Fillable AUTHORIZATION ACCOUNT TRANSFER IRA-TO-IRA Millennium Account Number (if

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AUTHORIZATION ACCOUNT TRANSFER IRA-TO-IRA Millennium Account Number (if

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IRA-007 03-20
IRA-TO-IRA
ACCOUNT TRANSFER
AUTHORIZATION
(Millennium Trust Company is Non-ACAT eligible.)
B
*IRA-007*
Please continue to page two to complete this form.
To complete this application, you will need:
A
IRA Compatibility
Choose only one
account type.
Not all account types are compatible; there may be additional steps and forms required in some cases.
Current IRA Type
transfer to
IRA Type at Millennium
Traditional IRA Traditional IRA SEP IRA
Inherited Traditional IRA
Inherited Traditional IRA
Roth IRA
Roth IRA
Inherited Roth IRA
Inherited Roth IRA
SEP IRA SEP IRA Traditional IRA
SIMPLE IRA SIMPLE IRA Traditional IRA (
after 2 years from
date of 1st deposit)
Account Owner’s Information
Enter Account Owner’s
full name.
Required if you have more
than one account with
Millennium.
 Current Custodian’s name, address, phone & fax
number, and e-mail address
 Account Number with current Custodian

Copy of your most recent statement from your
current Custodian (within past 3 months) if
transferring assets
 Millennium Account Number (if applicable)
 Copy of your most recent statement from
Alternative Investment Sponsor if transferring
alternative assets
 Check with your current Custodian to
determine if a Medallion Signature Guarantee
is required for this transfer
First: Middle: Last:
Social Security No. (9 digits required): Daytime Phone No.:
E-mail Address:
Millennium Account No.:
2001 Spring Road, Suite 700
Oak Brook, IL 60523
800.618.6177 Individual Service Team
866.388.5464 Institutional Service Team
800.560.1288 Investment Advisor Service Team
Please print after completion. For assistance with this form, please contact a Client Service Specialist during regular business hours,
Monday - Friday, 8:00 am to 4:30 pm Central time.
Referral Code:
IRA-007 03-20
IRA-TO-IRA ACCOUNT TRANSFER AUTHORIZATION, Page 2 of 3
D
Transfer of Current IRA
Incomplete information
may delay the transfer.
Please choose only one of
the following: Either a
Full or Partial transfer.
Please list any “In-Kind”
assets (non-cash assets
NOT being sold) to be
transferred.
Fee may apply for wire
transfer– please check
with your current
Custodian.
Non-Cash “In-Kind” Assets for Partial Transfers:
Please continue to page three to complete this form.
Current Custodian
(Name of Transferring Firm):
Custodian Street Address:
City: State: Zip:
Custodian Phone No.: Fax No.:
E-mail Address for Current Custodian:
Account No. w/ Current Custodian:
Current Custodian Information
C
For each alternative asset being re-registered, you must complete an “Investment Sponsor Contact
Information” form located on our website under the Forms tab. Please submit an Alternative
Investment Statement from your Fund Sponsor before any transfer can be complete. For
traditional investments, the dividend election from the prior custodian will not transfer over. Your
account will automatically default to dividend reinvestment for mutual fund positions. Contact
client service if you have any questions or issues.
Full Transfer (Transferring ALL assets to Millennium)
 Liquidate all assets and transfer entire balance as cash.
Transfer my entire account “In-Kind”.
Please specify the types of assets currently held in
your account.
Cash only
“In-Kind” assets only*
Both cash and “In-Kind” assets*
Partial Transfer (Transferring only some assets to Millennium)
 ALL available cash
 Transfer the following amount in cash: $
 Transfer In-Kind only the non-cash assets listed in the table below*
*If transferring non-cash assets “In-Kind”, Millennium requires a copy of your current custodian’s
statement, dated within 3 months.
Cash Delivery Option
Wire cash to Millennium. If this box is not checked, the cash will be sent to Millennium via check
and will be available 5 business days from date of deposit.
Quantity
(# of Shares, $
Amount, or “ALL”)
Description of Asset
(Name of Fund, Security or Asset)
Estimated Fair Value
IRA-007 03-20
IRA-TO-IRA ACCOUNT TRANSFER AUTHORIZATION, Page 3 of 3
F Signature Guarantee
Please read, sign, and
date to authorize this
transfer.
A Medallion Signature
Guarantee may be
obtained from an
authorized officer at a
brokerage firm, bank or
other financial institution.
Certification by a notary
public is not a substitute
for a signature guarantee.
This section to be
completed by
Millennium Trust
Company.
Millennium Trust Company will accept the above-captioned account as Successor Custodian.
___________________________________________________________________ Date:_______________
Authorized Officer Signature
Millennium Trust Company, LLC , Tax Identification No. 36-4400066
Custodian
FBO
: _________________________________________Account No.:______________________
Millennium IRA Type
Traditional IRA Inherited Traditional IRA
Roth IRA Inherited Roth IRA
SEP IRA SIMPLE IRA
G Millennium Acceptance
Please check with your current Custodian to determine if a Medallion Signature Guarantee is required.
[Medallion Signature Guarantee Stamp Here]
Mail Original Signed Documents to:
Millennium Trust Company, LLC
Attn: Transfers Department
2001 Spring Road, Suite 700
Oak Brook, IL 60523
I certify that the assets listed in Section D are held in an IRA and authorize my current custodian to
transfer these assets to Millennium. I understand that Millennium reserves the right to refuse custody
of certain assets prior to final acceptance as Successor Custodian. If original documents are required,
this transfer request will be sent to the current custodian via standard US Mail unless overnight delivery
is selected.
Overnight Delivery - An additional fee may be charged to your Millennium account if you
choose this option.
Print name: Date:
Signature:
Transfer Authorization
E
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Completed 14 April 2022

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