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. ROTH IRA OWNER

Name (First/MI/Last) __________________________________________

Social Security Number ________________________________________

Date of Birth ____________________ Phone ______________________

Email Address ________________________________________________

Account Number__________________________________ Sux ______

PART 2. ROTH IRA TRUSTEE OR CUSTODIAN

To be completed by the Roth 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 Roth IRA or eligible employer-sponsored rerement plan that is being deposited into this Roth IRA)

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

3. Transfer (Direct movement of assets from a Roth IRA into this Roth IRA)

4. Recharacterizaon (A nontaxable movement of a Tradional IRA contribuon into this Roth IRA)

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

5. Conversion (A taxable movement from a Tradional IRA or SIMPLE IRA into this Roth IRA)

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

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 Roth 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 Roth IRA and I authorize the deposit to be invested in the manner described above.

X_________________________________________________________________________________________________ ______________________________________

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

ROTH

IRA

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RULES AND CONDITIONS APPLICABLE TO ROTH IRA CONTRIBUTIONS

Roth 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 Roth 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. Your contribuon may be further limited if your income exceeds certain limits. If you also maintain a

Tradional IRA, the maximum contribuon to your Roth IRA is reduced by any contribuons you make to your Tradional 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 a Roth IRA for that tax year.

ROLLOVER

A rollover is a distribuon and a subsequent tax-free movement of assets from any of your Roth IRAs to your Roth IRA. A rollover from an eligible

employer-sponsored rerement plan to your Roth IRA will generally result in any pretax assets being subject to tax.

• 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 Roth IRA.

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

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

TRANSFER

A transfer is a direct movement of assets to your Roth IRA from any of your other Roth IRAs.

• You may perform an unlimited number of transfers.

• A transfer contribuon may not be made from a Tradional IRA or SIMPLE IRA.

RECHARACTERIZATION

A recharacterizaon is the procedure to treat all or a poron of a contribuon to a Tradional IRA as if it had been made to a Roth IRA.

• A contribuon 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.

CONVERSION

A conversion is a taxable movement of assets from any of your Tradional IRAs or SIMPLE IRAs to your Roth IRA. A conversion contribuon may not be

made from a SIMPLE IRA within two years of the rst contribuon to your SIMPLE IRA.

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