Withdrawals Ira One Time
Withdrawals Ira One Time
Helpful to Know
• It is your responsibility to ensure that your IRA distributions control the timing of the transaction, you should direct the
comply with IRS rules. All transactions made using this form sale of securities online or through a Fidelity representative.
are reported to the IRS as an IRA distribution. You may want Note: Certain securities (such as options, certain fixed income
to consult a tax advisor as such distribution generally results securities, and thinly traded securities) may not be eligible to
in taxable income to you. sell via this form, which may result in Fidelity not being able to
• You should also confirm that Fidelity has your most current process this withdrawal as requested.
address prior to submission so that we can withhold • For mutual funds, note that:
appropriate taxes. See the General Instructions and the – Withdrawals could trigger redemption or transaction fees
Marginal Rate Tables contained in the IRS Form W-4R at (see the applicable fund prospectus).
Fidelity.com/W-4R for additional information. To update your – If a fund is closed to new investors, you will not be able to
address, go to Fidelity.com. purchase new shares of the fund in the future
• Nonresident aliens must provide IRS form W-8BEN and a U.S. if you draw your fund balance down to zero.
or foreign tax identification number. • Any fees charged or expenses incurred in connection with
• If you are making withdrawals from more than one IRA, you your instructions will be assessed at the “rep-assisted” rates.
must complete a separate form for each account. Fees and expenses may be lower if you instead place your
• If this form directs Fidelity to sell shares of any security, be trades online. Please refer to the Schedule of Fees for more
aware that the timing of the transaction depends on when we information.
receive this form, which is outside of your control. To better • If you are rolling over these assets to an employer plan, you may
be responsible for obtaining your Plan Administrator’s consent.
1. Account Owner
Name Fidelity IRA Number
Phone number may
be used if we have
questions, but will not Social Security or Taxpayer ID Number Primary Phone
be used to update your
account information.
2. Request Reason
Check ONLY one. Normal You are AT LEAST 59½ at the time of distribution.
If directing your distri-
Early distribution You are younger than 59½ at the time of distribution. An IRS early distribution penalty may apply.
bution to an HSA as
Note: A distribution from a Roth IRA will be reported as an early distribution.
a qualified HSA fund-
ing distribution, check Death of original IRA owner For inherited accounts only.
either “Normal” or
“Early distribution,“ Direct rollover to a workplace retirement plan, such as a 401(k):
as appropriate. Plan Name
In the event that transactions cannot be processed within five business days of determining your request to be in good order,
Fidelity will notify you and you may have to resubmit your request on the unsold positions within your account.
Check ONLY ALL core cash and Fidelity money market funds in your brokerage account Skip to Section 4.
one and provide
any additional ONLY the following amount of cash in your brokerage account. Skip to Section 4.
requested Dollar Amount If the amount you indicate is greater
information. than your core account balance,
$ your request will be denied.
ENTIRE VALUE of your account in cash (all eligible securities will be sold)
ENTIRE VALUE of your account as shares (in kind) You must choose to distribute into a Fidelity account in
Section 4.
ONLY the following eligible securities and amounts:
Sell and distribute as cash Security Name or Symbol
4. Distribution Method
You must obtain a Medallion signature guarantee in Section 6 if requesting a bank wire, if sending a check to a payee other than the IRA
owner or alternate address, if the requested payment amount or direct rollover to a workplace retirement plan is over $100,000, or if the
address on the account has been changed within the past 10 days.
D
istribute into a Fidelity nonretirement, investment-only retirement, Defined Contribution Retirement Plan account,
or your own Fidelity HSA: Requires Medallion signature guarantee if going to an account of which you are not an owner.
Fidelity Nonretirement or HSA Account Number Fidelity Fund Name or Symbol Mutual fund accounts ONLY
Check one and irect rollover to a workplace retirement plan, check paid to a payee other than the IRA owner, or check
D
provide all required mailed to an alternate address:
information. Workplace Retirement Plan or Other Payee Name
Address
lectronic funds transfer (EFT) to a bank or credit union account using EFT instructions already in place on the
E
account (cash only). This form cannot be used to set up EFT. To add EFT to an account, go to Fidelity.com/eft or com-
plete the Electronic Funds Transfer (EFT) Authorization form.
A
. EFT to your bank account. The names on the bank account and the IRA are the same.
B. EFT to someone else. (Available for brokerage accounts only.) The names on the bank account and the IRA
are different.
If EFT has not been established prior to the receipt of this request, a check will be mailed to the address
Provide bank informa- of record.
tion ONLY if there are
multiple EFT instruc- Bank Account Number
tions on the account
identified in Section 1.
Check mailed to the address of record Default if no choice indicated or if we are unable to process your choice.
ank wire to a bank or credit union account in your name or someone else’s (cash only): Ask the bank for its wire
B
routing number. The bank may charge a fee for wire transfers.
Wire Recipient
All bank wire requests Bank Routing /ABA Number Bank Name
MUST have a Medallion
signature guarantee. A
notary seal/stamp is Account Number Account Owner Name(s) Required
NOT a Medallion
signature guarantee.
Address of Wire Recipient
FULL address is
required for City State/Province ZIP/Postal Code Country
international wires.
Additional Details (if applicable) Instructions to be included with the wire transfer.
Correspondent bank
information may not be
required for all wires.
Indicate if the recipient Account is OUTSIDE the United States:
bank is outside the
SWIFT Code Name of Country
United States.
Federal State
Check one in each Do NOT withhold federal taxes. Do NOT withhold state taxes unless required by law.
column. IRA owner’s
Withhold federal taxes at the rate of: Withhold state taxes at the applicable rate.
legal/residential
address determines Percentage Whole numbers; no dollar amounts or
Withhold state taxes at the rate of:
which state’s tax decimals. Note that if there is federal tax
% Percentage Whole numbers; no dollar amounts
rules apply. withholding, certain states require that
or decimals.
there also be state tax withholding.
%
OWNER SIGNATURE
X
SIGN
DATE MM/DD/YYYY
X
D AT E
Did you sign the form? Send the ENTIRE form Regular mail Overnight mail
to Fidelity Investments. Fidelity Investments Fidelity Investments
Attn: Retirement Distributions Attn: Retirement Distributions
Questions? Go to Fidelity.com/movemoney PO Box 770001 100 Crosby Parkway KC1B
or call 800-343-3548. Cincinnati, OH 45277-0035 Covington, KY 41015
On this form, “Fidelity” means Fidelity Brokerage Services LLC and its affiliates. Brokerage services are
provided by Fidelity Brokerage Services LLC, Member NYSE, SIPC. 592522.12.0 (11/22)
General Instructions on Federal Tax Note: If you don’t give Form W-4R to your payer, you
don’t provide an SSN, or the IRS notifies the payer that you
Withholding gave an incorrect SSN, then the payer must withhold 10% of
Nonperiodic payments—10% withholding. Your payer the payment for federal income tax and can’t honor requests
must withhold at a default 10% rate from the taxable amount to have a lower (or no) amount withheld. Generally, for pay-
of nonperiodic payments unless you enter a different rate. ments that began before 2024, your current withholding
Distributions from an IRA that are payable on demand are election (or your default rate) remains in effect unless you
treated as nonperiodic payments. Note that the default rate submit a new withholding election.
of withholding may not be appropriate for your tax situation.
Payments to nonresident aliens and foreign estates.
You may choose to have no federal income tax withheld.
Do not use Form W-4R. See Pub. 515, Withholding of Tax on
See the specific instructions below for more information.
Nonresident Aliens and Foreign Entities, and Pub. 519, U.S.
Generally, you are not permitted to elect to have federal
Tax Guide for Aliens, for more information.
income tax withheld at a rate of less than 10% (including
“-0-”) on any payments to be delivered outside the United Tax relief for victims of terrorist attacks. If your disability
States and its territories. payments for injuries incurred as a direct result of a terrorist
attack are not taxable, enter “-0-”. See Pub. 3920, Tax Relief
for Victims of Terrorist Attacks, for more details.
1.964543.108 Page 1 of 3
Specific Instructions for IRS Form W-4R If the two rates differ, multiply (a) the amount in the lower
rate bracket by the rate for that bracket, and (b) the amount
Line 1b in the higher rate bracket by the rate for that bracket. Add
For an estate, enter the estate’s employer identification these two numbers; this is the expected tax for this payment.
number (EIN) in the area reserved for “Social security To get the rate to have withheld, divide this amount by the
number.” taxable amount of the payment. Round up to the next whole
Line 2 number and enter that rate on line 2. (See Example 2 below.)
More withholding. If you want more than the default rate If you prefer a simpler approach (but one that may lead to
withheld from your payment, you may enter a higher rate on overwithholding), find the rate that corresponds to your total
line 2. income including the payment and enter that rate on line 2.
Less withholding (nonperiodic payments only). If permit- Examples. Assume the following facts for Examples 1 and 2.
ted, you may enter a lower rate on line 2 (including “-0-”) if Your filing status is single. You expect the taxable amount of
you want less than the 10% default rate withheld from your your payment to be $20,000. Appropriate amounts have
payment. If you have already paid, or plan to pay, your tax been withheld for all other sources of income and any
on this payment through other withholding or estimated tax deductions or credits.
payments, you may want to enter “-0-”. Example 1. You expect your total income to be $62,000
Suggestion for determining withholding. Consider using without the payment. Step 1: Because your total income
the Marginal Rate Tables on page 1 to help you select the without the payment, $62,000, is greater than $61,750 but
appropriate withholding rate for this payment or distribution. less than $115,125, the corresponding rate is 22%. Step 2:
The tables are most accurate if the appropriate amount of Because your total income with the payment, $82,000, is
tax on all other sources of income, deductions, and credits greater than $61,750 but less than $115,125, the correspond-
has been paid through other withholding or estimated tax ing rate is 22%. Because these two rates are the same, enter
payments. If the appropriate amount of tax on those sources “22” on line 2.
of income has not been paid through other withholding or Example 2. You expect your total income to be $43,700
estimated tax payments, you can pay that tax through without the payment. Step 1: Because your total income
withholding on this payment by entering a rate that is greater without the payment, $43,700, is greater than $26,200 but
than the rate in the Marginal Rate Tables. less than $61,750, the corresponding rate is 12%. Step 2:
The marginal tax rate is the rate of tax on each additional Because your total income with the payment, $63,700, is
dollar of income you receive above a particular amount of greater than $61,750 but less than $115,125, the correspond-
income. You can use the table for your filing status as a guide ing rate is 22%. The two rates differ. $18,050 of the $20,000
to find a rate of withholding for amounts above the total payment is in the lower bracket ($61,750 less your total
income level in the table. income of $43,700 without the payment), and $1,950 is in the
To determine the appropriate rate of withholding from higher bracket ($20,000 less the $18,050 that is in the lower
the table, do the following. Step 1: Find the rate that bracket). Multiply $18,050 by 12% to get $2,166. Multiply
corresponds with your total income not including the pay- $1,950 by 22% to get $429. The sum of these two amounts
ment. Step 2: Add your total income and the taxable amount is $2,595. This is the estimated tax on your payment. This
of the payment and find the corresponding rate. amount corresponds to 13% of the $20,000 payment ($2,595
If these two rates are the same, enter that rate on line 2. divided by $20,000). Enter “13” on line 2.
(See Example 1 below.)
1.964543.108 Page 2 of 3
State Tax Withholding Information
State of residence State tax withholding options
AK, FL, HI, NH, NV, SD,
• No state tax withholding is available (even if your state has income tax).
TN, TX, WA, WY
• If you choose federal withholding, you will also get state withholding at your state’s minimum withholding
rate or an amount greater as specified by you.
IA, KS, MA, ME, OK, VT • If you do NOT choose federal withholding, state withholding is voluntary.
• If you have state withholding, you can request a higher rate than your state’s minimum but not a lower rate,
except on Roth IRA distributions.
• If you choose federal withholding, you will also get state withholding at your state’s minimum withholding
rate unless you request otherwise.
AR, CA, DE, MN,
• If you do NOT choose federal withholding, state withholding is voluntary.
NC, OR
• If you have state withholding, you can request a higher rate than your state’s minimum but not a lower rate,
except on Roth IRA distributions.
•C T and MI generally require state income tax of at least your state’s minimum requirements regardless of
whether or not federal income tax is withheld.
• Tax withholding is not required if you meet certain state requirements governing pension and retirement
benefits. Please reference the CT or MI W-4P Form for additional information about calculating the amount
CT, MI to withhold from your distribution.
• If you are subject to state tax withholding, you must elect state tax withholding of at least your state’s
minimum by completing the Tax Withholding section.
• Contact your tax advisor or investment representative for additional information about your state’s requirements.
• If you are taking distribution of your entire account balance and not directly rolling that amount over to
another eligible retirement account, DC requires that a minimum amount be withheld from the taxable
DC portion of the distribution, whether or not federal income tax is withheld. In that case, you must elect to
Only applicable if taking have the minimum DC income tax amount withheld by completing the Tax Withholding section.
a full distribution of entire • If your entire distribution amount has already been taxed (for instance only after-tax or nondeductible contributions
account balance. were made and you have no pre-tax earnings), you may be eligible to elect any of the withholding options.
• If you wish to take a distribution of both taxable and nontaxable amounts, you must complete a separate
distribution request form for each and complete the Tax Withholding section of the forms, as appropriate.
• If you choose federal withholding, you will also get state withholding at your state’s minimum withholding
rate unless you request otherwise.
MS • If you do NOT choose federal withholding, state withholding will occur unless you request otherwise.
• If you have state withholding, you can request a higher rate than your state’s minimum but not a lower rate,
except on Roth IRA distributions.
•S
tate tax withholding is voluntary. If you choose state withholding, you can choose a higher rate than your
OH
state’s minimum but not a lower rate, except on Roth IRA distributions.
•S
C requires state withholding if you have not provided a Tax ID or if you have been notified of a name/
SC Tax ID mismatch and have not resolved the issue. Otherwise, state tax withholding is voluntary and you can
choose the rate you want.
All other states
(and DC if not taking a • State tax withholding is voluntary and you can choose the rate you want.
full distribution)
Important: Federal and/or state tax withholding rules can change, and the information cited above may not reflect the current legislation
and/or ruling of your state. Consult with your tax advisor, the IRS, or your state taxing authority to obtain the most up-to-date information
pertaining to your situation.
This tax information is for informational purposes only, and should not be considered legal or tax advice. Always consult a tax or legal
professional before making financial decisions.
We do not provide tax or legal advice and we will not be liable for any decisions you make based on this or other general tax information
we provide.
Fidelity Brokerage Services LLC, Member NYSE, SIPC; National Financial Services LLC, Member NYSE, SIPC 652041.9.0 (01/24)
1.964543.108 Page 3 of 3
Questions? Go to Fidelity.com/security/overview or call 800-343-3548.
Watch for red flags Here are some examples of red flags that should make you think twice before sending money.
• A person or company solicits business from you rather than your finding them on your own.
• The requestor asks you to send the wire to a name different from their own.
• After just a few contacts, they profess strong feelings for you and ask to chat with you.
• They threaten legal action if the funds are not sent “right away.”
• The wiring instructions seem unusual, they change, or you’re asked to go to a different financial institution.
• You are coached on how to respond to questions your financial institution might ask you regarding the transaction.
• If you met on a dating site, they will try and move you away from the site and communicate via chat or email instead.
• Messages may be full of typing errors, poorly written, or vague, and may escalate quickly if you show resistance.
• The messages or calls become more desperate and/or persistent, and if you do send money, they ask you to send more.
Remember, if it seems too good to be true, it probably is!
Your security is our top priority. We’re here to help. If you have any concerns or want to know more about how to help protect yourself, talk to a
Fidelity representative or visit Fidelity’s Security Center online at Fidelity.com/security/overview. 928234.1.0 (05/20)
1.9899061.100 Page 1 of 1