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Traditional IRA Required Distribution Age 70 1/2 and Over - Not Imprinted # 10562

This form is used to elect the amount and method of distribution for an accountholder age 70 1/2 and over. A federal income tax withholding election, which eliminates the bother and expense of using a separate election form, is also provided. A withholding 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.