Fillable Rlovpe Rollover – Parent

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Rlovpe Rollover – Parent

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Office of Student Financial Aid
Phone : (240)567-5100
Email: FinancialAid@montgomerycollege.edu
PRINT
M
Office use only Code RLOVPE / FA ROLLOVER PAR
EVEN
2019-2020 Rollover – Parent
SECTION A: STUDENT INFORMATION
Student Name:
MC ID#
During the Data Retrieval Tool (DRT) process, an amount greater than zero was transferred into the FAFSA or an
amount greater than zero appears on your Tax Transcript as Untaxed Portions of IRA Distribution field or the
Untaxed Portion of Pensions.
Section B: 2017 Federal Tax IRA Rollover
Please provide all of your parents’ 2017 1099R statement(s).
SECTION C: CERTIFICATION
I / We certify that all the information contained on this form is complete and correct. NOTE: If you purposely give false
or
misleading information, you may be imprisoned and/or fined up to $25,000. I / We
understand that this form must be
signed and submitted with all other requested documents before my financial aid will be processed.
Electronic signatures are not accepted.
Student Signature (must be signed in ink) Date
_____________________________________ _________
Parent Signature (must be signed in ink) Date
Office Use Only
_______________ Box 1 amount
_______________ Box 2a amount
_______________ Box 1 minus Box 2a
_______________ Box 7, if code G and/or H, report difference of box 1 minus box 2a
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Rlovpe Rollover Parent

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Completed 7 April 2020

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