IRA MINIMUM DISTRIBUTION WITHDRAWAL Name: Phone #: Contract #: Social Security #: Address: Street. City State Zip I would like to receive my distribution on an annual basis on the 1st of: (Please check one month only) January February March April May June July August September October November December Withhold Federal Income Tax. Amount to be withheld: (% or $): I would like a different distribution schedule: Monthly, beginning in: (for monthly withdrawals, please include a Direct Deposit Authorization form) Quarterly, beginning in: Semi-Annually, beginning in: Withhold Federal Income Tax. Amount to be withheld: (% or $): I understand that it is still my responsibility to make sure that I have taken and received my minimum distribution each year. Annuitant Signature Date National Slovak Society of the USA 351 Valley Brook Rd, McMurray, PA 15317-3337 Telephone (724)731-0094 Fax (724)731-0145 www.nsslife.org FORM # IRA-MDW – 003 G 05/01/2015
© Copyright 2024