IRA TRANSFER / DIRECT ROLLOVER
AUTHORIZATION and LETTER OF ACCEPTANCE
TRANSFER or DIRECT ROLLOVER INSTRUCTIONS SIGNATURE
1. TO: 5. Contact your existing Custodian/Trustee before signing to ask whether a
Name of current Trustee/Custodian or Employer if Direct Rollover Signature Guarantee is required.
SIGNATURE OF CUSTOMER DATE
City State Zip
SIGNATURE GUARANTEE (if required) DATE
TRANSFER / DIRECT ROLLOVER AUTHORIZATION
( ) 6. ______________________________________
Current Account Number Daytime Telephone No. Customer’s Name
has established an IRA with the Monteagle Funds for which Investors
Bank & Trust Company acts as Custodian. The Monteagle Funds
Current Account Type: hereby accepts transfer of the funds referenced above for the
Traditional IRA SEP-IRA Rollover IRA Custodian. Please make your check payable to:
The Monteagle Funds
SIMPLE-IRA* Roth IRA Qualified Plan†
* SIMPLE-IRAs must be in existence for at least 2 years to qualify for a IRA Customer’s Name (Traditional, ROTH, SEP, SIMPLE or Rollover IRA)
transfer, rollover, or conversion to another kind of IRA ____________________________
† A trustee-to-trustee direct rollover from a qualified employer-sponsored Account Number
retirement plan will be subject to IRS reporting.
Delivery Address: The Monteagle Funds / Investors Bank & Trust Company,
Custodian c/o Ultimus Fund Solutions, 225 Pictoria Drive, Suite 450,
AUTHORIZATION INSTRUCTIONS Cincinnati, OH 45246.
3. This is your authorization to transfer, rollover or convert: Note: Trustee-to-Trustee Transfers of Assets between a Traditional IRA and
another Traditional IRA, SEP-IRA or SIMPLE-IRA are not reported as a taxable
The entire value of the above referenced account, OR distribution. Conversions from a Traditional IRA, SEP-IRA or SIMPLE-IRA to a
Roth IRA or a recharacterization are reported as a taxable distribution. See the
A partial transfer of Certificate number(s) ____________, or Investors Bank IRA Disclosure Statement for additional information. Consult the
IRS or a qualified tax or financial planning professional if you have any questions
$ _____________, or ___________ % or __________ shares in kind about the rules applicable to transfers from one IRA to another. The Customer is
from my existing account. responsible for compliance of such rules.
Please deliver the proceeds to: The Monteagle Funds / Investors Bank
& Trust Company, Custodian c/o Ultimus Fund Solutions, 225 Pictoria __________________________________________________
Drive, Suite 450, Cincinnati, OH 45246. Authorized Signature – Investors Bank & Trust Co. Date
NEW ACCOUNT TYPE (at MONTEAGLE FUNDS) WITHHOLDING Check one:
4. Please establish the following account(s): 7. Federal tax laws require a 10% withholding of any amount converted
Traditional IRA SEP-IRA Rollover IRA from a non-Roth IRA to a Roth IRA, unless the IRA owner elects not to
have any amount withheld. If you do not elect to withhold, your
SIMPLE-IRA Roth IRA signature above acknowledges that you will pay all taxes due and
__________________ penalties that may apply to the insufficient payment of estimated tax.
(Consult your tax advisor.)
in the following amount(s):
Please do not withhold federal income taxes.
Please withhold 10% for federal income taxes or withhold ________%
MONTEAGLE FUNDS: (elect higher percentage, if desired).
Value Equity Growth Equity Gov’t Bond AGE 70 ½ Reminder:
_______% _______% ________% If this transfer is occurring during or after the year in which you attain age 70
½, the required minimum distribution (RMD) under this IRA is still required
to by distributed. You are responsible for satisfying your RMD applicable to
$______ $______ $_______ this IRA by withdrawing sufficient amounts from another IRA prior to your
deadline. Neither Monteagle Funds, nor Investors Bank & Trust Co. or your
current trustee/custodian are responsible for making RMD distributions prior
to or after your transfer.
If you have any questions about completing this form, please call (888) 263-5593.