_______ bank (to be completed by a KeyBank Employee) Request for one time distribution
Please complete this form to request a distribution from your KeyBank retirement account. Due to the tax consequences of these distributions,
please obtain the tax and legal advice necessary to make the proper elections below.
Name SSN Birth Date
WHAT TYPE OF DISTRIBUTION ARE YOU TAKING? (Complete information in one box only: PRE 59 ½, Normal, Age 70 ½, or Other)
PRE 59 ½
PREMATURE (You are under age 59 ½. The distribution may be subject to an IRS penalty tax.)
EXCEPTIONS TO IRS PENALTY Choose one of the following selections:
Disability (pursuant to IRS code section 72(m)(7)
Other (e.g. health insurance, medical expense, first time home buyer, or higher education --This distribution will be reported to the Internal Revenue Service as
“premature” and you will be required to provide proof to the IRS that an exception applies. This proof must be filed with Form 5329 and submitted with your taxes.)
NORMAL (You are between age 59 ½ and 70 ½.)
AGE 70 ½ or older (If you are scheduled to receive an automated distribution, and do not check the box below, we will ignore this distribution when
calculating and sending your next payment.)
Use the amount of this payment to reduce my required minimum distribution scheduled to be distributed later this year.
RETURN OF EXCESS CONTRIBUTION for tax year Choose one of the two following selections:
Before Tax Filing Deadline $_ _________ plus attributable earnings
After Tax Filing Deadline $_ __________ (Not applicable if you carry forward your excess non-deductible contributions.)
DIVORCE (Attach a copy of certified court documents. Receiving spouse must have or establish a retirement plan with KeyBank.)
CONVERSION to a KeyBank Roth IRA Total Partial Amount $
RECHARACTERIZATION (transfer of the amount specified below and the net income allocable to it)
The money is currently in a: The date this amount was originally deposited:
The amount being recharacterized was originally considered a: The amount to be recharacterized is the:
Contribution for year _____________ Total
Conversion Partial amount, $_______________
WHAT AMOUNT DO YOU WANT DISTRIBUTED?
Total payout (to close out all account(s) within plan)
Close the following account(s)
Partial payout $ Account Number
WHAT METHOD OF PAYMENT DO YOU WISH?
Mail Check Deposit to my KeyBank checking/savings#
CITIZENSHIP (choose one of the following):
I am a U.S. Citizen.
I am a Resident Alien.
I am a Non-Resident Alien and have attached IRS Form W-8BEN (additional forms may be required).
This information is necessary to determine the withholding rate that applies to your situation. (Certain payees may be subject to special withholding rules).
WITHHOLDING ELECTION (Please see the reverse side if you reside outside the United States.)
The distributions you receive from a Traditional IRA, a SEP IRA or a SIMPLE IRA are subject to Federal Income Tax withholding at a rate of 10% unless
you elect not to have withholding apply, you elect an additional percentage, or you reside outside the United States. Certain states (e.g., ME and OR) have
state income tax withholding requirements. Please see the reverse side of this document for more information and complete the following accordingly.
Withhold Federal Income Tax of % (not less than 10%) from the amount withdrawn.
Withhold State Tax at a rate of % (complete only if required by your state).
Do not withhold any income tax from my IRA distributions
Your Signature Date Daytime phone # with area code
(Your signature must be witnessed by a KeyBank representative, or notarized)
KeyBank Representative KeyCenter (Branch Number) KeyCenter Telephone # with area code
Notary Information: SEAL
IMPORTANT INFORMATION ABOUT YOUR ONE TIME DISTRIBUTION
(Please consult your tax advisor before making a decision.)
WHAT IS A RETIREMENT PLAN DISTRIBUTION?
A retirement plan distribution (or withdrawal) is a payment of assets to you from your retirement plan.
ARE RETIREMENT PLAN DISTRIBUTIONS TAXABLE?
Generally, yes. Distributed retirement funds are considered earned income in the tax year distributed and are subject to normal income tax. Any pro rata distribution
of non-deductible contributions, however, is not taxable. There may be a 10% income tax penalty on your distribution if you are younger than age 59 ½.
WHEN MAY RETIREMENT PLAN DISTRIBUTIONS BEGIN?
Retirement distributions may be made at any time. Tax implications depend on the type of retirement plan you are withdrawing from, your age, the type of
distribution you are taking, and the type of funds you are withdrawing. Please consult your tax advisor for information on how this withdrawal will affect you.
WHAT ARE THE GENERAL PARAMETERS?
There are four main categories:
• Prior to age 59 ½,
• Age 59 ½ to age 70 ½,
• Age 70 ½, and
GENERAL INFORMATION ABOUT DISTRIBUTIONS BEFORE AGE 59 ½
Distributions are reported as income in the tax year of distribution and may be subject to a 10% income tax penalty. Exceptions to the IRS penalty tax are noted in a
DISTRIBUTIONS MADE BETWEEN AGE 59 ½ AND 70 ½.
Between the ages of 59 ½ and 70 ½, IRS allows distributions without the 10% income tax penalty mentioned above. Income tax liabilities depend on the type of plan
from which you are making the distribution. (A withdrawal from a Roth IRA has different consequences than a withdrawal from a Traditional IRA.)
ARE THERE MINIMUM RETIREMENT PLAN DISTRIBUTION REQUIREMENTS?
When you reach age 70 ½, a Traditional IRA plan requires that you withdraw a minimum amount.
WHAT ARE EXCEPTIONS TO THE 10% INCOME TAX PENALTY?
Some of the exceptions to the IRS penalty tax are distributions:
• Made as a result of death (please use the withdrawal form specific to this situation),
• Made as a result of disability,
• Starting before you reach 59 ½ which are made in substantially equal payments over your life expectancy,
• Made as a result of medical expenses that exceed 7.5% of your adjusted gross income,
• Made for the payment of health insurance premiums for unemployed individuals,
• Made for a first-time homebuyer to acquire, construct or reconstruct a principle residence, and/or
• Made to pay for higher education.
All distributions noted, above except death or disability, will be reported to the Internal Revenue Service as “premature”. You will be required to complete Form
5329 and submit it with your taxes.
WHAT IS AN EXCESS CONTRIBUTION?
An excess contribution is any amount which you put in a retirement plan for a given tax year that exceeds contribution limits. Contribution limits refer to either the
annually permitted deposit amount or the amount of an eligible rollover. Excess contributions can be corrected in two ways, either by withdrawing the excess or
carrying it forward. If you withdraw this excess:
• Before your tax filing deadline: The excess contribution and any attributable earnings are distributed. Such earnings are taxed as ordinary income for the
tax year contributed and may be subject to a 10% income tax penalty.
• After your tax filing deadline: The excess contribution is distributed; taxed as ordinary income and may be subject to a 10% income tax penalty. The
10% income tax penalty is assessed if the total contribution exceeds certain limitations. Earnings attributable to the excess are not required to be
Alternatively, the excess may be carried forward by under contributing to your retirement plan in future years until the excess is eliminated. Any excess contribution
remaining after your tax deadline is subject to a cumulative, annual IRS 6% excess contribution fee.
A non-deductible contribution may not be removed after the tax-filing deadline as if it is an excess contribution. Non-deductible contributions may not be carried
WHAT PAYOUT OPTIONS ARE AVAILABLE?
TOTAL PAYOUT – A complete distribution from your plan.
PARTIAL PAYOUT – A partial withdrawal of retirement plan funds as needed. Your account remains open until the last assets are withdrawn.
HOW ARE DISTRIBUTION PAYMENTS MADE?
Payments can be mailed to you or deposited directly into your Key Checking or Savings Account.
NOTICE OF TAX WITHHOLDING
You are liable for payment of Federal Income Tax even if you elect not to have withholding applied to your distribution. If you do not have enough Federal Income
Tax withheld from your distribution, you may be responsible for payment of estimated tax and may incur penalties under the estimated tax rules if your withholding
and estimated tax payments are not sufficient. You may change your percent of withholding at any time.
If you are a U.S. Citizen and fail to make any election on the reverse side, we will be required to withhold 10% for Federal Income Tax.
Certain states also require income tax withholding. Should you fail to elect any withholding, and your state requires withholding, the state default will automatically
ARE WITHHOLDING RULES THE SAME FOR EVERYONE?
No. Certain payees may be subject to special withholding rules based on citizenship and mailing address. If your mailing address is outside the United States, we are
required to withhold at least 10% for federal income tax withholding. If you are a non-resident alien, we are required to withhold 30% for federal income tax
withholding an you must provide us with IRS Form W-8BEN. Additional forms may also be required. Please note that the processing of distributions for non-
resident aliens may be delayed by up to one business day. Missing information may cause longer delays.