Fillable IRA Simplifier INDIVIDUAL RETIREMENT ACCOUNT APPLICATION (Georgia's Own Credit Union)

Fill Online, Printable, Fillable, Blank IRA Simplifier INDIVIDUAL RETIREMENT ACCOUNT APPLICATION (Georgia's Own Credit Union) Form

Use Fill to complete blank online GEORGIA'S OWN CREDIT UNION pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

IRA Simplifier INDIVIDUAL RETIREMENT ACCOUNT APPLICATION (Georgia's Own Credit Union)

On average this form takes 44 minutes to complete

The IRA Simplifier INDIVIDUAL RETIREMENT ACCOUNT APPLICATION (Georgia's Own Credit Union) form is 20 pages long and contains:

0 signatures
17 check-boxes
168 other fields

Country of origin: US
File type: PDF

Use our library of forms to quickly fill and sign your Georgia's Own Credit Union forms online.

BROWSE GEORGIA'S OWN CREDIT UNION FORMS

Related forms

IRA Simplifier ROTH INDIVIDUAL RETIREMENT ACCOUNT APPLICATION (Georgia's Own Credit Union)
ESA WITHDRAWAL AUTHORIZATION (Georgia's Own Credit Union)
Simplifier HEALTH SAVINGS ACCOUNT APPLICATION (Georgia's Own Credit Union)
WITHDRAWAL AUTHORIZATION (Georgia's Own Credit Union)
ESA Simplifier COVERDELL EDUCATION SAVINGS ACCOUNT APPLICATION (Georgia's Own Credit Union)
IRA WITHDRAWAL AUTHORIZATION (Georgia's Own Credit Union)
IRA WITHDRAWAL AUTHORIZATION (Georgia's Own Credit Union)
IRA TRANSFER REQUEST TRADITIONAL ACCEPTING ACCOUNT TYPE (Select (Georgia's Own Credit Union)
IRA TRANSFER REQUEST ROTH PART 1. RECIPIENT PART (Georgia's Own Credit Union)
HOME EQUITY EARLY DISCLOSURE IMPORTANT TERMS OF OUR (Georgia's Own Credit Union)
TRANSFER REQUEST PART 1. RECIPIENT PART 2. ACCEPTING (Georgia's Own Credit Union)
ESA TRANSFER REQUEST COVERDELL PART 1. RECIPIENT PART (Georgia's Own Credit Union)
IRA CONTRIBUTION AND INVESTMENT SELECTION (Georgia's Own Credit Union)
IRA CONTRIBUTION AND INVESTMENT SELECTION (Georgia's Own Credit Union)
CONTRIBUTION AND INVESTMENT SELECTION (Georgia's Own Credit Union)
ESA CONTRIBUTION AND INVESTMENT SELECTION (Georgia's Own Credit Union)
SUBORDINATION AGREEMENT REQUEST All request are subject to (Georgia's Own Credit Union)
OUTGOING INTERNATIONAL WIRE TRANSFER CHECKLIST (Georgia's Own Credit Union)
Need Assistance? TAKE A PAYMENT HOLIDAY* Helping members (Georgia's Own Credit Union)
OUTGOING DOMESTIC WIRE TRANSFER REQUEST (Georgia's Own Credit Union)

Fill has a huge library of thousands of forms all set up to be filled in easily and signed.

Fill in your chosen form

Sign the form using our drawing tool

Send to someone else to fill in and sign.

find another form

Redo

Arial Font

Arial
Calibri
Roboto
Open Sans

AFont color

AB
A.B
A..B
A...B
A....B

Remove Field

ADD FIELDS

Page 1 of 14

PART 1. IRA OWNER

Name (First/MI/Last) _________________________________________

Address Line 1 _______________________________________________

Address Line 2 _______________________________________________

City/State/ZIP _______________________________________________

Social Security Number _______________________________________

Date of Birth ____________________ Phone _____________________

Email Address _______________________________________________

Account Number _____________________________________________

PART 2. IRA TRUSTEE

To be completed by the IRA trustee

Name ______________________________________________________

Address Line 1 _______________________________________________

Address Line 2 _______________________________________________

City/State/ZIP _______________________________________________

Phone _______________________ Organizaon Number ___________

 ThisisanamendmenttoanexisngIRA.

 ThisIRAcontainsmanagedinvestmentsasdescribedinthe

TrusteeManagementofInvestmentseconoftheagreement.

ThisIRAcontainsonlysimpliedemployeepension(SEP)planassets.

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an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intothisIRA)

4.Recharacterizaon (AnontaxablemovementofaRothIRAcontribuon,conversion,or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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.)

 InvestmentDescripon QuantyorAmount InvestmentNumber TermorMaturityDate Interest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____________________________________

INDIVIDUAL RETIREMENT ACCOUNT APPLICATION

Simplifier®

TRADITIONAL

IRA

Page 2 of 14

Checkhereifaddionalbeneciariesarelistedonanaachedaddendum. Total number of addendums aached to this IRA __________________

PART 5. BENEFICIARY DESIGNATION

I designate that upon my death, the assets in this account be paid to the beneciaries named below. The interest of any beneciary that predeceases

me terminates completely, and the percentage share of any remaining beneciaries will be increased on a pro rata basis. If no beneciaries are

named, my estate will be my beneciary.

I elect not to designate beneciaries at this me and understand that I may designate beneciaries at a later date.

PART 6. SPOUSAL CONSENT

Spousalconsentshouldbeconsideredifeitherthetrustortheresidenceof

theIRAownerislocatedinacommunityormaritalpropertystate.

CURRENT MARITAL STATUS

I Am Not Married – I understand that if I become married in the

future, I should review the requirements for spousal consent.

I Am Married – I understand that if I choose to designate a primary

beneciary other than or in addion to my spouse, my spouse should

sign below.

CONSENT OF SPOUSE

I am the spouse of the above-named IRA owner. I acknowledge that I have

received a fair and reasonable disclosure of my spouse’s property and

nancial obligaons. Because of the important tax consequences of giving

up my interest in this IRA, I have been advised to see a tax professional.

I hereby relinquish any interest that I may have in this IRA and consent to

the beneciary designaon indicated above. I assume full responsibility for

any adverse consequences that may result.

X____________________________________________ ____________________

Signature of Spouse Date (mm/dd/yyyy)

X____________________________________________ ____________________

Signature of Witness Date (mm/dd/yyyy)

PART 7. SIGNATURES

Important: Pleasereadbeforesigning.

I understand the eligibility requirements for the type of IRA contribuon I am

making, and I state that I do qualify to make the contribuon. I have received

a copy of the IRA Applicaon, the 5305 Trust Account Agreement, the

Financial Disclosure, and the Disclosure Statement. I understand that the

terms and condions that apply to this IRA are contained in this Applicaon

and the Trust Account Agreement. I agree to be bound by those terms and

condions. Within seven days from the date I open this IRA I may revoke it

without penalty by mailing or delivering a wrien noce to the trustee.

I assume complete responsibility for

• determining that I am eligible for an IRA each year I make a

contribuon,

• ensuring that all contribuons I make are within the limits set forth

by the tax laws, and

• the tax consequences of any contribuons (including rollover

contribuons) and distribuons.

X____________________________________________ ____________________

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

X____________________________________________ ____________________

Signature of Witness Date (mm/dd/yyyy)

X____________________________________________ ____________________

Signature of Trustee Date (mm/dd/yyyy)

Name ______________________________________________________

Address ____________________________________________________

City/State/ZIP _______________________________________________

Date of Birth _________________ Relaonship ___________________

Tax ID (SSN/TIN) ____________________ Percent Designated ________

Name ______________________________________________________

Address ____________________________________________________

City/State/ZIP _______________________________________________

Date of Birth _________________ Relaonship ___________________

Tax ID (SSN/TIN) ____________________ Percent Designated ________

Name ______________________________________________________

Address ____________________________________________________

City/State/ZIP _______________________________________________

Date of Birth _________________ Relaonship ___________________

Tax ID (SSN/TIN) ____________________ Percent Designated ________

Name ______________________________________________________

Address ____________________________________________________

City/State/ZIP _______________________________________________

Date of Birth _________________ Relaonship ___________________

Tax ID (SSN/TIN) ____________________ Percent Designated ________

CONTINGENT BENEFICIARIES (Thetotalpercentagedesignatedmustequal100%.Ifmorethanonebeneciaryisdesignatedandnopercentages

areindicated,thebeneciarieswillbedeemedtoownequalsharepercentagesintheIRA.Thebalanceintheaccountwillbepayabletothese

beneciariesifallprimarybeneciarieshavepredeceasedtheIRAowner.)

Name ______________________________________________________

Address ____________________________________________________

City/State/ZIP _______________________________________________

Date of Birth _________________ Relaonship ___________________

Tax ID (SSN/TIN) ____________________ Percent Designated ________

Name ______________________________________________________

Address ____________________________________________________

City/State/ZIP _______________________________________________

Date of Birth _________________ Relaonship ___________________

Tax ID (SSN/TIN) ____________________ Percent Designated ________

Name ______________________________________________________

Address ____________________________________________________

City/State/ZIP _______________________________________________

Date of Birth _________________ Relaonship ___________________

Tax ID (SSN/TIN) ____________________ Percent Designated ________

Name ______________________________________________________

Address ____________________________________________________

City/State/ZIP _______________________________________________

Date of Birth _________________ Relaonship ___________________

Tax ID (SSN/TIN) ____________________ Percent Designated ________

PRIMARY BENEFICIARIES (Thetotalpercentagedesignatedmustequal100%.Ifmorethanonebeneciaryisdesignatedandnopercentagesare

indicated,thebeneciarieswillbedeemedtoownequalsharepercentagesintheIRA.)

Name of IRA Owner ______________________________________________________________, Account Number _____________________________

Page 3 of 14

The grantor named on the applicaon is establishing a Tradional

individual rerement account under secon 408(a) to provide for his or

her rerement and for the support of his or her beneciaries aer death.

The trustee named on the applicaon has given the grantor the disclosure

statement required by Regulaons secon 1.408-6.

The grantor has assigned the trust account the sum indicated on the

applicaon.

The grantor and the trustee make the following agreement:

ARTICLE I

Except in the case of a rollover contribuon described in secon 402(c),

403(a)(4), 403(b)(8), 408(d)(3), or 457(e)(16), an employer contribuon to

a simplied employee pension plan as described in secon 408(k) or a

recharacterized contribuon described in secon 408A(d)(6), the trustee

will accept only cash contribuons up to $3,000 per year for tax years

2002 through 2004. That contribuon limit is increased to $4,000 for tax

years 2005 through 2007 and $5,000 for 2008 and thereaer. For

individuals who have reached the age of 50 before the close of the tax

year, the contribuon limit is increased to $3,500 per year for tax years

2002 through 2004, $4,500 for 2005, $5,000 for 2006 and 2007, and

$6,000 for 2008 and thereaer. For tax years aer 2008, the above limits

will be increased to reect a cost-of-living adjustment, if any.

ARTICLE II

The grantor’s interest in the balance in the trust account is nonforfeitable.

ARTICLE III

1. No part of the trust account funds may be invested in life insurance

contracts, nor may the assets of the trust account be commingled with

other property except in a common trust fund or common investment

fund (within the meaning of secon 408(a)(5)).

2. No part of the trust account funds may be invested in collecbles

(within the meaning of secon 408(m)) except as otherwise permied

by secon 408(m)(3), which provides an excepon for certain gold,

silver, and planum coins, coins issued under the laws of any state, and

certain bullion.

ARTICLE IV

1. Notwithstanding any provision of this agreement to the contrary, the

distribuon of the grantor’s interest in the trust account shall be made

in accordance with the following requirements and shall otherwise

comply with secon 408(a)(6) and the regulaons thereunder, the

provisions of which are herein incorporated by reference.

2. The grantor’s enre interest in the trust account must be, or begin to

be, distributed not later than the grantor’s required beginning date,

April 1 following the calendar year in which the grantor reaches age

70½. By that date, the grantor may elect, in a manner acceptable to the

trustee, to have the balance in the trust account distributed in: (a) A

single sum or (b) Payments over a period not longer than the life of the

grantor or the joint lives of the grantor and his or her designated

beneciary.

3. If the grantor dies before his or her enre interest is distributed to him

or her, the remaining interest will be distributed as follows:

(a) If the grantor dies on or aer the required beginning date and:

(i) the designated beneciary is the grantor’s surviving spouse, the

remaining interest will be distributed over the surviving spouse’s

life expectancy as determined each year unl such spouse’s

death, or over the period in paragraph (a)(iii) below if longer.

Any interest remaining aer the spouse’s death will be

distributed over such spouse’s remaining life expectancy as

determined in the year of the spouse’s death and reduced by

one for each subsequent year, or, if distribuons are being

made over the period in paragraph (a)(iii) below, over such

period.

(ii) the designated beneciary is not the grantor’s surviving spouse,

the remaining interest will be distributed over the beneciary’s

remaining life expectancy as determined in the year following

the death of the grantor and reduced by one for each

subsequent year, or over the period in paragraph (a)(iii) below

if longer.

(iii) there is no designated beneciary, the remaining interest will

be distributed over the remaining life expectancy of the grantor

as determined in the year of the grantor’s death and reduced by

one for each subsequent year.

(b) If the grantor dies before the required beginning date, the

remaining interest will be distributed in accordance with (i) below

or, if elected or there is no designated beneciary, in accordance

with (ii) below.

(i) The remaining interest will be distributed in accordance with

paragraphs (a)(i) and (a)(ii) above (but not over the period in

paragraph (a)(iii), even if longer), starng by the end of the

calendar year following the year of the grantor’s death. If,

however, the designated beneciary is the grantor’s surviving

spouse, then this distribuon is not required to begin before

the end of the calendar year in which the grantor would have

reached age 70½. But, in such case, if the grantor’s surviving

spouse dies before distribuons are required to begin, then the

remaining interest will be distributed in accordance with (a)(ii)

above (but not over the period in paragraph (a)(iii), even if

longer), over such spouse’s designated beneciary’s life

expectancy, or in accordance with (ii) below if there is no such

designated beneciary.

(ii) The remaining interest will be distributed by the end of the

calendar year containing the h anniversary of the grantor’s

death.

4. If the grantor dies before his or her enre interest has been distributed

and if the designated beneciary is not the grantor’s surviving spouse,

no addional contribuons may be accepted in the account.

5. The minimum amount that must be distributed each year, beginning

with the year containing the grantor’s required beginning date, is

known as the “required minimum distribuon” and is determined as

follows.

(a) The required minimum distribuon under paragraph 2(b) for any

year, beginning with the year the grantor reaches age 70½, is the

grantor’s account value at the close of business on December 31 of

the preceding year divided by the distribuon period in the uniform

lifeme table in Regulaons secon 1.401(a)(9)-9. However, if the

grantor’s designated beneciary is his or her surviving spouse, the

required minimum distribuon for a year shall not be more than the

grantor’s account value at the close of business on December 31 of

the preceding year divided by the number in the joint and last

survivor table in Regulaons secon 1.401(a)(9)-9. The required

minimum distribuon for a year under this paragraph (a) is

determined using the grantor’s (or, if applicable, the grantor and

spouse’s) aained age (or ages) in the year.

INDIVIDUAL RETIREMENT TRUST ACCOUNT AGREEMENT

Form 5305 under secon 408(a) of the Internal Revenue Code. FORM (Rev. March 2002)

Page 4 of 14

(b) The required minimum distribuon under paragraphs 3(a) and 3(b)

(i) for a year, beginning with the year following the year of the

grantor’s death (or the year the grantor would have reached age

70½, if applicable under paragraph 3(b)(i)) is the account value at

the close of business on December 31 of the preceding year

divided by the life expectancy (in the single life table in Regulaons

secon 1.401(a)(9)-9) of the individual specied in such paragraphs

3(a) and 3(b)(i).

reaches age 70½ can be made as late as April 1 of the following

year. The required minimum distribuon for any other year must

be made by the end of such year.

6. The owner of two or more Tradional IRAs may sasfy the minimum

distribuon requirements described above by taking from one

Tradional IRA the amount required to sasfy the requirement for

another in accordance with the regulaons under secon 408(a)(6).

ARTICLE V

1. The grantor agrees to provide the trustee with all informaon

necessary to prepare any reports required by secon 408(i) and

Regulaons secons 1.408-5 and 1.408-6.

2. The trustee agrees to submit to the Internal Revenue Service (IRS) and

grantor the reports prescribed by the IRS.

ARTICLE VI

Notwithstanding any other arcles which may be added or incorporated,

the provisions of Arcles I through III and this sentence will be controlling.

Any addional arcles inconsistent with secon 408(a) and the related

regulaons will be invalid.

ARTICLE VII

This agreement will be amended as necessary to comply with the

provisions of the Code and the related regulaons. Other amendments

may be made with the consent of the persons whose signatures appear on

the applicaon.

ARTICLE VIII

8.01 Denions– In this part of this agreement (Arcle VIII), the words

“you” and “your” mean the grantor. The words “we,” “us,” and

“our” mean the trustee. The word “Code” means the Internal

Revenue Code, and “regulaons” means the Treasury regulaons.

8.02 Noces and Change of Address – Any required noce regarding

this IRA will be considered eecve when we send it to the

intended recipient at the last address that we have in our records.

Any noce to be given to us will be considered eecve when we

actually receive it. You, or the intended recipient, must nofy us of

any change of address.

8.03 RepresentaonsandResponsibilies– You represent and warrant

to us that any informaon you have given or will give us with

respect to this agreement is complete and accurate. Further, you

agree that any direcons you give us or acon you take will be

proper under this agreement, and that we are entled to rely upon

any such informaon or direcons. If we fail to receive direcons

from you regarding any transacon, if we receive ambiguous

direcons regarding any transacon, or if we, in good faith, believe

that any transacon requested is in dispute, we reserve the right to

take no acon unl further claricaon acceptable to us is received

from you or the appropriate government or judicial authority. We

will not be responsible for losses of any kind that may result from

your direcons to us or your acons or failures to act, and you

agree to reimburse us for any loss we may incur as a result of such

direcons, acons, or failures to act. We will not be responsible for

any penales, taxes, judgments, or expenses you incur in connecon

with your IRA. We have no duty to determine whether your

contribuons or distribuons comply with the Code, regulaons,

rulings, or this agreement.

We may permit you to appoint, through wrien noce acceptable

to us, an authorized agent to act on your behalf with respect to this

agreement (e.g., aorney-in-fact, executor, administrator,

investment manager), but we have no duty to determine the

validity of such appointment or any instrument appoinng such

authorized agent. We will not be responsible for losses of any kind

that may result from direcons, acons, or failures to act by your

authorized agent, and you agree to reimburse us for any loss we

may incur as a result of such direcons, acons, or failures to act by

your authorized agent.

You will have 60 days aer you receive any documents, statements,

or other informaon from us to nofy us in wring of any errors or

inaccuracies reected in these documents, statements, or other

informaon. If you do not nofy us within 60 days, the documents,

statements, or other informaon will be deemed correct and

accurate, and we will have no further liability or obligaon for such

documents, statements, other informaon, or the transacons

described therein.

By performing services under this agreement we are acng as your

agent. Unless secon 8.06(b) of this agreement applies, you

acknowledge and agree that nothing in this agreement will be

construed as conferring duciary status upon us. We will not be

required to perform any addional services unless specically

agreed to under the terms and condions of this agreement, or as

required under the Code and the regulaons promulgated

thereunder with respect to IRAs. You agree to indemnify and hold

us harmless for any and all claims, acons, proceedings, damages,

judgments, liabilies, costs, and expenses, including aorney’s fees

arising from or in connecon with this agreement.

To the extent wrien instrucons or noces are required under this

agreement, we may accept or provide such informaon in any

other form permied by the Code or applicable regulaons

including, but not limited to, electronic communicaon.

8.04 Disclosure of Account Informaon – We may use agents and/or

subcontractors to assist in administering your IRA. We may release

nonpublic personal informaon regarding your IRA to such providers

as necessary to provide the products and services made available

under this agreement, and to evaluate our business operaons and

analyze potenal product, service, or process improvements.

8.05 Service Fees – We have the right to charge an annual service fee or

other designated fees (e.g., a transfer, rollover, or terminaon fee)

for maintaining your IRA. In addion, we have the right to be

reimbursed for all reasonable expenses, including legal expenses,

we incur in connecon with the administraon of your IRA. We may

charge you separately for any fees or expenses, or we may deduct

the amount of the fees or expenses from the assets in your IRA at

our discreon. We reserve the right to charge any addional fee

aer giving you 30 days’ noce. Fees such as subtransfer agent fees

or commissions may be paid to us by third pares for assistance in

performing certain transacons with respect to this IRA.

Any brokerage commissions aributable to the assets in your IRA

will be charged to your IRA. You cannot reimburse your IRA for

those commissions.

Page 5 of 14

8.06 Investment of Amounts in the IRA –

a. Grantor Management of Investment. Unless the IRA or a poron

of the IRA is a managed IRA, you have exclusive responsibility for

and control over the investment of the assets of your IRA. All

transacons will be subject to any and all restricons or

limitaons, direct or indirect, that are imposed by our charter,

arcles of incorporaon, or bylaws; any and all applicable federal

and state laws and regulaons; the rules, regulaons, customs,

and usages of any exchange, market, or clearing house where the

transacon is executed; our policies and pracces; and this

agreement. Aer your death, your beneciaries will have the

right to direct the investment of your IRA assets, subject to the

same condions that applied to you during your lifeme under

this agreement (including, without limitaon, secon 8.03 of this

arcle). We will have no discreon to direct any investment in

your IRA. We assume no responsibility for rendering investment

advice with respect to your IRA, nor will we oer any opinion or

judgment to you on maers concerning the value or suitability of

any investment or proposed investment for your IRA. In the

absence of instrucons from you, or if your instrucons are not

in a form acceptable to us, we will have the right to hold any

uninvested amounts in cash, and we will have no responsibility

to invest uninvested cash unless and unl directed by you. We

will not exercise the vong rights and other shareholder rights

with respect to investments in your IRA unless you provide mely

wrien direcons acceptable to us.

You will select the investment for your IRA assets from those

investments that we are authorized by our charter, arcles of

incorporaon, or bylaws to oer and do in fact oer for IRAs

(e.g., term share accounts, passbook accounts, cercates of

deposit, money market accounts). We may, in our sole discreon,

make available to you, addional investment oerings, that will

be limited to publicly-traded securies, mutual funds, money

market instruments, and other investments that are obtainable

by us and that we are capable of holding in the ordinary course

of our business.

b. Trustee Management of Investment. If any poron of this IRA is

a managed IRA, as indicated on the applicaon or any other

supporng documentaon, we will manage the investment of

the applicable IRA assets. Accordingly, we can manage, sell,

contract to sell, grant, or exercise opons to purchase, convey,

exchange, transfer, abandon, improve, repair, insure, lease for

any term, and otherwise deal with all property, real or personal,

in your IRA in such manner, for such prices and on such terms

and condions as we will decide.

We will have the power to do any of the following as we deem

necessary or advisable.

1. To invest your IRA assets in a single trust fund, and to collect

the income without disncon between principal and

income

2. To invest your IRA assets in a common trust fund or common

investment fund within the meaning of Code secon 408(a)(5)

3. To invest your IRA assets into savings instruments that we

oer

4. To invest your IRA assets in any other type of investment

permied by law, including, but not limited to, common or

preferred stock, open- or closed-end mutual funds, bonds,

notes, debentures, opons, U.S. Treasury bills, commercial

paper, or real estate

5. To hold any securies or other property under this

agreement in our own name, in the name of a nominee, or

in bearer form

6. To make, execute, acknowledge, and deliver any and all

documents of transfer and conveyance (including documents

for the transfer and conveyance of real estate), and any and

all instruments that may be necessary or appropriate to

carry out our powers

7. To employ suitable agents, aorneys, or other persons

8. To enter into lawsuits or sele any claims concerning the

assets in your IRA, and to be reimbursed for any expenses or

damages from you or your IRA assets

9. To exercise the vong rights and other shareholder rights

with respect to securies in your IRA, provided, however,

that we reserve the right to enter into a separate agreement

with you governing the exercise of vong and other

shareholder rights

10. To perform any and all acts that we deem necessary or

appropriate for the proper administraon of your IRA

All of the foregoing notwithstanding, our powers will be subject to

any and all restricons or limitaons, direct or indirect, that are

imposed by our charter, arcles of incorporaon, or bylaws; any

and all applicable federal and state laws and regulaons; the rules,

regulaons, customs, and usages of any exchange, market, or

clearing house where the transacon is executed; our policies and

pracces; and this agreement.

8.07 Beneciaries– If you die before you receive all of the amounts in

your IRA, payments from your IRA will be made to your beneciaries.

We have no obligaon to pay to your beneciaries unl such me

we are noed of your death by receiving a valid death cercate.

You may designate one or more persons or enes as beneciary of

your IRA. This designaon can only be made on a form provided by

or acceptable to us, and it will only be eecve when it is led with

us during your lifeme. Each beneciary designaon you le with us

will cancel all previous designaons. The consent of your beneciaries

will not be required for you to revoke a beneciary designaon. If

you have designated both primary and conngent beneciaries and

no primary beneciary survives you, the conngent beneciaries will

acquire the designated share of your IRA. If you do not designate a

beneciary or if all of your primary and conngent beneciaries

predecease you, your estate will be the beneciary.

A spouse beneciary will have all rights as granted under the Code

or applicable regulaons to treat your IRA as his or her own.

We may allow, if permied by state law, an original IRA beneciary

(the beneciary who is entled to receive distribuons from an

inherited IRA at the me of your death) to name successor

beneciaries for the inherited IRA. This designaon can only be

made on a form provided by or acceptable to us, and it will only be

eecve when it is led with us during the original IRA beneciary’s

lifeme. Each beneciary designaon form that the original IRA

beneciary les with us will cancel all previous designaons. The

consent of a successor beneciary will not be required for the

original IRA beneciary to revoke a successor beneciary

designaon. If the original IRA beneciary does not designate a

successor beneciary, his or her estate will be the successor

beneciary. In no event will the successor beneciary be able to

extend the distribuon period beyond that required for the original

IRA beneciary.

If we so choose, for any reason (e.g., due to limitaons of our

charter or bylaws), we may require that a beneciary of a deceased

IRA owner take total distribuon of all IRA assets by December 31

of the year following the year of death.

Page 6 of 14

8.08 Required Minimum Distribuons – Your required minimum

distribuon is calculated using the uniform lifeme table in

Regulaons secon 1.401(a)(9)-9. However, if your spouse is your

sole designated beneciary and is more than 10 years younger than

you, your required minimum distribuon is calculated each year

using the joint and last survivor table in Regulaons secon

1.401(a)(9)-9.

If you fail to request your required minimum distribuon by your

required beginning date, we can, at our complete and sole

discreon, do any one of the following.

• Make no distribuon unl you give us a proper withdrawal

request

• Distribute your enre IRA to you in a single sum payment

• Determine your required minimum distribuon from your IRA

each year based on your life expectancy, calculated using the

uniform lifeme table in Regulaons secon 1.401(a)(9)-9, and

pay those distribuons to you unl you direct otherwise

We will not be liable for any penales or taxes related to your

failure to take a required minimum distribuon.

8.09 TerminaonofAgreement,Resignaon,orRemovalofTrustee–

Either party may terminate this agreement at any me by giving

wrien noce to the other. We can resign as trustee at any me

eecve 30 days aer we send wrien noce of our resignaon to

you. Upon receipt of that noce, you must make arrangements to

transfer your IRA to another nancial organizaon. If you do not

complete a transfer of your IRA within 30 days from the date we

send the noce to you, we have the right to transfer your IRA assets

to a successor IRA trustee or custodian that we choose in our sole

discreon, or we may pay your IRA to you in a single sum. We will

not be liable for any acons or failures to act on the part of any

successor trustee or custodian, nor for any tax consequences you

may incur that result from the transfer or distribuon of your assets

pursuant to this secon.

If this agreement is terminated, we may charge to your IRA a

reasonable amount of money that we believe is necessary to cover

any associated costs, including but not limited to one or more of the

following.

• Any fees, expenses, or taxes chargeable against your IRA

• Any penales or surrender charges associated with the early

withdrawal of any savings instrument or other investment in

your IRA

If we are a nonbank trustee required to comply with Regulaons

secon 1.408-2(e) and we fail to do so or we are not keeping the

records, making the returns, or sending the statements as are

required by forms or regulaons, the IRS may require us to

substute another trustee or custodian.

We may establish a policy requiring distribuon of the enre

balance of your IRA to you in cash or property if the balance of your

IRA drops below the minimum balance required under the

applicable investment or policy established.

8.10 Successor Trustee – If our organizaon changes its name,

reorganizes, merges with another organizaon (or comes under the

control of any federal or state agency), or if our enre organizaon

(or any poron that includes your IRA) is bought by another

organizaon, that organizaon (or agency) will automacally

become the trustee or custodian of your IRA, but only if it is the type

of organizaon authorized to serve as an IRA trustee or custodian.

8.11 Amendments – We have the right to amend this agreement at any

me. Any amendment we make to comply with the Code and

related regulaons does not require your consent. You will be

deemed to have consented to any other amendment unless, within

30 days from the date we send the amendment, you nofy us in

wring that you do not consent.

8.12 Withdrawals or Transfers – All requests for withdrawal or transfer

will be in wring on a form provided by or acceptable to us. The

method of distribuon must be specied in wring or in any other

method acceptable to us. The tax idencaon number of the

recipient must be provided to us before we are obligated to make

a distribuon. Withdrawals will be subject to all applicable tax and

other laws and regulaons, including but not limited to possible

early distribuon penalty taxes, surrender charges, and withholding

requirements.

8.13 Transfers From Other Plans – We can receive amounts transferred

to this IRA from the trustee or custodian of another IRA. In addion,

we can accept rollovers of eligible rollover distribuons from

employer-sponsored rerement plans as permied by the Code.

We reserve the right not to accept any transfer or direct rollover.

8.14 LiquidaonofAssets– We have the right to liquidate assets in your

IRA if necessary to make distribuons or to pay fees, expenses,

taxes, penales, or surrender charges properly chargeable against

your IRA. If you fail to direct us as to which assets to liquidate, we

will decide, in our complete and sole discreon, and you agree to

not hold us liable for any adverse consequences that result from

our decision.

8.15 RestriconsontheFund–

Neither you nor any beneciary may sell,

transfer, or pledge any interest in your IRA in any manner whatsoever,

except as provided by law or this agreement.

The assets in your IRA will not be responsible for the debts,

contracts, or torts of any person entled to distribuons under this

agreement.

8.16 What Law Applies – This agreement is subject to all applicable

federal and state laws and regulaons. If it is necessary to apply any

state law to interpret and administer this agreement, the law of our

domicile will govern.

If any part of this agreement is held to be illegal or invalid, the

remaining parts will not be aected. Neither your nor our failure to

enforce at any me or for any period of me any of the provisions

of this agreement will be construed as a waiver of such provisions,

or your right or our right thereaer to enforce each and every such

provision.

GENERAL INSTRUCTIONS

SeconreferencesaretotheInternalRevenueCodeunlessotherwisenoted.

PURPOSE OF FORM

Form 5305 is a model trust account agreement that meets the requirements

of secon 408(a) and has been pre-approved by the IRS. A Tradional

individual rerement account (Tradional IRA) is established aer the

form is fully executed by both the individual (grantor) and the trustee and

must be completed no later than the due date (excluding extensions) of

the individual’s income tax return for the tax year. This account must be

created in the United States for the exclusive benet of the grantor and

his or her beneciaries.

Do not le Form 5305 with the IRS. Instead, keep it with your records.

For more informaon on IRAs, including the required disclosures the

trustee must give the grantor, see Pub. 590, Individual Rerement

Arrangements(IRAs).

Page 7 of 14

RIGHT TO REVOKE YOUR IRA

You have the right to revoke your IRA within seven days of the receipt of

the disclosure statement. If revoked, you are entled to a full return of the

contribuon you made to your IRA. The amount returned to you would

not include an adjustment for such items as sales commissions,

administrave expenses, or uctuaon in market value. You may make

this revocaon only by mailing or delivering a wrien noce to the trustee

at the address listed on the applicaon.

If you send your noce by rst class mail, your revocaon will be deemed

mailed as of the postmark date.

If you have any quesons about the procedure for revoking your IRA,

please call the trustee at the telephone number listed on the applicaon.

REQUIREMENTSOFANIRA

A. CashContribuons– Your contribuon must be in cash, unless it is a

rollover contribuon.

B. MaximumContribuon– The total amount you may contribute to an

IRA for any taxable year cannot exceed the lesser of 100 percent of

your compensaon or $5,500 for 2015 and 2016, with possible cost-of-

living adjustments each year thereaer. If you also maintain a Roth IRA

(i.e., an IRA subject to the limits of Internal Revenue Code Secon (IRC

Sec.) 408A), the maximum contribuon to your Tradional IRAs is

reduced by any contribuons you make to your Roth IRAs. Your total

annual contribuon to all Tradional IRAs and Roth IRAs cannot exceed

the lesser of the dollar amounts described above or 100 percent of

your compensaon.

C. ContribuonEligibility

– You are eligible to make a regular contribuon

to your IRA if you have compensaon and have not aained age

70½

the end of the taxable year for which the contribuon is made.

D. Catch-UpContribuons– If you are age 50 or older by the close of the

taxable year, you may make an addional contribuon to your IRA. The

maximum addional contribuon is $1,000 per year.

E. Nonforfeitability– Your interest in your IRA is nonforfeitable.

F. Eligible Trustees – The trustee of your IRA must be a bank, savings and

loan associaon, credit union, or a person or enty approved by the

Secretary of the Treasury.

G. Commingling Assets

– The assets of your IRA cannot be commingled

with other property except in a common trust fund or common

investment fund.

H. Life Insurance – No poron of your IRA may be invested in life

insurance contracts.

I. Collecbles– You may not invest the assets of your IRA in collecbles

(within the meaning of IRC Sec. 408(m)). A collecble is dened as any

work of art, rug or anque, metal or gem, stamp or coin, alcoholic

beverage, or other tangible personal property specied by the Internal

Revenue Service (IRS). However, specially minted United States gold

and silver coins, and certain state-issued coins are permissible

investments. Planum coins and certain gold, silver, planum, or

palladium bullion (as described in IRC Sec. 408(m)(3)) are also permied

as IRA investments.

J. RequiredMinimumDistribuons– You are required to take minimum

distribuons from your IRA at certain mes in accordance with Treasury

Regulaon 1.408-8. Below is a summary of the IRA distribuon rules.

1. You are required to take a minimum distribuon from your IRA for

the year in which you reach age 70½ and for each year thereaer.

You must take your rst distribuon by your required beginning

date, which is April 1 of the year following the year you aain age

70½. The minimum distribuon for any taxable year is equal to the

amount obtained by dividing the account balance at the end of the

prior year by the applicable divisor.

2. The applicable divisor generally is determined using the Uniform

Lifeme Table provided by the IRS. If your spouse is your sole

designated beneciary for the enre calendar year, and is more

than 10 years younger than you, the required minimum distribuon

is determined each year using the actual joint life expectancy of you

and your spouse obtained from the Joint Life Expectancy Table

provided by the IRS, rather than the life expectancy divisor from the

Uniform Lifeme Table.

We reserve the right to do any one of the following by April 1 of the

year following the year in which you turn age 70½.

(a) Make no distribuon unl you give us a proper withdrawal

request

DISCLOSURE STATEMENT

DEFINITIONS

Trustee – The trustee must be a bank or savings and loan associaon, as

dened in secon 408(n), or any person who has the approval of the IRS

to act as trustee.

Grantor – The grantor is the person who establishes the trust account.

IDENTIFYING NUMBER

The grantor’s Social Security number will serve as the idenfying number

of his or her IRA. An employer idencaon number (EIN) is required only

for an IRA for which a return is led to report unrelated business taxable

income. An EIN is required for a common fund created for IRAs.

TRADITIONAL IRA FOR NONWORKING SPOUSE

Form 5305 may be used to establish the IRA trust for a nonworking

spouse. Contribuons to an IRA trust account for a nonworking spouse

must be made to a separate IRA trust account established by the

nonworking spouse.

SPECIFIC INSTRUCTIONS

ArcleIV– Distribuons made under this arcle may be made in a single

sum, periodic payment, or a combinaon of both. The distribuon opon

should be reviewed in the year the grantor reaches age 70½ to ensure that

the requirements of secon 408(a)(6) have been met.

ArcleVIII– Arcle VIII and any that follow it may incorporate addional

provisions that are agreed to by the grantor and trustee to complete the

agreement. They may include, for example, denions, investment

powers, vong rights, exculpatory provisions, amendment and terminaon,

removal of the trustee, trustee’s fees, state law requirements, beginning

date of distribuons, accepng only cash, treatment of excess

contribuons, prohibited transacons with the grantor, etc. Aach

addional pages if necessary.

Page 8 of 14

(b) Distribute your enre IRA to you in a single sum payment

on your life expectancy calculated using the Uniform Lifeme

Table, and pay those distribuons to you unl you direct

otherwise

If you fail to remove a required minimum distribuon, an addional

penalty tax of 50 percent is imposed on the amount of the required

minimum distribuon that should have been taken but was not.

You must le IRS Form 5329 along with your income tax return to

report and remit any addional taxes to the IRS.

3. Your designated beneciary is determined based on the beneciaries

designated as of the date of your death, who remain your

beneciaries as of September 30 of the year following the year of

your death.

If you die on or aer your required beginning date, distribuons

must be made to your beneciaries over the longer of the single life

expectancy of your designated beneciaries, or your remaining life

expectancy. If a beneciary other than a person or qualied trust as

dened in the Treasury Regulaons is named, you will be treated as

having no designated beneciary of your IRA for purposes of

determining the distribuon period. If there is no designated

beneciary of your IRA, distribuons will commence using your

single life expectancy, reduced by one in each subsequent year.

If you die before your required beginning date, the enre amount

remaining in your account will, at the elecon of your designated

beneciaries, either

(a) be distributed by December 31 of the year containing the h

anniversary of your death, or

(b) be distributed over the remaining life expectancy of your

designated beneciaries.

If your spouse is your sole designated beneciary, he or she must

elect either opon (a) or (b) by the earlier of December 31 of the

year containing the h anniversary of your death, or December 31

of the year life expectancy payments would be required to begin.

Your designated beneciaries, other than a spouse who is the sole

designated beneciary, must elect either opon (a) or (b) by

December 31 of the year following the year of your death. If no

elecon is made, distribuon will be calculated in accordance with

opon (b). In the case of distribuons under opon (b), distribuons

must commence by December 31 of the year following the year of

your death. Generally, if your spouse is the designated beneciary,

distribuons need not commence unl December 31 of the year

you would have aained age 70½, if later. If a beneciary other

than a person or qualied trust as dened in the Treasury

Regulaons is named, you will be treated as having no designated

beneciary of your IRA for purposes of determining the distribuon

period. If there is no designated beneciary of your IRA, the enre

IRA must be distributed by December 31 of the year containing the

h anniversary of your death.

A spouse who is the sole designated beneciary of your enre IRA

will be deemed to elect to treat your IRA as his or her own by either

(1) making contribuons to your IRA or (2) failing to mely remove

a required minimum distribuon from your IRA. Regardless of

whether or not the spouse is the sole designated beneciary of

your IRA, a spouse beneciary may roll over his or her share of the

assets to his or her own IRA.

If we so choose, for any reason (e.g., due to limitaons of our

charter or bylaws), we may require that a beneciary of a deceased

IRA owner take total distribuon of all IRA assets by December 31

of the year following the year of death.

If your beneciary fails to remove a required minimum distribuon

aer your death, an addional penalty tax of 50 percent is imposed

on the amount of the required minimum distribuon that should

have been taken but was not. Your beneciary must le IRS Form

5329 along with his or her income tax return to report and remit

any addional taxes to the IRS.

K. Qualifying Longevity Annuity Contracts and RMDs – A qualifying

longevity annuity contract (QLAC) is a deferred annuity contract that,

among other requirements, must guarantee lifeme income starng

no later than age 85. The total premiums paid to QLACs in your IRAs

must not exceed 25 percent (up to $125,000) of the combined value of

your IRAs (excluding Roth IRAs). The $125,000 limit is subject to cost-

of-living adjustments each year.

When calculang your RMD, you may reduce the prior year end

account value by the value of QLACs that your IRA holds as investments.

For more informaon on QLACs, you may wish to refer to the IRS

website at www.irs.gov.

INCOMETAXCONSEQUENCESOFESTABLISHINGANIRA

A. IRA Deducbility – If you are eligible to contribute to your IRA, the

amount of the contribuon for which you may take a tax deducon will

depend upon whether you (or, in some cases, your spouse) are an

acve parcipant in an employer-sponsored rerement plan. If you

(and your spouse, if married) are not an acve parcipant, your enre

IRA contribuon will be deducble. If you are an acve parcipant (or

are married to an acve parcipant), the deducbility of your IRA

contribuon will depend on your modied adjusted gross income

(MAGI) and your tax ling status for the tax year for which the

contribuon was made. MAGI is determined on your income tax return

using your adjusted gross income but disregarding any deducble IRA

contribuon and certain other deducons and exclusions.

Denion of Acve Parcipant. Generally, you will be an acve

parcipant if you are covered by one or more of the following

employer-sponsored rerement plans.

1. Qualied pension, prot sharing, 401(k), or stock bonus plan

2. Qualied annuity plan of an employer

3. Simplied employee pension (SEP) plan

4. Rerement plan established by the federal government, a state, or

a polical subdivision (except certain unfunded deferred

compensaon plans under IRC Sec. 457)

5. Tax-sheltered annuity for employees of certain tax-exempt

organizaons or public schools

6. Plan meeng the requirements of IRC Sec. 501(c)(18)

7. Savings incenve match plan for employees of small employers

(SIMPLE) IRA plan or a SIMPLE 401(k) plan

If you do not know whether your employer maintains one of these

plans or whether you are an acve parcipant in a plan, check with

your employer or your tax advisor. Also, the IRS Form W-2, Wageand

Tax Statement, that you receive at the end of the year from your

employer will indicate whether you are an acve parcipant.

If you are an acve parcipant, are single, and have MAGI within the

applicable phase-out range listed below, the deducble amount of

your contribuon is determined as follows. (1) Begin with the

appropriate phase-out range maximum for the applicable year

(specied below) and subtract your MAGI; (2) divide this total by the

dierence between the phase-out maximum and minimum; and

(3) mulply this number by the maximum allowable contribuon for

the applicable year, including catch-up contribuons if you are age 50

or older. The resulng gure will be the maximum IRA deducon you

may take. For example, if you are age 30 with MAGI of $63,000 in 2016,

your maximum deducble contribuon is $4,400 (the 2016 phase-out

Page 9 of 14

range maximum of $71,000 minus your MAGI of $63,000, divided by

the dierence between the maximum and minimum phase-out range

limits of $10,000, and mulplied by the contribuon limit of $5,500).

If you are an acve parcipant, are married to an acve parcipant and

you le a joint income tax return, and have MAGI within the applicable

phase-out range listed below, the deducble amount of your

contribuon is determined as follows. (1) Begin with the appropriate

phase-out maximum for the applicable year (specied below) and

subtract your MAGI; (2) divide this total by the dierence between the

phase-out range maximum and minimum; and (3) mulply this number

by the maximum allowable contribuon for the applicable year,

including catch-up contribuons if you are age 50 or older. The

resulng gure will be the maximum IRA deducon you may take. For

example, if you are age 30 with MAGI of $103,000 in 2016, your

maximum deducble contribuon is $4,125 (the 2016 phase-out

maximum of $118,000 minus your MAGI of $103,000, divided by the

dierence between the maximum and minimum phase-out limits of

$20,000, and mulplied by the contribuon limit of $5,500).

If you are an acve parcipant, are married and you le a separate

income tax return, your MAGI phase-out range is generally $0–$10,000.

However, if you lived apart for the enre tax year, you are treated as a

single ler.

  JointFilers SingleTaxpayers

Tax Year Phase-Out Range* Phase-Out Range*

(minimum)(maximum) (minimum)(maximum)

2011 $90,000 – $110,000 $56,000 – $66,000

2012 $92,000 – $112,000 $58,000 – $68,000

2013 $95,000 – $115,000 $59,000 – $69,000

2014 $96,000 – $116,000 $60,000 – $70,000

2015 $98,000 – $118,000 $61,000 – $71,000

2016 $98,000 – $118,000 $61,000 – $71,000

*MAGI limits are subject to cost-of-living adjustments each year.

The MAGI phase-out range for an individual that is not an acve

parcipant, but is married to an acve parcipant, is $183,000–$193,000

for 2015 and $184,000–$194,000 for 2016. This limit is also subject to

cost-of-living increases for tax years aer 2016. If you are not an acve

parcipant in an employer-sponsored rerement plan, are married to

someone who is an acve parcipant, and you le a joint income tax

return with MAGI between the applicable phase-out range for the

year, your maximum deducble contribuon is determined as follows.

(1) Begin with the appropriate MAGI phase-out maximum for the year

and subtract your MAGI; (2) divide this total by the dierence between

the phase-out range maximum and minimum; and (3) mulply this

number by the maximum allowable contribuon for the applicable

year, including catch-up contribuons if you are age 50 or older. The

resulng gure will be the maximum IRA deducon you may take.

You must round the resulng deducon to the next highest $10 if the

number is not a mulple of 10. If your resulng deducon is between

$0 and $200, you may round up to $200.

B. ContribuonDeadline– The deadline for making an IRA contribuon

is your tax return due date (not including extensions). You may

designate a contribuon as a contribuon for the preceding taxable

year in a manner acceptable to us. For example, if you are a calendar-

year taxpayer and you make your IRA contribuon on or before your

tax ling deadline, your contribuon is considered to have been made

for the previous tax year if you designate it as such.

If you are a member of the Armed Forces serving in a combat zone,

hazardous duty area, or conngency operaon, you may have an

extended contribuon deadline of 180 days aer the last day served in

the area. In addion, your contribuon deadline for a parcular tax

year is also extended by the number of days that remained to le that

year’s tax return as of the date you entered the combat zone. This

addional extension to make your IRA contribuon cannot exceed the

number of days between January 1 and your tax ling deadline, not

including extensions.

C. Tax Credit for Contribuons – You may be eligible to receive a tax

credit for your Tradional IRA contribuons. This credit will be allowed

in addion to any tax deducon that may apply, and may not exceed

$1,000 in a given year. You may be eligible for this tax credit if you are

• age 18 or older as of the close of the taxable year,

• not a dependent of another taxpayer, and

• not a full-me student.

The credit is based upon your income (see chart below), and will range

from 0 to 50 percent of eligible contribuons. In order to determine

the amount of your contribuons, add all of the contribuons made to

your Tradional IRA and reduce these contribuons by any distribuons

that you have taken during the tesng period. The tesng period

begins two years prior to the year for which the credit is sought and

ends on the tax return due date (including extensions) for the year for

which the credit is sought. In order to determine your tax credit,

mulply the applicable percentage from the chart below by the

amount of your contribuons that do not exceed $2,000.

2016 Adjusted Gross Income*

Joint Head of a All Other

Applicable

Return Household Cases

Percentage

$1 – 37,000 $1 – 27,750 $1 – 18,500 50

$37,001 – 40,000 $27,751 – 30,000 $18,501 – 20,000 20

$40,001 – 61,500 $30,001 – 46,125 $20,001 – 30,750 10

Over $61,500 Over $46,125 Over $30,750 0

*Adjusted gross income (AGI) includes foreign earned income and

income from Guam, America Samoa, North Mariana Islands, and Puerto

Rico. AGI limits are subject to cost-of-living adjustments each year.

D. Excess Contribuons – An excess contribuon is any amount that is

contributed to your IRA that exceeds the amount that you are eligible

to contribute. If the excess is not corrected mely, an addional

penalty tax of six percent will be imposed upon the excess amount. The

procedure for correcng an excess is determined by the meliness of

the correcon as idened below.

1. Removal Before Your Tax Filing Deadline. An excess contribuon

may be corrected by withdrawing the excess amount, along with

the earnings aributable to the excess, before your tax ling

deadline, including extensions, for the year for which the excess

contribuon was made. An excess withdrawn under this method is

not taxable to you, but you must include the earnings aributable

to the excess in your taxable income in the year in which the

contribuon was made. The six percent excess contribuon penalty

tax will be avoided.

2. Removal Aer Your Tax Filing Deadline. If you are correcng an

excess contribuon aer your tax ling deadline, including

extensions, remove only the amount of the excess contribuon.

The six percent excess contribuon penalty tax will be imposed on

the excess contribuon for each year it remains in the IRA. An

excess withdrawal under this method will only be taxable to you if

the total contribuons made in the year of the excess exceed the

annual applicable contribuon limit.

Carry Forward to a Subsequent Year. If you do not withdraw the

excess contribuon, you may carry forward the contribuon for a

subsequent tax year. To do so, you under-contribute for that tax year

and carry the excess contribuon amount forward to that year on

your tax return. The six percent excess contribuon penalty tax will

be imposed on the excess amount for each year that it remains as an

excess contribuon at the end of the year.

Page 10 of 14

You must le IRS Form 5329 along with your income tax return to

report and remit any addional taxes to the IRS.

E. Tax-Deferred Earnings – The investment earnings of your IRA are not

subject to federal income tax unl distribuons are made (or, in certain

instances, when distribuons are deemed to be made).

F. Nondeducble Contribuons – You may make nondeducble

contribuons to your IRA to the extent that deducble contribuons

are not allowed. The sum of your deducble and nondeducble IRA

contribuons cannot exceed your contribuon limit (the lesser of the

allowable contribuon limit described previously, or 100 percent of

compensaon). You may elect to treat deducble IRA contribuons as

nondeducble contribuons.

If you make nondeducble contribuons for a parcular tax year, you

must report the amount of the nondeducble contribuon along with

your income tax return using IRS Form 8606. Failure to le IRS Form

8606 will result in a $50 per failure penalty.

If you overstate the amount of designated nondeducble contribuons

for any taxable year, you are subject to a $100 penalty unless

reasonable cause for the overstatement can be shown.

G. TaxaonofDistribuons–

The taxaon of IRA distribuons depends on

whether or not you have ever made nondeducble IRA contribuons. If

you have only made deducble contribuons, all IRA distribuon

amounts will be included in income.

If you have ever made nondeducble contribuons to any IRA, the

following formula must be used to determine the amount of any IRA

distribuon excluded from income.

(Aggregate Nondeducble Contribuons)

x (Amount Withdrawn)

–––––––––––––––––––––––––––––––––– = Amount Excluded From Income

Aggregate IRA Balance

NOTE: Aggregate nondeducble contribuons include all nondeducble

contribuons made by you through the end of the year of the

distribuon that have not previously been withdrawn and excluded

from income. Also note that the aggregate IRA balance includes the

total balance of all of your Tradional and SIMPLE IRAs as of the end of

the year of distribuon and any distribuons occurring during the year.

H. Income Tax Withholding – Any withdrawal from your IRA is subject to

federal income tax withholding. You may, however, elect not to have

withholding apply to your IRA withdrawal. If withholding is applied to

your withdrawal, not less than 10 percent of the amount withdrawn

must be withheld.

I. Early Distribuon Penalty Tax – If you receive an IRA distribuon

before you aain age 59

⁄2, an addional early distribuon penalty tax

of 10 percent will apply to the taxable amount of the distribuon

unless one of the following excepons apply. 1) Death. Aer your

death, payments made to your beneciary are not subject to the 10

percent early distribuon penalty tax. 2)Disability. If you are disabled

at the me of distribuon, you are not subject to the addional 10

percent early distribuon penalty tax. In order to be disabled, a

physician must determine that your impairment can be expected to

result in death or to be of long, connued, and indenite duraon.

3)Substanallyequalperiodicpayments. You are not subject to the

addional 10 percent early distribuon penalty tax if you are taking a

series of substanally equal periodic payments (at least annual

payments) over your life expectancy or the joint life expectancy of you

and your beneciary. You must connue these payments for the longer

of ve years or unl you reach age 59

⁄2. 4) Unreimbursed medical

expenses. If you take payments to pay for unreimbursed medical

expenses exceeding 10 percent of your adjusted gross income, you will

not be subject to the 10 percent early distribuon penalty tax. The

medical expenses may be for you, your spouse, or any dependent

listed on your tax return. 5) Health insurance premiums. If you are

unemployed and have received unemployment compensaon for 12

consecuve weeks under a federal or state program, you may take

payments from your IRA to pay for health insurance premiums without

incurring the 10 percent early distribuon penalty tax. 6) Higher

educaon expenses. Payments taken for certain qualied higher

educaon expenses for you, your spouse, or the children or

grandchildren of you or your spouse, will not be subject to the 10

percent early distribuon penalty tax. 7) First-me homebuyer. You

may take payments from your IRA to use toward qualied acquision

costs of buying or building a principal residence. The amount you may

take for this reason may not exceed a lifeme maximum of $10,000.

The payment must be used for qualied acquision costs within 120

days of receiving the distribuon. 8)IRSlevy. Payments from your IRA

made to the U.S. government in response to a federal tax levy are not

subject to the 10 percent early distribuon penalty tax. 9) Qualied

reservistdistribuons. If you are a qualied reservist member called to

acve duty for more than 179 days or an indenite period, the

payments you take from your IRA during the acve duty period are not

subject to the 10 percent early distribuon penalty tax.

You must le IRS Form 5329 along with your income tax return to the

IRS to report and remit any addional taxes or to claim a penalty tax

excepon.

J. Rollovers and Conversions – Your IRA may be rolled over to another

IRA, SIMPLE IRA, or an eligible employer-sponsored rerement plan of

yours, may receive rollover contribuons, or may be converted to a

Roth IRA, provided that all of the applicable rollover and conversion

rules are followed. Rollover is a term used to describe a movement of

cash or other property to your IRA from another IRA, or from your

employer’s qualied rerement plan, 403(a) annuity, 403(b) tax-

sheltered annuity, 457(b) eligible governmental deferred compensaon

plan, or federal Thri Savings Plan. The amount rolled over is not

subject to taxaon or the addional 10 percent early distribuon

penalty tax. Conversion is a term used to describe the movement of

Tradional IRA assets to a Roth IRA. A conversion generally is a taxable

event. The general rollover and conversion rules are summarized

below. These transacons are oen complex. If you have any quesons

regarding a rollover or conversion, please see a competent tax advisor.

1. Tradional IRA-to-Tradional IRA Rollovers. Assets distributed

from your Tradional IRA may be rolled over to the same Tradional

IRA or another Tradional IRA of yours if the requirements of IRC

Sec. 408(d)(3) are met. A proper IRA-to-IRA rollover is completed if

all or part of the distribuon is rolled over not later than 60 days

aer the distribuon is received. In the case of a distribuon for a

rst-me homebuyer where there was a delay or cancellaon of

the purchase, the 60-day rollover period may be extended to 120

days.

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. A distribuon may be rolled over to

the same IRA or to another IRA that is eligible to receive the

rollover. For more informaon on rollover limitaons, you may

wish to obtain IRS Publicaon 590-B, Distribuons fromIndividual

Rerement Arrangements (IRAs), from the IRS or refer to the IRS

website at www.irs.gov.

2. SIMPLE IRA-to-Tradional IRA Rollovers. Assets distributed from

your SIMPLE IRA may be rolled over to your Tradional IRA without

IRS penalty tax provided two years have passed since you rst

parcipated in a SIMPLE IRA plan sponsored by your employer. As

with Tradional IRA-to-Tradional IRA rollovers, the requirements

of IRC Sec. 408(d)(3) must be met. A proper SIMPLE IRA-to-IRA

rollover is completed if all or part of the distribuon is rolled over

not later than 60 days aer the distribuon is received.

Page 11 of 14

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. A distribuon may be rolled over to

the same IRA or to another IRA that is eligible to receive the

rollover. For more informaon on rollover limitaons, you may

wish to obtain IRS Publicaon 590-B, Distribuons fromIndividual

Rerement Arrangements (IRAs), from the IRS or refer to the IRS

website at www.irs.gov.

3. Employer-SponsoredRerementPlan-to-TradionalIRARollovers.

You may roll over, directly or indirectly, any eligible rollover

distribuon from an eligible employer-sponsored rerement plan.

An eligible rollover distribuon is dened generally as any

distribuon from a qualied rerement plan, 403(a) annuity, 403(b)

tax-sheltered annuity, 457(b) eligible governmental deferred

compensaon plan, or federal Thri Savings Plan unless it is a

required minimum distribuon, hardship distribuon, part of a

certain series of substanally equal periodic payments, correcve

distribuons of excess contribuons, excess deferrals, excess annual

addions and any income allocable to the excess, deemed loan

distribuon, dividends on employer securies, the cost of life

insurance coverage, or a distribuon of Roth elecve deferrals from

a 401(k), 403(b), governmental 457(b), or federal Thri Savings

Plan.

If you elect to receive your rollover distribuon prior to placing it in

an IRA, thereby conducng an indirect rollover, your plan

administrator generally will be required to withhold 20 percent of

your distribuon as a payment of income taxes. When compleng

the rollover, you may make up out of pocket the amount withheld,

and roll over the full amount distributed from your employer-

sponsored rerement plan. To qualify as a rollover, your eligible

rollover distribuon must be rolled over to your IRA not later than

60 days aer you receive the distribuon. Alternavely, you may

claim the withheld amount as income, and pay the applicable

income tax, and if you are under age 59

⁄2, the 10 percent early

distribuon penalty tax (unless an excepon to the penalty applies).

As an alternave to the indirect rollover, your employer generally

must give you the opon to directly roll over your employer-

sponsored rerement plan balance to an IRA. If you elect the direct

rollover opon, your eligible rollover distribuon will be paid

directly to the IRA (or other eligible employer-sponsored rerement

plan) that you designate. The 20 percent withholding requirements

do not apply to direct rollovers.

4. BeneciaryRolloversFromEmployer-SponsoredRerementPlans.

If you are a spouse, nonspouse, or qualied trust beneciary of a

deceased employer-sponsored rerement plan parcipant, you may

directly roll over inherited assets from a qualied rerement plan,

403(a) annuity, 403(b) tax-sheltered annuity, or 457(b) eligible

governmental deferred compensaon plan to an inherited IRA. The

IRA must be maintained as an inherited IRA, subject to the beneciary

distribuon requirements.

5. Tradional IRA-to-SIMPLEIRA Rollovers.Assets distributed from

your Tradional IRA may be rolled over to a SIMPLE IRA if the

requirements of IRC Sec. 408(d)(3) are met and two years have

passed since you rst parcipated in a SIMPLE IRA plan sponsored

by your employer. A proper Tradional IRA-to-SIMPLE IRA rollover

is completed if all or part of the distribuon is rolled over not later

than 60 days aer the distribuon is received. In the case of a

distribuon for a rst-me homebuyer where there was a delay or

cancellaon of the purchase, the 60-day rollover period may be

extended to 120 days.

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. A distribuon may be rolled over to

the same IRA or to another IRA that is eligible to receive the

rollover. For more informaon on rollover limitaons, you may

obtain IRS Publicaon 590-B, Distribuons from Individual

Rerement Arrangements (IRAs), from the IRS or refer to the IRS

website at www.irs.gov.

6. TradionalIRA-to-Employer-SponsoredRerementPlanRollovers.

You may roll over, directly or indirectly, any taxable eligible rollover

distribuon from an IRA to your qualied rerement plan, 403(a)

annuity, 403(b) tax-sheltered annuity, or 457(b) eligible

governmental deferred compensaon plan as long as the employer-

sponsored rerement plan accepts such rollover contribuons.

7. TradionalIRA-to-RothIRAConversions. If you convert to a Roth

IRA, the amount of the conversion from your Tradional IRA to your

Roth IRA will be treated as a distribuon for income tax purposes,

and is includible in your gross income (except for any nondeducble

contribuons). Although the conversion amount generally is

included in income, the 10 percent early distribuon penalty tax

will not apply to conversions from a Tradional IRA to a Roth IRA,

regardless of whether you qualify for any excepons to the 10

percent penalty tax. If you are age 70½ or older you must remove

your required minimum distribuon before converng your

Tradional IRA.

8. QualiedHSAFundingDistribuon. If you are eligible to contribute

to a health savings account (HSA), you may be eligible to take a one-

me tax-free qualied HSA funding distribuon from your IRA and

directly deposit it to your HSA. The amount of the qualied HSA

funding distribuon may not exceed the maximum HSA contribuon

limit in eect for the type of high deducble health plan coverage

(i.e., single or family coverage) that you have at the me of the

deposit, and counts toward your HSA contribuon limit for that

year. For further detailed informaon, you may wish to obtain IRS

Publicaon 969, Health Savings Accounts and Other Tax-Favored

HealthPlans.

9. RolloversofSelementPaymentsFromBankruptAirlines. If you

are a qualied airline employee who has received a qualied airline

selement payment from a commercial airline carrier under the

approval of an order of a federal bankruptcy court, you are allowed

to roll over up to 90 percent of the proceeds into your Tradional

IRA within 180 days aer receipt of such amount, or by a later date

if extended by federal law. If you make such a rollover contribuon,

you may exclude the amount rolled over from your gross income in

the taxable year in which the airline selement payment was paid

to you. For further detailed informaon and eecve dates you

may obtain IRS Publicaon 590-A, Contribuons to Individual

Rerement Arrangements (IRAs), from the IRS or refer to the IRS

website at www.irs.gov.

10. Rollovers ofExxonValdez Selement Payments. If you receive a

qualied selement payment from Exxon Valdez ligaon, you may

roll over the amount of the selement, up to $100,000, reduced by

the amount of any qualied Exxon Valdez selement income

previously contributed to a Tradional or Roth IRA or eligible

rerement plan in prior taxable years. You will have unl your tax

return due date (not including extensions) for the year in which the

qualied selement income is received to make the rollover

contribuon. To obtain more informaon on this type of rollover,

you may wish to visit the IRS website at www.irs.gov.

11. Wrien Elecon. At the me you make a rollover to an IRA, you

must designate in wring to the trustee your elecon to treat that

contribuon as a rollover. Once made, the rollover elecon is

irrevocable.

Page 12 of 14

K. Transfer Due to Divorce – If all or any part of your IRA is awarded to

your spouse or former spouse in a divorce or legal separaon

proceeding, the amount so awarded will be treated as the spouse’s IRA

(and may be transferred pursuant to a court-approved divorce decree

or wrien legal separaon agreement to another IRA of your spouse),

and will not be considered a taxable distribuon to you. A transfer is a

tax-free direct movement of cash and/or property from one Tradional

IRA to another.

L. Recharacterizaons– If you make a contribuon to a Tradional IRA

and later recharacterize either all or a poron of the original

contribuon to a Roth IRA along with net income aributable, you may

elect to treat the original contribuon as having been made to the Roth

IRA. The same methodology applies when recharacterizing a

contribuon from a Roth IRA to a Tradional IRA. If you have converted

from a Tradional IRA to a Roth IRA you may recharacterize the

conversion along with net income aributable back to a Tradional

IRA. The deadline for compleng a recharacterizaon is your tax ling

deadline (including any extensions) for the year for which the original

contribuon was made or conversion completed.

LIMITATIONS AND RESTRICTIONS

A. SEP Plans – Under a simplied employee pension (SEP) plan that meets

the requirements of IRC Sec. 408(k), your employer may make

contribuons to your IRA. Your employer is required to provide you

with informaon that describes the terms of your employer’s SEP plan.

B. Spousal IRA – If you are married and have compensaon, you may

contribute to an IRA established for the benet of your spouse for any

year prior to the year your spouse turns age 70½, regardless of

whether or not your spouse has compensaon. You may make these

spousal contribuons even if you are age 70½ or older. You must le a

joint income tax return for the year for which the contribuon is made.

The amount you may contribute to your IRA and your spouse’s IRA is

the lesser of 100 percent of your combined eligible compensaon or

$11,000 for 2015 and 2016. This amount may be increased with cost-

of-living adjustments each year. However, you may not contribute

more than the individual contribuon limit to each IRA.

If your spouse is age 50 or older by the close of the taxable year, and is

otherwise eligible, you may make an addional contribuon to your

spouse’s IRA. The maximum addional contribuon is $1,000 per year.

C. DeduconofRolloversandTransfers– A deducon is not allowed for

rollover or transfer contribuons.

D. Gi Tax – Transfers of your IRA assets to a beneciary made during

your life and at your request may be subject to federal gi tax under

IRC Sec. 2501.

E. Special Tax Treatment – Capital gains treatment and 10-year income

averaging authorized by IRC Sec. 402 do not apply to IRA distribuons.

F. Prohibited Transacons – If you or your beneciary engage in a

prohibited transacon with your IRA, as described in IRC Sec. 4975,

your IRA will lose its tax-deferred status, and you must include the

value of your account in your gross income for that taxable year. The

following transacons are examples of prohibited transacons with

your IRA. (1) Taking a loan from your IRA (2) Buying property for

personal use (present or future) with IRA assets (3) Receiving certain

bonuses or premiums because of your IRA.

G. Pledging – If you pledge any poron of your IRA as collateral for a loan,

the amount so pledged will be treated as a distribuon and will be

included in your gross income for that year.

OTHER

A. IRS Plan Approval – The agreement used to establish this IRA has been

approved by the IRS. The IRS approval is a determinaon only as to

form. It is not an endorsement of the plan in operaon or of the

investments oered.

B. Addional Informaon – For further informaon on IRAs, you may

wish to obtain IRS Publicaon 590-A, Contribuons to Individual

Rerement Arrangements (IRAs), or Publicaon 590-B, Distribuons

fromIndividualRerementArrangements(IRAs), by calling 1-800-TAX-

FORM, or by vising www.irs.gov on the Internet.

C. Important Informaon About Procedures for Opening a New

Account – To help the government ght the funding of terrorism and

money laundering acvies, federal law requires all nancial

organizaons to obtain, verify, and record informaon that idenes

each person who opens an account. Therefore, when you open an

IRA, you are required to provide your name, residenal address, date

of birth, and idencaon number. We may require other informaon

that will allow us to idenfy you.

D. Qualied Reservist Distribuons – If you are an eligible qualied

reservist who has taken penalty-free qualied reservist distribuons

from your IRA or rerement plan, you may recontribute those amounts

to an IRA generally within a two-year period from your date of return.

E. QualiedCharitableDistribuons– If you are age 70½ or older, you

may take tax-free IRA distribuons of up to $100,000 per year and have

these distribuons paid directly to certain charitable organizaons.

Special tax rules may apply. For further detailed informaon you may

obtain IRS Publicaon 590-B, DistribuonsfromIndividualRerement

Arrangements (IRAs), from the IRS or refer to the IRS website at

www.irs.gov.

F. Disaster Related Relief – If you qualify (for example, you sustained an

economic loss due to, or are otherwise considered aected by, certain

IRS designated disasters), you may be eligible for favorable tax

treatment on distribuons, rollovers, and other transacons involving

your IRA. Qualied disaster relief may include penalty-tax free early

distribuons made during specied meframes for each disaster, the

ability to include distribuons in your gross income ratably over

mulple years, the ability to roll over distribuons to an eligible

rerement plan without regard to the 60-day rollover rule, and more.

For addional informaon on specic disasters, including a complete

lisng of disaster areas, qualicaon requirements for relief, and

allowable disaster-related IRA transacons, you may wish to obtain IRS

Publicaon 590-B, Distribuons from Individual Rerement

Arrangements (IRAs), from the IRS or refer to the IRS website at

www.irs.gov.

Page 13 of 14

The term IRA willbeusedbelowtomeanTradionalIRA,RothIRA,andSIMPLEIRA,unlessotherwisespecied.

ThenancialorganizaonshouldcompletethenancialdisclosureusingMethodI,MethodII,orMethodIII. IfthegrowthoftheIRAcanreasonablybe

projected,useeitherMethodIorMethodII.TheaccountvaluesprojectedusingMethodIorMethodIImustbereducedbyallapplicablefeesandpenales.

Ifannualfeesareassessed,suchasanannualservicefee,useMethodII.IfnoprojeconofgrowthoftheIRAcanreasonablybeshown,useMethodIII.

METHOD I Growth can be projected (Do not use Method I if an annual fee is charged. Instead, use Method II for nancial projections.)

Your Age on Your Birth Date This Year _________ Length of Time Deposit (Ifapplicable) ________________________

The charts below give projecons of the value of your IRA by showing the amount available at the end of each year. These projecons assume an

interest rate of .25%, compounded annually. If you have invested your IRA in a me deposit, a loss-of-earnings penalty may be charged against a

withdrawal before maturity. A transacon fee may also apply to your IRA.

The Regular Contribuon chart assumes that an annual contribuon of $1,000 is made on the rst day of each year. The Rollover, Transfer, or

Conversion* chart assumes that a one-me deposit of $1,000 is made on the rst day of the rst year.

Indicatetheprojectedaccountvalueforeachoftheyears,takingintoconsideraonanyapplicablelossofearningspenaltyorotherfeesassessedifthe

IRAownerreceivedadistribuonattheendoftheyearforwhichtheprojeconisbeingmade.First,circletheyear-endprojectedIRAvaluethatis

applicableforeachoftherstveyears.Next,circletheapplicableIRAvaluefortheyearsinwhichtheIRAownerwillaainages60,65,and70.

FINANCIAL DISCLOSURE

REGULAR CONTRIBUTION

FINANCIAL PROJECTIONS WITH .25% RATE OF INTEREST

AMT. AFTER

NO. ACCOUNT 1 MO. 3 MO. 6 MO.

FEES AND

YRS VALUE PENALTY PENALTY PENALTY

PENALTIES

1 $1,002.50 $1,002.29 $1,001.87 $1,001.25

2 2,007.51 2,007.09 2,006.25 2,005.00

3 3,015.03 3,014.40 3,013.14 3,011.26

4 4,025.06 4,024.22 4,022.55 4,020.03

5 5,037.63 5,036.58 5,034.48 5,031.33

6 6,052.72 6,051.46 6,048.94 6,045.15

7 7,070.35 7,068.88 7,065.93 7,061.51

8 8,090.53 8,088.84 8,085.47 8,080.41

9 9,113.25 9,111.35 9,107.56 9,101.86

10 10,138.54 10,136.42 10,132.20 10,125.86

11 11,166.38 11,164.06 11,159.40 11,152.42

12 12,196.80 12,194.26 12,189.18 12,181.55

13 13,229.79 13,227.03 13,221.52 13,213.25

14 14,265.37 14,262.39 14,256.45 14,247.53

15 15,303.53 15,300.34 15,293.96 15,284.40

16 16,344.29 16,340.88 16,334.07 16,323.86

17 17,387.65 17,384.03 17,376.78 17,365.91

18 18,433.62 18,429.78 18,422.10 18,410.58

19 19,482.20 19,478.14 19,470.02 19,457.85

20 20,533.41 20,529.13 20,520.57 20,507.74

21 21,587.24 21,582.74 21,573.75 21,560.26

22 22,643.71 22,638.99 22,629.56 22,615.40

23 23,702.82 23,697.88 23,688.00 23,673.19

24 24,764.57 24,759.42 24,749.10 24,733.62

25 25,828.99 25,823.61 25,812.84 25,796.70

26 26,896.06 26,890.46 26,879.25 26,862.44

27 27,965.80 27,959.97 27,948.32 27,930.84

28 29,038.21 29,032.16 29,020.06 29,001.92

29 30,113.31 30,107.04 30,094.49 30,075.67

30 31,191.09 31,184.59 31,171.60 31,152.10

31 32,271.57 32,264.85 32,251.40 32,231.23

32 33,354.75 33,347.80 33,333.90 33,313.06

33 34,440.64 34,433.46 34,419.11 34,397.58

34 35,529.24 35,521.84 35,507.03 35,484.83

35 36,620.56 36,612.93 36,597.67 36,574.78

36 37,714.61 37,706.75 37,691.04 37,667.47

37 38,811.40 38,803.31 38,787.14 38,762.88

38 39,910.93 39,902.61 39,885.98 39,861.04

39 41,013.20 41,004.66 40,987.57 40,961.94

40 42,118.24 42,109.46 42,091.91 42,065.59

41 43,226.03 43,217.03 43,199.02 43,172.00

42 44,336.60 44,327.36 44,308.89 44,281.18

43 45,449.94 45,440.47 45,421.53 45,393.13

44 46,566.06 46,556.36 46,536.96 46,507.86

45 47,684.98 47,675.04 47,655.18 47,625.37

46 48,806.69 48,796.52 48,776.19 48,745.68

47 49,931.21 49,920.81 49,900.00 49,868.79

48 51,058.54 51,047.90 51,026.62 50,994.71

49 52,188.68 52,177.81 52,156.06 52,123.45

50 53,321.65 53,310.55 53,288.33 53,255.00

51 54,457.46 54,446.11 54,423.42 54,389.39

52 55,596.10 55,584.52 55,561.35 55,526.61

53 56,737.59 56,725.77 56,702.13 56,666.67

54 57,881.94 57,869.88 57,845.76 57,809.58

55 59,029.14 59,016.84 58,992.25 58,955.35

56 60,179.21 60,166.68 60,141.60 60,103.99

57 61,332.16 61,319.38 61,293.83 61,255.50

58 62,487.99 62,474.97 62,448.94 62,409.88

59 63,646.71 63,633.45 63,606.93 63,567.15

60 64,808.33 64,794.83 64,767.82 64,727.32

61 65,972.85 65,959.11 65,931.62 65,890.38

62 67,140.28 67,126.29 67,098.32 67,056.36

ADDITIONAL FINANCIAL DISCLOSURE

INFORMATION

The account values shown are projecons based

on many assumpons. They are not guaranteed,

but depend upon many factors, including the

interest rates and terms of future funding

instruments.

We may charge you fees in connecon with your

IRA. If we do not charge these fees now, we may

do so in the future aer giving you noce. If you

do not pay these fees separately, they may be

paid from the assets of your IRA.

CURRENT FEES

_____________________ $ _______________

IRA

ROLLOVER, TRANSFER, OR CONVERSION*

FINANCIAL PROJECTIONS WITH .25% RATE OF INTEREST

AMT. AFTER

NO. ACCOUNT 1 MO. 3 MO. 6 MO.

FEES AND

YRS VALUE PENALTY PENALTY PENALTY

PENALTIES

1 $1,002.50 $1,002.29 $1,001.87 $1,001.25

2 1,005.01 1,004.80 1,004.38 1,003.75

3 1,007.52 1,007.31 1,006.89 1,006.26

4 1,010.04 1,009.83 1,009.41 1,008.78

5 1,012.56 1,012.35 1,011.93 1,011.30

6 1,015.09 1,014.88 1,014.46 1,013.83

7 1,017.63 1,017.42 1,017.00 1,016.36

8 1,020.18 1,019.96 1,019.54 1,018.90

9 1,022.73 1,022.51 1,022.09 1,021.45

10 1,025.28 1,025.07 1,024.64 1,024.00

11 1,027.85 1,027.63 1,027.20 1,026.56

12 1,030.42 1,030.20 1,029.77 1,029.13

13 1,032.99 1,032.78 1,032.35 1,031.70

14 1,035.57 1,035.36 1,034.93 1,034.28

15 1,038.16 1,037.95 1,037.51 1,036.87

16 1,040.76 1,040.54 1,040.11 1,039.46

17 1,043.36 1,043.14 1,042.71 1,042.06

18 1,045.97 1,045.75 1,045.32 1,044.66

19 1,048.58 1,048.37 1,047.93 1,047.27

20 1,051.21 1,050.99 1,050.55 1,049.89

21 1,053.83 1,053.61 1,053.17 1,052.52

22 1,056.47 1,056.25 1,055.81 1,055.15

23 1,059.11 1,058.89 1,058.45 1,057.79

24 1,061.76 1,061.54 1,061.09 1,060.43

25 1,064.41 1,064.19 1,063.75 1,063.08

26 1,067.07 1,066.85 1,066.41 1,065.74

27 1,069.74 1,069.52 1,069.07 1,068.40

28 1,072.41 1,072.19 1,071.74 1,071.07

29 1,075.10 1,074.87 1,074.42 1,073.75

30 1,077.78 1,077.56 1,077.11 1,076.44

31 1,080.48 1,080.25 1,079.80 1,079.13

32 1,083.18 1,082.95 1,082.50 1,081.82

33 1,085.89 1,085.66 1,085.21 1,084.53

34 1,088.60 1,088.37 1,087.92 1,087.24

35 1,091.32 1,091.10 1,090.64 1,089.96

36 1,094.05 1,093.82 1,093.37 1,092.68

37 1,096.79 1,096.56 1,096.10 1,095.42

38 1,099.53 1,099.30 1,098.84 1,098.15

39 1,102.28 1,102.05 1,101.59 1,100.90

40 1,105.03 1,104.80 1,104.34 1,103.65

41 1,107.80 1,107.56 1,107.10 1,106.41

42 1,110.57 1,110.33 1,109.87 1,109.18

43 1,113.34 1,113.11 1,112.65 1,111.95

44 1,116.12 1,115.89 1,115.43 1,114.73

45 1,118.92 1,118.68 1,118.22 1,117.52

46 1,121.71 1,121.48 1,121.01 1,120.31

47 1,124.52 1,124.28 1,123.81 1,123.11

48 1,127.33 1,127.09 1,126.62 1,125.92

49 1,130.15 1,129.91 1,129.44 1,128.73

50 1,132.97 1,132.74 1,132.26 1,131.56

51 1,135.80 1,135.57 1,135.09 1,134.38

52 1,138.64 1,138.41 1,137.93 1,137.22

53 1,141.49 1,141.25 1,140.78 1,140.06

54 1,144.34 1,144.11 1,143.63 1,142.91

55 1,147.20 1,146.97 1,146.49 1,145.77

56 1,150.07 1,149.83 1,149.35 1,148.64

57 1,152.95 1,152.71 1,152.23 1,151.51

58 1,155.83 1,155.59 1,155.11 1,154.39

59 1,158.72 1,158.48 1,158.00 1,157.27

60 1,161.62 1,161.37 1,160.89 1,160.16

61 1,164.52 1,164.28 1,163.79 1,163.07

62 1,167.43 1,167.19 1,166.70 1,165.97

*Conversion applies to Roth IRAs only

Page 14 of 14

METHOD III Growth cannot be projected

The value of your IRA will be dependent solely upon the performance of

any investment instrument used to fund your IRA. Therefore, no projecon

of the growth of your IRA can reasonably be shown or guaranteed.

Terms and condions of the IRA that aect your investment are listed

below.

INVESTMENT OPTIONS

Your IRA will be invested in products that we oer directly or those we

oer through a relaonship with a registered securies broker-dealer.

FEES

There are certain fees and charges connected with your IRA investments.

These fees and charges may include the following.

• Sales Commissions • Set Up Fees

• Investment Management Fees • Annual Maintenance Fees

• Distribuon Fees • Surrender or Terminaon Fees

To nd out what fees apply, refer to the investment prospectus or contract.

There may be certain fees and charges connected with the IRA itself.

(Selectandcompleteasapplicable.)

Annual Service Fee $ _____________________________

Transfer Fee $ _____________________________

Rollover Fee $ _____________________________

Terminaon Fee $ _____________________________

Other (Explain) ______________________________

______________________________

We reserve the right to change any of the above fees aer noce to you,

as provided in your IRA agreement.

EARNINGS

The method for compung and allocang annual earnings (e.g., interest,

dividends) on your IRA will dier based on the nature and issuer of the

investments chosen. Refer to the investment prospectus or contract for

the methods used for compung and allocang annual earnings.

OTHER

Other terms or condions that apply to your IRA include the following.

____________________________________________________________

METHOD II Growth can be projected

The nancial projecons below show the amount that would be available

if you were to withdraw your IRA assets at the indicated mes. These

projecons are based on the following assumpons.

CONTRIBUTION (Selectone)

Regular. An annual $1,000 deposit is made on the rst day of

each year.

Rollover, Transfer, or Conversion.* A one-me $1,000 deposit is

made on the rst day of the rst year.

Your Age on Your Birth Date in Contribuon Year ___________________

Investment Instrument _________________________________________

Length of Time Deposit ________________________________________

Rate of Interest _____________________________________________ %

Compounding Method _________________________________________

FINANCIAL PROJECTIONS

Number of Total Amount

 YearsinIRA Accumulaon AerFees

 Program ofIRADollars andPenales

1 Year $ ________________ $ _________________

2 Years $ ________________ $ _________________

3 Years $ ________________ $ _________________

4 Years $ ________________ $ _________________

5 Years $ ________________ $ _________________

End of the Total Amount

YearYou Accumulaon AerFees

ReachAge ofIRADollars andPenales

60 $ ________________ $ _________________

65 $ ________________ $ _________________

70 $ ________________ $ _________________

ADDITIONAL FINANCIAL DISCLOSURE INFORMATION

The account values shown are projecons based on many assumpons.

These projecons have been reduced by any applicable fees. They are not

guaranteed, but depend upon many factors, including the interest rates

and terms of future funding instruments.

We may charge you an annual service fee or other fees in connecon with

your IRA. If we do not charge these fees now, we may do so in the future

aer giving you noce. If you do not pay these fees separately, they may

be paid from the assets of your IRA.

CURRENT FEES

___________________________________ $ _____________________

*Conversion applies to Roth IRAs only

Sign the document

DRAW TYPE UPLOAD

Choose file

Sending Options

Clear

Adding Fields

Fields are being added to your document to make it really easy to fill, send and sign this PDF. Once finished you can manually add any additional fields and signatures to the document by dragging them from the toolbar.

For larger documents this process may take up to one minute to complete

Finish

Download
Save PDF to desktop

Email
Email completed PDF

Send for Signing
Email for others to sign

Print
Print document

Send for signing

Email for others to sign

Choose a Field
Click on a field and
select the person that should complete it

Want to add a signature?
You can add a signature field
and assign it to someone else
to sign

Send for signing

Email for others to sign

Choose a Field
Click on a field and
select the person that should complete it

Send for signing

Email for others to sign

Someone else

NAME

Email completed PDF

Template

Convert to a reusable Template

Complete document

IRA Simplifier INDIVIDUAL RETIREMENT ACCOUNT APPLICATION (Georgia's Own Credit Union)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 23 December 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document

You're on your way to completing your first doc!

already registered?

First 20 documents completely FREE!

No credit card required

Digitally sign with 1 click

Request signatures from others

Secure storage for sensitive data

Upload your own forms

Simple PDF editing

Huge library of 1000's of forms