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Traditional IRA Beneficiary Request for Distribution - Imprinted # 10567

This form is used to elect the amount and method of distribution to beneficiaries after the accountholder dies. The options available for beneficiaries of an accountholder who died before, on, or after the accountholder's required beginning date are addressed. Additionally, a federal income tax withholding election, which eliminates the bother and expense of using a separate election form, is provided. A withholding notice (instructions for Form W-4P) is printed on the reverse side of this form. Imprinting includes up to 4 lines of tyhhpe (black ink). Two-part, two-sided, black ink, 8 1/2 x 11.