as nonperiodic payments.

8 YourIRA custodian/trustee must withhold at a flat 10% rate from your IRAdistributions unless you choose not to have federal income tax can choose not to have income tax withheld from a nonperiodicpayment by using IRS form W-4P or an appropriate substitute form andproviding your correct tax identification number (TIN). Generally, yourchoice to have income tax withheld or not will apply to any laterdistribution from your IRA. You may also specify an additional amountthat you want (or in the event ofdeath, your beneficiary or estate) can choose not to have income taxwithheld from your payments by using form W-4P or an appropriatesubstitute form . For an estate, the election to have no income tax withheldmay be made by the executor or personal representative of the executor/representative must provide the estate's TIN/employeridentification number (EIN).Tax Withholdingand Estimated If you previously chose not tohave income tax withheld and you now want 10% withholding, write"Revoked" next to the checkbox on line 1 of IRS form W-4P and providea copy to your IRA custodian/trustee.

9 To the extent you want a greateramount withheld, complete a new form W-4P or an appropriate substituteform for your IRA you are a nonresident alien, withholding (in the manner describedabove) is required on any nonperiodic payments that are delivered to yououtside the United States or its possessions. You cannot choose not to haveincome tax withheld on form W-4P. See IRS Publication 505,for additional the absence of a tax treaty exemption, nonresident aliens, nonresidentalien beneficiaries, and foreign estates generally are subject to a 30%withholding tax under IRC Section 1441 on the taxable portion of anonperiodic pension or annuity payment that is from , most tax treaties provide that private pensions and annuities areexempt from withholding and tax. Also, payments from certain pensionplans are exempt from withholding even if no tax treaty applies. See IRSP ublication 515,and IRS Publication 519,for foreign person should submit IRS form W-8 BEN,to the IRAcustodian/trustee before receiving any payments.

10 The form W-8 BEN mustcontain the foreign person's you are a foreign person who has provided an IRA custodian/trusteewith IRS W-8 BEN, the IRA custodian/trustee will furnish a statement toyou on IRS form 1042-S,by March 15 of next }}}}}}}}Individual Retirement Arrangements (IRAs)TaxWithholding and Estimated TaxIf you do not provide your correct TIN, your IRA custodian/trustee cannot honor your request not to have income tax withheld andmust withhold 10% of the payment for federal income are penalties for not paying enough federal income taxduring the year, either through withholding or estimated tax retirees, especially, should see IRS Publication 505,It explains the estimated tax requirements anddescribes penalties in detail. You may be able to avoid quarterly estimatedtax payments by having enough tax withheld from your IRA using FormW-4P or an appropriate substitute and Estimated TaxWithholding of Tax on Nonresident Aliens and ForeignEntities, Tax Guide for Aliens,Certificate of ForeignStatus of Beneficial Owner for United States Tax Withholding,Foreign Person's Source Income Subject toWithholding,f-1998, 2004 Wolters Kluwer Financial Services - Bankers Systems form IRA4/W4P-LAZ Rev.