Inherited IRA Distribution Form

Beneficiary Full Name

First NameLast Name

Beneficiary Email Address

example@example.com

Beneficiary Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Beneficiary Address

Street Address

Street Address Line 2

CityState / ProvincePostal / Zip CodeCountry

Relationship to Decedent

Decedent's Full Name

First NameLast Name

Decedent's Date of Death

Date

IRA Account Number (last 4 digits only)

Distribution Method Requested

Other

Distribution Amount Requested (USD)

Federal Tax Withholding Election

State Tax Withholding Election

Distribution Delivery Method

Other

Additional Instructions or Comments

Signature of Beneficiary (required for processing)