Sample IRA “Charitable Rollover” Distribution Request Letter
[Financial Institution Name]
[City, State, Zip]
Re: Request for Charitable Distribution from [Your Name] Individual Retirement
To Whom It May Concern:
Please make a direct charitable distribution of $_________________ from my Individual
Retirement Account # [Account Number] to Winter Park Library Association, Inc. The
Winter Park Library Association is a public charity qualified to receive this distribution
under the recently extended IRA Charitable Rollover provisions. The tax ID number for
Winter Park Library Association, Inc. is 59-0794396.
The check should be mailed to:
Winter Park Library Association
460 E New England Ave
Winter Park, FL 32789
Attn: Phyllis Corkum - IRA Gift Processing
In your transmittal to Winter Park Library Association, please give my name and address
as the donor of record for the transfer, and please send me a copy of the correspondence
with Winter Park Library Association. Enclosed please find a copy of the Internal
Revenue Service’s tax determination letter for the Winter Park Library Association as a
public charity, for your reference.
It is my intention to have this transfer qualify for exclusion during the 201__ tax year.
Therefore, it is imperative this distribution be postmarked no later than December 31,
Feel free to contact Phyllis Corkum of the Winter Park Public Library at (407) 623-3277
if you need any additional information from the Winter Park Library Association. If you
have any questions or need to contact me, I can be reached at [telephone number].
[City, State Zip]
Enclosure: IRS Tax Determination Letter for Winter Park Library Association, Inc.