Mutual Fund Qualified Charitable Distribution - PDF document

1 FMF4QCDD 2/20_w Mutual Fund Qualified
FMF4QCDD 2/20_w Mutual Fund Qualified Charitable Distribution Mail to: T.Rowe PriceP.O. Box 17302Express delivery only:T.Rowe Price Mail Code 17302 Owner Information Check IRA Type: Roth Rollover Roth Rollover Inherited Roth Inherited SEP-IRA Check if IRA assets are held in a brokerage account: Brokerage. It is your responsibility to ensure that sufficient funds are available in your sweep account to cover the amount of the NameSocial Security Number (SSN)PhoneDate of Birth (mm/dd/yyyy) Distribution Information 2AAmount For each fund and account number listed, provide the amount to be distributed. For more funds, check this box and attach a separate page. * NOTE: Dollar balances may fluctuate daily with the market. If the dollar amount is close to the total balance, provide percent or share This stamp indicates that a notary is required. This paper clip indicates that you may need to attach documentation. Use this form to:• (QCD) from a Traditional, Rollover, Roth, Inherited, SEP-IRA (inactive plans only), or SIMPLE IRA (inactive plans only). • employer-sponsored retirement plans, including active SEP-IRA or SIMPLE IRA plans. An “active” SEP-IRA or SIMPLE IRA is one in which an employer contribution or salary reduction contribution is made for the plan year ending with or within the participant’s tax • A QCD may count toward satisfying any required minimum distribution (“RMD”). Note: If you have a systematic withdrawal plan established and you would like to reduce any remaining payments by the distribution amount requested on this form, you must complete section 3.Each check will be made payable to the qualified charity and list your name as donor. Since you must receive acknowledgment of your contribution, you should follow up with the charity directly for a receipt of your donation.A Form 1099-R will be issued to you and the IRS for this distribution from your IRA. For a non-Inherited IRA, a distribution with IRC Section 408(d)(8). For more detailed information about IMPORTANT NOTE:The SECURE Act extended the age for individuals, who did not turn 70½ on or before 12/31/19, to start taking thier RMDs from 70½ to 72. If you turned 70½ on or before 12/31/19, your RMD age butions to a Traditional IRA beginning for taxable year 2020. However, the $100,000 annual exclusion from income for QCDs is reduced if you are Helpful Facts• • . A qualified charity is an organization des

2 cribed in Internal Revenue Code (IRC) Se
cribed in Internal Revenue Code (IRC) Section 170(b)(1)(A), generally a public charity that is eligible to receive tax-deductible contributions. The following charities are excluded: private foundations, donor-advised funds, and charitable supporting • • This $100,000 is reduced if you are making deductible IRA contributions after age 70½. FMF4QCDD 2/20_w Questions? troweprice.com/ira | 800-225-5132Page 2 of 2 Receiving Organization A check(s) will be made payable to the qualifying charity(ies) and mailed If an address is not provided, the check will be mailed to your address of record. Failure to provide the cation among the listed organizations. Total Check Amount Total Check Amount o list more receiving organizations, check this box and attach a Existing RMD Withdrawal Program On File be automatically updated unless you check the box below. the total requested withdrawal amount in Section 2 of this form. I tionately from each mutual fund within the type of IRA identified in Please note, this option only applies to a systematic withdrawal plan in which T. Rowe Price is calculating the RMD for you. To allow time for processing, please submit this form at least 14 days in advance of your next payment date. Failure to do so may prevent your systematic RMD from being updated timely. This may result in more money being distrib I direct T. Rowe Price to make a QCD in the manner I have indicated. I certify the following: requirements under Internal Revenue Code Section 408(d)(8). .Rowe Price and its affiliates from and against any and all claims or causes of action, or any losses and liabilities, incurred as a result of my instructions on this form. I elect no income tax withholding.• • RMD amounts under Internal Revenue Code Section 401(a)(9). I hereby indemnify and hold T. Rowe Price Trust Company, its parent and affiliates, successors, and employees harmless from any and all liability should I fail to receive the correct RMD amount in any calendar year.• If distributing the QCD from a SEP-IRA or SIMPLE IRA, I am not an active participant in the plan. Account Owner Sign Below fied charity address(es) AND your TOTAL distribution amount is greater than $10,000. Signature and Date RequiredOwner or BeneficiaryDate (mm/dd/yyyy)X 4BNotary Sworn to and subscribed before me, this ___________ day of ________________________, __________. In witness hereof, I hereunto set my hand and official seal. Applies to Account Owner(s)