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CM103-CTD
Revised 0220
Account Number
Instructions: Use this form to request a wire from an LPL Financial (“LPL”) individual retirement account or an LPL Coverdell Education Savings Account.
LPL will not honor requests to wire funds to a third party or to a foreign country.
Please mail the completed form to Trade Direct, P.O. Box 509049 San Diego, CA 92150-9049 or fax to (858) 202-8500.
Distribution Instructions
Account Holder Information
1.
Account Holder Name Social Security Number
2.
Member FINRA/SIPC
Move Money
IRA/ESA Distribution - Wired Funds
Note: Ensure cash and/or equivalent available in the account prior to submitting this request. For Optimum Market Portfolios necessary cash will be made available after submitting the request.
If this is a total and close, account will be closed and applicable fees assessed. Additional processing time required for advisory accounts.
Distribution Amount:
(gross amount before tax withholding) or Total and Close Account
$
A $25 wire fee will be charged to your account.
‡ Verify the Fed Fund Wire ABA number with your receiving financial institution.
Federal Income Tax Withholding
Under federal law, the Custodian is required to withhold federal income tax from distributions unless you elect out of this withholding below. If no election
is made, LPL will withhold 10%. You may change this election for future distributions at any time by sending a written request. Whether or not you elect to
have taxes withheld from your distribution, you are responsible for the full amount of income tax and any related penalties. If you do not withhold enough
tax or make appropriate estimated tax payments, you may be subject to additional penalties. If funds are distributed to a foreign address or if the address
of record on the LPL account is a foreign address, a minimum of 10% must be withheld regardless of your election below.
• Once taxes are withheld from the account and paid to the IRS, they cannot be reversed.
• If withholding is elected, the amount withheld must be 10% or greater of the gross distribution amount. If less than 10% is elected, LPL will round-up to
10%.
• Periodic distributions will continue at this rate until LPL is notified of a change.
• No tax withholding permitted for Coverdell Education Savings.
Tax Withholding
3.
Do not withhold any federal income taxes.
Withhold
% on my gross distribution for federal income taxes.
Withhold $
from available cash and/or equivalent on my gross distribution (must be at least 10% of gross distribution amount).
Bank Name Bank Phone
Bank Address Fed Funds Wire ABA Number ‡
Bank Account Name Bank Account Number
Further Credit Name Further Credit Number
Distribution Reason
The default distribution code will be based on age and the type of account. If this is a Roth IRA, I certify I have met the 5 year holding requirements unless
specified below. If any other exceptions apply to the distribution, select below.
Trustee to Trustee Transfer — Attach a Letter of Acceptance signed by the new custodian on company letterhead.
Direct Rollover—The wire must be payable to an accepting employer qualified retirement plan, governmental section 457(b) plan, or 403(b).
Note: IRA-to-IRA "60 day" rollovers will be default coded as age based distributions per 1099-R instructions if this selection is completed.
Early SIMPLE IRA distribution taken within the first 2 years of participation.
Substantially Equal Series Distribution/72(t), under age 59 1/2.
Roth Distribution - Select All that Apply:
5 year holding requirement has not been metDisability Distribution
Disability Distributions under age 59 ½ must qualify under the IRS definition of “disability” under IRC Section 72(m)(7). Please consult your tax
advisor.
