Form 5305-RA
(Rev. April 2017)
Department of the Treasury
Internal Revenue Service
Roth Individual Retirement Custodial Account
(Under section 408A of the Internal Revenue Code)
Do not file
with the Internal
Revenue Service
Name of depositor Date of birth of depositor Account number
Address of depositor
Check if amendment . . .
Name of custodian Address or principal place of business of custodian
The depositor named above is establishing a Roth individual retirement account (Roth IRA) under section 408A to provide for
his or her retirement and for the support of his or her beneficiaries after death.
The custodian named above has given the depositor the disclosure statement required by Regulations section 1.408-6.
The depositor assigned the custodial account .
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The depositor and the custodian make the following agreement.
Article I
Except in the case of a qualified rollover contribution described in section 408A(e) or a recharacterized contribution described in
section 408A(d)(6), the custodian will accept only cash contributions up to $5,500 per year for 2013 through 2017. For individuals who
have reached the age of 50 by the end of the year, the contribution limit is increased to $6,500 per year for 2013 through 2017. For
years after 2017, these 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 grantor who is single
or treated as single, the annual contribution is phased out between adjusted gross income (AGI) of $118,000 and $133,000; for a
married grantor filing jointly, between AGI of $186,000 and $196,000; and for a married grantor filing separately, between AGI of $0
and $10,000. These phase-out ranges are for 2017. For years after 2017, the phase-out ranges, except for the $0 to $10,000 range,
will be increased to reflect a cost-of-living adjustment, if any. Adjusted gross income is defined in section 408A(c)(3).
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 paragraph (a) below or, if elected or there is no
designated beneficiary, in accordance with paragraph (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).
Cat. No. 25094Y
Form 5305-RA (Rev. 4-2017)
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Form 5305-RA (Rev. 4-2017)
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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 below.
Article IX
Article IX may be used for any additional provisions. If no other provisions will be added, draw a line through this space. If
provisions are added, they must comply with applicable requirements of state law and the Internal Revenue Code and may not imply
that they have been reviewed or pre-approved by the IRS.
Depositor’s signature Date
Custodian’s signature Date
Witness’ signature Date
(Use only if signature of the depositor or the custodian is required to be witnessed.)
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. However,
only Articles I through VIII have been
reviewed 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
1
/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
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-A, Contributions to
Individual Retirement Arrangements
(IRAs), and Pub. 590-B, Distributions
from Individual Retirement Arrangements
(IRAs).
Definitions
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.
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.
Form 5305-RA (Rev. 4-2017)
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