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									 Fidelity Inherited IRA Automatic Withdrawal Service Form Instructions

Use this form to establish a new or update an existing Automatic Withdrawal Service plan, including Minimum
Required Distributions, for your Fidelity Inherited IRA or your Fidelity Inherited Roth IRA. A separate distribution
form must be completed for each Inherited IRA account you own. Because of unique withholding requirements,
Automatic Withdrawal Services are not available to non-resident aliens. You are encouraged to consult your tax
advisor regarding the implications associated with each distribution choice.
Please read all instructions carefully when completing the form. If you have any questions, call Inheritor Services
at 1-800-544-0003 between the hours of 8:00 a.m. and 6:30 p.m. Eastern time, Monday through Friday, or call a
Fidelity Retirement Representative at 1-800-544-4774 between 8 a.m. and 8 p.m. Eastern time, seven days a week.
Please use a pen and print clearly. Return the completed form to:
Fidelity Investments, Attn: Retirement Distributions, PO Box 770001, Cincinnati, OH 45277-0035.
Inherited IRA Beneficiary Distribution Account automatic withdrawals will be distributed proportionally from the
eligible mutual funds held in your account. Fidelity funds are generally eligible. For brokerage accounts, this
includes your core account, Fidelity Cash Reserves. If you have questions concerning which mutual fund posi-
tions in your account will be sold to fund automatic withdrawals, please contact a Fidelity Representative. Note:
Individual securities in your account (e.g., stocks and bonds) will not be sold to fund automatic withdrawals.
For Minimum Required Distributions (MRDs):
• Return this form no later than December 1 to allow adequate time for current calendar year processing.
• It is your responsibility to ensure that your distributions satisfy IRS requirements. Please consult a tax advisor to
   ensure that your payments will meet the requirements. Failure to satisfy your MRD requirements may result in
   an IRS penalty of up to 50% of the difference between the MRD amount you should have taken and the amount
   actually withdrawn.
• MRD calculations will include the specified Fidelity Inherited IRA only. If you have another Fidelity Inherited
   IRA or any Inherited IRAs at other institutions, you will be required to calculate your MRD for them separately.
Note: Inherited retirement plan accounts must be rolled over to your Inherited IRA by 12/31 of the year after the
date of death in order for Fidelity to calculate your MRD. See your tax attorney if you have questions. If you rolled
over to your Inherited IRA after that date, you must calculate your MRD and can only choose either Option B or C
in Section 3 Withdrawal Amount Options.
Fidelity cannot accept responsibility if we are unable to make your scheduled distribution due to insufficient funds
in your account or the eligible mutual fund positions in your account.
When you withdraw the entire balance from your Inherited IRA, a closeout fee may apply. Back-end loads,
redemption fees or transaction fees may also apply to mutual fund distributions. Low-balance fees may also apply
to mutual funds. Please refer to the IRA Schedule of Fees and the fund’s prospectus for details.
If the original IRA depositor was older than age 70½ at time of death, you may be responsible to take any remain-
ing year-of-death minimum required distributions (MRDs) to comply with the original depositor’s lifetime MRD
requirement. This requirement is separate from Inherited IRA MRD requirements.

CUSTOMER INFORMATION SECTION
Provide your name, Social Security number, date of birth, and daytime telephone number. Check the box if you are
making changes to an existing systematic withdrawal plan. The information you provide in this section must match
the information on your established Inherited IRA account.

 1 ORIGINAL DEPOSITOR INFORMATION
Provide the original depositor’s full name, date of birth and date of death. The original IRA owner is the original
depositor. The original employer sponsored retirement plan account owner is the original depositor in the case of a
non-spouse beneficiary inheritor of that account who subsequently rolled over that account into an IRA.

 2 YOUR INHERITED IRA INFORMATION
Provide your Fidelity Inherited IRA account number, and indicate the type of beneficiary you are:
• Individual: Indicate your relationship to the original owner as either Spouse or Non-Spouse.
• Non-Individual beneficiary such as a Trust Beneficiary, an Estate, an Entity or a Charity.
 3 WITHDRAWAL AMOUNT OPTIONS
Select one of the three withdrawal amount options, and complete all requested information for the option
you select.
A. Minimum Required Distribution (MRD) Option: If you select the MRD option, Fidelity will calculate your
annual MRD in accordance with IRS regulations based on the information you provide. If you are a non-spouse
inheritor of employer sponsored retirement plan assets who subsequently rolled over the account into an IRA, you
should consult your own tax advisor. You may only select options B or C if you are not eligible for MRDs based on
your life expectancy.
Note: Option A (the MRD option) is only available for Individual (spouse and non-spouse) beneficiaries of
the original IRA owner. Non-Individual beneficiaries (such as trusts, estates, legal entities, or charities) or successor
beneficiaries may not use this option, but may use option B or option C. Additionally, individual beneficiaries must
be the “Designated Beneficiary” as defined under the IRS MRD rules in order to use Option A, MRD. If you do not
meet the “Designated Beneficiary” rules described below, please call Inheritor Services at 1-800-544-0003 between
the hours of 8:00 a.m. and 6:30 p.m. Eastern time, Monday through Friday, or call a Fidelity Retirement Specialist
for instructions at 1-800-544-4774 between 8 a.m. and 8 p.m. Eastern time, available seven days a week.
Under IRS regulations, you are the Designated Beneficiary of your Inherited IRA only if you are an individual and:
• You were the sole beneficiary of the original owner’s IRA or employer sponsored retirement plan assets
• You were one of multiple beneficiaries designated by the original owner and you established your Inherited IRA
  by December 31 of the year following the original owner’s death (or if by that date all other beneficiaries had
  either taken their share from the account or had disclaimed their interest in the IRA or employer sponsored
  retirement plan assets).
Consult your legal or tax advisor if you have additional questions about your status as Designated Beneficiary.
The MRD calculation method for an Inherited IRA is based on the type of beneficiary you are and the timing
of your transfer of inherited IRA assets into an Inherited IRA. The chart below illustrates the MRD calculation
method based on your relationship to the original owner. Life expectancy is based on the approved IRS Single Life
Expectancy Table.
 Beneficiary Relationship          MRD Calculation
 to Original Owner
 Spouse                              Your life expectancy recalculated annually
 Non-Spouse                          Your life expectancy in the calendar year following the calendar year of
 (child or other person)             the original owner’s death reduced by one (1) annually. May not apply if
                                     you are a non-spouse inheritor of employer sponsored retirement plan assets
                                     who subsequently rolled over to an IRA

• The MRD calculation will be based on your life expectancy for all years provided that your portion of the account
  was transferred to an Inherited IRA by December 31 of the year following the original IRA owner’s death.
• Upon establishment of this automatic plan and each year thereafter, you will be sent a Revised Account Profile
  indicating the MRD amount to be distributed under the plan for that year based on the designated beneficiary’s
  life expectancy.
B. Fixed Period Calculation Option: This option depletes the entire balance of your Inherited IRA over the
number of years you specify. This may not meet MRD requirements in all situations. Consult a legal or tax advisor
before using this option for purposes of MRD. Fidelity will calculate the amount of each payment by dividing the
total Inherited IRA balance by the remaining number of years. Fidelity will use the total balance of all your posi-
tions in your Inherited IRA as of December 31 of the prior year.
C. Fixed Amount Option: This option withdraws the dollar amount you indicate for each payment. This may not
meet MRD requirements in all situations. Consult a legal or tax advisor before using this option for purposes of
MRD.

 4 TAX WITHHOLDING ELECTION
If you are not a U.S. person (including a U.S. resident alien), DO NOT complete this section. You must submit IRS
Form W-8BEN, Certificate of Foreign Status of Beneficial Owner for United States Tax Withholding, with this dis-
tribution request form to claim tax treaty benefits, if applicable. To obtain Form W-8BEN, please consult your tax
advisor or go to the IRS Web site at www.irs.gov.
Federal Tax Withholding
You may elect not to have federal withholding apply (provided you have supplied Fidelity with a U.S. address), or you
may elect to increase the rate of withholding. If left blank, IRS regulations require Fidelity to withhold federal income
tax at a rate of 10% from your total IRA distribution (excluding Roth IRA distributions). This applies even if you have
made non-deductible contributions to your IRA, and may result in excess taxes taken from your distribution.
 4 TAX WITHHOLDING ELECTION (CONTINUED)
Mandatory withholding does not apply to non-spouse inheritors of employer sponsored retirement plan assets who
subsequently rolled over into an IRA.
Federal income tax will not be withheld from a distribution from a Roth IRA unless you elect to have such tax
withheld, or are otherwise subject to withholding because you are a non-resident alien.
State Tax Withholding
If federal income tax withholding is applied to your distribution, state income tax may also apply. The state income
tax withholding requirements that your distribution will be subject to (if any) are determined by the legal address
of record on your Fidelity IRA.
Please review the state tax information provided below. If a minimum state tax applies, Fidelity will withhold taxes
at the greater of the minimum state tax or the amount you specify. For Roth IRAs, Fidelity will withhold at the
amount you specify since there is no minimum for Roth IRAs.

  IF YOUR STATE OF                 YOUR OPTIONS FOR STATE TAX WITHHOLDING ARE:
  RESIDENCE IS:

  AR, IA, KS, MA, ME,              If you elect federal income tax withholding, state tax withholding of at
  OK, VT                           least your state’s minimum requirements must also be withheld at the time
                                   of your distribution. If you elect out of federal tax withholding, state income
                                   tax will not be withheld unless you indicate otherwise. If you are requesting
                                   a distribution from your Roth IRA, state taxation is voluntary and will not be
                                   withheld unless you indicate otherwise.

  CA, DE, NC, OR                   If you elect federal income tax withholding, state income tax of at least your
                                   state’s minimum requirements will be withheld at the time of your distribu-
                                   tion unless you indicate you do not want to withhold state tax. If you elect
                                   out of federal income tax withholding, state income tax will not be withheld
                                   unless you indicate otherwise. If you are requesting a distribution from your
                                   Roth IRA, state tax is voluntary and will not be withheld unless you indicate
                                   otherwise.

  AK, FL, HI, MS, NH, NV,          You may not elect state tax withholding (for regular and Roth IRAs).
  PR, SD, TN, TX, WA, WY           State income tax withholding is not available on your IRA distributions.
                                   Please consult your tax advisor, state agency, or investment representative
                                   for more information.

  Residents of all other           You may elect to withhold state income tax from your distribution.
  states and the                   You must provide a percentage to be applied for state tax withholding.
  District of Columbia

Whether or not you elect to have federal or state taxes withheld from your distribution, you are responsible for
the full payment of federal income tax, any state or local taxes, and any penalties that may apply. You may be
responsible for estimated tax payments and could incur penalties if your estimated tax payments are not sufficient.
Your election will remain in effect on periodic distributions taken under this systematic withdrawal plan from your
Fidelity Inherited IRA account(s) until revoked by you. You can revoke this election for future distributions at any
time by phone or written request.


 5 FREQUENCY OF DISTRIBUTION
Select the day and month(s) you wish to have your regularly scheduled distributions made by writing in the day of
the month and marking the month(s) as appropriate. Please also indicate the year in which you want distributions
to begin. Any distribution taken from the account outside of this automatic plan during a calendar year will not
impact the amount of your automatic distributions for that calendar year.
Inherited IRA automatic withdrawals will be distributed proportionally from the eligible mutual funds held in your
selected account. Eligible mutual funds include all Fidelity funds that are available to Retail customers and also
funds available through Fidelity FundsNetwork® where the mutual fund company has agreed to make the fund
available for distributions through a systematic withdrawal plan (SWP), providing the requested amount meets or
exceeds any SWP minimum, if one exists. For brokerage accounts, eligible funds include your core account, Fidelity
Cash Reserves. If you have questions concerning which mutual fund positions in your account will be sold to fund
automatic withdrawals, please contact a Fidelity Representative. Note: Individual securities in your account
(e.g., stocks and bonds) will not be sold to fund automatic withdrawals.
 5 FREQUENCY OF DISTRIBUTION (CONTINUED)
IMPORTANT NOTES
Note: Certain Fidelity mutual funds have been closed to new investors. If one of these funds is subject to your
withdrawal instructions, be aware that your position could be fully liquidated, and this may prohibit you from
future investments in the fund.
Note: Withdrawals from any retirement plan that are scheduled to be paid out in December may result in
your payment being processed prior to the date selected to help ensure that your withdrawal is processed prior
to year end.
Note: If no schedule is elected, the plan will be established to pay annually on December 1 or the first available
date that meets the MRD deadline of December 31.

 6 PAYMENT METHOD
Choose one of the four options for receiving your withdrawal payments and complete any additional information
requested for that option. If no option is selected, a check will be sent to your address of record.
A. Direct deposit into your nonretirement Fidelity Brokerage or Fidelity Funds account (if you do
   not have a Fidelity nonretirement account, one can be established today at Fidelity.com, or call us at
   1-800-544-4774 to obtain an application). Please mark the checkbox if you are establishing a new account, and
   complete the application enclosed. The usual account minimum requirement is waived if your account is funded
   through an automatic plan. Distributions to a Fidelity brokerage account are invested into your core position.
   If you have a Fidelity mutual fund IRA, please specify the fund you wish to invest your distribution into on the
   line provided.
B. By check to your address of record.
C. By check to an alternate address (a signature guarantee is required for this option; see Section 7).
D. Deposited electronically into your bank or credit union account using Electronic Funds Transfer
   (EFT). Allow at least 10 days for EFT to become active. Once established, allow 2–3 days for funds to reach
   your bank or credit union. The recipient institution must be a member of the Automated Clearing House.
   Attach a voided check to supply your bank information.
   Fidelity does not charge for using EFT services. The maximum amount that may be sent via EFT is $100,000
   per distribution. Include a voided check and complete the requested information to establish EFT or to confirm
   existing EFT instructions. If you are unsure of any of the information, please verify with your bank or credit
   union.
Note: If you select Option A or D and the transaction cannot be completed using this Payment Method, the system
will default to sending a check to the address of record.

 7 AUTHORIZATION AND SIGNATURE
Read the authorization and sign as indicated. A signature guarantee is required if your:
• Withdrawal exceeds $100,000 per payment, or
• Current record address has been on file less than 15 days, or
• Check is being sent to an address other than your address of record.
A signature guarantee is designed to protect you and Fidelity from fraud. You should be able to obtain
a signature guarantee from a bank, broker, broker/dealer credit union (if authorized under state law), securities
exchange or association, clearing agency or savings association.
A notary public cannot provide a signature guarantee, and a notarization cannot be accepted in lieu of a
signature guarantee.
The information provided by Fidelity is general in nature and should not be considered legal or tax advice. Fidelity
does not provide legal or tax advice. Consult an attorney or tax professional regarding your specific legal or
tax situation.
                                            Fidelity Inherited IRA Automatic
                                            Withdrawal Service Form
                      Customer Information:


                      Your Name


                      Social Security Number

                               /        /                                                     (     )
                      Date of Birth                                                             Daytime Phone
                         Check here if this is a change to an existing systematic withdrawal plan.
Read the accompanying instructions carefully as you complete this form. Additional information is available at
Fidelity.com/goto/inheritedira or by calling Inheritor Services at 1-800-544-0003 between the hours of 8:00 a.m. and
6:30 p.m. Eastern time, Monday through Friday, or by calling a Retirement Representative at 1-800-544-4774 between
8 a.m. and 8 p.m. Eastern time. Return the completed form to Fidelity Investments, Attn: Retirement Distributions, PO Box
770001, Cincinnati, OH 45277-0035.

 1 ORIGINAL DEPOSITOR INFORMATION
Original Depositor's Full Name
                /       /                                                                        /        /
Original Depositor's Date of Death                                                  Original Depositor's Date of Birth

 2 YOUR INHERITED ACCOUNT INFORMATION


Your Fidelity Inherited account number
Please indicate the type of beneficiary you are:       Spouse of the original IRA owner
                                                       Non-Spouse individual inheritor of original IRA owner (i.e., child,
                                                       sibling, or friend)
                                                       Non-spouse inheritor of employer sponsored retirement plan assets
                                                       who subsequently rolled over into an IRA (i.e., child, sibling, or friend)
                                                       Other (i.e., trust, estate, charity, entity)

 3 WITHDRAWAL AMOUNT OPTIONS
Choose one of the following three withdrawal amount options (A, B or C) and complete the requested information for
the option that you select. If you are a Trust, Estate or Other non-individual, you must choose Option B or C. See
the instructions for important information and descriptions of these options.
     A. Minimum Required Distribution (MRD)
         This option is only available for individual person Designated Beneficiaries (spouse or non-spouse individual). By
         checking the box for option A, MRD, you are attesting that you are an individual and that you are the “Designated
         Beneficiary” of the original IRA owner’s account for MRD purposes. For questions about whether you are the
         Designated Beneficiary, see the instructions or consult your tax advisor.
         If this option is selected, Fidelity will calculate your MRD in accordance with IRS regulations using the information
         you have provided to Fidelity. See instructions for an explanation of how your MRD will be calculated.
For transfers of Inherited IRAs from other custodians to Fidelity:
If you transferred assets from another institution to a Fidelity Inherited IRA by December 31 of last year,
provide the market value of any outstanding transfer amount as of December 31 of last year: $
(Fidelity will add this amount together with your Fidelity IRA account balance to calculate the account’s MRD).




             1.820237.106                               Please continue to other side.               019000101
 3 WITHDRAWAL AMOUNT OPTIONS (CONTINUED)
A non-spouse inheritor of employer sponsored retirement plan assets, who subsequently rolled over into an
IRA, who is not eligible for MRDs based on life expectancy should choose B or C. You should consult your
own tax advisor.
   B. Fixed Period Calculation Option: Deplete the entire balance of my account over                                      years.
   C. Fixed Amount Option:

Withdraw $                              from my Fidelity Inherited IRA per withdrawal payment.


 4 TAX WITHHOLDING ELECTION
Federal Tax Withholding
Check one of the following to indicate whether you wish to have federal income taxes withheld. If no box is checked, Fidelity is
required to withhold 10% from the gross distribution (excluding Roth IRAs). (Mandatory withholding does not apply to
non-spouse inheritor of employer sponsored retirement plan assets who subsequently rolled over into an IRA.)

    I elect NOT to have federal taxes withheld when distributions under this systematic withdrawal plan are made.

    I want Fidelity to withhold federal taxes at the rate of                         % (specify a whole number percentage from
    10 to 99).
State Tax Withholding
Check one of the following to indicate whether you wish to have state income taxes withheld. State tax withholding may apply
even if you do not check a box below, and some states do not allow state tax withholding. Also, if your state has a minimum
tax rate, we will withhold taxes at the greater of the minimum or the amount you specify below. Refer to instructions for spe-
cific information concerning your state.
     I elect NOT to have state income taxes withheld.

    I want Fidelity to withhold state income taxes at a rate of                          %.


 5 FREQUENCY OF DISTRIBUTION
I would like my withdrawals made on the                  day of the months indicated below, starting in the year                   .
    Jan        Feb        Mar         Apr         May           Jun    Jul       Aug          Sep       Oct        Nov        Dec
If you are setting up your withdrawal plan mid-year to take an MRD, your entire MRD for the current year will be paid out
evenly over the remaining number of scheduled payments in the year.

 6 PAYMENT METHOD — CHOOSE ONE
     A. Directly deposited to my Fidelity nonretirement account:

     Account Number                                                        New Account (application enclosed)
     Distributions to a Fidelity brokerage account are invested into your core position. If you have a Fidelity mutual fund account,
     please specify the fund you wish to invest your distribution in:

     B. By check to be sent to my address of record.

     C. By check to be sent to me at an alternate address (signature guarantee required — see below).


    Street Address                                             City                            State          Zip Code

    D. Deposited electronically into my bank or credit union account using Electronic Funds Transfer (EFT).

    Account Type:       Checking            Savings (non-passbook)




              1.820237.106                                                                    019000102
 6 PAYMENT METHOD — CHOOSE ONE (CONTINUED)
                Please provide bank information and attach a voided check to this page.


                Your Bank’s Name


                Bank Routing Number                                                       Bank Account Number


                Name(s) on Bank Account
   Staple voided check here.




 7 REQUIRED SIGNATURES

I authorize and request the custodian for the Fidelity Inherited IRA, Fidelity Management Trust Company and its agents,
affiliates, employees or successor custodians (“Fidelity”), to make the above withdrawals. I understand that IRA withdrawals
will be taxed as ordinary income. I accept full responsibility for withdrawing the minimum required distribution required
by Section 401(a)(9) and 408 (a)(6) of the Internal Revenue Code and applicable regulation. I indemnify the Custodian for
the Fidelity Inherited IRA, its agents, successors, affiliates, and employees from any liability in the event that I fail to meet
the IRS requirements. I acknowledge that I received, read and understand the Fidelity Automatic Withdrawal Service Form
Instructions attached to this form. If I elect the Electronic Funds Transfer feature, I hereby authorize and request Fidelity to
make distributions from my Fidelity Inherited IRA by initiating debit entries to the account indicated above (contributions
are not allowed to be made to an IRA). I authorize and request the bank named above (“BANK”) to accept any such debit
and credit entries initiated by Fidelity in such account and to debit and credit the same account without responsibility for
the appropriateness thereof or for the existence of any further authorization relating hereto. I hereby ratify any telephone
instructions given pursuant to this authorization and agree Fidelity will not be liable for any losses resulting from unauthor-
ized transactions if it follows reasonable procedures designed to verify the identity of the caller. I further consent to the tape
recording of all instructions given by telephone. I hereby certify under penalties of perjury that I am a U.S. citizen or other
U.S. person (including a resident alien individual) and that the Social Security number shown in the Customer Information
section of this form is my correct tax identification number.
If indicated that I am a non-spouse inheritor of employer sponsored retirement plan assets who subsequently rolled over
into an IRA, I hereby certify that the withdrawal option selected in Section 3 is correct as to the accounts covered by this
automatic MRD Plan.




                               1.820237.106                                                                     019000103
 7 REQUIRED SIGNATURES (CONTINUED)


PRINT NAME                                                      SIGNATURE GUARANTEE STAMP




SIGNATURE OF OWNER Date

 X




                                                                See instructions for signature guarantee requirements.
                                                                A notary public cannot provide a signature guarantee,
                                                                and a notarization cannot be accepted in lieu of a signature
                                                                guarantee.

Fidelity Investments is a registered service mark owned by FMR LLC. Accounts are carried with our affiliate, National
Financial Services LLC, Member NYSE and SIPC.
The information provided by Fidelity is general in nature and should not be considered legal or tax advice. Fidelity does
not provide legal or tax advice. Consult an attorney or tax professional regarding your specific legal or tax situation.




            435837.7.0                  Fidelity Brokerage Services LLC, Member NYSE, SIPC                     INH-PWS-1010




             1.820237.106                                                                    019000104

								
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