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Traditional IRA Request for Distribution - Imprinted # 10555

This form is used to document every type of Traditional IRA distribution. It contains sections for type, amount, and method of distribution. Additionally, the "federal income tax withholding election" is included to save you the trouble and cost of providing a separate election form when your accountholder requests a distribution. A withhoding notice (instructions for Form W-4P) is printed on the reverse side of this form. Two-part, two-sided, black ink, 8 1/2 x 11.