Mutual Fund Qualified Charitable Distribution—IRA

1 Mutual fund Qualified Charitable distribution IRA. Use this form to: Mail to: Express delivery only: Make a one-time tax-reportable Qualified Charitable distribution T. Rowe Price T. Rowe Price Mail code 17302. (QCD) from a Traditional, Rollover, Roth, Inherited, SEP-IRA Box 17302 4515 Painters Mill Road (inactive plans only), or SIMPLE IRA (inactive plans only). Baltimore, MD 21297-1302 Owings Mills, MD 21117-4903. This stamp indicates that a notary is required. This paper clip indicates that you may need to attach documentation. IMPORTANT NOTE: The SECURE Act extended the age for individuals, T he distribution must be from an IRA.

2 QCDs are not permitted from who did not turn 70 on or before 12/31/19, to start taking thier RMDs employer-sponsored retirement plans, including active SEP-IRA or from 70 to 72. If you turned 70 on or before 12/31/19, your RMD age SIMPLE IRA plans. An active SEP-IRA or SIMPLE IRA is one in has not been extended. which an employer contribution or salary reduction contribution is made for the plan year ending with or within the participant's tax year in which the QCD would be made. In addition, the SECURE Act removed the maximum age for making contri- The amount of the QCD is limited to the amount that would normally butions to a Traditional IRA beginning for taxable year 2020.

3 However, the be subject to taxation. $100,000 annual exclusion from income for QCDs is reduced if you are also making deductible IRA contributions. A QCD may count toward satisfying any required minimum distribution ( RMD ). Note: If you have a systematic withdrawal plan established Helpful Facts and you would like to reduce any remaining payments by the distribu- A QCD is a distribution from your IRA that may be nontaxable if the follow- tion amount requested on this form, you must complete section 3. ing conditions are met: Each check will be made payable to the Qualified charity and list You must be age 70 or older on the date of the distribution .

4 Your name as donor. Since you must receive acknowledgment of The distribution payment must be made directly to a Qualified charity. your contribution, you should follow up with the charity directly for a A Qualified charity is an organization described in Internal Revenue code receipt of your donation. (IRC) Section 170(b)(1)(A), generally a public charity that is eligible to A Form 1099-R will be issued to you and the IRS for this distri- receive tax-deductible contributions. The following charities are excluded: bution from your IRA. For a non-Inherited IRA, a distribution private foundations, donor-advised funds, and Charitable supporting code of 7, a normal distribution , is used.

5 For an Inherited IRA, organizations. a distribution code of 4, a death distribution , is used. The distribution would otherwise be deductible as a Charitable You cannot claim a Charitable contribution deduction for any QCD not contribution under IRC Section 170. included in your income. The maximum annual exclusion from income per individual is $100,000. It is your responsibility to ensure that your IRA distribution complies This $100,000 is reduced if you are making deductible IRA contributions with IRC Section 408(d)(8). For more detailed information about after age 70 . QCDs, please consult a tax advisor or accountant for advice.

6 1 Owner Information 2 distribution Information Complete a separate form per IRA type. Check IRA Type: Traditional Roth Rollover 2A Amount Roth Rollover Inherited Roth Inherited SEP-IRA SIMPLE IRA For each fund and account number listed, provide the amount to be distributed. Check if IRA assets are held in a brokerage account: Brokerage. It is your responsibility to ensure that sufficient funds fund Name Account Number/Plan ID Amount*. are available in your sweep account to cover the amount of the requested distribution . $. Name Social Security Number (SSN) $. $. Phone Date of Birth (mm/dd/yyyy). $. For more funds, check this box and attach a separate page.

7 * NOTE: Dollar balances may fluctuate daily with the market. If the dollar amount is close to the total balance, provide percent or share amount instead. FMF4 QCDD 2/20_w Questions? | 800-225-5132 Page 1 of 2. 2B Receiving Organization 4 Signatures A check(s) will be made payable to the qualifying charity(ies) and mailed directly to the charity address(es). If an address is not provided, the I direct T. Rowe Price to make a QCD in the manner I have indicated. I. check will be mailed to your address of record. Failure to provide the certify the following: total check amount for each receiving organization will result in equal allo- I am responsible for determining if my distribution request satisfies the cation among the listed organizations.

8 Requirements under Internal Revenue code Section 408(d)(8). I agree to indemnify and hold harmless T. Rowe Price and its affiliates Qualified Charity Name from and against any and all claims or causes of action, or any losses and liabilities, incurred as a result of my instructions on this form. I elect no income tax withholding. Attention Total Check Amount I am a person (including a resident alien). I understand that I am responsible for calculating and withdrawing my RMD amounts under Internal Revenue code Section 401(a)(9). I hereby Address indemnify and hold T. Rowe Price Trust Company, its parent and affiliates, successors, and employees harmless from any and all liability should I fail to receive the correct RMD amount in any calendar year.

9 City State ZIP code If distributing the QCD from a SEP-IRA or SIMPLE IRA, I am not an active participant in the plan. Qualified Charity Name 4A Account Owner Sign Below Attention Total Check Amount ou must obtain a notary if sending the check directly to the quali- Y. fied charity address(es) AND your TOTAL distribution amount is greater than $10,000. Address Signature and Date Required Owner or Beneficiary Date (mm/dd/yyyy). City State ZIP code -X. T. o list more receiving organizations, check this box and attach a separate page. 4B Notary Sworn to and subscribed before me, this _____ day of Existing RMD Withdrawal Program _____, _____.

10 In witness hereof, I. 3 On File hereunto set my hand and official seal. Notary Public Notary Stamp Applies to Account Owner(s). Signature Above If you have an existing RMD program on file it will NOT be automatically updated unless you check the box below. My Commission Expires Please update my RMD program to reduce the distribution by the total requested withdrawal amount in Section 2 of this form. I. understand that it will reduce my IRA systematic withdrawals propor- tionately from each Mutual fund within the type of IRA identified in Section 1 unless I provide additional instructions. Please note, this option only applies to a systematic withdrawal plan in which T.