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USAA FEDERAL SAVINGS BANK
10750 McDermott Fwy
San Antonio, TX 78284
Authorization For Distribution Form
Traditional, Roth, and Coverdell Education Savings Accounts
ACCOUNT INFORMATION
Please Print
________________________________________________________________________________
Member #
Name of Participant (Responsible individual if Coverdell ESA)
Address
City
Residence Phone
Business Phone
________________________________________________________________________________
State
Zip
Country
________________________________________________________________________________
Fax Phone
________________________________________________________________________________
Beneficiary Name if Coverdell ESA
DISTRIBUTION INFORMATION
Type of Account
Traditional
Roth
CESA
IRA #__________________________
TRADITIONAL IRA DISTRIBUTION REASONS (ONLY)
Select only one. Please refer to IRS Publication 590 for further explanation regarding distribution reasons.
Normal:
I am 591/2 or older.
Premature Distribution:
I am under 591/2 and am not taking a distribution due to disability or part of a series of substantially equal payments. I understand that if
the amount distributed is not rolled over into another IRA within 60 days, the amount of the distribution may be included in my gross
income subject to taxes and may be subject to an additional 10% premature distribution penalty.
May not be subject to a premature distribution penalty if distribution is for:
• Qualified Education Expenses
• First Time Homebuyer Expenses
• Certain Medical Expenses
• Certain Health Insurance Premiums for the Unemployed
Consult your tax advisor regarding whether you should file IRS Form 5329 to claim exemption from the premature distribution tax when
you file your federal income tax return.
Substantially Equal Periodic Payments (SEPP):
I am under age 591/2 and wish to take a series of substantially equal periodic payments over my life expectancy or over the joint life
expectancy of my designated beneficiary and I, in accordance with the provisions of the Internal Revenue code section 72(t). These
payments must continue until the later 5 years or until I attain 591/2.
Divorce:
I am directing a distribution to be made to my former spouse in accordance with a divorce decree or property settlement agreement
entered into as part of the settlement of a divorce action. If my former spouse wishes to maintain an IRA account with USAA or with
another financial institution and does not already have such an account, I understand that an IRA Application and Adoption Agreement
must be completed by him/her and submitted with this request. A certified copy of your divorce decree and/or property settlement prior to
disbursement must be accompanied with your request.
Disability:
I am unable to engage in any substantial gainful activity because of medically determinable physical or mental impairment, and my
physician has determined that my condition can be expected to result in death or to be of long, continued, and indefinite duration.
Death:
An executor, administrator or beneficiary following the death of the IRA account owner is completing this form. A certified copy of the
participant’s death certificate should accompany the form. If an executor or administrator is completing the form, it should be
accompanied by letters of testamentary or letters of administration.
Continued on next page.
USAA Federal Savings Bank 1-800-531-8722
IMAGE=IRADIST #
Fax 1-800-531-5717
(USAA Member Number - No entry required.)
(EWL Code)
usaa.com
08306-0315
Conversion:
I wish to convert all or part of my Traditional IRA to a Roth IRA. [If I do not already have a Roth IRA with USAA FSB, this form should be
accompanied by a new Roth IRA Application.] Conversions are taxable events and will be reported to the IRS by USAA on IRS Forms
1099-R and 5498.
Recharacterization:
I wish to recharacterize the IRA contributions described below by transferring the amounts indicated to another type of IRA, also
described below pursuant to IRS Regulation 1.408A-5. Accordingly, I hereby direct you, as agent of USAA Federal Savings Bank, the
custodian of my IRAs, to transfer, in a trustee-to-trustee transfer, the amount(s) indicated below to the account(s) which I designated. In
that regard, I hereby certify that this direction is being given before the due date (including extensions) for filing my Federal income tax
return for the taxable year for which the contributions were made. I understand that I should report the transactions generated by this
request on IRS Form 8606, to be filed with my Federal Income Tax Return, and that these transactions will be reported to the IRS by
USAA on IRS Forms 1099-R and 5498. □
Withdrawal of Excess Contributions (select one in A or B)
A. The following elections apply when the excess contribution is corrected BEFORE your tax filing date, including extensions:
I am requesting that my excess contribution AND the excess earnings be withdrawn before I file my tax return. The excess
earnings are included as income for the year in which the excess contribution occurred. The excess earnings may be subject to a
10% premature distribution penalty if I am under the age of 59 ½ and not disabled.
I am requesting that the excess contribution be carried over to a later year, for which I will reduce my IRA or Coverdell ESA
contribution by the amount of excess contribution. The excess contribution will be subject to a 6% penalty tax for the year it was
made and each subsequent year in which it is not corrected by under-contributing. The earnings on the excess will remain in the
account.
B. The following elections apply when the excess contribution is corrected AFTER your tax filing date:
I am requesting a distribution of my excess contribution after the deadline for filing my tax return. The excess contribution will be
subject to a 6% penalty tax for each year it remains in my account. If I took a deduction for the year of excess contribution, I will
file an amended tax return removing the excess contribution. The earnings on the excess will remain in the account.
I am requesting that the excess contribution be carried over to a later year, for which I will reduce my IRA or Coverdell ESA
contribution by the amount of the excess contribution. The excess contribution will be subject to a 6% penalty tax for the year it
was made and each subsequent year in which it is not corrected by under-contributing. The earnings on the excess will remain in
the account.
ROTH IRA REASONS FOR DISTRIBUTION (ONLY)
Qualified Distributions:
I understand qualified Roth Distributions are not subject to taxes or penalties because I have met the 5-year aging period
AND:
I have attained the age of 591/2; or
I am disabled; or
Distribution is being made to a beneficiary in the event of the demise of the account owner.
Roth IRA Distributions, Exception Applies:
I understand that I have not met the 5-year aging period, but:
I am at least 591/2; or
Disabled; or
Distribution is being made to a beneficiary in the event of the demise of the account owner.
Roth Distributions, No Exception Applies:
I am under 591/2 and none of the distribution reasons above apply.
COVERDELL EDUCATION SAVINGS ACCOUNT REASONS FOR DISTRIBUTION (ONLY)
Normal
I am directing a distribution to be made to pay for the qualified higher education expenses of the designated beneficiary or for some
other purpose with the understanding that the distribution may be taxable if the beneficiary does not have qualified education expenses
which exceed the amount of the distribution in the current year.
Disability
The designated beneficiary has been rendered totally and permanently disabled.
Death
The designated beneficiary has died and a certified copy of his/her death certificate should accompany this form.
USAA Federal Savings Bank 1-800-531-8722
IMAGE=IRADIST #
Fax 1-800-531-5717
(USAA Member Number - No entry required.)
(EWL Code)
usaa.com
08306-0315
TYPE OF DISTRIBUTION
Choose one from A and B.
A.
One Time Request:
Partial Withdrawal in the amount of $ ________________________
(must leave a minimum on deposit of $250)
Or
Total Distribution
Regularly Scheduled Distribution: (Interest Only Payments) NOTE: YOU MUST BE OVER THE AGE OF 591/2
Frequency:
B.
Annually
Semiannually
Quarterly
Monthly
At maturity ___________________________
(date of maturity)
Immediately - Upon FSB’s receipt. I understand that if withdrawal is from an IRA Certificate of Deposit prior to maturity,
substantial interest earnings penalties may be imposed because of early withdrawal.
METHOD OF DISTRIBUTION
Choose one. (If you do not make a selection, a check will be mailed to your address of record.
Deposit to my existing non-IRA USAA FSB Account# ________________________
Mail check to address of record.
Send to financial institution below by: Electronic Funds Transfer (EFT)
Please verify your EFT instructions with your bank. Incorrect information can delay the transmission of funds.
 Personal  Business
Checking Savings
Name of Financial Institution
Name of Account Owner(s)
Account Owner’s Address
City
Type of Account
State
Zip Code
Transit Routing Number (The nine-digit number in lower left corner of check)
Account Number
Read and Sign
If I have selected EFT of my distribution by USAA Federal Savings Bank (the “Custodian”), I authorize the Custodian to begin, and the financial
institution named to accept, electronic deposits (credits) and withdrawals (debits) to my designated account(s) and to reverse, if necessary, any
deposits or withdrawals made in error to my account(s). Automated debit or credit entries shall constitute my receipt for the transaction(s). This
authority is to remain in full force and effect until sponsor has received written or phone notification from me of its termination at such time and in
such manner as to give Sponsor reasonable opportunity to act on it. I acknowledge that the origination of EFT transactions to my account(s) must
comply with the provisions of U.S. law.
X
Signature of Account Holder Date
(mm/dd/yy)
USAA Federal Savings Bank 1-800-531-8722
IMAGE=IRADIST #
Fax 1-800-531-5717
(USAA Member Number - No entry required.)
(EWL Code)
usaa.com
08306-0315
INCOME TAX WITHHOLDING
FEDERAL:
The distributions you receive from your IRA are subject to Federal income tax withholding unless you elect not to have withholding apply. If
you elect not to have withholding apply to your distributions; or if you do not have enough income tax withheld from your distribution, you
may be responsible for payment of estimated tax.
STATE:
If Federal Income Tax withholding is elected, some states require that we withhold state income tax. If you reside in DE, GA, IA, KS, ME,
MA, NE, NC, OK, OR, VT we are required to withhold state income tax when federal income tax is withheld. If you elect to not have federal
income tax withheld then we will not withhold state tax unless you elect to have state tax withholding. If you reside in AR, CA, or MI,
regardless of your federal withholding election, we are required to withhold state income tax unless you elect not to have state withholding.
Based upon the state you reside in, a state specific form may be required to elect or not elect to withhold state taxes. If a form is required, a
completed form must be received before your request can be processed.
* If no tax is withheld you are still subject to federal and state tax on this income. You may be subject to penalties under rules for estimated
tax if your payments of estimated tax and federal/state withholding tax, if any, are not sufficient. Your withholding election will remain in
effect until revoked by you in writing.
FEDERAL:
I elect NOT to have federal income tax withheld from my IRA distribution.
I DO elect to have federal income tax withheld at the rate of ________________ %
or in the amount of $___________________ . (Cannot be less than 10% of the total distribution.) .
IF NO ELECTION IS MADE, THE STANDARD AMOUNT OF 10% WILL BE WITHHELD.
(30% will be withheld if you are a non-U.S. citizen residing outside the United States.)
STATE:
□ I elect NOT to have state income tax withheld from my IRA distribution.
□ I DO elect to have state income tax withheld at the rate of ________________ %
or in the amount of $___________________ .
These rates are subject to legislative change without notice. As a result, your actual state tax withholding may differ from the rates
disclosed in this table. State tax will be withheld using the prescribed rate in force on the date of your retirement distribution.
State
AR
CA
MI
GA
IA
Rate
3% of Gross
10% of FIT*
4.35% of Gross
6% of Gross**
5% of Gross
State
KS
MA
ME
NC
OK
Rate
5% of Gross
5.3% of Gross
5% of Gross
4% of Gross
5% of Gross
State
OR
DE
VT
Rate
9.9% of Gross
5% of Gross
27% of FIT*
*FIT = Federal Income Tax
**SEPP distributions only
X
Signature of Account Holder Date (mm/dd/yy)
Select only one
IRA Owner
Power of Attorney
Or in the event of owner’s death:
Beneficiary
USAA Federal Savings Bank 1-800-531-8722
IMAGE=IRADIST #
Executor/Administrator
Fax 1-800-531-5717
(USAA Member Number - No entry required.)
(EWL Code)
usaa.com
08306-0315