Fill - Free fillable IRA CONTRIBUTION AND INVESTMENT SELECTION (Kinecta) 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__________________________________ Suffix ______

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 _______________________ Organization Number ____________

PART 3. CONTRIBUTION INFORMATION

Contribution Amount ____________________________ Contribution Date ________________

CONTRIBUTION TYPE (Select one)

1. Regular (Includes catch-up contributions)

Contribution for Tax Year _________

2. Rollover (Distribution from a Roth IRA or eligible employer-sponsored retirement plan that is being deposited into this Roth IRA)

By selecting this transaction, I irrevocably designate this contribution as a rollover.

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

4. Recharacterization (A nontaxable movement of a Traditional IRA contribution into this Roth IRA)

By selecting this transaction, I irrevocably designate this contribution as a recharacterization.

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

By selecting this transaction, I irrevocably designate this contribution as a conversion.

PART 4. INVESTMENT AND DEPOSIT INFORMATION

INVESTMENT INFORMATION (Complete this section as applicable.)

Quantity Status Investment Term Interest

Investment Description or Amount (new or existing) Number or Maturity Date Rate

_______________________________________________ ___________________ ___________ _______________________ _____________ ___________

DEPOSIT METHOD

Cash or Check (If the contribution type is transfer, the check must be from a financial organization 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) (Additional documentation may be required and fees may apply.)

Name of Organization Sending the Assets ____________________________________________ Routing Number (Optional) ___________________

Account Number _____________________________________________ Type (e.g., checking, savings, IRA) _________________________________

Deposit Taken by_____________________________________

PART 5. SIGNATURE

I certify that all of the information provided by me is accurate and may be relied upon by the trustee or custodian. I certify that the contribution

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

KINECTA FEDERAL CREDIT UNION

1440 ROSECRANS AVE

MANHATTAN BEACH CA 90266

(800) 854-9846

11379

ELECTRONIC TRANSFER NOT AVAILABLE

XXXXXN/AXXXX

XXXXXXXXXXXXN/AXXXXXXXXXXXXXX

XXXXXXXXXN/AXXXXXXXXX

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RULES AND CONDITIONS APPLICABLE TO ROTH IRA CONTRIBUTIONS

Roth IRA contribution rules are often complex. The general rules are listed below. If you have any questions regarding a contribution, please consult

with a competent tax professional or refer to IRS Publication 590-A, Contributions to Individual Retirement Arrangements (IRAs), for more information.

This publication 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 compensation. Your contribution may be further limited if your income exceeds certain limits. If you also maintain a

Traditional IRA, the maximum contribution to your Roth IRA is reduced by any contributions you make to your Traditional IRA.

• You may make a contribution for the prior year up until your tax filing deadline for that year, not including extensions. Designating a contribution

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 additional catch-up contribution to a Roth IRA for that tax year.

ROLLOVER

A rollover is a distribution 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 retirement plan to your Roth IRA will generally result in any pretax assets being subject to tax.

• You are permitted to roll over only one distribution from an IRA (Traditional, 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 retirement plans to a

Roth IRA.

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

• A rollover contribution of Traditional 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 contribution may not be made from a Traditional IRA or SIMPLE IRA.

RECHARACTERIZATION

A recharacterization is the procedure to treat all or a portion of a contribution to a Traditional IRA as if it had been made to a Roth IRA.

• A contribution that is recharacterized must be adjusted for earnings.

• The recharacterization deadline is your tax filing deadline for the year of the original transaction, including extensions.

CONVERSION

A conversion is a taxable movement of assets from any of your Traditional IRAs or SIMPLE IRAs to your Roth IRA. A conversion contribution may not be

made from a SIMPLE IRA within two years of the first contribution to your SIMPLE IRA.

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