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ROTH IRA

Precious Metals IRAs

PRECIOUS METALS ROTH IRA

INVESTMENT GUIDE

CHECKLIST FOR NEW ACCOUNTS

Please note: the minimum amount required to open a Precious

Metals IRA is $5,000.

 1. Roth IRA Simpliﬁ er (account application)

2. $50 Establishment Fee -

We MUST have a $50 check or credit card

payment with your completed Simpli er or the IRA cannot be opened.

3. Roth IRA Transfer Request OR Roth IRA Rollover Certiﬁ cation (if

you already have the rollover check in hand)

4. Identi cation - Enter your driver’s license information on the

Simpli er. If you do not have a valid state-issued driver’s license,

provide a legible photocopy of a valid government-issued photo ID,

passport or notarized document.

5. Most recent account statement (from existing Roth IRA custodian)

6. Precious Metal IRA Investment Direction (for initial purchase)

7. $25 Check for overnight delivery (optional)

FEE PAYMENT OPTIONS

1. Mail check or money order payable to GoldStar Trust Company

2. Call or e-mail Investor Services to request fees be taken from cash in the

account (must be su cient cash available)

3. Credit card: Call Investor Services to pay with a credit or debit card or

complete fee payment form

OVERNIGHT DELIVERY AVAILABLE - $25

GoldStar’s policy is to mail all transfer and/or rollover paperwork to the current

custodian by  rst class mail. If you would like your transfer and/or rollover request

to be expedited, GoldStar will prepare an overnight delivery of the paperwork

on your behalf. To take advantage of this service, please submit a separate check

of $25, made payable to GoldStar Trust Company, and attach to the transfer or

rollover request or elect to pay on the fee payment form.

Please write “Establishment Fee” and/or “Overnight Fee” in the memo section

of your check.

Page 1 of 15

ROTH INDIVIDUAL RETIREMENT ACCOUNT

APPLICATION

Simplifier

ROTH

IRA

PART 2. ROTH IRA CUSTODIAN

Name ______________________________________________________

Address Line 1 _______________________________________________

Address Line 2 _______________________________________________

City/State/ZIP________________________________________________

Phone _____________________________________________________

GoldStar Account Number

___________________________________________________________

(To be completed by GTC)

PART 3. CUSTOMER IDENTIFICATION PROGRAM INFORMATION (CIP)

USA PATRIOT Act Notice

In order to comply with the USA PATRIOT Act, we must be able to identify our customer. All new accounts must provide us with either the driver’s

license information; a photocopy of an unexpired, photo‐bearing, government‐issued identification, such as a passport, military, veteran or similar ID;

or a notarized document.

Driver’s License # _____________________________________________ State Issued _________________________________________________

Issuance Date _______________________________________________ Expiration Date ______________________________________________

If you do not have a valid state‐issued driver’s license, you must provide a legible photocopy of a valid government‐issued photo ID or a notarized

document.

PART 4. CONTRIBUTION INFORMATION

Contribution Amount ____________________________ Contribution Date ________________

CONTRIBUTION TYPE (Select one)

1. Regular (Includes catch‐up contributions)

Contribution for Tax Year _________

2. Rollover (Distribution from a Roth IRA or eligible employer‐sponsored retirement plan that is being deposited into this Roth IRA)

By selecting this transaction, I irrevocably designate this contribution as a rollover.

3. Transfer (Direct movement of assets from a Roth IRA into this Roth IRA)

4. Recharacterization (A nontaxable movement of a Traditional IRA contribution into this Roth IRA)

By selecting this transaction, I irrevocably designate this contribution as a recharacterization.

5. Conversion (A taxable movement from a Traditional IRA or SIMPLE IRA into this Roth IRA)

By selecting this transaction, I irrevocably designate this contribution as a conversion.

PART 1. IRA OWNER

Name (First/MI/Last) _________________________________________

Street Address (Physical Required)

___________________________________________________________

City/State/ZIP________________________________________________

Mailing Address (If different from Street Address)

___________________________________________________________

City/State/ZIP________________________________________________

Social Security Number ________________________________________

Date of Birth ________________________________________________

Home Phone ________________________________________________

Daytime Phone ______________________________________________

Email Address _______________________________________________

Preferred Method of Contact ___________________________________

GoldStar Trust Company

P.O. Box 719 (Mailing)

1401 4th Avenue (Street)

Canyon, TX 79015

(800) 486-6888

Page 2 of 15

Check here if additional beneficiaries are listed on an attached addendum. Total number of addendums attached to this Roth IRA ______________

PART 6. SPOUSAL CONSENT

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

the Roth 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

beneficiary other than or in addition to my spouse, my spouse should

sign below.

CONSENT OF SPOUSE

I am the spouse of the above‐named Roth IRA owner. I acknowledge that

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

and financial obligations. Because of the important tax consequences of

giving up my interest in this Roth IRA, I have been advised to see a tax

professional.

I hereby give the Roth IRA owner my interest in the assets or property

deposited in this Roth IRA and consent to the beneficiary designation

indicated above. I assume full responsibility for any adverse consequences

that may result. No tax or legal advice was given to me by the Custodian.

____________________________________________ _____________________

Signature of Spouse Date (mm/dd/yyyy)

PART 7. SIGNATURES

Important: Please read before signing.

I understand the eligibility requirements for the type of Roth IRA deposit I am

making, and I state that I do qualify to make the deposit. I have received a copy

of the Roth IRA Application, 5305‐RA Custodial Account Agreement, the

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

and conditions that apply to this Roth IRA are contained in this Application and

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

conditions. Within seven days from the date I open this Roth IRA I may revoke

it without penalty by mailing or delivering a written notice to the custodian.

I assume complete responsibility for

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

contribution,

• ensuring that all contributions I make are within the limits set forth

by the tax laws, and

• the tax consequences of any contributions (including rollover

contributions and conversions) and distributions.

I expressly certify that I take complete responsibility for the type of

investment instrument(s) I choose to fund my IRA, and that the Custodian

is released of any liability regarding the performance of any investment

choice I make.

____________________________________________ _____________________

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

____________________________________________ _____________________

Signature of Custodian Date (mm/dd/yyyy)

PART 5. BENEFICIARY DESIGNATION

I designate that upon my death, the assets in this account be paid to the beneficiaries named below. The interest of any beneficiary that predeceases

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

named, my estate will be my beneficiary.

I elect not to designate beneficiaries at this time and understand that I may designate beneficiaries at a later date.

Name ______________________________________________________

Address_____________________________________________________

City/State/ZIP________________________________________________

Date of Birth _________________ Relationship ____________________

Tax ID (SSN/TIN) ____________________ Percent Designated ________

Name ______________________________________________________

Address_____________________________________________________

City/State/ZIP________________________________________________

Date of Birth _________________ Relationship ____________________

Tax ID (SSN/TIN) ____________________ Percent Designated ________

Name ______________________________________________________

Address_____________________________________________________

City/State/ZIP________________________________________________

Date of Birth _________________ Relationship ____________________

Tax ID (SSN/TIN) ____________________ Percent Designated ________

Name ______________________________________________________

Address_____________________________________________________

City/State/ZIP________________________________________________

Date of Birth _________________ Relationship ____________________

Tax ID (SSN/TIN) ____________________ Percent Designated ________

Name ______________________________________________________

Address_____________________________________________________

City/State/ZIP________________________________________________

Date of Birth _________________ Relationship ____________________

Tax ID (SSN/TIN) ____________________ Percent Designated ________

Name ______________________________________________________

Address_____________________________________________________

City/State/ZIP________________________________________________

Date of Birth _________________ Relationship ____________________

Tax ID (SSN/TIN) ____________________ Percent Designated ________

Name ______________________________________________________

Address_____________________________________________________

City/State/ZIP________________________________________________

Date of Birth _________________ Relationship ____________________

Tax ID (SSN/TIN) ____________________ Percent Designated ________

Name ______________________________________________________

Address_____________________________________________________

City/State/ZIP________________________________________________

Date of Birth _________________ Relationship ____________________

Tax ID (SSN/TIN) ____________________ Percent Designated ________

CONTINGENT BENEFICIARIES (The total percentage designated must equal 100%.) (The balance in the account will be payable to these beneficiaries

if all primary beneficiaries have predeceased the Roth IRA owner.)

PRIMARY BENEFICIARIES (The total percentage designated must equal 100%.)

This is page 2 of the Roth IRA Application for__________________________________________, Account Number _____________________________

FOR INTERNAL USE

ROTH IRA

TRANSFER REQUEST

CUSTOMER SIGNATURE

I authorize the transfer of the Roth IRA assets in the manner described above and

certify that all of the information provided by me is correct and may be relied upon by

GoldStar Trust Company.

I understand that I am responsible for determining my eligibility to transfer within

the limits set forth by tax laws, related regulations and plan agreements. I assume

responsibility for any tax consequences or penalties that may apply to the transfer

of these assets and I agree that the Trustee or Custodian shall in no way be held

responsible.

X___________________________________________ ________________

Account Holder’s Signature Date

SELECT ONE:

Wire my funds to GoldStar Trust Company. I acknowledge that a wire fee may be charged by my current custodian.

Send a check payable to GoldStar Trust Company (for the beneﬁ t of my IRA).

Asset Description

Quantity Quantity To Liquidate Liquidate at Transfer

in IRA Be Transferred Immediately Maturity In-Kind

SELECT ONE: Close my current account after transfer OR Partial transfer

SIGNATURE GUARANTEE:

Check with your current custodian to determine if a Medallion

Stamp Guarantee is required. This is NOT a requirement of GoldStar Trust Company.

THIS BOX FOR INTERNAL USE ONLY

GoldStar Trust Company agrees to serve as the new Custodian for the

account of the above-named individual, and as Custodian, we agree to

accept the assets being transferred.

GoldStar Account Identiﬁ cation #

______________________

GoldStar Trust Company

Tax ID# 74-2557688

_________________________________ ___________

Authorized Signature for GoldStar Date

IMPORTANT! CONTACT YOUR CURRENT PLAN ADMINISTRATOR TO SEE IF THEY REQUIRE THEIR OWN PAPERWORK

GOLDSTAR IRA ACCOUNT OWNER

Name: ________________________________________________ SS #: _____________________ Date of Birth: _________________

Address: ___________________________________________________ Daytime Phone #: __________________________________

__________________________________________________________ E-mail: ___________________________________________

CURRENT ROTH IRA INFORMATION

Please provide a copy of a recent statement from your current Roth IRA custodian.

Custodian’s Name: ____________________________________________________ Account #: _______________________________

Custodian’s Address (physical if overnight): __________________________________________________________________________

City, State, & Zip ________________________________________________________ Phone #: ______________________________

ASSET LIQUIDATION INSTRUCTIONS

GTC Rev 2013/11

P. O. Box 719

1401 4th Avenue

Canyon, TX 79015

(800) 486-6888

NewBusiness@goldstartrust.com

ROTH IRA

ROLLOVER CERTIFICATION

ROTH IRA HOLDER’S NAME AND ADDRESS ROTH IRA TRUSTEE’S OR CUSTODIAN’S NAME AND ADDRESS

Social Security Number Date of Birth Home Phone

Trustee’s or Custodian’s

Roth IRA Account Identification

Phone Number

1. ELIGIBLE PERSON (Select one.)

Your status in the plan from which you received the funds or property intended for rollover is as follows.

Plan Participant Surviving Spouse Beneficiary Nonspouse Beneficiary of Plan Participant

Alternate Payee of Qualified Domestic Relations Order (If this is a rollover to an inherited IRA, it must be a direct rollover.)

2. ELIGIBLE PLAN (Select one.)

You received the distribution you are rolling over from the following type of plan.

Qualified Retirement Plan (IRC Sec. 401(a)) Tax-Sheltered Annuity Plan (IRC Sec. 403(b)) Governmental Deferred Compensation Plan (IRC Sec. 457(b))

3. ELIGIBLE ROLLOVER DEPOSIT (To be an eligible rollover, all questions must be answered NO.)

Does the rollover contribution contain any amounts which constitute a required minimum distribution? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . YES NO

Is the distribution which is being rolled over part of a series of substantially equal periodic payments? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . YES NO

Does the rollover contribution contain any amounts which are eligible for the death benefit exclusion (i.e., death before August 21, 1996)? . . . . YES NO

Does the rollover contribution include any nontaxable amounts attributable to the purchase of life insurance

under the distributing plan (i.e., P.S. 58 costs)? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . YES NO

Does the rollover contribution include any funds or property other than the funds or property you received from the distributing plan

(and/or proceeds from the sale of distributed property)? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . YES NO

Does the rollover contribution include any amounts which constitute a distribution due to hardship? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . YES NO

4. TIMELINESS

Have more than 60 days elapsed since you received the distribution from the distributing plan? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . YES NO

SIGNATURES

I have read and understand the rollover rules and conditions on both pages of this form and I have met the requirements for making a Roth IRA rollover. Due to the

important tax consequences of rolling over funds or property to a Roth IRA, I have been advised to see a tax professional. All information provided by me is true

and correct and may be relied on by the Trustee or Custodian. I assume full responsibility for this rollover transaction and will not hold the Trustee or Custodian

liable for any adverse consequences that may result. I hereby irrevocably designate this contribution of $_____________________________ in cash and/or property

as a rollover contribution.

__________________________________________________________________________________________ _______________________________________________

(Roth IRA Holder or Inherited Roth IRA Holder) (Date)

__________________________________________________________________________________________ _______________________________________________

(Witness) (Date)

Please read both pages of this form. Complete Option One, Option Two, or Option Three and the Signatures section.

ROTH IRA TO ROTH IRA ROLLOVER REQUIREMENTS

To be an eligible rollover, all questions must be answered NO.

OPTION ONE

1. TIMELINESS

Have more than 60 days elapsed since you received the distribution from the distributing Roth IRA? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . YES NO

2. TWELVE MONTH RESTRICTION

Did you receive any other distributions from the distributing Roth IRA during the preceding 12 months which you also rolled over? . . . . . . . . . . YES NO

Have the assets involved in this transaction been previously rolled over from one Roth IRA to another Roth IRA within the past 12 months? . . . YES NO

ELIGIBLE RETIREMENT PLAN TO ROTH IRA ROLLOVER REQUIREMENTSOPTION TWO

MILITARY DEATH GRATUITY AND SERVICEMEMBERS’ GROUP LIFE INSURANCE (SGLI) PAYMENT

ROLLOVER REQUIREMENTS To be an eligible rollover, all questions must be answered NO.

OPTION THREE

1. AMOUNT

Does the amount being rolled over exceed the death gratuity or SGLI payment received, less any amount rolled over to a Coverdell ESA? . . . . . YES NO

2. TIMELINESS

Has more than one year passed since the receipt of the gratuity or SGLI payment? (NOTE: For deaths occurring between October 7, 2001

and June 17, 2008 you have until June 17, 2009 to complete the rollover.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . YES NO

GoldStar Trust Company

1401 4th Avenue (Street)

P.O. Box 719 (Mailing)

Canyon, TX 79015

800-486-6888

NOT REQUIRED

I acknowledge:

• I am solely responsible for all matters regarding taxation arising from transactions involving my IRA as well as determining that investments I direct are

allowable under applicable law and regulations.

• GoldStar has not rendered any advice and has no discretion or responsibility to direct any investment for my self-directed IRA.

• I am solely responsible for the selection of my dealer and negotiation of prices and terms.

• I authorize GoldStar to proceed with my instructions directed on this form (purchase or sale of precious metals) according to the details

provided by my dealer and without further written or verbal authorization from me.

• I am solely responsible for reading my IRA statement and conﬁ rming that precious metals quantities and prices, either bought or sold, agree with

arrangements I have made with my dealer.

• I understand that precious metal investments are received by, stored at, and delivered from a depository. Annual fees are due for this storage, and neither

GoldStar nor the depository is responsible for purity, weight, metal content, or authenticity of any coins or bars.

• I understand that with exception of cash invested in an FDIC insured bank account, investments held in my IRA may lose value, are not FDIC insured, and

are not guaranteed by GoldStar.

IMPORTANT: READ BEFORE SIGNING!

__________________________________________________ _______________

Signature of Account Holder Date

Precious Metals IRA

INVESTMENT DIRECTION

GTC Rev 2014/09

THIS SECTION FOR DEALER USE

Special Instructions

P. O. Box 719

Canyon, TX 79015

(800) 486-6888

Fax (806) 655-2530

IRAmetals@goldstartrust.com

NEW ACCOUNTS: All precious metals IRA fees must be paid

prior to your initial transaction (Establishment, Maintenance

& Storage Fees).

FUNDS COMING IN FROM MULTIPLE TRANSFERS OR ROLLOVERS?

(complete this section only if applicable)

Wait until all IRA funds are received before notifying the dealer below.

Notify the dealer below as soon as IRA funds become available.

PDF

IMPORTANT INFORMATION! READ BEFORE COMPLETION OF THIS FORM

GoldStar Trust Company (“GoldStar”) does not offer investment advice and does not buy or sell precious metals. You determine the precious metals dealer to be

used for your IRA. GoldStar is disqualiﬁ ed by the Internal Revenue Code from trading with an IRA for which it is the custodian. GoldStar is compensated through

administrative fees and cash management fees. GoldStar is not liable for pricing changes due to ﬂ uctuations in market values for precious metals.

GOLDSTAR IRA ACCOUNT OWNER

Account Number New Account

Name _____________________________________________________ (if known) ____________________ Pending

Address _____________________________________________________ Daytime Phone ________________________________

_____________________________________________________ E-mail _______________________________________

REQUIRED – SELECT EITHER PURCHASE OR LIQUIDATE BELOW

GoldStar will notify your dealer of your intent upon receipt of this form. If you do not hear from your dealer within 48 hours, please contact your

dealer to make sure your instructions were received.

PURCHASE: Please notify the dealer below of my intent to purchase.

LIQUIDATE: Please notify the dealer below of my intent to sell.

Dealer ______________________________________________________ Phone ______________________________________

Representative ________________________________________________ E-mail _______________________________________

Initial here to authorize purchase of proof coins for your IRA and to acknowledge receipt of disclosure concerning price spreads

for proof coins from your dealer (see Investment Disclosures for Precious Metals IRAs).

Quantity Type of Description of Bullion or Coin Troy Oz. Price Amount

Metal Each

Total

This form expires 90 days after the signature date and is valid only once.

PRECIOUS METALS IRA

FEE PAYMENT FORM

First Name: __________________________________________

Last Name: __________________________________________

Address: __________________________________________

City: __________________________________________

State/Province: __________________________________________

Zip Code: __________________________________________

BILLING INFORMATION ON CARD

PAYMENT/AUTHORIZATION

Card Number: __________________________________________

Expiration Date: __________________________________________

Card Code: __________________________________________

FEE PAYMENT OPTIONS (select one)

Pay All First Year Fees - $225 - Additional fees will be charged to accounts larger than $100K.

Pay Establishment Fee Only - $50 - Deduct all other ﬁ rst year fees from my transferred funds.

Name on Retirement Account (First/MI/Last): _________________________________________________

Expedite process by paying with a credit/debit card: Enter information below.

Call GoldStar Trust to pay with a credit/debit card: 1-800-486-6888

Mail check to GoldStar Trust: P.O. Box 719, Canyon, TX 79015

*All fees ($225) must be paid before precious metals can be purchased.

*RECOMMENDED

Note: Your credit card payment may not be processed on the same day it was received.

GoldStar does not keep credit card info on ﬁ le.

PDF

Send transfer or rollover paperwork overnight for an additional $25? YES NO

TOTAL:

P. O. Box 719

Canyon, TX 79015

(800) 486-6888

Fax (806) 655-2530

IRAmetals@goldstartrust.com

$ 0.00

PRECIOUS METALS ROTH IRA

INVESTMENT GUIDE

ESTABLISH YOUR SELFDIRECTED ROTH IRA

IRA Account Application

Complete the GoldStar IRA Account Application (Roth IRA Simpliﬁ er)

which can be obtained from our website - www.GoldStarTrust.com.

GoldStar o ers Self-Directed Traditional, Roth, SEP and SIMPLE

IRAs. A completed Simpli er (speci c to the type of IRA) is required.

A nonrefundable Establishment Fee of $50 is due with application.

Identi cation

Enter your driver’s license information on the Simpli er. If you do not

have a valid state-issued driver’s license, provide a legible photocopy of

a valid government-issued photo ID, passport or notarized document.

FUND YOUR ROTH IRA

A Roth IRA is funded through contributions, transfers and rollovers from existing

Roth IRAs. An initial minimum investment of $5,000 is required to establish your

IRA and purchase precious metals through GoldStar.

Transfer an Existing Roth IRA to GoldStar

Required documents and forms needed:

• Completed Roth IRA Simpliﬁ er with driver’s license information (or

legible photocopy of your valid state-issued photo ID, passport or

notarized document, alternatively)

• Completed

Roth IRA Transfer Request form with original signature

• Most recent account statement from existing Roth IRA custodian

GoldStar will send the completed Roth IRA Transfer Request form to your

resigning Roth IRA custodian and follow up periodically on your transfer until

the funds (or precious metals for a transfer in-kind) are received.  e transfer

process typically takes 2-4 weeks.

– IMPORTANT – Contact your current plan’s administrator  rst

to see if their speci c Transfer/Rollover paperwork is required.

If you are rolling over funds from a previous retirement plan AND you,

the client, have a check in hand or the rollover check has been made

payable to you, please complete the

Roth IRA Rollover Certiﬁ cation

form.

Otherwise, completing this form is not necessary to open your GoldStar

account.

PRECIOUS METALS ROTH IRA

INVESTMENT GUIDE

CHOOSE A PRECIOUS METALS DEALER

Once your IRA is funded, GoldStar will contact the precious metals dealer of your

choice to facilitate the trade. You will designate the dealer to be contacted in the

next step.

GoldStar Trust Company is an IRA Custodian and does not o er investment

products or advice. GoldStar cannot refer dealers; it is up to you to determine the

precious metals dealer to be used.

GIVE GOLDSTAR INVESTMENT INSTRUCTIONS

To instruct GoldStar to notify your dealer of your intent to purchase precious

metals for your Self-Directed IRA, complete and sign the

Precious Metals IRA

Investment Direction

.  e completed investment direction authorizes GoldStar to

initiate the transaction and make payment to the dealer designated. You will need

to complete a new investment direction for

each

purchase or sale.  is form can be

submitted by:

Fax: (806) 655-2530

E-mail:

IRAmetals@GoldStarTrust.com

Mail: P. O. Box 719, Canyon, TX 79015

IMPORTANT

If you are transferring funds to GoldStar from more than one source, it is imperative

that you submit a separate investment direction for each transfer request OR direct

GoldStar to wait until all of your funds are received before notice is sent to your dealer.

If you do not hear from your dealer within 2-3 business days of submitting the

investment direction, please contact them to make sure they have received your

instructions.

Investing in proof coins: please read the information regarding proof spreads and initial

the appropriate box.

GoldStar’s policy is to notify the dealer you have chosen within 48 business

hours of receipt of your Precious Metals Investment Direction unless otherwise

instructed. GoldStar is not liable for pricing changes due to  uctuations in

market values for precious metals.

DELIVERY AND PAYMENT

After GoldStar receives a delivery con rmation of your order from the depository,

GoldStar will issue payment to your precious metals dealer, following the instructions

you provide on the Investment Direction. You will now be able to view the precious

metals in your IRA statement online (call to enroll for online access).

PRECIOUS METALS ROTH IRA

INVESTMENT GUIDE

STORAGE

IRA assets must remain in the custody of the IRA custodian until distribution, which means that

you can’t hold them yourself while in the IRA or determine your own storage facility. Precious

metals for GoldStar IRAs are held within one of the three depositories below.  e dealer you buy

precious metals from usually determines which depository will be used.

DELAWARE DEPOSITORY SERVICE COMPANY

Delaware Depository Service Company (DDSC) is an exchange approved limited liability

company that provides a full range of secure storage, accounting, and shipping of precious metals

to  nancial institutions and industrial companies worldwide.

Customer bullion is stored in DDSC’s high-security vaults located in Wilmington, Delaware.

Vaults are constructed and maintained in compliance with the Bank Protection Act and UL

standards, and are equipped with time locks and automatic re-locking devices. Access is restricted

and regulated by dual control procedures.  e entire facility is protected by numerous, redundant

alarm and security devices that are independently monitored 24 hours a day, 365 days a year. All

activity in and around the facility is captured on video.

For more information about DDSC, please visit

www.delawaredepository.com

INTERNATIONAL DEPOSITORY SERVICES OF DELAWARE

IDS-Delaware, a state-of-the-art precious metals depository, is located in the heart of America’s

east coast business corridor in New Castle, Delaware. With 24-hour monitored, multi-redundant

security systems, all-risk insurance through Lloyds of London and UL-Rated Class III vault, IDS-

Delaware maintains stringent dual-control procedures and o ers fully segregated and standard

storage to its clients. IDS-Delaware clients receive exceptional, responsive service from trained

depository professionals. Additionally, IDS-Delaware has the distinction of being an Associate of

the London Bullion Market Association as well maintaining active participation in the Industry

Council for Tangible Assets.

For more information about IDS-Delaware, visit

www.IDS-Delaware.com

BRINK’S GLOBAL SERVICES

Brink’s Global Services (BGS) is a division of Brink’s, Incorporated, a leading international

provider of secure logistics and security solutions.  e Brink’s global network comprises of

approximately 1,000 facilities, 12,000 vehicles and 71,000 employees working in partnership

with customers in more than 120 countries on six continents. Utilizing this worldwide network,

BGS specializes in creating and innovating customized solutions to support and enhance

services throughout clients’ respective value chains.  ese services span areas such as secure

transportation, customs brokerage, vaulting and handling of precious metals and other valuables

on behalf of  nancial institutions, government bodies, retailers and industrial companies.

Precious metals for GoldStar IRAs are stored in the BGS facility in Los Angeles, California.

For more information about BGS, visit

www.brinksglobal.com

PRECIOUS METALS ROTH IRA

INVESTMENT GUIDE

SET-UP FEES AND CARRYING COSTS

Use the examples in the chart below as a guide to calculate fees due when your

GoldStar Precious Metals IRA is opened. Please see the full Fee Schedule for speci c

details or call Investor Services @ 1-800-486-6888 for an estimation of annual fees.

Precious Metals IRA Maintenance and/or Storage fees may vary in the years to come according to change

in account value. These fees are based on the Market Value of your account prior to the billing period.

Billing

• Maintenance Fees are assessed annually on the anniversary date in

which your account is opened.

• Storage Fees are assessed annually in the month the depository  rst

received noti cation of the metals to be purchased.

Example:

For a new investor (with an account value of $100,000 or less) the fees

for the  rst year are $225 (this is due when the account is opened) and

$175 each following year. For a small investment, this can represent

excessive carrying costs. Please bear in mind, investments in precious

metals do not yield any dividends and these costs must be paid annually

in cash by the investor.

ACCOUNT VALUE ACCOUNT VALUE ACCOUNT VALUE

$100,000 OR LESS $125,000 $150,000

One-Time

Establishment Fee $50 $50 $50

Annual IRA

Maintenance Fee $75 $125 $150

($75 min. / $275 max.)

($1 per $1000 if > $100K)

Annual Storage Fee $100 $125 $150

($100 minimum fee)

($1 per $1000 if > $100K)

TOTALS

INITIAL SET-UP FEES $225 $300 $350

(Due when account

is established)

RECURRING

ANNUAL FEES $175 $250 $300

(Maintenance (+) Storage)

ALLOWABLE METALS AND VALUATION

An IRA may hold investments in certain precious metals allowed by the Internal

Revenue Code. Coin or bullion that is not speci cally permitted are considered

to be collectibles and are disallowed for IRAs.  e allowable exceptions were

broadened by the

Taxpayer Relief Act of 1997

, e ective January 1, 1998.

 e speci c precious metals permitted are: silver, gold and platinum American

Eagle coins, a coin issued under the laws of any State, and gold, silver, platinum or

palladium bullion that meets the minimum  neness requirements.

Fineness Requirements

• Currently, gold must be .9950 pure, silver must be .9990 pure, and both

platinum and palladium must be .9995 pure to qualify.

• Bullion bars must be fabricated by COMEX, NYMEX, or ISO 9000

approved re ners in order to be accepted by GoldStar.

• Proof American Eagle coins must be ungraded, complete with certi cate of

authenticity and in original mint packaging.

• Bullion coins must be uncirculated in excellent condition.

ACCOUNT VALUATION

Call Investor Services to set up your password and access your GoldStar

account online!

A statement of your account will be mailed out semi-annually in January and

July of each year. You may view your statement online, 24 hours a day at

www.GoldStarTrust.com.  e valuations (Market Values) of precious metals shown

on your statement re ect estimated bid values for each asset and not a  rm price

gauge to buy or sell through a dealer. Additionally, these estimated values do not

include dealer mark-ups, discounts, or commissions. Current price estimations for

bullion and proof products can be obtained from various sources including your

dealer or websites such as

www.bullionvalues.com.

PRECIOUS METALS ROTH IRA

INVESTMENT GUIDE

• Silver

America  e Beautiful coins

American Eagle coins

Australian Kookaburra coins

Austrian Vienna Philharmonic coins

British Britannia (2013 and newer)

Canadian Maple Leaf coins

Chinese Panda coins

Mexican Libertad coins

Various bars and rounds .999

• Palladium

Canadian Maple Leaf coins

Various bars .9995

PRECIOUS METALS ROTH IRA

INVESTMENT GUIDE

• Hungarian 100 Korona

• Italian 20 Lira

• Mexican 50 Peso

• South African Krugerrand

• Swiss 20 Franc

• U.S. Bu alo

Proof

• U.S. Liberty

Bullion bars and rounds must be fabricated by COMEX, NYMEX, or ISO 9000 approved re ners

EXAMPLES OF ALLOWABLE PRECIOUS METALS

• Gold

American Eagle coins

Australian Kangaroo/Nugget coins

Australian Lunar Series coins

Austrian Philharmonic coins

British Britannia (2013 and newer)

Canadian Maple Leaf coins

Chinese Panda coins

Credit Suisse – PAMP Suisse Bars

U.S. Bu alo Bullion coins

Various bars and rounds .995

• Platinum

American Eagle coins

Australian Koala coins

Canadian Maple Leaf coins

Various bars .9995

EXAMPLES OF UNACCEPTABLE PRECIOUS METALS

• Rare or collectible coins,

including certi ed or “graded” coins

• Austrian Corona

• Belgian 20 Franc

• British Britannia (pre-2013)

• Chilean 100 Peso

• Dutch 10 Guilder

• French 20 Franc

Investor Services

(800) 486-6888

www.GoldStarTrust.com

GoldStar Trust Company is a quali ed IRA custodian serving broker-dealers, investment

providers and their clients across the country. GoldStar self-directed IRAs o er our investors

unique retirement solutions that allow for diversi cation beyond conventional retirement plans.

With more than twenty years of trust experience and leadership in the markets we serve, our

capable sta is ready to assist with your retirement goals.

GoldStar:

• serves as custodian for more than 37,000 IRA accounts with total assets of more than

$1.9 billion (as of March 31, 2014)

• is located in Canyon, Texas and employs more than 60 people

• is a trust-only branch of Happy State Bank, chartered in Happy, Texas and based out of

Amarillo, Texas

Happy State Bank:

• has been in business since 1908 and is one of the largest banks in the panhandle of Texas.

For more information, visit www.happybank.com

• has current total assets of $2.4 billion

• is a 4 star rated bank by www.bauerﬁ nancial.

com.  e bank’s most recent  nancials

can be viewed at www

.fdic.gov

(FDIC Cert:10359)

Hours

Mon. –  urs. 7 am – 5 pm CST

Fri. 7 am – 4 pm CST

Investor Services

(800) 486-6888

Mailing Address

GoldStar Trust Company

PO Box 719

Canyon, TX 79015

Fax

(806) 655-2530 (Precious Metals)

(806) 655-2490 (Main)

IRAmetals@GoldStarTrust.com (Precious Metals)

Info@GoldStarTrust.com (Investor Services)

Physical/Overnight Address

1401 4th Avenue

Canyon, TX 79015

ABOUT US

CONTACT INFORMATION

PRECIOUS METALS ROTH IRA

INVESTMENT GUIDE

FEE SCHEDULE

for Self-Directed Traditional, Roth, SEP

or SIMPLE IRAs and ESAs

P. O. Box 719

Canyon, TX 79015

(800) 486-6888

Fax (806) 655-2490

Info@goldstartrust.com

STANDARD ASSETS:

Includes any number or combination of Fixed-Rate Investments, Bank Certiﬁ cates of Deposit, Money Market Funds, Mutual Funds,

Publicly Traded Securities in U.S. Exchanges, Privately Offered Stock, Brokerage Accounts, REITs, Limited Liability Company Stock,

Secondary Market Annuities and Hedge Funds.

One-Time Establishment Fee $25 Due with application; nonrefundable

Annual Maintenance Fee $65 ﬂ at

Additional fees charged when applicable:

Hedge Fund Annual Asset Holding Fee $50 Unlimited number of hedge funds allowed

Transaction Fees for Security Trades $25 each + brokerage fees

Applies to stock trades through GoldStar’s omnibus account

(at cost)

CHURCH BONDS / CHURCH LOAN AND EXTENSION FUNDS

Annual Maintenance Fee $45 ﬂ at

Partial Transfer or Distribution In-Kind Fee

$25 Church Bonds/Loan and Extension Fund investments only

Bond Re-Registration Fee: GoldStar Bonds $10 each

Bond Re-Registration Fee: Other Bonds Varies

Subject to other Trustees’ re-registration fees

Full Termination Fee

$50 Church Bonds/Loan and Extension Fund investments only

GTC Rev 2014/09

ACCOUNT FEES BY ASSET TYPE

Annual Maintenance, Asset Holding and Depository Storage Fees are due when the account is established and billed annually thereafter on the

account opening anniversary date.

• Annual Fees are not prorated. • Accounts holding multiple asset types: only one Maintenance Fee will be

charged based on the asset type with the greater fee.

PRECIOUS METALS

One-Time Establishment Fee $50 Due with application; nonrefundable

Annual Maintenance Fee $75 min. / $275 max. $1 per $1000 of market value greater than $100,000 (10 basis points) **

Annual Depository Storage Fee $100 min. / No max. $1 per $1000 of precious metals value greater than $100,000 (10 basis points)

Buy, Sell or Exchange NO FEE

Partial Distribution or Transfer In-Kind $40 + cost of shipping IRA holder is responsible for actual shipping, handling and insurance costs

PERTH MINT CERTIFICATES

One-Time Establishment Fee $50 Due with application; nonrefundable

Annual Maintenance Fee $75 ﬂ at

Annual Asset Holding Fee $150

Partial Liquidation/Re-registration Fee $40

BANK ACCOUNTS OUTSIDE THE U.S.

Annual Maintenance Fee $75 min. / $275 max. $1 per $1000 of market value greater than $100,000 (10 basis points) **

Annual Asset Holding Fee $200

Additional Purchase and/or Liquidation Order

$75

SWISS ANNUITIES

Annual Maintenance Fee $75 min. / $275 max. $1 per $1000 of market value greater than $100,000 (10 basis points) **

Annual Asset Holding Fee $25

Purchase, Distribution or Transfer $100

Modiﬁ cation or Surrender $50

RIGHT TO MAKE ADJUSTMENTS TO THIS FEE SCHEDULE: GoldStar Trust

Company reserves the right to make any adjustments in its fees for custodial or

agency services when such adjustments are warranted by changes in governing

laws, regulations, operating technology or economic conditions. This schedule may

be modiﬁ ed only upon revision by GoldStar of its published schedule of IRA fees.

Such fees shall become effective on the 30th day after mailing the notice of such

revision to the participant at the address shown on the records of GoldStar.

CASH MANAGEMENT FEE: GoldStar Trust Company receives a monthly

record keeping fee on the uninvested cash equal to .000833 or 1.00% per

annum. If and when the interest rate earned on the uninvested cash in a

given month is below 1.15%, .15% will be paid on the uninvested cash and

the difference will be retained as the record keeping fee. Interest earnings

will be posted monthly to each account. No interest will be earned during

the month an account closes.

Partial Transfer of Cash Fee $25

Partial Transfer of Assets / Distribution In-Kind Fee $40

Recharacterization Fee $40

Excess Contribution Removal Fee $40

Roth Conversion Fee $40

Late Fee: $25 per occurrence

Distribution Via Check Fee

Distribution Via ACH NO FEE

Wire Fee $25

Overnight Fee $25

Research Assistance Fee $50/hour

Insufﬁ cient Funds / Returned Check Fee $50

Full Termination Fee

$100

SERVICE FEES

Applies to any fees not paid within 30 days

of the due date.

** The minimum $75 Maintenance Fee applies up to $100,000 of market value; thereafter, 10 basis points applies.

SELF-DIRECTED IRA OR ESA: This account is termed a Self-Directed Individual Retirement Account (IRA) or Education Savings Account (ESA). You may direct the

investment of your funds within this IRA or ESA into any investment instrument approved by, or through GoldStar Trust Company. GoldStar Trust Company will not

exercise any investments discretion regarding your IRA or ESA, as this is solely your responsibility.

Because this is a Self-Directed IRA or ESA, no projection of the growth of your IRA or ESA can be reasonably shown or guaranteed. The value of your IRA or ESA will

be solely dependent upon the performance of any investment instrument chosen by you.

INVESTMENT OPTIONS:

This is a Self-Directed IRA or ESA; you choose the investments which will fund your IRA or ESA. Your investment choices are limited to:

• Church Bonds

• Charter School Bonds

• Church Loan and Extension Fund Investments

• Fixed-Rate Investments

• Bank Certiﬁ cates of Deposit

• Money Market Funds

• Secondary Market Annuities

• Precious Metals: gold, silver, platinum and palladium

American Eagles and other bullion coins and bars that

meet the minimum ﬁ neness requirements as allowed

under Internal Revenue Code Section 408(m)(3)

• Perth Mint Certiﬁ cates

• Swiss Annuities

• Approved Bank Accounts Outside the U.S.

• Mutual Funds

• Hedge Funds

• Publicly Traded Securities in U.S.Exchanges

• Privately Offered Stock

• Brokerage Accounts

• REITs (public and non-traded)

• Limited Liability Company Stock

Examples of investments NOT permitted in the Self-Directed IRA or ESA are Limited Partnerships, Real Estate, Collectibles, Viaticals and Promissory Notes.

EARNINGS:

The method for computing and allocating annual earnings (interest, dividends, etc.) on your investments will vary with the nature and issuer of the investment

chosen. Please refer to the prospectus or contract of the investment(s) of your choice for the method(s) used for computing and allocating annual earnings. The

valuations of nonstandard assets such as Privately Offered Stock and other Private Placement Investments are reported at either the most recent price provided

to the custodian by the investment issuer or at investment cost. Nonstandard assets are generally illiquid, and the custodian does not seek to verify the valuations

provided to it by the investment issuer. The custodian does not guarantee that the reported valuation could be received in the event the position was sold or

liquidated. As such, the reported valuation may be different from the actual value and should be used as guidance and for reporting purposes only since the

valuation was not obtained or veriﬁ ed by a third party.

Custodian shall be under no obligation to forward any proxies, ﬁ nancial statements or other literature received by it in connection with or relating to Custodial

Property held under this agreement. Custodian shall be under no obligation to take any action with regard to proxies, stock dividends, warrants, rights to subscribe,

plans of reorganization or recapitalization, or plans for exchange of securities.

FINANCIAL DISCLOSURE

IRA CUSTOMER IDENTIFICATION REQUIREMENTS

Section 326 of the Uniting and Strengthening America by Providing Appropriate Tools Required to Intercept and Obstruct Terrorism Act (USA PATRIOT Act)

authorizes and requires the Department of the Treasury to add to its rules for banks to establish Customer Identiﬁ cation Programs. Previously, trust companies

were not treated as banks and trust relationships were not treated as “accounts.” However, GoldStar and the GoldStar IRA account establishment process are

now subject to these requirements.

Federal law requires all ﬁ nancial institutions to obtain, verify, and record information that identiﬁ es each person who opens an account.

When you open an account, we will ask for your name, residence address, social security number, date of birth, and other information that will allow us to

identify you. We may also ask for copies of your passport, driver’s license or other identifying documents.

We are required to compare your identity to lists of persons and organizations maintained by any federal agency designated by the Department of the

Treasury. If your name appears on any of these lists, we must refuse to open your account, close your account if it is already open, notify federal

authorities, and follow all federal directives. If you attempt to falsify or conceal your identity, we may be required to ﬁ le a Suspicious Activity Report.

We may also use independent sources to verify identifying information. Federal law requires us to retain the identiﬁ cation information for a certain period

of time (currently ﬁ ve years after closing your account), and may require that we provide this information to federal authorities without notice to you.

This notice is in addition to our Privacy Disclosure and may describe potential disclosures of non-public personal information that were not known to us at

the time that the Privacy Disclosure was prepared.

NOTICE

IDENTIFYING DOCUMENTS REQUESTED

The easiest means for GoldStar to comply is to receive documents with your application, such as:

• Completion of the Customer Identiﬁ cation Requirements section of the IRA Application

• Any document with your notarized signature

• A notarized copy of your passport or driver’s license or other state-issued photo ID that is not expired

• An ordinary copy of your unexpired photo ID, if GoldStar is able to complete other procedures

IDENTIFYING DOCUMENTS REQUIRED

If you intend to direct investment outside the U.S., GoldStar will require a notarized copy of your passport (or driver’s license if you do not have a passport).

This may be the same document that is to be forwarded to a non-U.S. bank.

QUESTIONS OR CONCERNS?

GoldStar Trust Company

Investor Services Department

P.O. Box 719

Canyon, TX 79015

(800) 486-6888

GTC Rev 2014/09

INVESTMENT DISCLOSURES

(for Precious Metals IRAs)

Use the Precious Metals IRA Investment Direction form to provide investment directions to GoldStar Trust Company (GoldStar) for

the purchase or sale of precious metals by your self-directed IRA.  e IRA may be a Traditional IRA (including SEP or Conduit), Roth

IRA, or SIMPLE IRA. By directing investment in precious metals, you acknowledge and agree to GoldStar’s terms and conditions for

precious metals investment in self-directed IRAs. Please note: your  rst precious metals purchase must be a minimum of $5,000.

REQUIREMENTS

To invest in precious metals through a self-directed IRA, you must  rst establish a valid IRA and have cash available in the IRA.

Obtain application kits and forms from GoldStar, a dealer, or www.goldstartrust.com. Cash comes from contributions, transfers and

rollovers from other IRAs, rollovers from Quali ed Retirement Plans (such as a 401k), or from the sale of other assets.

DEALER AND INVESTMENT DIRECTIONS

You determine the precious metals dealer to be used for your IRA. GoldStar does not o er investment products, and does not buy or

sell precious metals. GoldStar is disquali ed by the Internal Revenue Code from trading with an IRA for which it is the custodian.

GoldStar is compensated through administrative fees and cash management fees. Negotiate the precious metals to be purchased or

sold and the price directly with the dealer and give written directions to GoldStar. GoldStar will make a reasonable e ort to notify the

dealer when funds arrive. However, it is the customer’s responsibility to monitor IRA assets and investments.

FUNDING NOTICE TO DEALERS

GoldStar’s policy is to notify the dealer you have chosen within 48 business hours of receipt of your investment direction unless

otherwise instructed. If you are transferring or rolling over funds to GoldStar from more than one source, it is imperative that you

submit a separate investment direction for each transfer request OR direct GoldStar to wait until all funds are received before notice

is sent to your dealer. Please notify GoldStar of your intentions on the investment direction form(s), in a separate letter, or by emailing

IRAmetals@goldstartrust.com. GoldStar is not liable for pricing changes due to  uctuations in market values for precious metals.

STATEMENTS

Access to your account information is available 24/7 via GoldStar’s web site at www.goldstartrust.com. Please call our Investor Services

Department at (800) 486-6888 to establish a password. Additionally, paper statements are mailed semi-annually.

FAIR MARKET VALUES AND PRICING

 e market values of precious metals shown on your Statement of Assets re ect estimated bid values for each asset and are not a  rm

price gauge to buy or sell through a dealer.  ese estimated values do not include dealer mark-ups, discounts, or commissions.  is

price is used for reports of fair market value to the IRS. Contact a dealer for speci c, current price quotes for precious metals, or on

websites such as www.bullionvalues.org.

PRICE SPREADS AND PROOF AMERICAN EAGLE COINS

Generally, the value of precious metals at the bid price will be less than the amount paid if precious metals prices have not changed.

 e di erence between the price at which precious metals can be bought and the price at which they can be sold at a particular time is

called “price spread”. In addition to bullion coins, “proof” American Eagle coins may be held in an IRA if they are ungraded and not

considered to be collectible coins. Proof coins delivered for an IRA must be accompanied by intact box and packaging with matching

certi cate of authenticity. Price spread has generally been greater for proof coins than the price spread for bullion precious metals.

Obtain all necessary information from your dealer before investing.

STORAGE AND DELIVERY OF PRECIOUS METALS

All precious metals are stored at a specialized depository. A fee is charged for storage based on the calendar year.  e full annual charge

is due for each full or fractional calendar year during which precious metals are stored. Dealers deliver directly to the depository which

issues formal advice of its receipt. GoldStar relies on the accuracy of advice by the depository.

DISTRIBUTION OR SALE OF PRECIOUS METALS

Delivery is required when a customer requests “in kind” distribution of precious metals from the IRA, or directs GoldStar to deliver

precious metals to a dealer for sale.  e cost of shipment is paid by the customer or deducted from the IRA if shipped to a dealer for

sale, or paid COD if sent “in kind” to the customer. Costs include U.S. Postal Service postage and insurance, and packaging by the

depository. You may request distribution of precious metals from an IRA at anytime, though IRS taxes and/or penalties may apply.

Please contact GoldStar for a Withdrawal Statement or go online at www.goldstartrust.com.

CANCELLATIONS

In the event that either a GoldStar IRA holder or their dealer wishes to cancel a purchase or sale of precious metals after the terms have

been settled and instructions are sent to GoldStar, the cancellation must be agreed upon by both parties in writing and submitted to

GoldStar within 10 business days. It is the customer’s responsibility to notify GoldStar.

P. O. Box 719

Canyon,

TX 79015

(800) 486-6888

Fax (806) 655-2530

IRAmetals@goldstartrust.com

Rules And Conditions Applicable To Rollovers

GENERAL INFORMATION

A rollover is a way to move money or property from one Roth IRA or eligible retirement plan to another Roth IRA. The Internal Revenue Code (IRC) limits how many

distributions may be rolled over, how quickly they must be completed and how the Trustee or Custodian must report them. By properly completing this form you are

certifying to the Trustee or Custodian that you have satisfied the rules and conditions applicable to a rollover and that you are making an irrevocable election to treat the

transaction as a rollover.

ROTH IRA TO ROTH IRA ROLLOVER REQUIREMENTS (Option One)

1. TIMELINESS

The funds you receive from the distributing Roth IRA must be deposited into another Roth IRA within 60 days after you receive them. However, this period is 120 days

for certain rollovers relating to first-home purchases. When counting the 60 (or 120) days include weekends and holidays. Receipt generally means the day you actually

have the funds in hand. For example, the 60 days would begin on the day following the day you pick up the check from the Trustee or Custodian or you receive the check

in the mail.

The IRS has the authority to grant extensions to the 60 (or 120) day rule in cases where a hardship would be related (e.g., casualty, disaster, etc.). Generally, in order to

receive this relief you must apply for a Private Letter Ruling accompanied by the applicable user fee. An automatic waiver (no application to the IRS) is available if all the

following are true: (1) the financial institution receives the funds prior to the expiration of the 60-day rollover period, (2) you follow all procedures required for depositing

the funds into an eligible Roth IRA within the 60-day period, (3) the funds are not deposited due to financial institution error, (4) the funds are deposited into a Roth IRA

within one year from the beginning of the 60-day rollover period, and (5) if the financial institution had deposited the funds as instructed, it would have been a valid

rollover.

2. TWELVE MONTH RESTRICTION

You are entitled to one distribution per year per Roth IRA which may be rolled over. Twelve (12) months must pass after receipt of one distribution which you roll over

before you may take another distribution from the same Roth IRA to roll over. A Roth IRA is created by executing a plan agreement, not by depositing a contribution into

a separate investment within an existing Roth IRA.

You are entitled to roll over the same assets only once in a twelve (12) month period. Twelve (12) months must elapse between the time you receive a distribution of the

assets to be rolled over until the time you receive another distribution of those same assets for rollover purposes.

ELIGIBLE RETIREMENT PLAN TO ROTH IRA ROLLOVER REQUIREMENTS (Option Two)

1. ELIGIBLE PERSON

Only an eligible person may roll funds from a 401(a), 403(b), or 457(b) Plan, into a Roth IRA. You will only be an eligible person if you were or are a participant in the

distributing plan, the surviving spouse beneficiary of a deceased participant, or the alternate payee identified in a Qualified Domestic Relations Order (QDRO). A QDRO

is a domestic relations order issued in a divorce proceeding which meets certain conditions and grants to an alternate payee (e.g., exspouse) the right to receive all or a

portion of a participant’s benefits under a QRP. If the alternate payee is a spouse or former spouse, the alternate payee may be able to roll over all or a portion of the

amount received to a Roth IRA. In order to roll over retirement plan assets, other than designated Roth 401(k) or 403(b) contributions, you must meet the following

eligibility requirements. If your modified adjusted gross income is not more than $100,000, and you are not married filing a separate income tax return, you are eligible to

roll over the retirement plan assets to a Roth IRA. Beginning in 2010, these eligibility requirements will be eliminated. A nonspouse beneficiary may only roll over to an

inherited Roth IRA. A rollover to an inherited Roth IRA must be done as a direct rollover from an eligible retirement plan.

2. ELIGIBLE PLAN

A distribution will not be eligible to be rolled over unless that distribution is made from an eligible retirement plan. An eligible retirement plan is a plan that is qualified

under IRC Section 401(a), 403(b), or 457(b).

3. ELIGIBLE ROLLOVER DEPOSIT

Only certain types of eligible retirement plan distributions, called “eligible rollover distributions,” may be deposited into a Roth IRA. Eligible rollover distributions

include most distributions from eligible plans except the following:

Required Minimum Distributions – Distributions which represent required minimum distributions paid during a participant’s first distribution calendar year or later may

not be rolled over.

Substantially Equal Periodic Payments – For purposes of determining an eligible rollover distribution, substantially equal periodic payments are defined as a series of

substantially equal distributions made not less frequently than annually and calculated 1) over the life (or life expectancy) of the individual or the joint lives (or life

expectancies) of the individual and the individual’s beneficiary or, 2) for a specified period of 10 years or more.

P.S. 58 Costs – If you received distribution of a life insurance policy from a plan, the amounts attributable to the cost of life insurance purchased by the plan which have

been previously taxed to the participant may not be rolled over.

Property Distributions – If property other than cash is distributed, only the same property or the proceeds from its sale may be rolled over. If you receive property but

wish to roll over cash, you must actually sell the property and roll over the proceeds.

Hardship Distributions – Distributions taken on account of financial hardship are not eligible to be rolled over.

4. TIMELINESS

If the check is payable to you, the funds you receive from the distributing plan must be deposited in a Roth IRA within 60 days after you receive them. When counting the

60 days include weekends and holidays. Receipt generally means the day you actually have the funds in hand.

The IRS has the authority to grant extensions to the 60 day rule in cases where a hardship occurs (e.g. casualty, disaster, etc.). Generally, in order to receive this relief you

must apply for a Private Letter Ruling accompanied by the applicable user fee. An automatic waiver (no application to the IRS) is available if all the following are true:

(1) the financial institution receives the funds prior to the expiration of the 60-day rollover period, (2) you follow all procedures required for depositing the funds into an

eligible Roth IRA within the 60-day period, (3) the funds are not deposited due to financial institution error, (4) the funds are deposited into a Roth IRA within one year

from the beginning of the 60-day rollover period, and (5) if the financial institution had deposited the funds as instructed, it would have been a valid rollover.

MILITARY DEATH GRATUITY AND SGLI PAYMENT ROLLOVER REQUIREMENTS (Option Three)

AMOUNT AND TIMELINESS

If you have received a military death gratuity or a payment from the Servicemembers’ Group Life Insurance program, you may be able to roll over the proceeds to a Roth

IRA. The rollover contribution amount is limited to the sum of the death benefits received, less any such amount that was rolled over to a Coverdell education savings

account. Proceeds must be rolled over within one year of receipt of the gratuity or SGLI payment for deaths occurring on or after June 17, 2008. For deaths occurring between

October 7, 2001 and June 17, 2008, proceeds may be rolled over no later than one year from June 17, 2008.

Page 7 of 15

The depositor named on the application is establishing a Roth individual

retirement account under section 408A to provide for his or her

retirement and for the support of his or her beneficiaries after death.

The custodian named on the application has given the depositor the

disclosure statement required by Regulations section 1.408‐6.

The depositor has assigned the custodial account the sum indicated on the

application.

The depositor and the custodian make the following agreement:

ARTICLE I

Except in the case of a rollover contribution described in section 408A(e),

a recharacterized contribution described in section 408A(d)(6), or an IRA

conversion contribution, the custodian will accept only cash contributions

up to $3,000 per year for tax years 2002 through 2004. That contribution

limit is increased to $4,000 for tax years 2005 through 2007 and $5,000 for

2008 and thereafter. For individuals who have reached the age of 50

before the close of the tax year, the contribution 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 thereafter. For tax years after

2008, the above limits will be increased to reflect a cost‐of‐living

adjustment, if any.

ARTICLE II

1. The annual contribution limit described in Article I is gradually reduced

to $0 for higher income levels. For a single depositor, the annual

contribution is phased out between adjusted gross income (AGI) of

$95,000 and $110,000; for a married depositor filing jointly, between

AGI of $150,000 and $160,000; and for a married depositor filing

separately, between AGI of $0 and $10,000. In the case of a conversion,

the custodian will not accept IRA conversion contributions in a tax year

if the depositor’s AGI for the tax year the funds were distributed from

the other IRA exceeds $100,000 or if the depositor is married and files

a separate return. Adjusted gross income is defined in section

408A(c)(3) and does not include IRA conversion contributions.

2. In the case of a joint return, the AGI limits in the preceding paragraph

apply to the combined AGI of the depositor and his or her spouse.

ARTICLE III

The depositor’s interest in the balance in the custodial account is

nonforfeitable.

ARTICLE IV

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

insurance contracts, nor may the assets of the custodial account be

commingled with other property except in a common trust fund or

common investment fund (within the meaning of section 408(a)(5)).

2. No part of the custodial account funds may be invested in collectibles

(within the meaning of section 408(m)) except as otherwise permitted

by section 408(m)(3), which provides an exception for certain gold,

silver, and platinum coins, coins issued under the laws of any state, and

certain bullion.

ARTICLE V

1. If the depositor dies before his or her entire interest is distributed to

him or her and the depositor’s surviving spouse is not the designated

beneficiary, the remaining interest will be distributed in accordance

with (a) below or, if elected or there is no designated beneficiary, in

accordance with (b) below:

(a) The remaining interest will be distributed, starting by the end of

the calendar year following the year of the depositor’s death, over

the designated beneficiary’s remaining life expectancy as

determined in the year following the death of the depositor.

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

calendar year containing the fifth anniversary of the depositor’s

death.

2. The minimum amount that must be distributed each year under

paragraph 1(a) above 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 Regulations section 1.401(a)(9)‐9) of the

designated beneficiary using the attained age of the beneficiary in the

year following the year of the depositor’s death and subtracting 1 from

the divisor for each subsequent year.

3. If the depositor’s surviving spouse is the designated beneficiary, such

spouse will then be treated as the depositor.

ARTICLE VI

1. The depositor agrees to provide the custodian with all information

necessary to prepare any reports required by sections 408(i) and

408A(d)(3)(E), Regulations sections 1.408‐5 and 1.408‐6, or other

guidance published by the Internal Revenue Service (IRS).

2. The custodian agrees to submit to the IRS and depositor the reports

prescribed by the IRS.

ARTICLE VII

Notwithstanding any other articles which may be added or incorporated,

the provisions of Articles I through IV and this sentence will be controlling.

Any additional articles inconsistent with section 408A, the related

regulations, and other published guidance will be invalid.

ARTICLE VIII

This agreement will be amended as necessary to comply with the

provisions of the Code, the related Regulations, and other published

guidance. Other amendments may be made with the consent of the

persons whose signatures appear on the application.

ARTICLE IX

9.01 Definitions – In this part of this agreement (Article IX), the words

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

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

Revenue Code, and “regulations” means the Treasury regulations.

9.02 Notices and Change of Address – Any required notice regarding

this Roth IRA will be considered effective when we send it to the

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

Any notice to be given to us will be considered effective when we

actually receive it. You, or the intended recipient, must notify us of

any change of address.

9.03 Representations and Responsibilities – You represent and warrant

to us that any information you have given or will give us with

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

agree that any directions you give us or action you take will be

proper under this agreement, and that we are entitled to rely upon

any such information or directions. If we fail to receive directions

from you regarding any transaction, if we receive ambiguous

directions regarding any transaction, or if we, in good faith, believe

that any transaction requested is in dispute, we reserve the right to

take no action until further clarification acceptable to us is received

from you or the appropriate government or judicial authority. We

ROTH INDIVIDUAL RETIREMENT CUSTODIAL ACCOUNT AGREEMENT

Form 5305‐RA under section 408A of the Internal Revenue Code. FORM (Rev. March 2002)

Page 8 of 15

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

your directions to us or your actions or failures to act, and you

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

directions, actions, or failures to act. We will not be responsible for

any penalties, taxes, judgments, or expenses you incur in

connection with your Roth IRA. We have no duty to determine

whether your contributions or distributions comply with the Code,

regulations, rulings, or this agreement.

We may permit you to appoint, through written notice acceptable

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

agreement (e.g., attorney‐in‐fact, executor, administrator,

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

validity of such appointment or any instrument appointing such

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

that may result from directions, actions, 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 directions, actions, or failures to act by

your authorized agent.

You will have 60 days after you receive any documents, statements,

or other information from us to notify us in writing of any errors or

inaccuracies reflected in these documents, statements, or other

information. If you do not notify us within 60 days, the documents,

statements, or other information will be deemed correct and

accurate, and we will have no further liability or obligation for such

documents, statements, other information, or the transactions

described therein.

By performing services under this agreement we are acting as your

agent. You acknowledge and agree that nothing in this agreement

will be construed as conferring fiduciary status upon us. We will not

be required to perform any additional services unless specifically

agreed to under the terms and conditions of this agreement, or as

required under the Code and the regulations promulgated

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

hold us harmless for any and all claims, actions, proceedings,

damages, judgments, liabilities, costs, and expenses, including

attorney’s fees arising from or in connection with this agreement.

To the extent written instructions or notices are required under this

agreement, we may accept or provide such information in any

other form permitted by the Code or applicable regulations

including, but not limited to, electronic communication.

9.04 Disclosure of Account Information – We may use agents and/or

subcontractors to assist in administering your Roth IRA. We may

release nonpublic personal information regarding your Roth IRA to

such providers as necessary to provide the products and services

made available under this agreement, and to evaluate our business

operations and analyze potential product, service, or process

improvements.

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

other designated fees (e.g., a transfer, rollover, or termination fee)

for maintaining your Roth IRA. In addition, we have the right to be

reimbursed for all reasonable expenses, including legal expenses,

we incur in connection with the administration of your Roth 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

Roth IRA at our discretion. We reserve the right to charge any

additional fee after giving you 30 days’ notice. Fees such as

subtransfer agent fees or commissions may be paid to us by third

parties for assistance in performing certain transactions with

respect to this Roth IRA.

Any brokerage commissions attributable to the assets in your Roth

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

Roth IRA for those commissions.

9.06 Investment of Amounts in the IRA – You have exclusive

responsibility for and control over the investment of the assets of

your IRA. All investment transactions, including the reinvestment of

dividends, interest, and proceeds from securities sales, shall be

directed by you. Absent or pending such direction, we shall be

entitled on a daily basis to sweep all IRA account balances. Such

balances shall be invested in short‐term investments, which shall

include insured savings accounts, insured savings certificates,

federal funds, insured money market accounts, government

securities, federal agency securities, and treasury notes, bonds and

bills in which book value and interest is guaranteed (including any of

the foregoing offered by Happy State Bank) (“Temporary

Investments”). We shall have all power and authority necessary to

hold, administer, vote and negotiate such Temporary Investment so

as to enforce every right and benefit thereunder on your behalf. In

making all Temporary Investments, we shall not be limited to

investments now or hereinafter designated by statute or decision of

a court as “legal investments” for funds held by fiduciaries. You

hereby agree that we may, but shall not be required (unless required

under applicable law) to inform you by forwarding materials or

otherwise communicating with you under the provisions of Article

VIII as to any questions, decisions or other matters for which a vote

may be requested, necessary or helpful as to any Temporary

Investment, and we shall thereafter have no responsibility

whatsoever with respect thereto. You agree and acknowledge that

unless required by applicable law, we are not responsible for

communicating, forwarding, or notifying any party, including you,

with respect to any communication or matter which comes to the

attention of or is received by us with respect to Trust investments,

including Temporary Investments, and that you are responsible for

making separate arrangements for receiving such communications.

9.07 Beneficiaries – If you die before you receive all of the amounts in

your Roth IRA, payments from your Roth IRA will be made to your

beneficiaries. We have no obligation to pay to your beneficiaries

until such time we are notified of your death by receiving a valid

death certificate.

You may designate one or more persons or entities as beneficiary

of your Roth IRA. This designation can only be made on a form

provided by or acceptable to us, and it will only be effective when

it is filed with us during your lifetime. Each beneficiary designation

you file with us will cancel all previous designations. The consent of

your beneficiaries will not be required for you to revoke a

beneficiary designation. If you have designated both primary and

contingent beneficiaries and no primary beneficiary survives you,

the contingent beneficiaries will acquire the designated share of

your Roth IRA. If you do not designate a beneficiary or if all of your

primary and contingent beneficiaries predecease you, your estate

will be the beneficiary.

If your surviving spouse is the designated beneficiary, your spouse

may elect to treat your Roth IRA as his or her own Roth IRA, and

would not be subject to the required minimum distribution rules.

Your surviving spouse will also be entitled to such additional

beneficiary payment options as are granted under the Code or

applicable regulations.

We may allow, if permitted by state law, an original Roth IRA

beneficiary (the beneficiary who is entitled to receive distributions

from an inherited Roth IRA at the time of your death) to name

successor beneficiaries for the inherited Roth IRA. This designation

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

will only be effective when it is filed with us during the original Roth

IRA beneficiary’s lifetime. Each beneficiary designation form that

the original Roth IRA beneficiary files with us will cancel all previous

designations. The consent of a successor beneficiary will not be

Page 9 of 15

required for the original Roth IRA beneficiary to revoke a successor

beneficiary designation. If the original Roth IRA beneficiary does not

designate a successor beneficiary, his or her estate will be the

successor beneficiary. In no event will the successor beneficiary be

able to extend the distribution period beyond that required for the

original Roth IRA beneficiary.

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

charter or bylaws), we may require that a beneficiary of a deceased

Roth IRA owner take total distribution of all Roth IRA assets by

December 31 of the year following the year of death.

9.08 Termination of Agreement, Resignation, or Removal of Custodian –

Either party may terminate this agreement at any time by giving

written notice to the other. We can resign as custodian at any time

effective 30 days after we send written notice of our resignation to

you. Upon receipt of that notice, you must make arrangements to

transfer your Roth IRA to another financial organization. If you do

not complete a transfer of your Roth IRA within 30 days from the

date we send the notice to you, we have the right to transfer your

Roth IRA assets to a successor Roth IRA trustee or custodian that we

choose in our sole discretion, or we may pay your Roth IRA to you

in a single sum. We will not be liable for any actions 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

distribution of your assets pursuant to this section.

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

• Any penalties or surrender charges associated with the early

withdrawal of any savings instrument or other investment in

your Roth IRA

If we are a nonbank custodian required to comply with Regulations

section 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 regulations, the IRS may require us to

substitute another trustee or custodian.

We may establish a policy requiring distribution of the entire

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

your Roth IRA drops below the minimum balance required under

the applicable investment or policy established.

9.09 Successor Custodian – If our organization changes its name,

reorganizes, merges with another organization (or comes under the

control of any federal or state agency), or if our entire organization

(or any portion that includes your Roth IRA) is bought by another

organization, that organization (or agency) will automatically

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

the type of organization authorized to serve as a Roth IRA trustee

or custodian.

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

time. Any amendment we make to comply with the Code and

related regulations 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 notify us in

writing that you do not consent.

9.11 Withdrawals or Transfers – All requests for withdrawal or transfer

will be in writing on a form provided by or acceptable to us. The

method of distribution must be specified in writing or in any other

method acceptable to us. The tax identification number of the

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

a distribution. Withdrawals will be subject to all applicable tax and

other laws and regulations, including but not limited to possible

early distribution penalty taxes, surrender charges, and withholding

requirements.

You are not required to take a distribution from your Roth IRA at

age 70

⁄2. At your death, however, your beneficiaries must begin

taking distributions in accordance with Article V and section 9.07 of

this article. We will make no distributions to you from your Roth IRA

until you provide us with a written request for a distribution on a

form provided by or acceptable to us.

9.12 Transfers From Other Plans – We can receive amounts transferred

to this Roth IRA from the trustee or custodian of another Roth IRA

as permitted by the Code. In addition, we can accept rollovers of

eligible rollover distributions from employer‐sponsored retirement

plans as permitted by the Code. We reserve the right not to accept

any transfer.

9.13 Liquidation of Assets – We have the right to liquidate assets in your

Roth IRA if necessary to make distributions or to pay fees, expenses,

taxes, penalties, or surrender charges properly chargeable against

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

we will decide, in our complete and sole discretion, and you agree

to not hold us liable for any adverse consequences that result from

our decision.

9.14 Restrictions on the Fund – Neither you nor any beneficiary may

sell, transfer, or pledge any interest in your Roth IRA in any manner

whatsoever, except as provided by law or this agreement.

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

contracts, or torts of any person entitled to distributions under this

agreement.

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

federal and state laws and regulations. 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 affected. Neither your nor our failure to

enforce at any time or for any period of time any of the provisions

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

or your right or our right thereafter to enforce each and every such

provision.

9.16 Broker – The Broker will be responsible for the execution of securities

orders. The Broker may require that you sign an agreement which

sets forth, among other things, its responsibilities and your

responsibilities regarding securities transactions for your Roth IRA.

9.17 Prohibited Transaction – If during any taxable year you engage in a

so‐called “prohibited transaction” with respect to your regular Roth

IRA, Spousal Roth IRA, or Rollover Roth IRA, the account will lose its

tax‐exempt status. In this event, the fair market value of all account

assets, valued as of the first day of such taxable year, will be

deemed distributed to you and includible in your gross income.

These prohibited transactions would include borrowing money

from your account or pledging your account or any portion thereof

as security for a loan. If you pledge your account or any portion

thereof as security for a loan, such pledge position will be deemed

distributed to you and includible in your gross income. If you have

not yet attained age fifty‐nine and one‐half (59

⁄2) years of age, an

additional excise tax equal to ten percent (10%) of the amount

pledged will be imposed on such funds includible in gross income.

Similarly, if your spouse engages in a prohibited transaction with

respect to his or her account, it will result in the same

consequences because he or she is the individual for whose benefit

the account was established.The assets in your Roth IRA shall not

be responsible for the debt, contracts or torts of any person

entitled to distributions under this Agreement.

Page 10 of 15

9.18 Mediation/Arbitration – If a dispute arises out of or relates to this

agreement, or the performance or breach thereof, the parties

agree first to try in good faith to settle the dispute by mediation

under the commercial mediation rules of the American Arbitration

Association, before resorting the arbitration. Thereafter, any

remaining unresolved controversy or claim arising out of or relating

to this agreement, or the performance or breach thereof, shall be

settled by arbitration in accordance with the commercial

arbitration rules of the American Arbitration Association. Any

mediation or arbitration shall be conducted in Canyon, TX. The sole

arbitrator shall be a retired or former judge of the Randall or Potter

County District Courts. Judgement upon the award rendered by the

arbitrator may be entered in any court having jurisdiction thereof.

GENERAL INSTRUCTIONS

Section references are to the Internal Revenue Code unless otherwise noted.

PURPOSE OF FORM

Form 5305‐RA is a model custodial account agreement that meets the

requirements of section 408A and has been pre‐approved by the IRS. A

Roth individual retirement account (Roth IRA) is established after the form

is fully executed by both the individual (depositor) and the custodian. This

account must be created in the United States for the exclusive benefit of

the depositor and his or her beneficiaries.

Do not file Form 5305‐RA with the IRS. Instead, keep it with your records.

Unlike contributions to Traditional individual retirement arrangements,

contributions to a Roth IRA are not deductible from the depositor’s gross

income; and distributions after 5 years that are made when the depositor

is 59

⁄2 years of age or older or on account of death, disability, or the

purchase of a home by a first‐time homebuyer (limited to $10,000), are

not includible in gross income. For more information on Roth IRAs,

including the required disclosures the custodian must give the depositor,

see Pub. 590, Individual Retirement Arrangements (IRAs).

DEFINITIONS

IRA Conversion Contributions – IRA conversion contributions are amounts

rolled over, transferred, or considered transferred from a nonRoth IRA to

a Roth IRA. A nonRoth IRA is an individual retirement account or annuity

described in section 408(a) or 408(b), other than a Roth IRA.

Custodian – The custodian must be a bank or savings and loan association,

as defined in section 408(n), or any person who has the approval of the IRS

to act as custodian.

Depositor – The depositor is the person who establishes the custodial

account.

SPECIFIC INSTRUCTIONS

Article I – The depositor may be subject to a 6% tax on excess

contributions if (1) contributions to other individual retirement

arrangements of the depositor have been made for the same tax year, (2)

the depositor’s adjusted gross income exceeds the applicable limits in

Article II for the tax year, or (3) the depositor’s and spouse’s compensation

is less than the amount contributed by or on behalf of them for the tax

year. The depositor should see the disclosure statement or Pub. 590 for

more information.

Article V – This article describes how distributions will be made from the

Roth IRA after the depositor’s death. Elections made pursuant to this

article should be reviewed periodically to ensure they correspond to the

depositor’s intent. Under paragraph 3 of Article V, the depositor’s spouse

is treated as the owner of the Roth IRA upon the death of the depositor,

rather than as the beneficiary. If the spouse is to be treated as the

beneficiary and not the owner, an overriding provision should be added to

Article IX.

Article IX – Article IX and any that follow it may incorporate additional

provisions that are agreed to by the depositor and custodian to complete

the agreement. They may include, for example, definitions, investment

powers, voting rights, exculpatory provisions, amendment and

termination, removal of the custodian, custodian’s fees, state law

requirements, beginning date of distributions, accepting only cash,

treatment of excess contributions, prohibited transactions with the

depositor, etc. Attach additional pages if necessary.

Page 11 of 15

RIGHT TO REVOKE YOUR ROTH IRA

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

receipt of the disclosure statement. If revoked, you are entitled to a full

return of the contribution you made to your Roth IRA. The amount

returned to you would not include an adjustment for such items as sales

commissions, administrative expenses, or fluctuation in market value. You

may make this revocation only by mailing or delivering a written notice to

the custodian at the address listed on the application.

If you send your notice by first class mail, your revocation will be deemed

mailed as of the postmark date.

If you have any questions about the procedure for revoking your Roth IRA,

please call the custodian at the telephone number listed on the

application.

REQUIREMENTS OF A ROTH IRA

A. Cash Contributions – Your contribution must be in cash, unless it is a

rollover or conversion contribution.

B. Maximum Contribution – The total amount you may contribute to a

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

of your compensation or $5,000 for 2011 and for 2012, with possible

cost‐of‐living adjustments each year thereafter. If you also maintain a

Traditional IRA (i.e., an IRA subject to the limits of Internal Revenue

Code Sections (IRC Secs.) 408(a) or 408(b)), the maximum contribution

to your Roth IRAs is reduced by any contributions you make to your

Traditional IRAs. Your total annual contribution to all Roth IRAs and

Traditional IRAs cannot exceed the lesser of the dollar amounts

described above or 100 percent of your compensation.

Your Roth IRA contribution is further limited if your modified adjusted

gross income (MAGI) equals or exceeds $173,000 (for 2012) if you are

a married individual filing a joint income tax return, or equals or

exceeds $110,000 (for 2012) if you are a single individual. Married

individuals filing a joint income tax return with MAGI equaling or

exceeding $183,000 (for 2012) may not fund a Roth IRA. Single

individuals with MAGI equaling or exceeding $125,000 (for 2012) may

not fund a Roth IRA. Married individuals filing a separate income tax

return with MAGI equaling or exceeding $10,000 may not fund a Roth

IRA. The MAGI limits described above are subject to cost‐of‐living

increases for tax years beginning after 2012.

If you are married filing a joint income tax return and your MAGI is

between the applicable MAGI phase‐out range for the year, your

maximum Roth IRA contribution is determined as follows. (1) Begin

with the appropriate MAGI phase‐out maximum for the applicable year

and subtract your MAGI; (2) divide this total by the difference between

the phase‐out range maximum and minimum; and (3) multiply this

number by the maximum allowable contribution for the applicable

year, including catch‐up contributions if you are age 50 or older. For

example, if you are age 30 with MAGI of $178,000, your maximum

Roth IRA contribution for 2012 is $2,500 ([$183,000 minus $178,000]

divided by $10,000 and multiplied by $5,000).

If you are single and your MAGI is between the applicable MAGI phase‐

out for the year, your maximum Roth IRA contribution is determined as

follows. (1) Begin with the appropriate MAGI phase‐out maximum for

the applicable year and subtract your MAGI; (2) divide this total by the

difference between the phase‐out range maximum and minimum; and

(3) multiply this number by the maximum allowable contribution for

the applicable year, including catch‐up contributions if you are age 50

or older. For example, if you are age 30 with MAGI of $113,000, your

maximum Roth IRA contribution for 2012 is $4,000 ([$125,000 minus

$113,000] divided by $15,000 and multiplied by $5,000).

Contribution Eligibility –

You are eligible to make a regular

contribution to your Roth IRA, regardless of your age, if you have

compensation and your MAGI is below the maximum threshold. Your

Roth IRA contribution is not limited by your participation in an

employer‐sponsored retirement plan, other than a Traditional IRA.

D. Catch‐Up Contributions – If you are age 50 or older by the close of the

taxable year, you may make an additional contribution to your Roth

IRA. The maximum additional contribution is $1,000 per year.

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

F. Eligible Custodians – The custodian of your Roth IRA must be a bank,

savings and loan association, credit union, or a person or entity

approved by the Secretary of the Treasury.

Commingling Assets –

The assets of your Roth IRA cannot be

commingled with other property except in a common trust fund or

common investment fund.

H. Life Insurance – No portion of your Roth IRA may be invested in life

insurance contracts.

I. Collectibles – You may not invest the assets of your Roth IRA in

collectibles (within the meaning of IRC Sec. 408(m)). A collectible is

defined as any work of art, rug or antique, metal or gem, stamp or coin,

alcoholic beverage, or other tangible personal property specified by

the Internal Revenue Service (IRS). However, specially minted United

States gold and silver coins, and certain state‐issued coins are

permissible investments. Platinum coins and certain gold, silver,

platinum, or palladium bullion (as described in IRC Sec. 408(m)(3)) are

also permitted as Roth IRA investments.

J. Beneficiary Payouts – Your designated beneficiary is determined

based on the beneficiaries designated as of the date of your death,

who remain your beneficiaries as of September 30 of the year

following the year of your death. The entire amount remaining in your

account will, at the election of your designated beneficiaries, either

1. be distributed by December 31 of the year containing the fifth

anniversary of your death, or

2. be distributed over the remaining life expectancy of your designated

beneficiaries.

If your spouse is your sole designated beneficiary, he or she must elect

either option (1) or (2) by the earlier of December 31 of the year

containing the fifth anniversary of your death, or December 31 of the

year life expectancy payments would be required to begin. Your

designated beneficiaries, other than a spouse who is the sole

designated beneficiary, must elect either option (1) or (2) by December

31 of the year following the year of your death. If no election is made,

distribution will be calculated in accordance with option (2). In the case

of distributions under option (2), distributions must commence by

December 31 of the year following the year of your death. Generally, if

your spouse is the designated beneficiary, distributions need not

commence until December 31 of the year you would have attained age

⁄2, if later. If a beneficiary other than a person or qualified trust as

defined in the Treasury Regulations is named, you will be treated as

having no designated beneficiary of your Roth IRA for purposes of

determining the distribution period. If there is no designated

beneficiary of your Roth IRA, the entire Roth IRA must be distributed by

December 31 of the year containing the fifth anniversary of your death.

DISCLOSURE STATEMENT

Page 12 of 15

A spouse who is the sole designated beneficiary of your entire Roth IRA

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

either (1) making contributions to your Roth IRA or (2) failing to timely

remove a required minimum distribution from your Roth IRA.

Regardless of whether or not the spouse is the sole designated

beneficiary of your Roth IRA, a spouse beneficiary may roll over his or

her share of the assets to his or her own Roth IRA.

If we so choose, for any reason (e.g., due to limitations of our charter

or bylaws), we may require that a beneficiary of a deceased Roth IRA

owner take total distribution of all Roth IRA assets by December 31 of

the year following the year of death.

If your beneficiary fails to remove a required minimum distribution

after your death, an additional penalty tax of 50 percent is imposed on

the amount of the required minimum distribution that should have

been taken but was not. Your beneficiary must file IRS Form 5329 along

with his or her income tax return to report and remit any additional

taxes to the IRS.

INCOME TAX CONSEQUENCES OF ESTABLISHING A ROTH IRA

A. Contributions Not Deducted – No deduction is allowed for Roth IRA

contributions, including transfers, rollovers, and conversion

contributions.

B. Contribution Deadline – The deadline for making a Roth IRA

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

may designate a contribution as a contribution for the preceding

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

calendar‐year taxpayer and you make your Roth IRA contribution on or

before your tax filing deadline, your contribution 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 contingency operation, you may have an

extended contribution deadline of 180 days after the last day served in

the area. In addition, your contribution deadline for a particular tax

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

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

additional extension to make your Roth IRA contribution cannot

exceed the number of days between January 1 and your tax filing

deadline, not including extensions.

C. Tax Credit for Contributions – You may be eligible to receive a tax

credit for your Roth IRA contributions. This credit 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‐time student.

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

from 0 to 50 percent of eligible contributions. In order to determine

the amount of your contributions, add all of the contributions made to

your Roth IRA and reduce these contributions by any distributions that

you have taken during the testing period. The testing period begins

two years prior to the year for that the credit is sought and ends on the

tax return due date (including extensions) for the year for that the

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

applicable percentage from the chart below by the amount of your

contributions that do not exceed $2,000.

2012 Adjusted Gross Income*

Joint Head of a All Other

Applicable

Return Household Cases

Percentage

$1 – 34,500 $1 – 25,875 $1 – 17,250 50

$34,501 – 37,500 $25,876 – 28,125 $17,251 – 18,750 20

$37,501 – 57,500 $28,126 – 43,125 $18,751 – 28,750 10

Over $57,500 Over $43,125 Over $28,750 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 Contributions – An excess contribution is any amount that is

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

eligible to contribute. If the excess is not corrected timely, an

additional penalty tax of six percent will be imposed upon the excess

amount. The procedure for correcting an excess is determined by the

timeliness of the correction as identified below.

1. Removal Before Your Tax Filing Deadline. An excess contribution

may be corrected by withdrawing the excess amount, along with

the earnings attributable to the excess, before your tax filing

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

contribution was made. An excess withdrawn under this method is

not taxable to you, but you must include the earnings attributable

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

contribution was made. The six percent excess contribution penalty

tax will be avoided.

2. Removal After Your Tax Filing Deadline. If you are correcting an

excess contribution after your tax filing deadline, including

extensions, remove only the amount of the excess contribution.

The six percent excess contribution penalty tax will be imposed on

the excess contribution for each year it remains in the Roth IRA. An

excess withdrawal under this method is not taxable to you.

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

excess contribution, you may carry forward the contribution for a

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

year and carry the excess contribution amount forward to that year

on your tax return. The six percent excess contribution penalty tax

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

as an excess contribution at the end of the year.

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

report and remit any additional taxes to the IRS.

E. Tax‐Deferred Earnings – The investment earnings of your Roth IRA are

not subject to federal income tax as they accumulate in your Roth IRA.

In addition, distributions of your Roth IRA earnings will be free from

federal income tax if you take a qualified distribution, as described

below.

Taxation of Distributions

– The taxation of Roth IRA distributions

depends on whether the distribution is a qualified distribution or a

nonqualified distribution.

1. Qualified Distributions. Qualified distributions from your Roth IRA

(both the contributions and earnings) are not included in your

income. A qualified distribution is a distribution that is made after

the expiration of the five‐year period beginning January 1 of the

first year for which you made a contribution to any Roth IRA

(including a conversion from a Traditional IRA), and is made on

account of one of the following events.

• Attainment of age 59

⁄2

• Disability

• First‐time homebuyer purchase

• Death

Page 13 of 15

For example, if you made a contribution to your Roth IRA for 2007,

the five‐year period for determining whether a distribution is a

qualified distribution is satisfied as of January 1, 2012.

2. Nonqualified Distributions. If you do not meet the requirements

for a qualified distribution, any earnings you withdraw from your

Roth IRA will be included in your gross income and, if you are under

age 59

⁄2, may be subject to an early distribution penalty tax.

However, when you take a distribution, the amounts you

contributed annually to any Roth IRA and any military death

gratuity or Servicemembers’ Group Life Insurance (SGLI) payments

that you rolled over to a Roth IRA, will be deemed to be removed

first, followed by conversion and employer‐sponsored retirement

plan rollover contributions made to any Roth IRA on a first‐in, first‐

out basis. Therefore, your nonqualified distributions will not be

taxable to you until your withdrawals exceed the amount of your

annual contributions, rollovers of your military death gratuity or

SGLI payments, and your conversions and employer‐sponsored

retirement plan rollovers.

Income Tax Withholding

– Any nonqualified withdrawal of earnings

from your Roth IRA may be subject to federal income tax withholding.

You may, however, elect not to have withholding apply to your Roth

IRA withdrawal. If withholding is applied to your withdrawal, not less

than 10 percent of the amount withdrawn must be withheld.

Early Distribution Penalty Tax

– If you are under age 59

⁄2 and receive a

nonqualified Roth IRA distribution, an additional early distribution

penalty tax of 10 percent generally will apply to the amount includible

in income in the year of the distribution. If you are under age 59

⁄2 and

receive a distribution of conversion amounts or employer‐sponsored

retirement plan rollover amounts within the five‐year period beginning

with the year in which the conversion or employer‐sponsored

retirement plan rollover occurred, an additional early distribution

penalty tax of 10 percent generally will apply to the amount of the

distribution. The additional early distribution penalty tax of 10 percent

generally will not apply if one of the following exceptions apply.

1) Death. After your death, payments made to your beneficiary are not

subject to the 10 percent early distribution penalty tax. 2) Disability. If

you are disabled at the time of distribution, you are not subject to the

additional 10 percent early distribution 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, continued, and indefinite

duration. 3) Substantially equal periodic payments. You are not

subject to the additional 10 percent early distribution penalty tax if you

are taking a series of substantially equal periodic payments (at least

annual payments) over your life expectancy or the joint life expectancy

of you and your beneficiary. You must continue these payments for the

longer of five years or until you reach age 59

⁄2. 4) Unreimbursed

medical expenses. If you take payments to pay for unreimbursed

medical expenses exceeding 7.5 percent of your adjusted gross income

(increasing to 10 percent of adjusted gross income beginning in 2013),

you will not be subject to the 10 percent early distribution 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 compensation for 12

consecutive weeks under a federal or state program, you may take

payments from your Roth IRA to pay for health insurance premiums

without incurring the 10 percent early distribution penalty tax.

6) Higher education expenses. Payments taken for certain qualified

higher education expenses for you, your spouse, or the children or

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

percent early distribution penalty tax. 7) First‐time homebuyer. You

may take payments from your Roth IRA to use toward qualified

acquisition costs of buying or building a principle residence. The

amount you may take for this reason may not exceed a lifetime

maximum of $10,000. The payment must be used for qualified

acquisition costs within 120 days of receiving the distribution. 8) IRS

levy. Payments from your Roth IRA made to the U.S. government in

response to a federal tax levy are not subject to the 10 percent early

distribution penalty tax. 9) Qualified reservist distributions. If you are

a qualified reservist member called to active duty for more than 179

days or an indefinite period, the payments you take from your Roth IRA

during the active duty period are not subject to the 10 percent early

distribution penalty tax.

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

IRS to report and remit any additional taxes or to claim a penalty tax

exception.

I. Required Minimum Distributions – You are not required to take

distributions from your Roth IRA at age 70

⁄2 (as required for Traditional

and savings incentive match plan for employees of small employers

(SIMPLE) IRAs). However, your beneficiaries generally are required to

take distributions from your Roth IRA after your death. See the section

titled Beneficiary Payouts in this disclosure statement regarding

beneficiaries’ required minimum distributions.

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

another Roth IRA of yours, may receive rollover contributions, or may

receive conversion contributions, provided that all of the applicable

rollover or conversion rules are followed. Rollover is a term used to

describe a movement of cash or other property to your Roth IRA from

another Roth IRA, or from your employer’s qualified retirement plan,

403(a) annuity, 403(b) tax‐sheltered annuity, 457(b) eligible

governmental deferred compensation plan, or federal Thrift Savings

Plan. Conversion is a term used to describe the movement of

Traditional IRA or SIMPLE IRA assets to a Roth IRA. A conversion

generally is a taxable event. The general rollover and conversion rules

are summarized below. These transactions are often complex. If you

have any questions regarding a rollover or conversion, please see a

competent tax advisor.

1. Roth IRA to Roth IRA Rollovers. Assets distributed from your Roth

IRA may be rolled over to a Roth IRA of yours if the requirements of

IRC Sec. 408(d)(3) are met. A proper Roth IRA to Roth IRA rollover is

completed if all or part of the distribution is rolled over not later

than 60 days after the distribution is received. You may not have

completed another Roth IRA to Roth IRA rollover from the

distributing Roth IRA during the 12 months preceding the date you

receive the distribution. Further, you may roll over the same dollars

or assets only once every 12 months. In the case of a distribution for

a first‐time homebuyer where there was a delay or cancellation of

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

days. Roth IRA assets may not be rolled over to other types of IRAs

(e.g., Traditional IRA, SIMPLE IRA), or employer‐sponsored

retirement plans.

2. Traditional IRA to Roth IRA Conversions. If you convert to a Roth

IRA, the amount of the conversion from your Traditional IRA to your

Roth IRA will be treated as a distribution for income tax purposes,

and is includible in your gross income (except for any nondeductible

contributions). Although the conversion amount generally is

included in income, the 10 percent early distribution penalty tax

will not apply to conversions from a Traditional IRA to a Roth IRA,

regardless of whether you qualify for any exceptions to the 10

percent early distribution penalty tax. If you are age 70

⁄2 or older,

you must remove your required minimum distribution before

converting your Traditional IRA.

3. SIMPLE IRA to Roth IRA Conversions. You are eligible to convert all

or any portion of your existing SIMPLE IRA into your Roth IRA,

provided two years have passed since you first participated in a

SIMPLE IRA plan sponsored by your employer. The amount of the

conversion from your SIMPLE IRA to your Roth IRA will be treated

Page 14 of 15

as a distribution for income tax purposes and is includible in your

gross income. Although the conversion amount generally is

included in income, the 10 percent early distribution penalty tax

will not apply to conversions from a SIMPLE IRA to a Roth IRA,

regardless of whether you qualify for any exceptions to the 10

percent early distribution penalty tax. If you are age 70

⁄2 or older

you must remove your required minimum distribution before

converting your SIMPLE IRA.

4. Rollovers of Roth Elective Deferrals. Roth elective deferrals

distributed from a 401(k) cash or deferred arrangement, 403(b) tax‐

sheltered annuity, 457(b) eligible governmental deferred

compensation plan, or federal Thrift Savings Plan, may be rolled

into your Roth IRA.

5. Employer‐Sponsored Retirement Plan to Roth IRA Rollovers.

Assets distributed from your qualified retirement plan, 403(a)

annuity, 403(b) tax‐sheltered annuity, 457(b) eligible governmental

deferred compensation plan, or federal Thrift Savings Plan may be

rolled over to your Roth IRA. If you are a spouse, nonspouse, or

qualified trust beneficiary who has inherited a qualified retirement

plan, 403(a) annuity, 403(b) tax‐sheltered annuity, or 457(b) eligible

governmental deferred compensation plan, you may be eligible to

directly roll over the assets to an inherited Roth IRA. The inherited

Roth IRA is subject to the beneficiary distribution requirements.

Although the rollover amount generally is included in income, the

10 percent early distribution penalty tax will not apply to rollovers

from eligible employer‐sponsored retirement plans to a Roth IRA or

inherited Roth IRA, regardless of whether you qualify for any

exceptions to the 10 percent early distribution penalty tax.

6. Beneficiary Rollovers From 401(k), 403(b), or 457(b) Eligible

Governmental Plans Containing Roth Elective Deferrals. If you are

a spouse, nonspouse, or qualified trust beneficiary of a deceased

401(k), 403(b), or 457(b) eligible governmental deferred

compensation plan participant who had made Roth elective

deferrals to the plan, you may directly roll over the Roth elective

deferrals and their earnings to an inherited Roth IRA. The Roth IRA

must be maintained as an inherited Roth IRA, subject to the

beneficiary distribution requirements.

7. Rollovers of Military Death Benefits. If you receive or have

received a military death gratuity or a payment from the SGLI

program, you may be able to roll over the proceeds to your Roth

IRA. The rollover contribution amount is limited to the sum of the

death benefits or SGLI payment received, less any such amount that

was rolled over to a Coverdell education savings account. Proceeds

must be rolled over within one year of receipt of the gratuity or SGLI

payment for deaths occurring on or after June 17, 2008. Any

amount that is rolled over under this provision is considered

nontaxable basis in your Roth IRA.

8. Qualified HSA Funding Distribution. If you are eligible to

contribute to a health savings account (HSA), you may be eligible to

take a one‐time tax‐free qualified HSA funding distribution from

your Roth IRA and directly deposit it to your HSA. The amount of

the qualified HSA funding distribution may not exceed the

maximum HSA contribution limit in effect for the type of high

deductible health plan coverage (i.e., single or family coverage) that

you have at the time of the deposit, and counts toward your HSA

contribution limit for that year. For further detailed information,

you may wish to obtain IRS Publication 969, Health Savings

Accounts and Other Tax‐Favored Health Plans.

9. Rollovers of Settlement Payments From Bankrupt Airlines. If

you are a qualified airline employee who has received an airline

settlement payment from a commercial airline carrier under the

approval of an order of a federal bankruptcy court in a case filed

after September 11, 2001, and before January 1, 2007, you are

allowed to roll over any portion of the proceeds into your Roth

IRA by the later of 180 days after receipt of such amount, or June

21, 2009. To obtain more information on this type of rollover,

you may wish to visit the IRS website at www.irs.gov.

10. Rollovers of Exxon Valdez Settlement Payments. If you receive a

qualified settlement payment from Exxon Valdez litigation, you may

roll over the amount of the settlement, up to $100,000, reduced by

the amount of any qualified Exxon Valdez settlement income

previously contributed to a Traditional or Roth IRA or eligible

retirement plan in prior taxable years. You will have until your tax

return due date (not including extensions) for the year in which the

qualified settlement income is received to make the rollover

contribution. To obtain more information on this type of rollover,

you may wish to visit the IRS website at www.irs.gov.

11. Written Election. At the time you make a rollover or conversion to

a Roth IRA, you must designate in writing to the custodian your

election to treat that contribution as a rollover or conversion. Once

made, the election is irrevocable.

K. Transfer Due to Divorce – If all or any part of your Roth IRA is awarded

to your spouse or former spouse in a divorce or legal separation

proceeding, the amount so awarded will be treated as the spouse’s

Roth IRA (and may be transferred pursuant to a court‐approved

divorce decree or written legal separation agreement to another Roth

IRA of your spouse), and will not be considered a taxable distribution

to you. A transfer is a tax‐free direct movement of cash and/or

property from one Roth IRA to another.

L. Recharacterizations – If you make a contribution to a Traditional IRA

and later recharacterize either all or a portion of the original

contribution to a Roth IRA along with net income attributable, you may

elect to treat the original contribution as having been made to the Roth

IRA. The same methodology applies when recharacterizing a

contribution from a Roth IRA to a Traditional IRA. If you have converted

from a Traditional IRA to a Roth IRA you may recharacterize the

conversion along with net income attributable back to a Traditional

IRA. If you have rolled over an eligible employer‐sponsored retirement

plan to a Roth IRA, you may recharacterize the rollover amount along

with net income attributable to a Traditional IRA. The deadline for

completing a recharacterization is your tax filing deadline (including

any extensions) for the year for which the original contribution was

made or conversion or rollover completed.

LIMITATIONS AND RESTRICTIONS

A. Spousal Roth IRA – If you are married and have compensation, you

may contribute to a Roth IRA established for the benefit of your

spouse, regardless of whether or not your spouse has compensation.

You must file a joint income tax return for the year for which the

contribution is made.

The amount you may contribute to your Roth IRA and your spouse’s

Roth IRA is the lesser of 100 percent of your combined eligible

compensation or $10,000 for 2012. This amount may be increased with

cost‐of‐living adjustments each year. However, you may not contribute

more than the individual contribution limit to each Roth IRA. Your

contribution may be further limited if your MAGI falls within the

minimum and maximum thresholds.

If your spouse is age 50 or older by the close of the taxable year, and is

otherwise eligible, you may make an additional contribution to your

spouse’s Roth IRA. The maximum additional contribution is $1,000 per

year.

B. Gift Tax – Transfers of your Roth IRA assets to a beneficiary made

during your life and at your request may be subject to federal gift tax

under IRC Sec. 2501.

Page 15 of 15

C. Special Tax Treatment – Capital gains treatment and 10‐year income

averaging authorized by IRC Sec. 402 do not apply to Roth IRA

distributions.

D. Prohibited Transactions – If you or your beneficiary engage in a

prohibited transaction with your Roth IRA, as described in IRC Sec.

4975, your Roth IRA will lose its tax‐deferred or tax‐exempt status, and

you generally must include the value of the earnings in your account in

your gross income for that taxable year. The following transactions are

examples of prohibited transactions with your Roth IRA. (1) Taking a

loan from your Roth IRA (2) Buying property for personal use (present

or future) with Roth IRA assets (3) Receiving certain bonuses or

premiums because of your Roth IRA.

E. Pledging – If you pledge any portion of your Roth IRA as collateral for

a loan, the amount so pledged will be treated as a distribution and may

be included in your gross income for that year.

OTHER

A. IRS Plan Approval – The agreement used to establish this Roth IRA has

been approved by the IRS. The IRS approval is a determination only as

to form. It is not an endorsement of the plan in operation or of the

investments offered.

B. Additional Information – You may obtain further information on Roth

IRAs from your District Office of the IRS. In particular, you may wish to

obtain IRS Publication 590, Individual Retirement Arrangements (IRAs),

by calling 1‐800‐TAX‐FORM, or by visiting www.irs.gov on the Internet.

Important Information About Procedures for Opening a New Account –

To help the government fight the funding of terrorism and money

laundering activities, federal law requires all financial organizations to

obtain, verify, and record information that identifies each person who

opens an account. Therefore, when you open a Roth IRA, you are

required to provide your name, residential address, date of birth, and

identification number. We may require other information that will

allow us to identify you.

D. Qualified Reservist Distributions – If you are an eligible qualified

reservist who has taken penalty‐free qualified reservist distributions

from your Roth IRA or retirement plan, you may recontribute those

amounts to a Roth IRA generally within a two‐year period from your

date of return.

E. Qualified Charitable Distributions – If you are age 70

⁄2 or older, you

may take tax‐free Roth IRA distributions of up to $100,000 per year and

have these distributions paid directly to certain charitable

organizations. Special tax rules may apply. This provision applies to

distributions during tax years 2012 and 2013 and may apply to

subsequent years if extended by Congress. For further detailed

information and effective dates you may wish to obtain IRS Publication

590, Individual Retirement 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 affected by, certain

IRS designated disasters), you may be eligible for favorable tax

treatment on distributions, rollovers, and other transactions involving

your Roth IRA. Qualified disaster relief may include penalty‐tax free

early distributions made during specified timeframes for each disaster,

the ability to include distributions in your gross income ratably over

multiple years, the ability to roll over distributions to an eligible

retirement plan without regard to the 60‐day rollover rule, and more.

For additional information on specific disasters, including a complete

listing of disaster areas, qualification requirements for relief, and

allowable disaster‐related Roth IRA transactions, you may wish to

obtain IRS Publication 590, Individual Retirement Arrangements (IRAs),

from the IRS or refer to the IRS website at www.irs.gov.

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