SAMPLE INSTRUCTION LETTER FROM DONOR TO IRA ADMINISTRATOR
To Whom It May Concern:
Section 208 of the American Taxpayer Relief Act of 2013 (ATRA) permits an IRA direct
rollover to a qualified charity through December 31, 2013. Please make a direct charitable
distribution of $_______________ from my IRA account number__________________.
The distribution should be payable to:
United Way of Siouxland
701 Steuben Street
Sioux City, IA 51101
You can reach the United Way of Siouxland by contacting Tim Stiles at
firstname.lastname@example.org and 712-255-3551 for additional information. In your
correspondence with United Way please include my name and address as the donor.
Please copy me on your correspondence. If you have any questions I can be reached at:
My Phone Number _______________________
Donor Name ___________________________