589432 (Rev 09 - 02/19)
Page 1 of 5
IRA Beneciary Claim
To claim the assets from a Decedent IRA, this form needs to be completed by the beneciary. A separate form is
required for each beneciary. Before completing, read the important information on inheriting an IRA attached to
this form. Do not use this form for Coverdell ESAs; use the ESA Request form.
Important note concerning international claims: If this claim (1) is being submitted by a beneciary who
resides in a country outside of the United States, or (2) involves a decedent who resided outside of the United
States at the time of their passing, then, regardless of decedent’s citizenship, additional documentation and
processing requirements will be applicable. Further, if the IRS “Transfer Certicates” are required for the distribution
of the non-U.S. resident decedent’s assets, then a copy of the IRS Transfer Certicate specically referencing the
decedent’s Wells Fargo Clearing Services, LLC (WFCS) IRA account must be submitted to WFCS before any transfer
instructions from the decedent IRA will be accepted.
Name
Section 1 Deceased IRA Holder’s Information
Section 2 Beneciary’s Information
All elds must be
completed.
Account Number
Country Phone Number
Name/Trust/Estate/Charity
Date of Birth (mm/dd/yyyy)
State ZIP Code
SSN/TIN
City
Current Address
Disclaim. Do not complete this form if you are disclaiming all assets. Instead, complete
the IRA Beneciary Disclaimer Certication form. If you are claiming a portion of the assets
and disclaiming a portion, you will need to complete both this form and the IRA Beneciary
Disclaimer Certication form.
Irrevocable. You must refuse all or a portion of the IRA within nine months of the owner’s
death. Once you disclaim, you cannot dictate who will inherit assets.
All elds must be
completed.
Account(s) carried by First Clearing. First Clearing is a trade name used by Wells Fargo Clearing Services, LLC, a registered broker-dealer and non-bank
aliate of Wells Fargo & Company.
Spouse
Relationship to Original Account Holder
Successor BeneciaryIf Claiming an Inherited IRA, check here:
Beneciary may only elect one option for their designated portion of the account.
Non-Spouse
Oce Use Only: Sub Firm BR Code FA Code: Account Number
Spouse Only
selection.
Section 3 Beneciary Election Options
You may want to move the assets to an Inherited IRA if you are under age 59½. Distributions
from your own IRA before age 59½ may have a 10% IRS tax penalty. Inherited IRA distributions
have no 10% IRS tax penalty. You will have no required minimum distributions (RMDs) due from
a Traditional IRA until you are age 70½ or older. There are no RMDs for Roth IRA owners. This
is not an option if you are inheriting your spouse’s Inherited IRA because you are a Successor
Beneciary.
(See attached information on inheriting an IRA)
Roll Over/Treat as My Own. Transfer assets to account number .
In the United States
At the time of passing, Deceased IRA Holder resided:
Outside of the United States
In the United States
Beneciary resides:
Outside the United States Both
Clear
IRA Beneciary Claim
Page 2 of 5
589432 (Rev 09 - 02/19)
Use Beneficiary
Asset Worksheet
(589387)
to assist
with uneven
breakdowns.
Section 4 Payment Instructions
take a lump-sum distribution, it cannot be rolled over into an Inherited IRA or his or her own IRA.
In this situation, a spouse beneciary would have 60 days to roll over the inherited assets into
his or her own IRA. You will not have a 10% IRS penalty on the distribution. Taxable distribution
included as part of all ordinary income. Complete Payment Instructions section.
will require the receiving institution’s transfer paperwork, which will include account number,
delivery instructions, and letter of acceptance. All assets might not be transferable. Please work
with receiving broker to determine if assets are transferable.
sum section of this form.
Lump Sum. This is a taxable, irrevocable event. Once a non-spouse beneciary chooses to
IRA To IRA/Inherited IRA (non-taxable transfer): In order to transfer your assets, we
In certain instances, if the IRA Decedent resided, or a beneciary resides, outside of the United
States, regardless of citizenship, the beneciary may be required to establish an Inherited IRA
account prior to distribution.
External Transfers:
International Claims:
IRA to Non-IRA account (taxable distribution): You will need to complete the lump
Distribution Information
Any RMD that should have been taken by the deceased in the year of death must be
taken by the beneciaries by December 31 of the year of death.
A spouse who rolls over can satisfy the RMD from his or her own IRA. A spouse under
59½ may have a 10% penalty if the RMD is taken from the spouse’s own IRA and not the
Inherited IRA.
As a “successor” beneciary you inherit an Inherited IRA, so you will continue taking
RMDs over the original beneciary’s life expectancy rather than using your own life
expectancy.
The Wells Fargo Clearing Services, LLC IRA Custodial Agreement default is the Life
Expectancy option. Beneciaries may always take more than the RMD.
Method
Use Beneficiary
Asset Worksheet
(589387) to assist
with uneven
breakdowns.
Oce Use Only: Sub Firm BR Code FA Code: Account Number
Spouse and
Non-Spouse
selections.
Only a spouse does not need to take RMDs from an Inherited IRA until the deceased spouse would
have become age 70½. Only a spouse can transfer assets, at any time, to an IRA in their own
name. All beneciaries avoid the 10% IRS tax penalty when taking distributions from an Inherited
IRA.
Inherited IRA. Move assets to account number .
FedWire Funds. This method requires completion of the wire instructions page.
Deposit electronically via ACH. This method requires completion of the ACH bank
information below.
Transfer
Check
To Account Number Account Name
Payable to:
Mail to Address:
Mail to Address of Record
Hold for Pick-Up at Branch
Mail to above Recipient Address
IRA Beneciary Claim
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589432 (Rev 09 - 02/19)
Withhold state income tax of % or $ from my IRA distribution.
If this is a total distribution, for the state of CT or for Washington, D.C., you can only elect
an amount greater than the state withholding minimum (CT is a 6.99% minimum, D.C. is a
8.95% minimum).
Withhold federal income tax of % or $ from my IRA distribution.
ACH BANK INFORMATION
Account Number to Credit
Name on Account
Bank State
ABA/Routing Number
Name of Bank
Bank City
Checking or
Type of Account
Savings
Section 5 Tax Withholding Certications and Elections
Required if the
Lump Sum option
was selected in
Section 3.
Withholding elections are made by choosing one option in the federal taxes and one option in
the state taxes section. If you are eligible to elect out of federal or state withholding
and decide to do so, you will be liable for taxes due on the taxable portion of your
distribution and potential penalties for underpayment of estimated taxes. You should
consult with your tax advisor before making your elections. After completing this form,
to make a change to a federal and/or state withholding election, a new form and signature are
required. The tax withholding election is for this distribution ONLY and does not revoke or change
any separate distribution instructions that may be on le.
You cannot elect out of the 10% mandatory withholding if you have not supplied Wells Fargo
Clearing Services, LLC with your correct SSN or TIN and a “residence address” within the United
States. If no election is made, we are required to withhold federal income taxes at a
rate of 10% of the gross distribution amount. If you elect to withhold a percentage or a
dollar amount, the value must be equal to or greater than 10% of the gross distribution amount.
Withholding is required in some states if federal withholding applies, unless you specically elect
out. Residents of CA or VT: The withholding rate applies to the federal withholding amount
and not the gross distribution amount. Residents of MI: If you elect out, you are certifying
your distribution is not taxable because you were born before 1946 or you believe that you
will not have a balance due on your MI-1040. Residents of CT: If you’ve opted out of state
tax withholding or elected an amount to withhold for partial or scheduled distributions, you are
electing withholding code “E,as dened by Connecticut’s form CT-W4P.
IRS Transfer Certicates are generally required when an IRA holder, regardless of their citizenship,
passes away while residing outside of the United States and the decedent’s total U.S. assets (held
at Wells Fargo Clearing Services, LLC and elsewhere) exceeded $60,000 in value at the date of
death. In instances where IRS Transfer Certicates are required, the Transfer Certicates must be
obtained by the heirs or executor of the decedent and provided to WFCS before assets
are transferred out of the decedent’s IRA account. Applying for IRS Transfer Certicates
requires ling certain documents with the U.S. Internal Revenue Service and may have tax
implications for the decedent’s estate. Consequently, any heir, executor, or estate administrator/
Selection Required (choose one)
Selection Required (choose one) State taxes will be withheld based on the state listed on
your account registration.
Federal Taxes W-4P, OMB No.1547-0074
State Taxes
IRS Transfer Certicates
Do NOT withhold federal income tax from my IRA distribution.
Do NOT withhold state income tax from my IRA distribution. If this is a total distribution,
for the state of CT or for Washington, D.C., you cannot opt out of withholding.
Oce Use Only: Sub Firm BR Code FA Code: Account Number
IRA Beneciary Claim
Page 4 of 5
589432 (Rev 09 - 02/19)
Section 6 Client Signature and Acknowledgement
I hereby certify that the above-named individual is deceased and that I am the beneciary
of said individual. A copy of the Death Certicate for the above individual is attached to this
form. I certify that the information provided above is true and correct. I acknowledge that I
am responsible for calculating and taking the owner’s RMD if any is due. Due to the important
tax implications of this transaction, I agree to consult a tax professional for advice and I have
not relied on information provided by WFCS to determine what action I should take at this
time. I agree to indemnify and hold WFCS harmless from any resulting liabilities. WFCS has
not provided me with any tax or legal advice and I assume full responsibility. Furthermore,
I acknowledge that I received the beneciary option information pages that accompany this
form and will retain them for my records.
Connecticut Perjury Declaration: I declare under penalty of law that I have examined
this certicate and, to the best of my knowledge and belief, it is true, complete, and correct.
I understand the penalty for reporting false information is a ne of not more than $5,000,
imprisonment for not more than ve years, or both (as dened by the state of Connecticut on
the CT-W4P).
Following are Signature(s) for Beneciary, Executor/Executrix, Charity
Representative, Trustee Representative, Conservator/Guardian, or POA attorney-
in-fact (POA Document Required). Execution by more than one of the preceding
parties may be required in certain instances.
X
X
Print Name
Print Name
Date (mm/dd/yyyy)
Date (mm/dd/yyyy)
X
X
Print Name
Print Name
Date (mm/dd/yyyy)
Date (mm/dd/yyyy)
Oce Use Only: Sub Firm BR Code FA Code: Account Number
representative who is seeking to resolve the decedent’s IRA account is advised to consult a
professional tax advisor. Please note that for IRS Transfer Certicates to be acceptable they must
specically identify (i.e., by account number) and release the decedents WFCS IRA account.
IRA Beneciary Claim
Page 5 of 5
589432 (Rev 09 - 02/19)
Federal Wire Funds Request (Fee may apply)
Do not complete this section if requesting an international wire; instead complete the International Wire Funds
Request from IRA form and submit with this Beneciary Claim form.
In consideration of WFCS accepting the instructions on page one of this document, I hereby release and
discharge WFCS and its aliates from any liability or claims in connection with the aforementioned instructions
and agree to indemnify and hold WFCS harmless against any losses from any action, claim, or demand of any
person based upon WFCS acting under these instructions.
It is my responsibility to verbally verify the legitimacy of the source and the accuracy of instructions provided
by any third party. Examples of third parties include, but are not limited to, title companies, attorneys,
accountants, and business associates.
SUBMIT THIS PAGE ONLY IF REQUESTING A FEDERAL WIRE
Recipient Name
Local Routing Code (if applicable)
Recipient Address (include City, State, Zip Code, and Country – No P.O. Box or APO)
Special Instructions
Future Credit (if applicable)
Purpose of Wire
Account Number
Phone Number
Name on Bank Account
Bank State
ABA Routing NumberBank Name
Bank CityBank Address
CheckAccount Type: Savings
SR#
Oce Use Only: Sub Firm BR Code FA Code: Account Number
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When you inherit an IRA, you will have many planning and
distribution considerations. Some of your decisions will be based on
your current needs, but your ultimate goal is to maximize the value
of the assets you received. Because it is important to be informed,
so that you can make the most of this opportunity and avoid
common mistakes, we have prepared this information to help you.
Tax Considerations
Managing the amount you will pay in taxes for distributions from a Traditional IRA you inherit or an
Inherited Traditional IRA and understanding if you will owe any tax on distributions from a Roth IRA
you inherit or an Inherited Roth IRA is a key consideration when deciding how to best take money
from the IRA you inherit.
Qualified distributions from an Inherited Roth IRA are tax-free. Distributions from Inherited IRAs
are qualified if the account has been open for more than five years. If the Roth IRA owner died
before the account had been open for more than five years, you would have a non‑qualified
distribution. Non-qualified distributions from Inherited Roth IRAs may be subject to taxes, but no
10% IRS tax penalty. The five-year clock will continue in the Inherited IRA and until that fifth year
has been reached. Until that time, as long as your distributions are equal to or less than the total
amount the IRA owner contributed and/or converted, you have no taxes due. After you take all
contribution and conversion amounts, any earnings distributed before the five-year clock ends will
be taxable.
Income tax will apply to taxable amounts when distributions are taken from an Inherited
Traditional IRA. Larger dollar amounts can quickly put you into a higher tax bracket, whereas
taking smaller distributions over time can help avoid a significant tax bill.
No matter your age, you will avoid the 10% IRS tax penalty on distributions from the IRA you
inherited or your Inherited IRA. If you dont have an immediate need for the assets, it makes sense to
minimize distribution of the inherited assets so that you can preserve their tax-advantaged features.
What to Know When You Inherit an IRA
Keep in Mind
No matter your age, you will
avoid the 10% IRS tax
penalty on distributions from
the IRA you inherited or your
Inherited IRA.
A “successor” beneficiary is
someone who has inherited
an Inherited IRA. As a
successor beneficiary you
can take a lump sum,
disclaim, or continue taking
RMDs over the original
beneficiary’s life expectancy.
The IRS does not let a
successor beneficiary start
over and stretch inherited
assets out over his or her
own lifetime.
Investment and Insurance Products:
NOT FDIC Insured NO Bank Guarantee MAY Lose Value
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Understanding Your Options
You have a few decisions to make if you have been named as the beneficiary of an IRA. It is important
to understand the features and things to keep in mind of each option. Certain distribution methods
preserve the account’s tax-advantaged status while others do not. Keep in mind that after a distribution
is taken from IRA assets you inherit, unless you are the spouse, you are not able to put it back.
Rollover/Transfer to own IRA: If you are a spouse, you can always roll over or transfer the funds
into an IRA in your own name, as this keeps the funds growing tax-advantaged and defers income
taxes until distributions are taken. IRA distribution rules will apply based on your age—meaning no
Required Minimum Distributions (RMDs) from your Traditional IRA until you reach age 70½ and
no RMDs from your Roth IRA. However, it may make sense for you to open an Inherited IRA
because distributions prior to age 59½ may incur the 10% IRS tax penalty. You can always transfer
the assets from the Inherited IRA into your own IRA at any time, and once you obtain age 59½ it
may be your best option. A non-spouse beneficiary does not have this option.
Open an Inherited IRA: An Inherited IRA allows beneficiaries a way to keep the funds growing
tax-advantaged while taking distributions. The account titling will always refer to the deceased IRA
owner, with you listed as the beneficiary. Remember, once a distribution is taken you will not be
able to put it back in your Inherited IRA within 60 days, because rollovers and contributions are
not allowed in these accounts. Unless you are the spouse, you cannot roll this money into your own
IRA. The benefit of this arrangement is that you have the option to distribute the funds over a
longer period of time and are taxed only on that amount.
Inherited IRA distribution options:
Life expectancy: This option is available for Inherited Roth and Inherited Traditional IRAs and is
often referred to as the stretch IRA strategy
1
.
Non-spouse beneficiary: You will take annual RMDs based on your life expectancy using a divisor
from the IRS Single Life Table and the year-end IRA value, on a term-certain basis. Term-certain
means that instead of using a new divisor from the table, one is subtracted from the original divisor
in each subsequent year. These RMDs will begin the year following the death of the IRA owner.
Beneficiaries may always take more than the RMD, but by taking no more than the RMD, the
remainder of the money invested remains tax advantaged over a longer time frame.
Spouse beneficiary: Establishing an Inherited IRA when you are under age 59½ allows you to avoid
the 10% IRS tax penalty on distributions that you might have if the assets were taken from your
own IRA. You always have the ability to transfer the Inherited IRA to your own IRA, even if you
have been taking distributions.
You do not need to take RMDs from the Inherited IRA until:
Your deceased spouse would have become age 70½.
1. Stretching an IRA simply refers to the ability to tak e RMDs over the beneficiary’s single life expectancy (using the
term-certain calculation method) rather than over the life expectancy of the original IRA owner.
2. When deciding whether to initiate a stretch IRA strategy, an investor should consider such factors as possible changes to
tax laws, the impact of inflation, and other risks. Please note that designating a beneficiary two or more generations below
the IRA owner may result in additional taxes when the distribution is made (exemptions may apply). Please consult with
your tax advisor for more information.
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If your spouse was already age 70½ or older, you would have to begin RMDs the year following
their death.
If you are older than your deceased spouse, you may delay any RMDs until your deceased spouse
would have turned age 70½.
Annual RMD calculations are based on your life expectancy using a divisor from the IRS Single Life
Table, the year-end IRA value, and the recalculation method. The recalculation method uses a new
divisor from the table each year.
Please note that the stretch IRA strategy is designed for investors who will not need the money in the account
for their own retirement. There is no guarantee that there will be assets remaining in the account at the time
of the IRA owner’s death.
2
Five-year rule: This option is available for Inherited Roth IRAs. It is also available for Inherited Traditional
IRAs if the owner died before meeting their required beginning date (RBD), generally April 1 following
the year they turned age 70½. With this option, the entire account must be depleted during a five-year
period that begins on December 31 in the year the IRA owner died. The entire account must be
distributed by December 31 of the year containing the fifth anniversary of the owners death. The
beneficiary is allowed, but not required, to take distributions prior to that date. The five-year rule never
applies if the owner died on or after his or her RBD. This can help avoid having to pay taxes on the entire
amount in the first year, but requires larger distributions over a shorter time.
Lump-sum: This strategy will exhaust the entire account in one distribution, with retirement assets
losing their tax-advantaged status. Taxes will be due on the taxable portion of the distribution in the
year received and may place you in a higher tax bracket. Once a non-spouse beneficiary chooses to
take a lump-sum distribution, it cannot be undone. In this situation, a spouse beneficiary would
have 60 days to roll over the inherited assets into his or her own IRA.
Disclaim: If you do not need or want the asset, you can disclaim, or refuse, all or a portion of the
assets within nine months after the IRA owners death. The person who disclaims is considered to
have predeceased the IRA owner and cannot dictate who will inherit the assets as the IRA generally
passes to any other named primary beneficiaries or if none, then to the named contingent
beneficiaries. The IRA default beneficiaries may be used if there are no valid beneficiaries on file.
The defaults on a Wells Fargo Clearing Services IRA are:
– First, a surviving spouse
– Second, surviving children (as defined under state law)
Third, the estate
If You Inherit an Inherited IRA
A “successor” beneficiary is someone who has inherited an Inherited IRA. As a successor beneficiary
you can take a lump sum, disclaim, or continue taking RMDs over the original beneficiary’s life
expectancy. Of course, you can always take more than the RMD. It is important to note that the IRS
does not let a successor beneficiary start over and stretch inherited assets out over his or her own
lifetime. Additionally, if you are a spouse and are the beneficiary of your deceased spouse’s Inherited
IRA, you are not able to roll these assets into an IRA in your name.
4 of 4
Account(s) carried by First Clearing. First Clearing is a trade name used by Wells Fargo Clearing Services, LLC,
Member SIPC. © 2018 Wells Fargo Clearing Services, LLC. All rights reserved. 1217 IHA-5420101
The following table summarizes the options you have if the IRA owner has passed away either before or after their RBD. Remember, you will need to
take distributions whether you inherit a Roth or a Traditional IRA.
Beneficiary distribution options
Rollover/
Open Inherited IRA
Transfer to Life-
expectancy
Five-year
rule
own IRA Lump-sum Disclaim
Spouse beneficiary — Owner dies before RBD
Spouse beneficiary — Owner dies on or after RBD
Non-spouse beneficiary — Owner dies before RBD
Non-spouse beneficiary — Owner dies on or after RBD
Qualified “Look through” trust beneficiary — Owner dies before RBD
3
Qualified “Look through” trust beneficiary — Owner dies on or
after RBD
3
Estate/nonqualified trust beneficiary — Owner dies before RBD
3
Estate/nonqualified trust beneficiary — Owner dies on or after RBD
3
4
Charity — Owner dies before RBD
Charity — Owner dies on or after RBD
4
Please Note: This material has been prepared for informational purposes only and is not a solicitation or an offer to buy any
security or instrument or to participate in any trading or distribution strategy. The accuracy and completeness of the
information is not guaranteed and is subject to change. It is based on current tax information and legislation as of November
2017. Since each investor’s situation is unique, you need to review your specific investment objectives, risk tolerance, and
liquidity needs with your financial professional(s) before a suitable investment or distribution strategy can be selected. Also,
since our firm does not provide tax or legal advice, investors need to consult with their own tax and legal advisors before
taking any action that may have tax or legal consequences.
3. In some instances for a trust and estate beneficiary.
4. RMDs based on owner’s age in year of death, divisor reduced by one each subsequent year.
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