IRA Distribution Form

IRA Distribution Form
Important IRA Distribution Information:

What is a distribution? A distribution is a withdrawal or removal of assets (cash or in-kind) from your IRA account. Distributions from an IRA are reported to the IRS on tax form 1099-R and may be taxable depending on your age, IRA type, tax status, who the funds are going to, etc. Solera National Bank does not provide tax advice nor can confirm if this transaction will be taxable. We highly recommend you consult your tax advisor before proceeding.

Can I take a distribution from my LLC/Trust checking account? Solera National Bank is unable to report any checking account transactions to the IRS on tax forms 1099-R and 5498. If you issue funds from your checking account as a distribution you may be required to submit additional paperwork to your tax advisor. To ensure it is coded through your IRA by Solera National Bank please submit the distribution form to our IRA Team for further processing of the distribution and our team will confirm with you when complete. Then, Solera National Bank will report the distribution to the IRS on your behalf on tax form 1099-R.

Version 6.0 04012025

IRA Account Information

Please enter your personal information and Solera National Bank IRA information.
Name*

First NameLast Name
Email*
example@example.com
Social Security Number*
Date of Birth*

MonthDayYear
IRA Account Number*
IRA Type*

Traditional IRARoth IRAInherited Traditional IRAInherited Roth IRA
IRA Owned Trust/LLC Name*

IRA Distribution Details
By continuing, you are requesting to move the following assets (cash and/or in-kind) from the IRA-owned entity checking account to the IRA to complete your distribution request.
Exact IRA Distribution Cash Amount*
Federal tax withholding election later in this form.
Will you be distributing in-kind (non-cash) assets?*

NoYes
Please * once the distribution is complete.

In-Kind Asset Details
In-Kind Asset Name(s)*
In-Kind Asset Valuation*

In additional to this form, please provide a signed valuation of the asset(s). This value will be reported to the IRS on tax form 1099-R. We recommend working with a qualified asset appraiser.
Cancelof

Tax Withholding
The distributions you receive from your individual retirement account are subject to federal income tax withholding unless you elect not to have withholding apply. You may elect not to have withholding apply to your distribution payments by completing the “Withholding Election” section below.

If you elect to not have withholding, or if you do not have enough federal incoming tax withheld from your distribution, you may be responsible for payment of estimated tax. You may incur penalties under the estimated tax rules if your withholding and estimated tax payments are not sufficient.

If you elect to withhold, you must withhold at least 10% of the distributions total value. An additional fee of $25 will be incurred if you elect to withhold unless you are taking a Required Minimum Distribution.

International distributions may have additional requirements.

State withholding is not supported. Speak with your tax professional for guidance.
Federal Tax Withholding Election*

I elect to waive Federal Tax Withholding.I elect to withhold Federal Taxes.
I direct Solera National Bank to withhold whole percentage (%)*% of my ${exactIra74} distribution request for Federal Taxes.

Payment Instructions
Payment Election*

Cashier's CheckDomestic WireInternational Wire

International Wire Information

Be advised, funds sent by international wire will incur an additional $50 outgoing international wire fee.
Receiving International Bank Name*
Receiving International Bank Address*
Receiving International Bank SWIFT Code*
Will you be using your own U.S. intermediary bank?*

No, I confirm that Solera National Bank can chose a valid U.S. intermediary bank to send my international wire.Yes, I will provide wire instructions for the intermediary bank of my choice.
Intermediary Bank Name*
Intermediary Bank ABA/Routing Number*

Domestic Wire Information

Be advised, funds sent by wire will incur an additional $30 outgoing wire fee.
Receiving Bank Name*
Receiving Bank Address*
Receiving Bank Wire ABA/Routing Number*
Receiving Account Number*
For Further Credit/Memo*

Cashier's Check Information

Be advised, funds sent by check are issued as cashier's checks. Solera National Bank is not responsible for any loss/delay due to mailing.
Made Payable To*
Memo*
Mail to Address*
Street Address, Apt/Suite #, City, State, ZIP Code
Shipping Options*

Regular Mail2-day Mail (based on current rates)

Acknowledgement & Signature
I certify that I am the IRA account owner, the beneficiary, or individual legally authorized to complete this form and the proper party to receive payment(s) from the IRA. I certify that all information provided on this form is true and accurate. I acknowledge that I have read the above Tax Withholding Notice and have completed the withholding election above, which will remain in effect until revoked. I understand that I am responsible for any consequences resulting from this distribution, including taxes and penalties owed. I also accept responsibility for maintaining the appropriate cash balance for any recurring distributions. I understand that processing this request may result in applicable fees and account termination. By signing below, I certify that the valuation provided separately to Solera National Bank for any in-kind assets is true and correct to the best of my knowledge and that Solera may rely on the valuation for reporting purposes. I accept all responsibilities regarding this valuation. I certify that Solera National Bank has not provided me with tax, investment, or legal advice; and I will indemnify Solera National Bank, its affiliates, successors, and assignors, from all liability arising from this distribution request. I agree that all decisions regarding this are my own and assume responsibility for any consequences that may arise. My signature serves as legal authorization granting Solera National Bank authority to process this distribution request.
Clear
Date of Signature*

MonthDayYear
Should be Empty:

IRA Distribution Form

IRA Account Information

IRA Distribution Type

IRA Distribution Details

In-Kind Asset Details

Tax Withholding

Payment Instructions

International Wire Information

Domestic Wire Information

Cashier's Check Information

Acknowledgement & Signature