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DO NOT STAPLE
Instructions if Assets have been redeemed
Assets redeemed from another 529 plan, Qualified U.S. Savings Bond, or ESA must be deposited within 60 days of the withdrawal. You
must include a statement from the former institution certifying the breakdown of contributions and earnings of the amount transferred.
Until such statement is provided, the TD Ameritrade 529 College Savings Plan will treat the entire deposit as earnings.
Enclosed is a check made payable to TD Ameritrade 529 College Savings Plan for
Total Amount of Redemption
Principal Amount of Redemption
Earnings Amount of Redemption
Signature — YOU MUST SIGN BELOW
• I certify that I have read and understand, consent, and agree to all the terms and conditions of the TD Ameritrade 529 College Savings
Plan Program Disclosure Statement and Participation Agreement as they relate to this Incoming Rollover request.
• By signing below, I authorize the Program Manager or its designee to roll over assets into the TD Ameritrade 529 College Savings Plan
according to the instructions above.
• If the Account is owned by an entity or trust, I certify that I am authorized to act on its behalf in making this request. If the Account
is a minor-owned Account or is funded with UGMA/UTMA assets, I further certify that I am the parent/guardian/custodian of the
Account in question, and that this request is in the best interest of the Beneficiary.
• If I am rolling over assets from another 529 plan, by signing below I certify that there has not been a rollover for this Beneficiary during
the prior 12-month period. I further understand that moving assets among the same Account Owner and Beneficiary Account that is in
any 529 plan issued by the Nebraska Educational Savings Plan Trust will count toward my twice per calendar year Investment Option
change limit and I certify that more than one Investment Option change has not occurred during the calendar year.
• If rolling over assets from another 529 plan to a new Beneficiary, I certify that the new Beneficiary is a “Member of the Family” of the
current Beneficiary at the distributing 529 plan.
• I further certify that if I have already redeemed the rollover amount for deposit into a TD Ameritrade 529 College Savings Plan
Account, this request is within 60 days of the withdrawal.
• If I am requesting a direct rollover, by signing below I authorize the current 529 Plan manager or custodian to liquidate my investment
identified in Section 3 and roll over the assets into the TD Ameritrade 529 College Savings Plan Account indicated in Section 2 of
this form. I understand I may need a signature guarantee in Section 6.
• I understand that I cannot make additional contributions for a Beneficiary when the fair market value of all accounts maintained for
that Beneficiary within all programs offered by the State of Nebraska exceeds $400,000.
• I understand that the program manager, custodian or financial institution of the account from which assets are being redeemed is
responsible for providing the TD Ameritrade 529 College Savings Plan with a statement certifying the breakdown of contributions and
earnings of the amount transferred. I further understand that until such statement is provided, the TD Ameritrade 529 College Savings
Plan will treat the entire deposit as earnings.
• I understand that rollovers, deposits, or Beneficiary changes not meeting these conditions may result in the earnings portion of the
deposit being considered a Non-Qualified Withdrawal subject to federal income tax and an additional 10% federal income tax,
and may be subject to state or local income tax. I acknowledge that any such tax consequences are not the responsibility of TD
Ameritrade, TD Ameritrade Investment Management, LLC, the Program Manager, or their authorized agents or any of their affiliates,
the TD Ameritrade 529 College Savings Plan, the State of Nebraska, the Nebraska State Treasurer, the Nebraska Investment Council,
or the Nebraska Educational Savings Plan Trust, or any of their authorized agents or affiliates.
Signature of Account Owner Date (mm/dd/yyyy)