ES_TDR_WD_081901 1119 — Page 3 of 4
DO NOT STAPLE
Amount of withdrawal (Choose one.)
A. Full balance. Withdraw the entire amount held in all of the Investment Options in my Account, discontinue my Automatic
Investment Plan (AIP) (if applicable), and close this Account.
Important: If you contribute to your Account through payroll direct deposit, you must notify your employer to cancel these contributions.
B. Partial amount of
Withdraw this amount proportionately from among my current Investment Options. If the amount you indicate exceeds the
amount available, TD Ameritrade 529 College Savings Plan will liquidate the entire balance, discontinue your AIP, and close
C. Partial amount as follows.
Important: If the dollar amount you indicate for a particular Investment Option exceeds the amount available for withdrawal,
we will liquidate the entire balance of that Investment Option.
Dollar amount OR Total balance
Name of Investment Option (For partial amounts.) (Check if applicable.)
Signature — YOU MUST SIGN BELOW
• I certify that I have read, understand, consent, and agree to all terms and conditions of the Program Disclosure Statement and
understand the rules and regulations governing withdrawals from my TD Ameritrade 529 College Savings Plan Account. I also certify
that the information provided on this form is accurate and hereby instruct the TD Ameritrade 529 College Savings Plan to distribute
my Account as I have indicated.
• By signing below, I authorize the Program Manager or its designees to withdraw funds according to the instructions above. I
understand that if I have changed my address or the Account Owner, I cannot withdraw funds within ten (10) business days of the
change without the Medallion Signature Guarantee.
• I understand that the earnings portion of Non-Qualied Withdrawals is subject to federal income tax and an additional 10%
federal tax, and may be subject to state income tax. I understand that Non-Qualied Withdrawals due to the death, disability, or
scholarship awarded to the Beneciary (up to the scholarship amount) may not be subject to the additional 10% federal tax. Further,
I also understand that I am responsible for reporting the withdrawal on my income tax returns for the tax year the Non-Qualied
Withdrawal was made.
• I understand that if I had taken a state income tax deduction or credit on my state income taxes I will need to check with my home
state to determine if my deduction or credit is subject to recapture.
• If the Account is owned by an entity or trust, I certify that I am authorized to act on its behalf in making this request. If the Account
is minor-owned or is funded with UGMA/UTMA assets, I further certify that I am the Parent/Guardian/Custodian of the Account in
question, and that this request is in the best interest of the Beneciary.
• I understand investments are not guaranteed or insured by the FDIC, the SIPC or any other government agency, and are not deposits
or other obligations of any depository institution. Investments are not guaranteed or insured by the TD Ameritrade 529 College
Savings Plan, the Trust, the State of Nebraska, the Nebraska State Treasurer, the Nebraska Investment Council, or any of their
authorized agents or afliates, or the Program Manager or its authorized agents or any of their afliates, or TD Ameritrade, TD
Ameritrade Investment Management, LLC or their authorized agents or afliates, and are subject to investment risks including the
loss of the principal amount invested.
Signature of Account Owner Date (mm/dd/yyyy)