7. Minimum Required Distribution (MRD) for the Deceased Only
Instructions
Skip section if If the deceased was over 70½ and had not withdrawn his or her total MRD in the year he or she died, as a bene-
the deceased was ficiary you must withdraw the appropriate amount by December 31 of the year of death. The distribution amount
younger than 70½ must be based on the deceased’s MRD schedule but reported under your tax ID number.
when he or she died.
To comply with IRS regulations, Fidelity requires the remaining year-of-death MRD, if applicable, to be taken from an
Inherited IRA. Please note: If you wish to withdraw an amount other than the MRD of the deceased, please complete
the enclosed Fidelity IRA One-Time Withdrawal Form. If you wish to establish periodic withdrawals on your newly
established Inherited IRA, please complete the Fidelity Inherited IRA Automatic Withdrawal Service Form or go
online at Fidelity.com/autowithd.
Call Fidelity Request for MRD of the deceased
Inheritor Services
Amount (required if box is checked) If there are multiple beneficiaries inheriting the IRA, please provide
at 800-544-0003 if
you need the MRD $ . ONLY the amount you wish distributed from your inherited IRA.
calculated.
The MRD will be taken from the cash position. If there is not enough cash available, please complete the following
in the order in which to liquidate a fund or individual security to meet the MRD amount. Please note that if multi-
ple securities are listed, trades may be placed over multiple days. If no securities are provided, your requested MRD
will be withdrawn proportionately from all eligible money market and mutual fund positions.
1. Security/Fund Name 2. Security/Fund Name
Distribution Method
Check one and Directly deposited to my Fidelity nonretirement account:
provide any required Fidelity Nonretirement Account Number Fidelity Fund Name or Symbol Mutual Fund Accounts only Brokerage accounts will be
information.
deposited into core position.
Check mailed to the address of record
Default if no choice indicated or if we are unable to process your choice.
Tax Withholding
MRDs from a non-Roth IRA are subject to federal and, where applicable, state income tax withholding unless you elect not to have
withholding apply below (if you are a U.S. citizen or other U.S. person, including a resident alien individual). If you do not elect out of
withholding, federal income tax will be withheld at the rate of 10% from your total IRA distribution amount, unless you indicate a higher
percentage below. If there are nondeductible contributions in your IRA, this may result in excess withholding from your distribution. If you
elect not to have withholding apply to your distribution or if you do not have enough federal income 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. See “State Tax Withholding information — IRA Withdrawals” on the last page of this form.
Federal State
Check one in each Do NOT withhold federal taxes. Do NOT withhold state taxes unless required by law.
column. IRA owner’s
legal/residential W ithhold federal taxes at the rate of: W ithhold state taxes at the applicable rate.
address determines Percentage Minimum 10%, maximum 99%. Whole W ithhold state taxes at the rate of:
which state’s tax numbers, no dollar amounts. Note that if
rules apply. % there is federal withholding, certain states Percentage Maximum 99%. Whole numbers, no
dollar amounts.
require that there also be state withholding. %
Account owner must sign and date at the end of section 8. Form continues on next page.