Fidelity Retirement Plan Single Withdrawal Request Form Instructions by IanKnott

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									   Fidelity Retirement Plan Single Withdrawal Request Form Instructions

To request a one-time immediate distribution, or a direct rollover to a qualified plan, IRA, Inherited IRA, or
qualified annuity, please read the instructions below as you complete the application at right.
If you have any questions, call a Fidelity Retirement Specialist at 1-800-544-4774 from 8 a.m. to 8 p.m. Eastern time, seven
days a week.
Distributions from the Fidelity Retirement Plan (i.e., Keogh Profit Sharing, Keogh Money Purchase Pension Plan, or Self-
Employed 401(k) Plan) are only permitted when a participant reaches age 59 1⁄2, separates from service, dies, is disabled,
or the plan is terminated. Distributions for any other reasons can result in plan disqualification. Distributions to married
participants from all Money Purchase Plans and certain Profit Sharing Plans must be made in the form of a joint and survivor
annuity unless your spouse waives this right by providing spousal consent in Section 6. You are encouraged to consult your
tax advisor regarding the tax implications associated with each distribution.


 1       YOUR INFORMATION
Please use a black pen and print clearly.

 2       REASONS FOR WITHDRAWAL
Check the appropriate box to reflect the reason for your withdrawal request to ensure appropriate reporting for your Retirement
Plan distribution. If nothing is checked, your distribution can be improperly reported or delayed.
Retirement Plan withdrawals made before age 591⁄2 are generally subject to a 10% early withdrawal penalty. You may be required
to file IRS Form 5329.

 3       TAX WITHHOLDING ELECTION
If you are not a U.S. person (including a U.S. resident alien), you must submit IRS Form W-8BEN, Certificate of Foreign Status of
Beneficial Owner for United States Tax Withholding, with this distribution request form to claim tax treaty benefits, if applicable. To
obtain Form W-8BEN, please consult your tax advisor or the IRS.
If your distribution is eligible to be rolled over, 20% will be withheld for federal income taxes, unless that distribution
is directly rolled over as specified in Section 5. You cannot elect out of 20% withholding for federal income tax.
If you are taking a distribution of after-tax contributions or a Minimum Required Distribution, the mandatory 20% withholding
for federal income tax does not apply. If the distribution is not eligible to be rolled over, IRS regulations require withholding at
the rate of 10% for one-time withdrawals or, according to the IRS wage tables for periodic withdrawals, unless you elect not to have
the withholding apply.
State Tax Withholding
If federal income tax withholding is applied to your distribution, state income tax may also apply. Your state of residence will
determine your state income tax withholding requirements, if any. Please refer to the matrix below. Your state of residency is
determined by the legal address of record on your Fidelity Retirement Plan account.

 If your state of residence is:     your options for state tax withholding are:
 AR, CA, DE, IA, KS, MA, ME,        If you elect federal tax withholding, state tax withholding will be applied. (CA, DE, NC, and
 NC, NE, OK, OR, PR, VA, VT         OR residents may elect not to have state tax withheld when federal tax withholding is elected.)
                                    If you do not elect federal tax withholding, you may optionally elect to have state tax with-
                                    holding apply.
                                    If state tax withholding is applied, it will be calculated based on your state’s applicable minimum
                                    requirements. You may optionally elect a specific percentage or dollar amount; however, your
                                    requested amount must be equal to or greater than your state’s minimum withholding
                                    requirement, otherwise we will apply your state’s applicable minimum withholding requirement.
 AK, FL, HI, MS, NH, NV,            You may not elect state tax withholding. State tax withholding is not available on your
 SD, TN, TX, WA, WY                 Retirement Plan distributions even if your state has state income taxes.
 Residents of all other states      You may elect voluntary state income tax withholding. You must provide a percentage or dollar
 and the District of Columbia       amount to be applied for state tax withholding.

Whether or not you elect to have federal, and if applicable, state tax withholding apply, you are responsible for the full payment
of federal income tax, any state or local taxes, and any penalties which may apply to your distribution. You may be responsible
for estimated tax payments and could incur penalties if your estimated tax payments are not sufficient.
 4       WITHDRAWAL INSTRUCTIONS
Mutual fund distributions will be paid from the Fidelity Funds account(s) you indicate.
Unless you instruct a withdrawal of shares in kind, brokerage distributions will be paid from the balance in your core account.
Direct rollovers to Fidelity accounts are processed as shares in kind for any eligible holdings. You must ensure there are sufficient
funds in this account for the withdrawal to be made. If a liquidating trade is necessary, please call 1-800-544-3939. Allow at
least 3 business days for trade settlement. Fidelity cannot assume responsibility if you do not meet a Minimum Required
Distribution deadline.
When you withdraw the entire balance from your Retirement Plan account, a closeout fee of $10 per mutual fund position or
$50 per brokerage account will be deducted from the proceeds. Close-out fees are waived on a direct transfer to a Fidelity non-
retirement account or on a direct rollover to a Fidelity IRA or Inherited IRA.
Note: If you would like to request a distribution from both a Money Purchase Plan and a Profit Sharing Plan, please complete a
separate form for each.

 5       METHOD OF PAYMENT
A. Direct deposit to your existing Fidelity non-retirement account. If you do not currently have a Fidelity non-retirement
   account, visit Fidelity.com or call 1-800-544-6666 to obtain the necessary account application.
B. Direct rollover of an eligible distribution into a Fidelity IRA or Fidelity Inherited IRA.
The distribution will be sent directly to Fidelity Management Trust Company, the IRA custodian:
   • If you are an inheriting spouse, you may elect to roll over the inherited account assets to a Fidelity IRA.
   • For non-spouse individuals and eligible trusts who have inherited a Fidelity Retirement Plan account, the account may be
      able to be rolled over to a Fidelity Inherited IRA, subject to applicable minimum required distribution rules.
     Attach a completed Fidelity IRA and Inherited IRA Application, establish a Fidelity IRA at Fidelity.com, or indicate
     the account number for an existing Fidelity IRA or Fidelity Inherited IRA. Before commingling inherited plan assets
     into an existing Inherited IRA, note that generally the commingled inherited assets must be from the same decedent
     and be subject to the same minimum required distribution rule calculation method. Consult your tax advisor prior
     to commingling inherited assets.
     Distributions to the existing or newly established account will be invested as indicated by you in section 4 of this form.
C. Direct Rollover of an eligible distribution into a non-Fidelity IRA, Inherited IRA, Individual Retirement Annuity, or
   Qualified Plan. Note: Distribution must be in cash and the check payable to the Trustee or Custodian. Please indicate where
   to send the check.
D. Wire to your bank or credit union account. There is a $5,000 minimum per fund from a mutual fund account. Certain
   funds may also charge a $5 fee. Any fee will be deducted from the wire amount. Your bank may also charge a fee for receipt.
   The recipient institution must be a member of the Federal Reserve System or we cannot wire your distribution.
E. By check to your record address.
F. By check to the indicated address. This requires a signature guarantee. Refer to Section 6.

 6       REQUIRED SIGNATURES
The Plan Administrator and the Plan Participant must sign this request. If you are married, your spouse also may be
required to sign this request. If you are requesting a distribution due to death from your Inherited Retirement Plan
Account, the Inherited Account owner and Plan Administrator or Executor of Plan Administrator’s estate must sign.
Your spouse MUST consent to this distribution by signing in the presence of a notary public if:
• you are a participant in a Profit Sharing Plan and elect to have your distribution paid in the form of a life annuity contract.
• you are a participant in a Money Purchase Pension Plan and elect a form of distribution other than a joint and survivor annuity,
   or a Profit Sharing Plan consisting of assets which have been transferred from a plan previously subject to the spousal consent
   rules, such as a money purchase pension plan, and elect a form of distribution other than a joint and survivor annuity.
No spousal beneficiary signature is required when requesting a distribution due to death. Note that spousal consent to the
designation of non-spouse beneficiary is required.
Important note: A participant may waive a qualified joint and survivor annuity option, and a spouse may consent to such
waiver, provided it is made within ninety (90) days before the first plan distribution.
The Plan Administrator’s signature must be guaranteed if the:
• withdrawal exceeds $100,000
• check is to be sent to an address other than the address of record
• withdrawal is made by bank wire
• withdrawal is being directly deposited into an account where the participant is not an owner
• record address has changed within the last 15 days
If you are directing a distribution to a joint tenant non-retirement account and the joint tenant is not your spouse, a federal gift tax
may be imposed. Consult your tax advisor for more information.
What is a Signature Guarantee?
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.
                                                                                                                                  L




                         Please detach application along the perforation and return in envelope provided.
                Fidelity Retirement Plan Single Withdrawal Request Form

 1        YOUR INFORMATION

Name:                                                                                                                   –         –
                                                                             Social Security # (required):
Date of Birth (Month/Day/Year):                       /          /


 2        REASON FOR WITHDRAWAL
   Normal Distribution, age 59½ or older, including MRD                         Distribution due to death
   Separated from service, under age 59½                                        Plan termination
   Disability, under age 59½



 3        TAX WITHHOLDING ELECTION – not required for direct rollovers to IRAs, Inherited IRAs or
          qualified plans
If you are not a U.S. person (including a U.S. resident alien) do not complete this section.
Federal Tax Withholding
To the extent the distribution is not subject to 20% mandatory federal withholding (refer to instructions for more information), 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.
    I elect NOT to have federal taxes withheld.
    I want Fidelity to withhold federal taxes at the rate of ______% (specify a whole number percentage between 10-99).
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. Also, some states do not offer state tax withholding. Refer to the instructions for specific 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 ________% (specify a whole number) or for $______________________.


 4        WITHDRAWAL INSTRUCTIONS

Plan Name:                                                                     Please withdraw my distribution from my Fidelity Brokerage
                                                                               Retirement Plan account.
Plan type (Check only one):         Money Purchase
                                                                                                                –
                                                                                Account Number
   Profit Sharing (including Self-Employed 401(k))
                                                                                Withdrawal Amount: $
   Please withdraw my distribution from my Fidelity Mutual Fund
   Retirement Plan account.                                                     OR     Entire Balance in Brokerage Retirement Plan Account in cash
   Account Number
                                     –                                          OR     Entire Balance in Brokerage Retirement Plan Account in-
                                                                                       kind*
   Fund Name:
                                                                                OR The following shares/bonds in-kind:*
   Withdrawal Amount: $
                                                                                Number of Shares/Bonds:
   OR      Entire Balance in cash OR       This number of shares*
                                                                                Specify Name of Stock, Bond, or Mutual Fund
   Fund Name:
   Withdrawal Amount: $
                                                                                Number of Shares/Bonds:
   OR      Entire Balance in cash OR       This number of shares*               Specify Name of Stock, Bond, or Mutual Fund
*In-kind distributions of securities other than cash are only available if
distributed assets are directed into another Fidelity account (Section A
under “Method of Payment. )  ”




              1.812111.103                                                                                     015220001
5      METHOD OF PAYMENT

A. Directly deposited to my existing Fidelity non-retirement account indicated below:
             –
Fidelity Funds Account Number
OR
             –
Fidelity Brokerage Account Number

B. Direct Rollover of an eligible distribution into a Fidelity IRA or Fidelity Inherited IRA (for non-spouse
   inheriting individuals and eligible trusts).
    A completed Fidelity IRA or Inherited IRA application is attached.
    Please direct the eligible distribution to the following existing Fidelity IRA or Fidelity Inherited IRA. (For inherited IRAs, the
    decedent must be the same. Please see instructions for more details.)

Name on the Account
                               –
Account Number
Recent tax law changes have generally increased your rollover options. However, we encourage you to consult with your tax advisor before consoli-
dating your retirement savings assets.

C. Direct Rollover of an eligible distribution into an established non-Fidelity IRA, Inherited IRA, Individual
   Retirement Annuity, or Qualified Plan.

Name of Trustee or Custodian

Account Number
Send check to:

Name

Street Address

City                                    State         Zip

D. Wired to my bank or credit union account.
Name of Bank

Bank Account Number

Name(s) on Bank Account

Bank’s ABA/Routing Number (contact your bank)



If your bank is not a member of the Federal Reserve, you must obtain the following information from your bank. There may be a delay in receiving a
wire through a correspondent bank.
E. By check to be sent to my record address.
F. By check to be sent to me at an address other than my record address.

Street Address

City                                              State                     Zip
 6      REQUIRED SIGNATURE IDENTIFICATION
Please mark the Marital Status that applies below:
Marital Status:       Single             Married
I (We) hereby certify that this distribution is being made pursuant to the Fidelity Retirement Plan and Trust Agreement
and the instructions contained herein. I (We) authorize and request the trustee of the Fidelity Retirement Plan, Fidelity
Management Trust Company, or its agents, affiliates, employees, or successor trustees, to make the above withdrawal.
Participants over age 701⁄2 accept full responsibility for withdrawing the Minimum Required Distribution required by
Section 401(a)(9) of the Internal Revenue Code, and I (We) indemnify the Trustee of the Fidelity Retirement Plan and
Trust Agreement, its agent(s), successors, affiliates, and employees from any liability associated with the distributions
made at the direction of me and/or the Plan Administrator.
I hereby authorize and request National Financial Services LLC (NFS), and/or Fidelity Brokerage Services LLC (FBS), to
make distributions according to the above instructions. If I have indicated herein that such payments are to be credited
to my bank account, I authorize the bank or credit union for the account information provided above (“Depository”) to
accept any such credit entries initiated by NFS or FBS to such account and to credit the same to such account, without
responsibility for the correctness thereof or for the existence of any further authorization relating hereto.
To the extent that assets inherited by a trust are being directly rolled to an Inherited IRA, as trustee for the above-ref-
erenced trust, I hereby certify that the trust is a qualifying non-spouse beneficiary for purpose of Section 402(c) of the
Internal Revenue Code and is therefore eligible to directly roll over assets to an Inherited IRA.
To the extent that plan assets are being directly rolled to an IRA or Inherited IRA, I understand that it is my responsibility
to ensure that only eligible assets are rolled and all minimum distribution requirements are satisfied.
If I am a U.S. citizen or other U.S. person (including a U.S. resident alien individual), I hereby certify under the penalties
of perjury that the number shown on this form is my correct taxpayer identification number. If I am not a U.S. person
(including a U.S. resident alien), I have attached IRS Form W-8BEN with this Fidelity Retirement Plan Single Withdrawal
Request Form and included my U.S. taxpayer identification number in order to claim tax treaty benefits, if applicable.

SIGNATURE OF PLAN ADMINISTRATOR OR EXECUTOR
OF THE PLAN ADMINISTRATOR’S ESTATE   Date  SIGNATURE GUARANTEE STAMP

X
SIGNATURE OF PLAN PARTICIPANT OR
INHERITED ACCOUNT OWNER                                  Date     SIGNATURE GUARANTEE STAMP

X
SPOUSAL CONSENT FOR PLAN
PARTICIPANT DISTRIBUTIONS
I hereby consent to the form of distribution selected by   NOTARY’S SIGNATURE                                      Date
my spouse herein. I understand that by signing this
consent, I am giving up the right to receive annuity               X
benefit payments that would otherwise be payable to me.
Sign this section in the presence of a notary public.
                                                           NOTARY SEAL
SPOUSE’S SIGNATURE                                    Date

X
See instructions for signature guarantee requirements.
A notary public cannot provide a signature guarantee.
We cannot accept a notarization instead of a signature
guarantee.




454857.2.0                   Attention: Retirement Distributions, P.O. Box 770001, Cincinnati, OH 45277-0039   FRP-DSTKFM-0807
                                            Fidelity Brokerage Services LLC, Member NYSE, SIPC                      1.812111.103
                                                       Fidelity Distributors Corporation
  Special Tax Notice Regarding Plan Payments

This notice explains how you can continue to defer federal         • The taxable portion of your payment will be taxed later when
income tax on your retirement savings in the Fidelity Defined        you take it out of the traditional IRA or the eligible employer
Contribution Retirement Plan and Trust Agreement (the “Plan”)        plan. Depending on the type of plan, the later distribution
and contains important information you will need before you          may be subject to different tax treatment than it would be if
decide how to receive your Plan benefits.                            you received a taxable distribution from this Plan.
This notice is provided to you at the request of the Plan          If you choose to have a Plan payment that is eligible for
Administrator because all or part of the payment that you          rollover PAID TO YOU:
will soon receive from the Plan may be eligible for rollover       • You will receive only 80% of the taxable amount of the
by you or your Plan Administrator to a traditional IRA or an         payment, because the Plan Administrator is required to
eligible employer plan. A rollover is a payment by you or the        withhold 20% of that amount and send it to the IRS as
Plan Administrator of all or part of your benefit to another         income tax withholding to be credited against your taxes.
plan or IRA that allows you to continue to postpone taxation
                                                                   • The taxable amount of your payment will be taxed in the
of that benefit until it is paid to you. Your payment cannot
                                                                     current year unless you roll it over. Under limited circum-
be rolled over to a Roth IRA, a SIMPLE IRA, or a Coverdell
                                                                     stances, you may be able to use special tax rules that could
Education Savings Account (formerly known as an education
                                                                     reduce the tax you owe. However, if you receive the pay-
IRA). An “eligible employer plan” includes a plan qualified
                                                                     ment before age 59½, you may have to pay an additional
under section 401(a) of the Internal Revenue Code, includ-
                                                                     10% tax.
ing a 401(k) plan, profit-sharing plan, defined benefit plan,
stock bonus plan, and money purchase plan; a section 403(a)        • You can roll over all or part of the payment by paying it
annuity plan; a section 403(b) tax-sheltered annuity; and            to your traditional IRA or to an eligible employer plan
an eligible section 457(b) plan maintained by a governmental         that accepts your rollover within 60 days after you receive
employer (governmental 457 plan).                                    the payment. The amount rolled over will not be taxed
                                                                     until you take it out of the traditional IRA or the eligible
An eligible employer plan is not legally required to accept          employer plan.
a rollover. Before you decide to roll over your payment to
                                                                   • If you want to roll over 100% of the payment to a tradi-
another employer plan, you should find out whether the
                                                                     tional IRA or an eligible employer plan, you must find
plan accepts rollovers and, if so, the types of distributions it
                                                                     other money to replace the 20% of the taxable portion
accepts as a rollover. You should also find out about any
                                                                     that was withheld. If you roll over only the 80% that you
documents that are required to be completed before the
                                                                     received, you will be taxed on the 20% that was withheld
receiving plan will accept a rollover. Even if a plan accepts
                                                                     and that is not rolled over.
rollovers, it might not accept rollovers of certain types of
distributions, such as after-tax amounts. If this is the case,     Your Right to Waive the 30-Day Notice Period. Generally,
and your distribution includes after-tax amounts, you may          neither a direct rollover nor a payment can be made from
wish instead to roll your distribution over to a traditional       the plan until at least 30 days after your receipt of this notice.
IRA or split your rollover amount between the employer             Thus, after receiving this notice, you have at least 30 days
plan in which you will participate and a traditional IRA. If       to consider whether or not to have your withdrawal directly
an employer plan accepts your rollover, the plan may restrict      rolled over. If you do not wish to wait until this 30-day
subsequent distributions of the rollover amount or may             notice period ends before your election is processed, you
require your spouse’s consent for any subsequent distribution.     may waive the notice period by making an affirmative
A subsequent distribution from the plan that accepts your          election indicating whether or not you wish to make a
rollover may also be subject to different tax treatment than       direct rollover. Your withdrawal will then be processed in
distributions from this Plan. Check with the administrator         accordance with your election as soon as practical after it
of the plan that is to receive your rollover prior to making       is received by the Plan Administrator.
the rollover.
                                                                   MORE INFORMATION
If you have additional questions after reading this notice, you    I. PAYMENTS THAT CAN AND CANNOT
can contact your plan administrator.                                    BE ROLLED OVER
Summary                                                            II. DIRECT ROLLOVER
There are two ways you may be able to receive a Plan payment       III. PAYMENT PAID TO YOU
that is eligible for rollover:                                     IV. SURVIVING SPOUSES, ALTERNATE PAYEES,
(1) Certain payments can be made directly to a traditional              AND OTHER BENEFICIARIES
    IRA that you establish or to an eligible employer plan
    that will accept it and hold it for your benefit (“DIRECT      I. Payments that can and cannot be rolled over
    ROLLOVER”); or                                                 Payments from the Plan may be “eligible rollover distributions.”
(2) The payment can be PAID TO YOU.                                This means that they can be rolled over to a traditional
If you choose a DIRECT ROLLOVER:                                   IRA or to an eligible employer plan that accepts rollovers.
                                                                   Payments from a plan cannot be rolled over to a Roth IRA,
• Your payment will not be taxed in the current year and no        a SIMPLE IRA, or a Coverdell Education Savings Account.
  income tax will be withheld.                                     Your Plan administrator should be able to tell you what
• You choose whether your payment will be made directly            portion of your payment is an eligible rollover distribution.
  to your traditional IRA or to an eligible employer plan that
  accepts your rollover. Your payment cannot be rolled over
  to a Roth IRA, a SIMPLE IRA, or a Coverdell Education
  Savings Account because these are not traditional IRAs.
After-tax Contributions. If you made after-tax contributions        II. Direct Rollover
to the Plan, these contributions may be rolled into either          A DIRECT ROLLOVER is a direct payment of the amount of
a traditional IRA or to certain employer plans that accept          your Plan benefits to a traditional IRA or an eligible employer
rollovers of the after-tax contributions. The following             plan that will accept it. You can choose a DIRECT ROLLOVER
rules apply:                                                        of all or any portion of your payment that is an eligible roll-
a) Rollover into a Traditional IRA. You can roll over your          over distribution, as described in Part I above. You are not
   after-tax contributions to a traditional IRA either directly     taxed on any taxable portion of your payment for which you
   or indirectly. Your plan administrator should be able to tell    choose a DIRECT ROLLOVER until you later take it out of
   you how much of your payment is the taxable portion and          the traditional IRA or eligible employer plan. In addition, no
   how much is the after-tax portion.                               income tax withholding is required for any taxable portion of
   If you roll over after-tax contributions to a traditional IRA,   your Plan benefits for which you choose a DIRECT ROLLOVER.
   it is your responsibility to keep track of, and report to the    This Plan might not let you choose a DIRECT ROLLOVER if
   Service on the applicable forms, the amount of these after-      your distributions for the year are less than $200.
   tax contributions. This will enable the nontaxable amount        DIRECT ROLLOVER to a Traditional IRA. You can open a
   of any future distributions from the traditional IRA to          traditional IRA to receive the direct rollover. If you choose
   be determined.                                                   to have your payment made directly to a traditional IRA,
   Once you roll over your after-tax contributions to a tradi-      contact an IRA sponsor (usually a financial institution) to
   tional IRA, those amounts CANNOT later be rolled over            find out how to have your payment made in a direct rollover
   to an employer plan.                                             to a traditional IRA at that institution. If you are unsure of
                                                                    how to invest your money, you can temporarily establish a
b) Rollover into an Employer Plan. You can roll over after-         traditional IRA to receive the payment. However, in choosing
   tax contributions from an employer plan that is qualified        a traditional IRA, you may wish to make sure that the tradi-
   under Code section 401(a) or a section 403(a) annuity            tional IRA you choose will allow you to move all or a part of
   plan to another such plan using a direct rollover if the         your payment to another traditional IRA at a later date, with-
   other plan provides separate accounting for amounts              out penalties or other limitations. See IRS Publication 590,
   rolled over, including separate accounting for the after-tax     Individual Retirement Arrangements, for more information
   employee contributions and earnings on those contribu-           on traditional IRAs (including limits on how often you can
   tions. You can also roll over after-tax contributions from       roll over between IRAs).
   a section 403(b) tax-sheltered annuity to another section
   403(b) tax-sheltered annuity using a direct rollover if the      DIRECT ROLLOVER to a Plan. If you are employed by a
   other tax-sheltered annuity provides separate accounting         new employer that has an eligible employer plan, and you
   for amounts rolled over, including separate accounting for       want a direct rollover to that plan, ask the plan administrator
   the after-tax employee contributions and earnings on those       of that plan whether it will accept your rollover. An eligible
   contributions. You CANNOT roll over after-tax contribu-          employer plan is not legally required to accept a rollover.
   tions to a governmental 457 plan. If you want to roll            Even if your new employer’s plan does not accept a rollover,
   over your after-tax contributions to an employer plan            you can choose a DIRECT ROLLOVER to a traditional IRA.
   that accepts these rollovers, you cannot have the after-tax      If the employer plan accepts your rollover, the plan may
   contributions paid to you first. You must instruct the Plan      provide restrictions on the circumstances under which you
   Administrator of this Plan to make a direct rollover on          may later receive a distribution of the rollover amount or
   your behalf. Also, you cannot first roll over after-tax          may require spousal consent to any subsequent distribution.
   contributions to a traditional IRA and then roll over that       Check with the plan administrator of that plan before making
   amount into an employer plan.                                    your decision.
                                                                    DIRECT ROLLOVER of a Series of Payments. If you receive
The following types of payments cannot be rolled over:              a payment that can be rolled over to a traditional IRA or an
Payments Spread over Long Periods. You cannot roll over             eligible employer plan that will accept it, and it is paid in
a payment if it is part of a series of equal (or almost equal)      a series of payments for less than 10 years, your choice to
payments that are made at least once a year and that will           make or not make a DIRECT ROLLOVER for a payment
last for:                                                           will apply to all later payments in the series until you change
                                                                    your election. You are free to change your election for any
• your lifetime (or a period measured by your life expec-
                                                                    later payment in the series.
   tancy), or
                                                                    Change in Tax Treatment Resulting from a DIRECT
• your lifetime and your beneficiary’s lifetime (or a period
                                                                    ROLLOVER. The tax treatment of any payment from the
   measured by your joint life expectancies), or
                                                                    eligible employer plan or traditional IRA receiving your
• a period of 10 years or more.                                     DIRECT ROLLOVER might be different than if you received
Required Minimum Payments. Beginning when you reach                 your benefit in a taxable distribution directly from the Plan.
age 70½ or retire, whichever is later, a certain portion of your    For example, if you were born before January 1, 1936, you
payment cannot be rolled over because it is a “required mini-       might be entitled to ten-year averaging or capital gain treat-
mum payment” that must be paid to you. Special rules apply          ment, as explained below. However, if you have your ben-
if you own 5% or more of your employer.                             efit rolled over to a section 403(b) tax-sheltered annuity, a
                                                                    governmental 457 plan, or a traditional IRA in a DIRECT
Corrective Distributions. A distribution that is made to cor-       ROLLOVER, your benefit will no longer be eligible for that
rect a failed nondiscrimination test or because legal limits on     special treatment. See the sections below entitled “Additional
certain contributions were exceeded cannot be rolled over.          10% Tax if You Are under Age 59½” and “Special Tax
The Plan Administrator of this Plan should be able to tell          Treatment if You Were Born before January 1, 1936.”
you if your payment includes amounts which cannot be
rolled over.
III. Payment paid to you                                              of part of the $2,000 withheld. (However, any refund is likely
If your payment can be rolled over (see Part I above) and the         to be larger if you roll over the entire $10,000.)
payment is made to you in cash, it is subject to 20% federal          Additional 10% Tax If You Are under Age 59½. If you
income tax withholding on the taxable portion (state tax              receive a payment before you reach age 59½ and you do not
withholding may also apply). The payment is taxed in the              roll it over, then, in addition to the regular income tax, you
year you receive it unless, within 60 days, you roll it over to       may have to pay an extra tax equal to 10% of the taxable
a traditional IRA or an eligible employer plan that accepts           portion of the payment. The additional 10% tax generally
rollovers. If you do not roll it over, special tax rules may apply.   does not apply to (1) payments that are paid after you sepa-
Income Tax Withholding:                                               rate from service with your employer during or after the year
                                                                      you reach age 55, (2) payments that are paid because you
Mandatory Withholding. If any portion of your payment can             retire due to disability, (3) payments that are paid as equal
be rolled over under Part I above and you do not elect to             (or almost equal) payments over your life or life expectancy
make a DIRECT ROLLOVER, the Plan is required by law to                (or your and your beneficiary’s lives or life expectancies), (4)
withhold 20% of the taxable amount. This amount is sent to            dividends paid with respect to stock by an employee stock
the IRS as federal income tax withholding. For example, if            ownership plan (ESOP) as described in Code section 404(k),
you can roll over a taxable payment of $10,000, only $8,000           (5) payments that are paid directly to the government to sat-
will be paid to you because the Plan must withhold $2,000             isfy a federal tax levy, (6) payments that are paid to an alter-
as income tax. However, when you prepare your income tax              nate payee under a qualified domestic relations order, or (7)
return for the year, unless you make a rollover within 60             payments that do not exceed the amount of your deductible
days (see “Sixty-Day Rollover Option” below), you must                medical expenses. See IRS Form 5329 for more information
report the full $10,000 as a taxable payment from the Plan.           on the additional 10% tax.
You must report the $2,000 as tax withheld, and it will be
credited against any income tax you owe for the year. There           The additional 10% tax will not apply to distributions from a
will be no income tax withholding if your payments for the            governmental 457 plan, except to the extent the distribution
year are less than $200.                                              is attributable to an amount you rolled over to that plan
                                                                      (adjusted for investment returns) from another type of eli-
Voluntary Withholding. If any portion of your payment is              gible employer plan or IRA. Any amount rolled over from a
taxable but cannot be rolled over under Part I above, the             governmental 457 plan to another type of eligible employer
mandatory withholding rules described above do not apply.             plan or to a traditional IRA will become subject to the addi-
In this case, you may elect not to have withholding apply to          tional 10% tax if it is distributed to you before you reach age
that portion. If you do nothing, 10% will be taken out of this        59½, unless one of the exceptions applies.
portion of your payment for federal income tax withholding.
To elect out of withholding, ask the Plan Administrator for           Special Tax Treatment If You Were Born before January 1,
the election form and related information.                            1936. If you receive a payment from a plan qualified under
                                                                      section 401(a) or a section 403(a) annuity plan that can be
Sixty-Day Rollover Option. If you receive a payment that              rolled over under Part I and you do not roll it over to a tradi-
can be rolled over under Part I above, you can still decide to        tional IRA or an eligible employer plan, the payment will be
roll over all or part of it to a traditional IRA or to an eligible    taxed in the year you receive it. However, if the payment quali-
employer plan that accepts rollovers. If you decide to roll           fies as a “lump sum distribution,” it may be eligible for special
over, you must contribute the amount of the payment you               tax treatment. A lump sum distribution is a payment, within
received to a traditional IRA or eligible employer plan within        one year, of your entire balance under the Plan (and certain
60 days after you receive the payment. The portion of your            other similar plans of the employer) that is payable to you after
payment that is rolled over will not be taxed until you take it       you have reached age 59½ or because you have separated from
out of the traditional IRA or the eligible employer plan.             service with your employer (or, in the case of a self-employed
You can roll over up to 100% of your payment that can be              individual, after you have reached age 59½ or have become
rolled over under Part I above, including an amount equal             disabled). For a payment to be treated as a lump sum distribu-
to the 20% of the taxable portion that was withheld. If you           tion, you must have been a participant in the plan for at least
choose to roll over 100%, you must find other money within            five years before the year in which you received the distribution.
the 60-day period to contribute to the traditional IRA or the         The special tax treatment for lump sum distributions that may
eligible employer plan, to replace the 20% that was withheld.         be available to you is described below.
On the other hand, if you roll over only the 80% of the tax-               Ten-Year Averaging. If you receive a lump sum distribu-
able portion that you received, you will be taxed on the 20%               tion and you were born before January 1, 1936, you can
that was withheld.                                                         make a one-time election to figure the tax on the pay-
Example: The taxable portion of your payment that can be                   ment by using “10-year averaging” (using 1986 tax rates).
rolled over under Part I above is $10,000, and you choose                  Ten-year averaging often reduces the tax you owe.
to have it paid to you. You will receive $8,000, and $2,000                Capital Gain Treatment. If you receive a lump sum dis-
will be sent to the IRS as income tax withholding. Within 60               tribution and you were born before January 1, 1936, and
days after receiving the $8,000, you may roll over the entire              you were a participant in the Plan before 1974, you may
$10,000 to a traditional IRA or an eligible employer plan. To              elect to have the part of your payment that is attributable
do this, you roll over the $8,000 you received from the Plan,              to your pre-1974 participation in the Plan taxed as long-
and you will have to find $2,000 from other sources (your                  term capital gain at a rate of 20%.
savings, a loan, etc.). In this case, the entire $10,000 is not
taxed until you take it out of the traditional IRA or an eligible     There are other limits on the special tax treatment for lump
employer plan. If you roll over the entire $10,000, when you          sum distributions. For example, you can generally elect this
file your income tax return you may get a refund of part or           special tax treatment only once in your lifetime, and the elec-
all of the $2,000 withheld.                                           tion applies to all lump sum distributions that you receive in
                                                                      that same year. You may not elect this special tax treatment if
If, on the other hand, you roll over only $8,000, the $2,000          you rolled amounts into this Plan from a 403(b) tax-sheltered
you did not roll over is taxed in the year it was withheld.           annuity contract or from an IRA not originally attributable to
When you file your income tax return, you may get a refund            a qualified employer plan. If you have previously rolled over
a distribution from this Plan (or certain other similar plans
of the employer), you cannot use this special averaging treat-
ment for later payments from the Plan. If you roll over your
payment to a traditional IRA, governmental 457 plan, or
403(b) tax-sheltered annuity, you will not be able to use spe-
cial tax treatment for later payments from that IRA, plan, or
annuity. Also, if you roll over only a portion of your payment
to a traditional IRA, governmental 457 plan, or 403(b) tax-
sheltered annuity, this special tax treatment is not available
for the rest of the payment. See IRS Form 4972 for additional
information on lump sum distributions and how you elect
the special tax treatment.

IV. Surviving spouses, alternate payees and other
    beneficiaries
In general, the rules summarized above that apply to payments
to employees also apply to payments to surviving spouses of
employees and to spouses or former spouses who are “alternate
payees.” You are an alternate payee if your interest in the Plan
results from a “qualified domestic relations order,” which is an
order issued by a court, usually in connection with a divorce or
legal separation.
If you are a surviving spouse or an alternate payee, you may
choose to have a payment that can be rolled over, as described
in Part I above, paid in a DIRECT ROLLOVER to a traditional
IRA or to an eligible employer plan or paid to you. If you have
the payment paid to you, you can keep it or roll it over yourself
to a traditional IRA or to an eligible employer plan. Thus, you
have the same choices as the employee.
If you are a beneficiary other than a surviving spouse or an
alternate payee, you cannot choose a direct rollover, and you
cannot roll over the payment yourself.
If you are a surviving spouse, an alternate payee, or another
beneficiary, your payment is generally not subject to the addi-
tional 10% tax described in Part III above, even if you are
younger than age 59½.
If you are a surviving spouse, an alternate payee, or another
beneficiary, you may be able to use the special tax treatment for
lump sum distributions as described in Part III above. If you
receive a payment because of the employee’s death, you may
be able to treat the payment as a lump sum distribution if the
employee met the appropriate age requirements, whether or
not the employee had 5 years of participation in the Plan.


           How to obtain additional information
   This notice summarizes only the federal (not state or
   local) tax rules that might apply to your payment. The
   rules described above are complex and contain many
   conditions and exceptions that are not included in
   this notice. Therefore, you may want to consult with
   the Plan Administrator or a professional tax advisor
   before you take a payment of your benefits from your
   Plan. Also, you can find more specific information on
   the tax treatment of payments from qualified employer
   plans in IRS Publication 575, Pension and Annuity
   Income, and IRS Publication 590, Individual Retirement
   Arrangements. These publications are available from
   your local IRS office, on the IRS’s Internet Web Site
   at www.irs.gov or by calling 1-800-TAX-FORMS.




 307457                                                             KET-402F-0102

								
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