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Part 1. Please Tell Us About Yourself Instructions to Present IRA Custodian or Trustee Completed by Depositor NAME NAME OF CUSTODIAN/TRUSTEE ADDRESS ATTN MR./MS. CITY STATE ZIP SOCIAL SECURITY NO. DAYTIME PHONE Part 2. Type of Account You Would Like To Transfer Choose one Traditional lRA Rollover IRA Qualified Plan SEP IRA Roth IRA SIMPLE IRA Transfers from a Roth IRA into a Traditional IRA a Rollover IRA or a Simplified Employee Pension SEP IRA are not allowed. Qualified Plans are 401...
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