IRA Conversion Form

IRA Conversion Form
Important IRA Conversion Information:

An IRA Conversion is the process of rolling over retirement assets from a Traditional IRA to a Roth IRA. Generally, conversions are taxable, meaning you will owe taxes on the amount converted since a conversion changes the assets tax status from pre-tax to post-tax. You will have the option to withhold Federal Taxes while completing this form.

Completing a conversion can potentially put you into a higher tax bracket for the year the conversion is done. 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.

Version 5.0 04012025

Personal Information

Please enter your personal information.
Name*

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

MonthDayYear

IRA Account Information

List the information of your existing accounts. You will need to have a Traditional IRA and a Roth IRA open to complete the conversion.
Do you have a Traditional IRA open with Solera National Bank?*

YesNo
Traditional IRA Account Number *
Traditional IRA Trust/LLC Name
Do you have a Roth IRA open with Solera National Bank*

YesNo
Roth IRA Account Number*
Roth IRA Owned Trust/LLC Name
Our applications team will contact you to assist in completing an application to open the necessary Traditional IRA or Roth IRA for your IRA conversion request.

IRA Conversion Details
By continuing, you are requesting to rollover the following assets (cash and/or in-kind) from your Traditional IRA to your Roth IRA as a conversion.
Type of IRA Conversion*

Full Conversion, Including the Traditional IRA LLC/Trust and All CashPartial Conversion, Exact Cash Amount and/or Individual In-Kind Asset(s)
Exact IRA Conversion Cash Amount*
Federal tax withholding election later in this form.
Will you be converting in-kind (non-cash) assets)*

NoYes
Amended IRA Entity Agreement*

The Operating Agreement for your LLC or the Trust agreement should be amended to reflect the change in IRA ownership. The amendment will remove the Traditional IRA as a member or trustor and replace it with the Roth IRA. For assistance with this amendment, please contact your provider.
Cancelof
IRA Entity Valuation*

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

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

In addition to this form, please provide a valuation of the asset(s). We recommend working with a qualified asset appraiser.
Cancelof
In-Kind Asset Proof of Ownership*

In addition to this form, please provide proof (statement, agreement, etc.) that the asset(s) ownership is now under the Roth LLC/Trust.
Cancelof

Traditional IRA Intent
Once the conversion is complete, please select if you'd like to keep or close your Traditional IRA Account.*

Close the Traditional IRAKeep the Traditional IRA open for all transactions*Keep the Traditional IRA open for conversions only**
*To keep the Traditional IRA open for all transactions, it must own an LLC or Trust for investment purposes. This is our standard, self-directed, checkbook control set up. If you did a full conversion of the existing LLC or Trust, you will be required to create a new LLC or Trust for the purpose of investing the Traditional IRA funds.

**The 'Conversion Only' Traditional IRA, unlike our standard set up, allows you to hold a Traditional IRA without the need for an LLC or Trust relationship. This account is exclusively for conversions, with no annual fee or closing fee. Any funds deposited into the 'Conversion Only' Traditional IRA will remain in the account until you initiate a conversion to the Roth IRA. Please note, that the $100 conversion fee will apply to each conversion processed through the account.

Tax Withholding
The IRS requires withholding of 10% of Traditional IRA funds being converted to a Roth IRA unless you elect otherwise. If you withhold taxes from this conversion, you may owe a federal early penalty on the funds if you are under 59 1/2 (because the IRS may treat this money as a withdrawal from your IRA), and you will also owe income taxes. Withholding for conversion are withdrawn from the Traditional IRA.

State withholding is not supported. Speak with your tax professional for guidance.

Solera National Bank cannot withhold taxes on an in-kind conversion. Speak to your tax professional for guidance.
Federal Tax Withholdng 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 ${exactIra} IRA conversion for Federal Taxes.

Acknowledgement & Signature
I acknowledge a conversion from a Traditional IRA to a Roth IRA is treated as a taxable distribution. I have been advised to consult with a tax advisor before completing this transaction. I acknowledge that this transaction is subject to federal income tax withholding in the year in which the conversion occurs. I understand that I am eligible to opt out of this withholding by indicating my intention above. I acknowledge that state tax withholding rules may also apply. I understand that the full amount of any taxes being deducted from my account as a result of this Roth conversion must be available before my transaction can be processed.

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 National Bank may rely on their valuation for reporting purposes. I accept all responsibilities regarding this valuation.

I declare that I have fully examined this document, including accompanying information, and to the best of my knowledge and belief, it is true, correct, and complete. 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 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 request.
Clear
Date of Signature*

MonthDayYear
Should be Empty:

IRA Conversion Form

Personal Information

IRA Account Information

IRA Conversion Details

In-Kind Asset Details

Traditional IRA Intent

Tax Withholding

Acknowledgement & Signature