Fillable IRA TRANSFER REQUEST TRADITIONAL ACCEPTING ACCOUNT TYPE (Select (Georgia's Own Credit Union)

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IRA TRANSFER REQUEST TRADITIONAL ACCEPTING ACCOUNT TYPE (Select (Georgia's Own Credit Union)

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Page 1 of 2
302 / 2325 (Rev. 10/2015) ©2015 Ascensus, Inc.
PART 1. RECIPIENT
Individual requesng the transfer
Name (First/MI/Last) _________________________________________
Date of Birth ____________________ Phone ______________________
Email Address _______________________________________________
Account Number__________________________________ Sux ______
ACCEPTING ACCOUNT TYPE (Select one)
Tradional IRA SIMPLE IRA
Inherited Tradional IRA Inherited SIMPLE IRA
PART 2. ACCEPTING IRA TRUSTEE OR CUSTODIAN
To be completed by the IRA trustee or custodian receiving the assets
Name ______________________________________________________
Address Line 1 _______________________________________________
Address Line 2 _______________________________________________
City/State/ZIP _______________________________________________
Phone_______________________ Organizaon Number ___________
Contact Name _______________________________________________
PART 4. CURRENT IRA OWNER
Name (First/MI/Last) __________________________________________
Social Security Number ________________________________________
Account Number__________________________________ Sux ______
CURRENT ACCOUNT TYPE (Select one)
Tradional IRA SIMPLE IRA
Inherited Tradional IRA Inherited SIMPLE IRA
PART 5. CURRENT IRA TRUSTEE OR CUSTODIAN
Name ______________________________________________________
Address Line 1 _______________________________________________
Address Line 2 _______________________________________________
City/State/ZIP _______________________________________________
Phone _____________________________________________________
TRANSFER REQUEST
The term IRA will be used below to mean Tradional IRA and SIMPLE IRA, unless otherwise specied.
PART 6. REQUIRED MINIMUM DISTRIBUTION (RMD) OR LIFE EXPECTANCY PAYMENT INSTRUCTIONS
IF YOU ARE 70
1
⁄2 OR OLDER THIS YEAR OR ARE A BENEFICIARY RECEIVING LIFE EXPECTANCY PAYMENTS, AND HAVE NOT YET
TAKEN YOUR REQUIRED PAYMENT FOR THIS YEAR, COMPLETE THE FOLLOWING.
Distribute my RMD or life expectancy payment to me before transferring my IRA assets.
Retain my RMD or life expectancy payment amount. I understand that I am responsible for sasfying my RMD or life expectancy payment.
Include the amount that represents my RMD or life expectancy payment in the transfer. I understand that I am responsible for sasfying my RMD
or life expectancy payment.
PART 3. RELATIONSHIP OF RECIPIENT TO CURRENT IRA OWNER
RELATIONSHIP TYPE (Select one)
I am the current IRA owner.
I am the former spouse of the current IRA owner.
I am the spouse beneciary of the original IRA owner transferring assets to my own IRA.
I am the beneciary of the original IRA owner transferring assets to an inherited IRA.
TRADITIONAL
& SIMPLE
IRA
Page 2 of 2
302 / 2325 (Rev. 10/2015) ©2015 Ascensus, Inc.
PART 8. SIGNATURES
I authorize the transfer of these IRA assets and cerfy that all informaon provided by me is true and accurate. I understand that I am responsible for
determining that this IRA transfer qualies under the rules that apply to such transfers and agree to comply with those rules. I understand that
special rules apply to SIMPLE IRA to Tradional IRA transfers. I assume responsibility for any consequences that may result from this transfer and I
agree that the trustee or custodian is not responsible for any consequences that may arise from execung this transfer request.
The trustee or custodian signing below agrees to accept the assets being transferred.
X_________________________________________________________________________________________________ ______________________________________
Signature of Recipient Date (mm/dd/yyyy)
X_________________________________________________________________________________________________ ______________________________________
Notary Public/Signature Guarantee (If required by the trustee or custodian) Date (mm/dd/yyyy)
X_________________________________________________________________________________________________ ______________________________________
Authorized Signature of Accepng Trustee or Custodian Date (mm/dd/yyyy)
PART 7. TRANSFER INSTRUCTIONS
TRANSFER OPTIONS (Select one)
One-Time Transfer
Transfer Amount ____________________________ Transfer Date ________________
Enre IRA Balance   This Transfer Will Close the Current IRA
Recurring Transfer
Transfer Amount ____________________________ Transfer Start Date ________________
Frequency (Select one)  
Monthly   Quarterly   Semi-Annually   Annually   Other ______________________________________
MAKE PAYABLE TO (If the accepng account type is an inherited IRA, the Name of Recipient must idenfy both the recipient and the original IRA
owner.)
_______________________________________________________________________ as Trustee or Custodian of
Name of Accepng IRA Trustee or Custodian
___________________________________________________________________________ IRA
Name of Recipient
ASSET HANDLING (Investments idened below will be liquidated immediately unless otherwise specied in the Special Instrucons secon.)
Asset Descripon Amount to be Transferred Special Instrucons
__________________________________________ _____________________ ___________________________________________________________________
__________________________________________ _____________________ ___________________________________________________________________
__________________________________________ _____________________ ___________________________________________________________________
Name of Recipient ______________________________________________________________, Account Number ______________________________
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IRA TRANSFER REQUEST TRADITIONAL ACCEPTING ACCOUNT TYPE (Select (Georgia's Own Credit Union)

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Completed 23 December 2020

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