Form 5305-R (Rev. 3-2002) Page 2
Article VII
Notwithstanding any other articles which may be added or incorporated, the provisions of Articles I through IV and this
sentence will be controlling. Any additional articles inconsistent with section 408A, the related regulations, and other published
guidance will be invalid.
Article VIII
This agreement will be amended as necessary to comply with the provisions of the Code, the related regulations, and other
published guidance. Other amendments may be made with the consent of the persons whose signatures appear below.
Article IX
Article IX may be used for any additional provisions. If no other provisions will be added, draw a line through this space. If
provisions are added, they must comply with applicable requirements of state law and the Internal Revenue Code.
Grantor’s signature Date
Trustee’s signature Date
Witness’ signature
(Use only if signature of the grantor or the trustee is required to be witnessed.)
Date
General Instructions
Section references are to the Inter nal
Revenue Code unless otherwise noted.
Purpose of Form
Form 5305-R is a model trust account
agreement that meets the requirements
of section 408A and has been
pre-approved by the IRS. A Roth
individual retirement account (Roth IRA)
is established after the form is fully
executed by both the individual (grantor)
and the trustee. This account must be
created in the United States for the
exclusive benefit of the grantor and his
or her beneficiaries.
Do not file Form 5305-R with the IRS.
Instead, keep it with your records.
Unlike contributions to traditional
individual retirement arrangements,
contributions to a Roth IRA are not
deductible from the grantor’s gross
income; and distributions after 5 years
that are made when the grantor is 59
1
⁄2
years of age or older or on account of
death, disability, or the purchase of a
home by a first-time homebuyer (limited
to $10,000), are not includible in gross
income. For more information on Roth
IRAs, including the required disclosures
the trustee must give the grantor, see
Pub. 590, Individual Retirement
Arrangements (IRAs).
Definitions
IRA Conversion Contributions. IRA
Conversion Contributions are amounts
rolled over, transferred, or considered
transferred from a nonRoth IRA to a
Roth IRA. A nonRoth IRA is an individual
retirement account or annuity described
in section 408(a) or 408(b), other than a
Roth IRA.
Trustee. The trustee must be a bank or
savings and loan asociation, as defined
in section 408(n), or any person who has
the approval of the IRS to act as trustee.
Grantor. The grantor is the person who
establishes the trust account.
Specific Instructions
Article I. The grantor may be subject to
a 6% tax on excess contributions if
(1) contributions to other individual
retirement arrangements of the grantor
have been made for the same tax year,
(2) the grantor’s adjusted gross income
exceeds the applicable limits in Article II
for the tax year, or (3) the grantor’s and
spouse’s compensation is less than the
amount contributed by or on behalf of
them for the tax year. The grantor should
see the disclosure statement or Pub.
590 for more information.
Article V. This article describes how
distributions will be made from the Roth
IRA after the grantor’s death. Elections
made pursuant to this article should be
reviewed periodically to ensure they
correspond to the grantor’s intent. Under
paragraph 3 of Article V, the grantor’s
spouse is treated as the owner of the
Roth IRA upon the death of the grantor,
rather than as the beneficiary. If the
spouse is to be treated as the
beneficiary, and not the owner, an
overriding provision should be added to
Article IX.
Article IX. Article IX and any that follow
it may incorporate additional provisions
that are agreed to by the grantor and
trustee to complete the agreement. They
may include, for example, definitions,
investment powers, voting rights,
exculpatory provisions, amendment and
termination, removal of the trustee,
trustee’s fees, state law requirements,
beginning date of distributions,
accepting only cash, treatment of
excess contributions, prohibited
transactions with the grantor, etc. Attach
additional pages if necessary.
Form 5305-R (Rev. 3-2002)