IRA DEPOSIT SLIP
DATE
Please read the attached instructions.
ACCOUNT HOLDER’S INFORMATION
Name
Account No.
Social Security No. (Last 4 Digits)
CONTRIBUTION INFORMATION
(If no tax year is provided for Traditional, Roth, or Coverdell, the deposit will be reported to the IRS as a current-year contribution)
Contribution Amount $ Contribution Date
Traditional IRA Annual Contribution for Tax-Year 20__ (Includes Catch-Up Contributions)
Roth IRA Annual Contribution for Tax-Year 20__ (Includes Catch-Up Contributions)
Coverdell ESA Annual Contribution for Tax-Year 20__ (Includes Catch-Up Contributions)
*Employer Contribution (SEP, Profit Sharing, Money Purchase, Individual 401K)
*Employee Salary Deferral (401K)
Transfer from Identical IRA
**Rollover Contribution Direct or 60-Day (See Irrevocable Rollover Designation Below)
*REPORTING OF EMPLOYER & EMPLOYEE SALARY DEFFERAL CONTRIBUTIONS
Internal Revenue Service (IRS) regulations require Apex to report employer contributions (PSP, MPP, and SEP, including employee salary deferrals) in the calendar
year in which they are made.
**IRREVOCABLE ROLLOVER DESIGNATION
I attest and acknowledge that the funds deposited are eligible to be contributed to this IRA, that the assets are the same assets that were
distributed as a Direct Rollover or as an Indirect Rollover less than 60 days ago, and that I am allowed only one 60-day rollover distribution from
an IRA in a rolling 12-month period regardless of the number of IRAs I own. Due to the important tax consequences of rolling over a cash balance,
or securities, I have been advised to consult with a tax professional and I attest that the custodian has not provided any tax advice. By selecting
this option, I certify that no part of his contribution contains amounts required to be distributed under Internal Revenue Code Sections 408(a)(6)
and 401(a)(9), and I acknowledge that I am making an irrevocable election to designate this contribution as a rollover contribution.
SIGNATURE
All information provided by me is true and correct and may be relied upon by the custodian. I assume full responsibility for these transactions and
release, indemnify and hold Apex Clearing Corporation and its officers, directors, employees, affiliates, assigns, agents, employees or successors
harmless from and against any and all liabilities, damages, losses, costs (including attorney’s fees), claims or actions arising from or related to any
errors, improper instructions, or misrepresentations in this request.
IRA Holder’s Printed Name IRA Holder’s Signature Date
PF10071-U Rev. 12/10/2020
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signature
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IRA DEPOSIT SLIP
INSTRUCTIONS
Mail checks with this form to: tastyworks, Inc., Attn: Account Services, 1000 W. Fulton Market Street, Suite 220, Chicago, IL 60607
Use this form to remit Traditional, Roth, Coverdell, or SEP IRA contributions, or Employer QRP contributions (including Employee Salary
Deferrals). All requested information is required. Unclear, incomplete or incorrect instructions (e.g., your check amount and your
contribution amount on the form do not match) may result in delays in processing, including return of your check to you.
For efficient processing, please forward your instructions to your broker or investment advisor.
RULES AND CONDITIONS APPLICABLE TO TRADITIONAL IRA CONTRIBUTIONS
The 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), or IRS Publication
560, Retirement Plans for Small Business (SEP, SIMPLE, and Qualified Plans) for more information. These publications are available on the IRS website
at www.irs.gov or by calling 1-800-TAX-FORM.
REGULAR
The total amount you may contribute to all IRAs combined (including accounts held away from Apex Clearing) for any tax year cannot exceed the
lesser of the published annual limit or 100 percent of your earned income and other eligible compensation. If you also maintain a Roth IRA, the
maximum contribution to your Traditional IRA is reduced by any contributions you make to your Roth 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 an IRA for that tax year.
ROLLOVER
A rollover is a distribution and a subsequent tax-free movement of assets from any of your Traditional IRAs (including Rollover and SEP IRAs), and
SIMPLE IRAs, or eligible employer- sponsored retirement plans to your Traditional IRA.
Effective for distributions taken on or after January 1, 2015, 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.
A rollover generally must be completed within 60 days from the date you receive the assets.
A rollover contribution of Roth IRA assets may not be made to a Traditional IRA, or SIMPLE IRA, to a Coverdell ESA or to a Qualified
Retirement Plan.
A rollover contribution of assets distributed from a SIMPLE IRA within two years of the first contribution to your SIMPLE IRA may not be
made to a Traditional IRA.
TRANSFER
A transfer is a direct movement of assets to your Traditional IRA from any of your other Traditional IRAs or SIMPLE IRAs.
You may perform an unlimited number of transfers.
A transfer contribution may not be made from a Roth IRA to a Traditional IRA, SEP, or SIMPLE IRA, to a Coverdell ESA or to a Qualified
Retirement Plan.
A transfer contribution may not be made from a SIMPLE IRA within two years of the first contribution to your SIMPLE IRA.
SEP CONTRIBUTION
If you are a participant in your employer’s simplified employee pension (SEP) plan, contributions may be made to your Traditional IRA.
Your employer may make SEP contributions to your Traditional IRA within the published annual limits.
If your employer maintains a salary deferral SEP plan, your elective 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 additional catch-up salary deferral contributions.
PF10071-U Rev. 12/10/2020
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