Request Distribution from Traditional
or Roth IRA for Charitable Purposes
Date
Name
Address
City, State, Zip
ATTN: IRA Plan Administrator
Dear :
Please accept this letter of instruction as authorization to make a tax-free distribution from my Individual Retirement Account for charitable purposes as described in Section 208 of the American Taxpayer Relief Act of 2012.
A distribution in the amount of $ __________ shall be made to the following Charity(ies):
(Legal Name of Charity)
Address
City, State, Zip
Attention: (Name of person at charity to whom distribution is to be sent.)
Please include my name and address with the distribution for acknowledgment purposes and please copy me on your transmittal.
If there are any questions concerning this distribution, please do not hesitate to call me
at (xxx) xxx-xxxx.
Sincerely yours,
Name of IRA holder
cc: Charitable Recipient