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Form 5305-SA (Rev. 4-2017)
Page 2
(a) The required minimum distribution under paragraph 2(b) for any year, beginning with the year the participant reaches age 70
1
/2, is the
participant’s account value at the close of business on December 31 of the preceding year divided by the distribution period in the uniform
lifetime table in Regulations section 1.401(a)(9)-9. However, if the participant’s designated beneficiary is his or her surviving spouse, the required
minimum distribution for a year shall not be more than the participant’s account value at the close of business on December 31 of the preceding
year divided by the number in the joint and last survivor table in Regulations section 1.401(a)(9)-9. The required minimum distribution for a year
under this paragraph (a) is determined using the participant’s (or, if applicable, the participant and spouse’s) attained age (or ages) in the year.
(b) The required minimum distribution under paragraphs 3(a) and 3(b)(i) for a year, beginning with the year following the year of the
participant’s death (or the year the participant would have reached age 70
1
/2, if applicable under paragraph 3(b)(i)) is the account value at the
close of business on December 31 of the preceding year divided by the life expectancy (in the single life table in Regulations section
1.401(a)(9)-9) of the individual specified in such paragraphs 3(a) and 3(b)(i).
(c) The required minimum distribution for the year the participant reaches age 70
1
/2 can be made as late as April 1 of the following year. The
required minimum distribution for any other year must be made by the end of such year.
6. The owner of two or more IRAs (other than Roth IRAs) may satisfy the minimum distribution requirements described above by taking from
one IRA the amount required to satisfy the requirement for another in accordance with the regulations under section 408(a)(6).
Article V
1. The participant agrees to provide the trustee with all information necessary to prepare any reports required by sections 408(i) and
408(l)(2) and Regulations sections 1.408-5 and 1.408-6.
2. The custodian agrees to submit to the Internal Revenue Service (IRS) and participant the reports prescribed by the IRS.
3. The custodian also agrees to provide the participant’s employer the summary description described in section 408(l)(2) unless this SIMPLE
IRA is a transfer SIMPLE IRA.
Article VI
Notwithstanding any other articles which may be added or incorporated, the provisions of Articles I through III and this sentence will be
controlling. Any additional articles inconsistent with sections 408(a) and 408(p) and the related regulations will be invalid.
Article VII
This agreement will be amended as necessary to comply with the provisions of the Code and the related regulations. Other amendments may
be made with the consent of the persons whose signatures appear below.
Article VIII
Article VIII 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 and may not imply that they have been reviewed or
pre-approved by the IRS.
Participant’s signature Date
(If an individual other than the participant signs this form for the participant, indicate the individual’s relationship to the participant.)
Custodian’s signature Date
Witness’ signature
(Use only if signature of the participant or the custodian is required to be witnessed.)
Date
General Instructions
Section references are to the Internal
Revenue Code unless otherwise noted.
Purpose of Form
Form 5305-S is a model custodial account
agreement that meets the requirements of
sections 408(a) and 408(p). However, only
Articles I through VII have been reviewed by
the IRS. A SIMPLE individual retirement
account (SIMPLE IRA) is established after the
form is fully executed by both the individual
(participant) and the custodian. This account
must be created in the United States for the
exclusive benefit of the participant and his or
her beneficiaries.
Do not file Form 5305-S with the IRS.
Instead, keep it with your records.
For more information on SIMPLE IRAs,
including the required disclosures the
custodian must give the participant, see
Pub. 590-A, Contributions to Individual
Retirement Arrangements (IRAs); Pub. 590-B,
Distributions from Individual Retirement
Arrangements (IRAs); and Pub 560,
Retirement Plans for Small Business (SEP,
SIMPLE, and Qualified Plans).
Definitions
Participant. The participant is the person
who establishes the custodial account.
Custodian. The custodian must be a bank or
savings and loan association, as defined in
section 408(n), or any person who has the
approval of the IRS to act as custodian.
Transfer SIMPLE IRA
This SIMPLE IRA is a “transfer SIMPLE IRA”
if it is not the original recipient of
contributions under any SIMPLE IRA plan.
The summary description requirements of
section 408(l)(2) do not apply to transfer
SIMPLE IRAs.
Specific Instructions
Article IV. Distributions made under this
article may be made in a single sum, periodic
payment, or a combination of both. The
distribution option should be reviewed in the
year the participant reaches age 70
1
/2 to
ensure that the requirements of section
408(a)(6) have been met.
Article VIII. Article VIII and any that follow it
may incorporate additional provisions that are
agreed to by the participant and custodian to
complete the agreement. They may include,
for example, definitions, investment powers,
voting rights, exculpatory provisions,
amendment and termination, removal of the
custodian, custodian’s fees, state law
requirements, beginning date of distributions,
accepting only cash, treatment of excess
contributions, prohibited transactions with the
participant, etc. Attach additional pages if
necessary.
Form 5305-SA (Rev. 4-2017)
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