Fillable Change of Ownership Form (New York's 529 Advisor-Guided College Savings Program)

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Change of Ownership Form (New York's 529 Advisor-Guided College Savings Program)

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Use this form to transfer your entire Account balance to a new Account Owner. A transfer of control of an Account may result in adverse
income or gift tax consequences. You should consult a qualified tax professional regarding the application of federal, state, and local tax law to
your circumstances before transferring Ownership of an Account. Once the transfer is complete, the new Account Owner will control the Account
and the disposition of all assets held in the Account. If you would like to transfer Ownership of more than one Account, please add Account
number and Beneficiary’s name for each Account below in Section 1.
Important: If the new Account Owner does not already have an Account for the Beneficiary, he or she must also submit an Enrollment
Application for each Beneficiary.
You must have the current Account Owner’s signature notarized. Don’t sign this form until you’re in the presence of a notary public.
Do not use this form if the current Account Owner is deceased. Instead, call 1.800.774.2108 for assistance.
Important Tax Information: The current Account Owner must disclose to the new Account Owner any previous New York State tax deductions
taken for contributions to the Account listed in Section 1. If the new Account Owner takes a withdrawal, he or she will be liable for any previous
New York State tax deductions taken by the current Account Owner if those deductions are subject to recapture, including in the case of non-qualified
withdrawals and rollovers to a non-New York 529 Program plan. The new Account Owner’s liability for such deductions applies even if he or she is not
a New York State resident; consult a tax professional for guidance.
Forms can be downloaded from our website at www.ny529advisor.com, or you can call us to order any form — or request assistance in completing
this form — at 1.800.774.2108 any business day from 8 a.m. to 7 p.m. Eastern time.
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REMEMBER TO SIGN IN SECTION 3.
Return this form and any other required documents to:
New York’s 529 Advisor-Guided College Savings Program
P.O. Box 55498
Boston, MA 02205-5498
For overnight delivery or registered mail, send to:
New York’s 529 Advisor-Guided College Savings Program
95 Wells Avenue, Suite 155
Newton, MA 02459
New York’s 529 Advisor-Guided College Savings Program
Change of Ownership Form
ES_NYA_CO 072001 0820 — Page 1 of 4
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1.
Current Account Owner Information
Account Number
Name of Beneficiary (first, middle initial, last)
Account Number
Name of Beneficiary (first, middle initial, last)
Account Number
Name of Beneficiary (first, middle initial, last)
Name of Current Account Owner (first, middle initial, last), Trust, or Business/Entity
Last Four Digits of the Current Account Owner’s Social Security Number or Other Taxpayer ID Number
Daytime Telephone Number Evening Telephone Number
Note: If you are transferring Accounts for more than three Beneficiaries, please write the additional Account Numbers and
Beneficiary names on a separate sheet.
2.
New Account Owner Information
Legal Name of New Account Owner (first, middle initial, last), Trust, or Business/Entity
Birth Date or Trust Date (month, day, year) Last Four Digits of Social Security Number or Other Taxpayer ID Number
Does the new Account Owner have an existing Account for the Beneficiary(ies) listed in Section 1? (Check one.)
No. The new Account Owner must complete an Enrollment Application.
Yes. The Units will transfer based on the new Account Owner’s
Account Number portfolio allocation.
Account Number
Account Number
Remember: You must include a New York’s 529 Advisor-Guided College Savings Program Enrollment Application for each
Beneficiary if the new Account Owner does not currently have an existing Account for the Beneficiary.
ES_NYA_CO 072001 0820 — Page 2 of 4
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2
3.
Authorization—THE CURRENT AND NEW ACCOUNT OWNERS MUST SIGN BELOW
Note: Do not sign below until you are in the presence of a notary public.
As current Account Owner: I certify that New York’s 529 Advisor-Guided College Savings Program is authorized to close the Account(s) I
indicated in Section 1 and transfer all of the assets to an Account for the new Account Owner named in Section 2. I understand that if I
have an Automatic Investment Plan (AIP) established on the Account, it will be stopped. If I contribute to the Account by payroll direct
deposit, I must notify my payroll department of the change.
As current Account Owner: I certify that I have provided the new Account Owner, named in Section 2, with the total amount of
contributions I have made to the Account, listed in Section 1, that are deductible under New York State tax law. I also give the State of
New York Department of Taxation and Finance permission to share with the new Account Owner my tax return information relating to my
deductible contributions. This is necessary in determining the amount of contributions that the new Account Owner may need to add back
to his or her New York State income. Please consult a tax professional.
As current Account Owner: I certify that the information provided in this form is true and complete in all respects.
Name of Current Account Owner (first, middle initial, last), Trust, or Business/Entity
Signature of Current Account Owner, Trustee, or Authorized Individual Date (month, day, year)
(Your signature must be notarized. See below. We are not able to accept a signature guarantee in place of a notary’s seal.)
STATE OF _______________________)
) ss.:
COUNTY OF _____________________)
This document was acknowledged before me on ______________ (date) by _________________________________________ (name of current Account Owner),
who certifies the correctness of this signature.
Signature of Notary Public Date (month, day, year)
Notary Public’s Name (first, middle initial, last)
My commission expires:
Date (month, day, year)
Notary to Place Seal Here
Applies to Current Account Owner signature
in Section 3.
ES_NYA_CO 072001 0820 — Page 3 of 4
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As new Account Owner: I acknowledge and agree that I am responsible for reporting as gross income on my New York State income tax
return the portion of any withdrawals I take from the Account that are subject to recapture of any previous New York State tax deductions
taken for contributions made to the Account by the current Account Owner. Recapture applies in the case of certain withdrawals as
determined by New York law and the State of New York Department of Taxation and Finance, and include non-qualified withdrawals and
rollovers to a non-New York Program 529 plan. I understand and agree that I may be required to file a New York State income tax return
to report such income even if I’m not a New York State resident.
As new Account Owner: I certify that the information provided in this form is true and complete in all respects.
Name of New Account Owner (first, middle initial, last), Trust or Business/Entity
Signature of New Account Owner, Trustee or Authorized Indivdual Date (month, day, year)
529-F-OWNCHG 0720
ES_NYA_CO 072001 0820 — Page 4 of 4
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Change of Ownership Form (New York's 529 Advisor-Guided College Savings Program)

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Completed 16 May 2021

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