IRA DISTRIBUTION REQUEST

IRA Account Holder Payee Name (If Different from IRA Holder) IRA Account Number

Residence Address ( If different from address on SS# or Tax ID to be used for Tax Reporting Trust Officer’s Printed Name
record)
City: State: Zip:
Please complete Section A, B, and C to initiate a distribution from your IRA.
A. REASON FOR WITHDRAWAL (Please select all that apply)
1. Normal Distribution (Over 59 ½) 6. Payment Due to owner’s Death or Disability
2. Early Distribution (Under 59 ½) Reason for W/D 7. Terminate my entire IRA & distribute outright-taxable event.
3. Required Minimum Dist $ 8. Roth Distribution
4. Series of Substantially Equal Periodic Payment 9. Qualified Charitable Distribution (QCD)
5. Withdrawal of Excess Contribution a. Must be 70 ½ on date of distribution
Including gain/loss for tax year 20 b. Not allowed if IRA has received a current year SEP contribution
B. DISTRIBUTION AMOUNT AND FREQUENCY (Please indicate the amount of the distribution and tax election)
1. Standing Instructions for Merrill Lynch Clients ONLY: Distribute upon If selected, must complete Standing Authorization
my request to the account(s) listed in Section C and in accordance with section below and Fed and State Income Tax Withholding
Sections 3 through 6 below. elections (sections 3 through 6 below).
2. GROSS AMOUNT (The gross amount to be distributed one-time OR EVERY $ Gross = the amount before withholding is deducted. Not
month, quarter, semi-annual pymt) required if Net Amt is provided
3. I AM A NON-RESIDENT ALIEN (check one) YES NO If not selected, default is NO
4. DO NOT WITHHOLD FEDERAL INCOME TAX Required, if electing out of fed income tax
5. FEDERAL INCOME TAX WITHHOLDING (% OR $) 0 If requested, cannot be less than 10%
6. STATE INCOME TAX WITHHOLDING (% OR $) 0 *STATE OF RESIDENCE
If a net amount is specified, fed & state fields are
7. SPECIFIC NET AMOUNT (after withholding deductions) $
required to calculate the Gross Amount
8. Frequency: One Time Payment PERIODIC: Monthly Quarterly Semi-Annually Annually
9. Distribution Date: - - Stop Date: - -
C. METHOD OF DISTRIBUTION (Please select the appropriate method)
Mail check to Payee Mail check to Payee via overnight mail Mail check to City Office-Sub Class (required Trust Officer)
Credit Bank of America Bank Account # Checking Savings ABA#
Credit Merrill Lynch Account # Acct Type (required)
Credit U.S. TRUST Acct # Acct Type (required)
[I/I or I/P or P/I or P/P] (if left blank, default is P/P) (required by Trust Officer
ACH deposit to: Bank Name: Checking Savings ABA#
Acct #
WIRE DOMESTIC INTERNATIONAL FOREIGN
Wire Transfer to: Bank Name: ABA#
Credit Account Name: Acct #
FFC – Account Name: Acct #
Standing Authorization to Relay Distribution Requests Through Named Financial Advisor
I authorize this option. Note: Check the first box in Section B, indicate withholding election, and select one or more payment methods in Section C listed above.
The undersigned hereby authorizes U.S. Trust to make distributions from the above referenced account to me upon my verbal request based on any distribution instructions
provided in Sections B and C listed above. I agree to phone any such instructions either (1) directly to my Trust Officer (or his/her associate) or (2) directly to my Merrill Lynch
financial advisor (or his/her associate) listed below who shall then communicate such instructions to my Trust Officer. U.S. Trust is authorized to rely on such verbal instructions
consistent with the terms of my account’s governing instrument and the terms of this authorization.
Name of Primary advisor: Name of Alternate advisor:
If the verbal instructions are inconsistent with certain internally established U.S. Trust procedures and guidelines, it is understood that U.S. Trust reserves the right to require that
such verbal requests must be memorialized in the form of a written letter of authorization.
Withholding Notice – For Traditional IRA Only
Federal Income taxes are required to be withheld (subtracted) from your non-periodic distributions at a flat rate of 10% and from your periodic distributions as if the distributions are
wages and you are married with three exemptions, unless you tell us that you don’t want any taxes withheld. State income taxes will be withheld according to the specific
requirements of the state in which you reside. You must use this form to instruct us whether you want income taxes withheld from the distributions you will receive from your
retirement account and to withhold on a different basis than the prescribed methods. Even if you elect not to have Federal and State income taxes withheld from your distribution,
you are liable for payment of Federal and State income taxes on the taxable portion of your distribution. If you do not want any Federal Income Taxes withheld from your
distribution, please check the appropriate box located under the Gross Amount field. Please consult with your tax advisor to determine if State Income Tax is mandatory in your
State of Residence.
Estimated taxes. Under Internal Revenue Service rules, if you choose not to have federal income taxes withheld - or if the amount withheld from your distributions is not sufficient -
you may be responsible for paying estimated taxes every quarter. When your actual taxes for a year are determined, you could incur IRS penalties if your estimated federal income
tax payments were not sufficient. You may incur similar tax penalties under state law.
The undersigned herby authorizes and directs Bank of America to withdraw funds from the indicated account above and to disburse them in accordance with the above instructions.
The undersigned hereby certifies that this distribution request satisfies the requirements of the Internal Revenue Code regarding required minimum annual IRA distributions. Bank of
America may rely on this certification without further investigation and inquiry and shall incur no liability thereon, including calculations provided by Bank of America. The
undersigned, also acknowledges that he/she has been advised to seek competent tax and/or estate planning advice. The undersigned expressly assumes the responsibility of any
adverse consequences that may arise from this distribution. The undersigned understands that neither Bank of America nor its employees can give an opinion or advice regarding
the consequences of the tax or other laws as they relate to a particular situation, and the undersigned has neither received nor relied upon any such opinion or advice from Bank of
America or its employees.
Comments: This is instruction to transfer ALL REMAINING BALANCE OF THE ACCOUNT.
I have read the terms of the Bank of America Trusteed IRA from which I am taking the withdrawal and my instructions comply with those terms.
IRA Holder’s Printed Name: IRA Holder’s Signature Date:

Revise Date -1-13-2017

00-42-2683NSB, RPP 6012B