Fill - Free fillable IRA CONTRIBUTION AND INVESTMENT SELECTION (Georgia's Own Credit Union) PDF form

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CONTRIBUTION AND INVESTMENT SELECTION

PART 1. IRA OWNER

Name (First/MI/Last) __________________________________________

Social Security Number ________________________________________

Date of Birth ____________________ Phone ______________________

Email Address ________________________________________________

Account Number__________________________________ Sux ______

PART 2. IRA TRUSTEE OR CUSTODIAN

To be completed by the IRA trustee or custodian

Name ______________________________________________________

Address Line 1 _______________________________________________

Address Line 2 _______________________________________________

City/State/ZIP ________________________________________________

Phone _______________________ Organizaon Number ____________

PART 3. CONTRIBUTION INFORMATION

Contribuon Amount ____________________________ Contribuon Date ________________

CONTRIBUTION TYPE (Select one)

1. Regular (Includes catch-up contribuons)

Contribuon for Tax Year _________

2. Rollover (Distribuon from a Tradional IRA, SIMPLE IRA, or eligible employer-sponsored rerement plan that is being deposited into this IRA)

By selecng this transacon, I irrevocably designate this contribuon as a rollover.

3. Transfer (Direct movement of assets from a Tradional IRA or SIMPLE IRA into this IRA)

4.Recharacterizaon (A nontaxable movement of a Roth IRA contribuon, a conversion, or eligible employer-sponsored rerement plan rollover to

a Roth IRA into this IRA)

By selecng this transacon, I irrevocably designate this contribuon as a recharacterizaon.

5.SEPContribuon (Contribuon made under a simplied employee pension (SEP) plan; SEP contribuons are reported for the year in which the

contribuon is made)

IF YOU ARE 70½ OR OLDER THIS YEAR, COMPLETE THE FOLLOWING IF APPLICABLE

(Checking any of the following will require adjusng your required minimum distribuon.)

This is a rollover or transfer of assets removed last year. Date of Removal ________________

This is a transfer from my deceased spouse’s Tradional IRA and the assets were removed from the IRA in any year aer death.

The value of my poron of my deceased spouse’s IRA on December 31 of last year ____________________________.

This is a recharacterizaon of a conversion or taxable rerement plan rollover to a Roth IRA made last year.

PART 4. INVESTMENT AND DEPOSIT INFORMATION

INVESTMENT INFORMATION (Complete this secon as applicable.)

  Quanty Status Investment Term Interest

 InvestmentDescripon orAmount (new or exisng) Number orMaturityDate Rate

_______________________________________________ ___________________ ___________ _______________________ _____________ ___________

DEPOSIT METHOD

Cash or Check (If the contribuon type is transfer, the check must be from a nancial organizaon made payable to the trustee for this IRA.)

Internal Account

Account Number ______________________________________________ Type (e.g., checking, savings, IRA) ________________________________

External Account (e.g., EFT, ACH, wire) (Addional documentaon may be required and fees may apply.)

Name of Organizaon Sending the Assets ____________________________________________ Roung Number (Oponal) ___________________

Account Number______________________________________________ Type (e.g., checking, savings, IRA) ________________________________

Deposit Taken by _____________________________________

PART 5. SIGNATURE

I cerfy that all of the informaon provided by me is accurate and may be relied upon by the trustee or custodian. I cerfy that the contribuon

described above is eligible to be contributed to the IRA and I authorize the deposit to be invested in the manner described above.

X_________________________________________________________________________________________________ ______________________________________

Signature of IRA Owner Date (mm/dd/yyyy)

TRADITIONAL

IRA

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RULES AND CONDITIONS APPLICABLE TO TRADITIONAL IRA CONTRIBUTIONS

The IRA contribuon rules are oen complex. The general rules are listed below. If you have any quesons regarding a contribuon, please consult

with a competent tax professional or refer to IRS Publicaon 590-A, Contribuons to Individual Rerement Arrangements (IRAs), for more informaon.

This publicaon is available on the IRS website at www.irs.gov or by calling 1-800-TAX-FORM.

REGULAR

The total amount you may contribute to a Tradional IRA for any tax year cannot exceed the lesser of the published annual limit or 100 percent of your

earned income and other eligible compensaon. If you also maintain a Roth IRA, the maximum contribuon to your Tradional IRA is reduced by any

contribuons you make to your Roth IRA.

• You may make a contribuon for the prior year up unl your tax ling deadline for that year, not including extensions. Designang a contribuon

for the prior year is irrevocable.

• If you are age 50 or older by the end of the year, you may be eligible to make an addional catch-up contribuon to an IRA for that tax year.

ROLLOVER

A rollover is a distribuon and a subsequent tax-free movement of assets from any of your Tradional IRAs, SIMPLE IRAs, or eligible employer-

sponsored rerement plans to your Tradional IRA.

• EecvefordistribuonstakenonoraerJanuary1,2015, you are permied to roll over only one distribuon from an IRA (Tradional, Roth, or

SIMPLE) in a 12-month period, regardless of the number of IRAs you own. There is no limit to the number of rollovers you may perform from any

of your eligible employer-sponsored rerement plans to a Tradional IRA.

• Any required minimum distribuons paid to an IRA owner or beneciary may not be rolled over.

• A rollover generally must be completed within 60 days from the date you receive the assets.

• A rollover contribuon of Roth IRA assets may not be made to a Tradional IRA.

• A rollover contribuon of assets distributed from a SIMPLE IRA within two years of the rst contribuon to your SIMPLE IRA may not be made to a

Tradional IRA.

TRANSFER

A transfer is a direct movement of assets to your Tradional IRA from any of your other Tradional IRAs or SIMPLE IRAs.

• You may perform an unlimited number of transfers.

• A transfer contribuon may not be made from a Roth IRA.

• A transfer contribuon may not be made from a SIMPLE IRA within two years of the rst contribuon to your SIMPLE IRA.

RECHARACTERIZATION

A recharacterizaon is the procedure to treat all or a poron of a contribuon, conversion, or eligible employer-sponsored rerement plan rollover to a

Roth IRA as if it had been made to a Tradional IRA.

• A contribuon, conversion, or eligible employer-sponsored rerement plan rollover that is recharacterized must be adjusted for earnings.

• The recharacterizaon deadline is your tax ling deadline for the year of the original transacon, including extensions.

SEP CONTRIBUTION

If you are a parcipant in your employer’s simplied employee pension (SEP) plan, contribuons may be made to your Tradional IRA.

• Your employer may make SEP contribuons to your Tradional IRA within the published annual limits.

• If your employer maintains a salary deferral SEP plan, your elecve deferrals may not exceed the published annual limit.

• If your employer maintains a salary deferral SEP plan and you are age 50 or older by the end of the calendar year, you may be eligible to make

addional catch-up salary deferral contribuons.

• SEP contribuons to your Tradional IRA are reported for the year in which the contribuons are made.

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