1
NC 529 Plan
P.O. Box 40877
Raleigh, NC 27629-0877
This Contribution will be allocated according to the
Participant’s most recent investment allocation
instructions.
If this Contribution is a “rollover” from another state’s 529
plan, Coverdell Education Savings Account, or a
qualified U.S. Savings Bond, see page 2 for further
instructions.
Account Owner ___________________________
Beneficiary ___________________________
Account Number ___________________________
,.
Amount Enclosed ($25.00 Minimum)
Make checks payable to NC 529 Plan
NC 529 Plan
P.O. Box 40877
Raleigh, NC 27629-0877
This Contribution will be allocated according to the
Participant’s most recent investment allocation
instructions.
If this Contribution is a “rollover” from another state’s 529
plan, Coverdell Education Savings Account, or a
qualified U.S. Savings Bond, see page 2 for further
instructions.
Account Owner ___________________________
Beneficiary ___________________________
Account Number ___________________________
,.
Amount Enclosed ($25.00 Minimum)
Make checks payable to NC 529 Plan
NC 529 Plan
P.O. Box 40877
Raleigh, NC 27629-0877
This Contribution will be allocated according to the
Participant’s most recent investment allocation
instructions.
If this Contribution is a “rollover” from another state’s 529
plan, Coverdell Education Savings Account, or a
qualified U.S. Savings Bond, see page 2 for further
instructions.
Account Owner ___________________________
Beneficiary ___________________________
Account Number ___________________________
,.
Amount Enclosed ($25.00 Minimum)
Make checks payable to NC 529 Plan
CFNC.org/NC529 800-600-3453
CFI Form C420ab (10/11)
CFNC.org/NC529 800-600-3453
CFI Form C420ab (10/11)
CFNC.org/NC529 800-600-3453
CFI Form C420ab (10/11)
2
If this contribution to your NC 529 Plan is a rollover from another state’s 529 plan, a Coverdell Education
Savings Account, or a U.S. Savings Bond, you must provide documentation related to the principal and
earnings portion of your assets for tax purposes. If we do not receive this information, your contribution
will be designated as 100% earnings.
529 Plan Assets (held in another state’s plan): Provide an account statement issued by the
state’s 529 program which shows the principal and earnings of your withdrawal.
Coverdell Education Savings Accounts: Provide an account statement or documentation
issued by the account custodian that shows the basis and earnings in your account.
U.S. Savings Bond: Provide an account statement or IRS Form 1099-INT from the
redeeming institution that shows the interest which has accrued on the bond.