Fill - Free fillable IRA WITHDRAWAL AUTHORIZATION (Kinecta) PDF form

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Traditional and Simple IRA

TRADITIONAL

& SIMPLE

IRA

WITHDRAWAL AUTHORIZATION

The term IRA will be used below to mean Traditional IRA and SIMPLE IRA, unless otherwise specified.

Refer to pages 2 and 3 of this form for reporting and withholding notice information.

PART 1. IRA OWNER

Name (First/MI/Last)

Social Security Number

Date of Birth Phone

Email Address

Account Number Suffix

ACCOUNT TYPE (Select one)

Traditional IRA SIMPLE IRA

PART 2. IRA TRUSTEE OR CUSTODIAN

To be completed by the IRA trustee or custodian

Name

Address Line 1

Address Line 2

City/State/ZIP

Phone Organization Number

PART 3. BENEFICIARY OR FORMER SPOUSE INFORMATION

This section should only be completed by a beneficiary taking a death withdrawal or transferring inherited IRA assets to another IRA, or by a former

spouse taking a withdrawal as a result of a court-approved property settlement due to divorce or legal separation.

Name (First/MI/Last) Address Line 1

Tax ID (SSN/TIN) Address Line 2

Date of Birth Phone City/State/ZIP

Account Number Suffix

PART 4. WITHDRAWAL INFORMATION

Total Withdrawal Amount

Withdrawal Date

This Withdrawal Will Close This IRA

WITHDRAWAL REASON (Select one)

1. Transfer to Another IRA

2. Normal Withdrawal (Age 59½ or older)

3. Early Withdrawal (Under age 59½) (Select a, b, or c if applicable)

a. Disability

b. Direct Conversion to a Roth IRA, Substantially Equal

Periodic Payments, or IRS Levy

c. SIMPLE IRA Withdrawal in the First Two Years (No IRS

penalty exception)

4. Death Withdrawal by a Beneficiary

5. Direct Rollover to an Eligible Employer-Sponsored Retirement Plan

6. Prohibited Transaction

7. Excess Contribution Removed Before the Excess Removal Deadline

(Enter the net income attributable to the excess and select a or b)

Net Income Attributable

a. Excess Contributed and Removed in the Same Year

Excess Contributed in One Year and Removed in the Next Year

8. Excess Contribution Removed After the Excess Removal Deadline

9. SEP or SIMPLE IRA Excess Contribution Removed Under the EPCRS

10. Recharacterization (Enter the net income attributable to the

recharacterized amount and select a or b)

Net Income Attributable

a. Same-Year Recharacterization

b. Prior-Year Recharacterization

11. Revocation of a Regular Contribution

Earnings

12.

Revocation of a Rollover, Transfer, or SEP or SIMPLE IRA Contribution

PART 5. WITHHOLDING ELECTION

(Form W-4P/OMB No. 1545-0074)

Do not complete this section for a transfer, recharacterization, or direct

rollover to an eligible employer-sponsored retirement plan, or if you are

a nonresident alien.

Your withholding election will remain in effect for any subsequent

withdrawal unless you change or revoke the election.

FEDERAL WITHHOLDING (Select one)

Withhold % (Must be 10% or greater)

Withhold Additional Federal Income Tax of $

(If applicable)

Do Not Withhold Federal Income Tax

STATE WITHHOLDING (If applicable, select one)

Name of Withholding State

Withhold %

Withhold $

Do Not Withhold State Income Tax

PART 6. WITHDRAWAL SUMMARY

This section may be completed for informational purposes only.

Trustee or Custodian Penalties and Fees

Gross Withdrawal Amount*

Federal Withholding Amount

State Withholding Amount

Net Amount Paid to Recipient

* The gross withdrawal amount is the total withdrawal amount in Part 4

after any penalties and fees assessed by the trustee or custodian.

KINECTA FEDERAL CREDIT UNION

1440 ROSECRANS AVE

MANHATTAN BEACH CA 90266

(800) 854-9846

11379

CALIFORNIA RESIDENTS ONLY

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Name of IRA Owner , Account Number

PART 7. WITHDRAWAL INSTRUCTIONS

ASSET HANDLING (Assets identified below will be liquidated immediately unless otherwise specified in the Special Instructions section.)

Asset Description Amount to be Withdrawn Special Instructions

PAYMENT METHOD

Cash

Check (If the withdrawal reason is transfer to another IRA, direct conversion to a Roth IRA, or direct rollover to an eligible employer-sponsored

retirement plan, the check must be made payable to the receiving organization.)

Make payable to

Internal Account

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

External Account (e.g., EFT, ACH, wire) (Additional documentation may be required and fees may apply.)

Name of Organization Receiving the Assets Routing Number (Optional)

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

PART 8. SIGNATURES

I certify that I am authorized to receive payments from this IRA and that all information provided by me is true and accurate. I have received a copy of

the Withholding Notice Information. No tax advice has been given to me by the trustee or custodian. All decisions regarding this withdrawal are my

own, and I expressly assume responsibility for any consequences that may arise from this withdrawal. I agree that the trustee or custodian is not

responsible for any consequences that may arise from processing this withdrawal authorization.

Signature of Recipient Date (mm/dd/yyyy)

Notary Public/Signature Guarantee (If required by the trustee or custodian) Date (mm/dd/yyyy)

Authorized Signature of Trustee or Custodian Date (mm/dd/yyyy)

WITHHOLDING NOTICE INFORMATION (Form W-4P/OMB No. 1545-0074)

Basic Information About Withholding From Pensions and Annuities. Generally, federal income tax withholding applies to the taxable part of payments made from

pension, profit sharing, stock bonus, annuity, and certain deferred compensation plans; from IRAs; and from commercial annuities.

Caution: There may be penalties for not paying enough tax during the year, through either withholding or estimated tax payments. New retirees should see Publication

505, Tax Withholding and Estimated Tax. It explains the estimated tax requirements and penalties in detail. You may be able to avoid quarterly estimated tax payments

by having enough tax withheld from your IRA using form W-4P.

Purpose of Form W-4P. Unless you elect otherwise, 10 percent federal income tax will be withheld from payments from individual retirement accounts (IRAs). You can

use Form W-4P (or a substitute form, such as this form), provided by the trustee or custodian, to instruct your trustee or custodian to withhold no tax from your IRA

payments or to withhold more than 10 percent. This substitute form should be used only for withdrawals from IRAs that are payable upon demand.

Nonperiodic Payments. Payments made from IRAs that are payable upon demand are treated as nonperiodic payments for federal income tax purposes. Generally,

nonperiodic payments must have at least 10 percent income tax withheld.

Your election will remain in effect for any subsequent withdrawal unless you change or revoke it.

Payments Delivered Outside of the U.S. A U.S. citizen or resident alien may not waive withholding on any withdrawal delivered outside of the U.S. or its possessions.

Withdrawals by a nonresident alien generally are subject to a tax withholding rate of 30 percent. A reduced withholding rate may apply if there is a tax treaty between

the nonresident alien’s country of residence and the United States and if the nonresident alien submits Form W-8BEN, Certificate of Foreign Status of Beneficial Owner

for United States Tax Withholding, or satisfies the documentation requirements as provided under federal regulations. The Form W-8BEN must contain the foreign

person’s taxpayer identification number.

For more information, Publication 515, Withholding of Tax on Nonresident Aliens and Foreign Entities, and Publication 519, U.S. Tax Guide for Aliens, are available on the

IRS website at www.irs.gov or by calling 1-800-TAX-FORM.

Revoking the Exemption From Withholding. If you want to revoke your previously filed exemption from withholding, file another Form W-4P with the trustee or

custodian and check the appropriate box on that form.

Statement of Income Tax Withheld From Your IRA. By January 31 of next year, your trustee or custodian will provide a statement to you and to the IRS showing the total

amount of your IRA distributions and the total federal income tax withheld during the year. Copies of Form W-4P will not be sent to the IRS by the trustee or custodian.

ELECTRONIC TRANSFER NOT AVAILABLE

XXXX N/A XXXXX

XXXXXXXXXXXXXXX N/A XXXXXXXXXXX

XXXXXXX N/A XXXXXXXX

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REPORTING INFORMATION APPLICABLE TO TRADITIONAL IRA AND SIMPLE IRA WITHDRAWALS

You must supply all requested information for the withdrawal so the trustee or custodian can properly report the withdrawal.

If you have any questions regarding a withdrawal, please consult a competent tax professional or refer to IRS Publication 590-B, Distributions from

Individual Retirement Arrangements (IRAs), for more information. This publication is available on the IRS website at www.irs.gov or by calling

1-800-TAX-FORM.

WITHDRAWAL REASON

IRA assets can be withdrawn at any time. Most IRA withdrawals are reported to the IRS. IRS rules specify the distribution code that must be used to

report each withdrawal on IRS Form 1099-R, Distributions From Pensions, Annuities, Retirement or Profit-Sharing Plans, IRAs, Insurance Contracts, etc.

Transfer to Another IRA. Transfers are not reported on Form 1099-R. Transfers may be made by an IRA owner, beneficiary, or former spouse under a

transfer due to a divorce. Inherited IRA assets may only be transferred to another inherited IRA, unless you are a spouse beneficiary.

Normal Withdrawal (Age 59½

or older). If you are age 59½ or older, withdrawals (including required minimum distributions) are reported on Form

1099-R using code 7.

Early Withdrawal (Under age 59½). If you are under age 59½, withdrawals for any reason not listed below are reported on Form 1099-R using code 1.

• Disability. If you are under age 59½ and disabled, withdrawals are reported on Form 1099-R using code 3.

• Direct Conversion to a Roth IRA, Substantially Equal Periodic Payments, or IRS Levy. If you are under age 59½, withdrawals due to direct

conversions to a Roth IRA, substantially equal periodic payments, or IRS levy are reported on Form 1099-R using code 2. Certain distributions

taken due to federally declared disasters also are reported using code 2. Please refer to the IRS website at www.irs.gov for more information and

a listing of the disaster areas.

• SIMPLE IRA Withdrawal in the First Two Years (No IRS penalty exception). If you are under age 59½ and less than two years have passed since

the first contribution to your SIMPLE IRA, withdrawals are reported on Form 1099-R using code S.

Death Withdrawal by a Beneficiary. Withdrawals by beneficiaries following the death of the original IRA owner are reported on Form 1099-R using

code 4. Use code G with code 4 for a surviving spouse beneficiary who elects a direct rollover to an eligible employer-sponsored retirement plan.

Direct Rollover to an Eligible Employer-Sponsored Retirement Plan. Direct rollovers to eligible employer-sponsored retirement plans (Internal

Revenue Code Section (IRC Sec.) 401(a) (e.g., 401(k), profit sharing, money purchase pension plan), annuity plan (IRC Sec. 403(a)), tax-sheltered

annuity plan (IRC Sec. 403(b)), or governmental deferred compensation plan (IRC Sec. 457(b)) are reported on Form 1099-R using code G.

Prohibited Transaction. Prohibited transactions as defined in IRC Sec. 4975(c) are reported on Form 1099-R using code 5.

Excess Contribution Removed Before the Excess Removal Deadline. Excess contributions removed before the excess removal deadline (your tax filing

deadline, including extensions) must include the net income attributable to the excess.

• If your excess contribution was contributed and removed in the same year, before the excess removal deadline, the withdrawal is reported on

Form 1099-R using code 8. If you are under age 59½ also use code 1.

• If your excess contribution was contributed in one year and removed in the next year, before the excess removal deadline, the withdrawal is

reported on Form 1099-R using code P. If you are under age 59½ also use code 1.

Excess Contribution Removed After the Excess Removal Deadline. If your excess contribution is removed after the excess removal deadline, the

withdrawal is reported on Form 1099-R using code 1 if you are under age 59½ or code 7 if you are age 59½ or older.

SEP or SIMPLE IRA Excess Contribution Removed Under the EPCRS. Excess SEP or SIMPLE IRA contributions removed under the Employee Plans

Compliance Resolution System (EPCRS) generally are reported on Form 1099-R using code E.

Recharacterization. A Traditional IRA contribution including the net income attributable may be recharacterized as a Roth IRA contribution up until

your tax filing deadline, including extensions.

• Recharacterizations that occur in the same year for which the contribution was made are reported on Form 1099-R using code N.

• Recharacterizations that occur after the year for which the contribution was made are reported on Form 1099-R using code R.

Revocation of a Regular Contribution. Revocations of regular contributions are reported on Form 1099-R using code 8. If you are under age 59½ and

earnings on the contribution are distributed, also use code 1.

Revocation of Rollover, Transfer, or SEP or SIMPLE IRA Contribution. Revocations of rollovers, transfers, or SEP or SIMPLE IRA plan contributions are

reported on Form 1099-R using code 1 if you are under age 59½ or code 7 if you are age 59½ or older.

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Fillable IRA WITHDRAWAL AUTHORIZATION (Kinecta)

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