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Professional Experience Company

Location:
New York, New York, United States
Posted:
March 11, 2018

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A plan sponsor should assist a participant when completing this form to request a one-time full or partial distribution from a 401(k), 403(b), or governmental 457(b) plan. Please contact your tax advisor regarding your specific tax obligation or potential IRS penalties that may apply to your distribution and read and retain for your records the Special Tax Notice Regarding Plan Payments accompanying this form. Step 1: Account RegiStRAtion infoRmAtion

Plan Name Plan/Account Number

Participant Name (First Name, MI, Last Name) Participant Social Security Number

Participant Email Address Participant Daytime Phone Number

Check plan type: 401(k) 403(b) Governmental 457(b) Other : Step 2: DiStRibution ReASon (choose only one distribution reason, if applicable.) Distributions prior to age 591 2 that are not rolled over or transferred to another IRA or retirement plan are subject to a 10% IRS penalty tax for premature withdrawal, unless an exception applies.

Age 591 2 or older

Separation from service

Plan termination

Age 701 2 required minimum distribution

Disability

Purchase of Service Credits (401(a) provider form must be included)

Withdrawal of rollover money only

In-service withdrawal

Hardship withdrawal (does not apply to governmental 457(b)) 403(b) Contract Exchange:

403(b) to 403(b) with a new custodian of the same employer, also known as Contract Exchange. Choose one of the following:

Information-sharing agreement (ISA) on file.

ISA attached.

Approved vendor list attached.

Plan document attached.

Governmental 457(b) Plans Only:

Unforeseeable emergency

De minimis amount

Transfer of assets to another qualified plan

Mail completed application to: Lord Abbett Service Center, PO Box 219198, Kansas City, MO 64121-9198 Overnight mail: Lord Abbett Distributor LLC, 330 West 9th Street, Kansas City, MO 64105-1514 Fax: 816-***-**** Email: ac4ru8@r.postjobfree.com (Fax and email form only when Medallion Signature Guarantee is not required.) Call Lord Abbett for assistance: 888-***-**** (Monday–Friday between 8:30 a.m. and 6:00 p.m. Eastern Time) gRoup RetiRement plAn one-time DiStRibution foRm

2

STEP 3: DISTRIBUTION REQUEST (Choose only one payment type.) Vesting Percentage (required): %

Note: If the account is not 100% vested, the participant will forfeit the nonvested portion of account during distribution.

Request a partial distribution of $ .

A lump-sum payment of the participant’s entire vested account, less any income tax withholding. (Please see Step 4: Federal Income Tax Withholding.)

A direct rollover via check of the participant’s entire vested account to an IRA.

A direct rollover via check of the participant’s entire vested account to a qualified retirement plan.

A direct rollover via check of the participant’s entire vested account to a non-governmental 457(b) plan.

A direct rollover via a transfer-in-kind of the participant’s entire vested account to the IRA. IRA account number . Lord Abbett Fund Name(s)

(If no investment elections are selected, any contributions will be invested in the Lord Abbett U.S. Government & Government Sponsored Enterprises Money Market Fund.)

Share Class (A or C)

(If a share class is not

selected, Class A shares

will be purchased.)

Lord Abbett

Account Number(s)

Percentage

(Total must

equal 100%)

Please consult your tax or financial advisor regarding transfers between different types of accounts. Please note: Effective November 29, 2013, the Lord Abbett Diversified Income Strategy Fund changed its name to Lord Abbett Multi-Asset Income Fund, the Lord Abbett Balanced Strategy Fund changed its name to Lord Abbett Multi-Asset Balanced Opportunity Fund, the Lord Abbett Growth & Income Strategy Fund changed its name to Lord Abbett Multi-Asset Growth Fund, and the Lord Abbett Global Allocation Fund changed its name to Lord Abbett Multi-Asset Global Opportunity Fund.

STEP 4: FEDERAL INCOME TAX WITHHOLDING

Mandatory tax withholding: Distributions from a qualified, 403(b), or 457(b) governmental plan are subject to mandatory 20% withholding, unless transferred directly to your IRA account or other qualified plan account. Mandatory 20% withholding does not apply if this distribution is considered a hardship, unforeseeable emergency, age 701 2 required minimum, or transfer to a qualified plan. Once taxes are withheld, the withholding will not be returned to you by Lord Abbett.

Choose only one: Do not withhold taxes. (Mandatory withholding does not apply.)

Mandatory 20% withholding applies.

Withhold taxes at the rate of % (10% or higher in whole percentages). Note: For 457(b) nonprofit plans, different taxation rules apply. STEP 5: STATE INCOME TAX WITHHOLDING (optional)

States have varying tax withholding election requirements (the withholding status of each state is subject to change). Mandatory withholding states:

Arkansas, California, Delaware, Iowa, Kansas, Maine, Massachusetts, Nebraska, North Carolina, Oklahoma, Oregon, Vermont, and Virginia. Lord Abbett will withhold the required amount mandated by your state’s income tax bureau automatically. Optional: I reside in a mandatory withholding state (listed above). Withhold an additional $ (over the state’s withholding requirements) from my distribution.

Voluntary withholding states:

Alabama, Arizona, Colorado, Connecticut, District of Columbia, Georgia, Idaho, Illinois, Indiana, Kentucky, Louisiana, Michigan, Minnesota, Mississippi, Missouri, Montana, New Jersey, New Mexico, New York, North Dakota, Ohio, Pennsylvania, Rhode Island, South Carolina, Utah, West Virginia, and Wisconsin. If you are a resident in a voluntary withholding state, Lord Abbett will not withhold automatically. Optional: I reside in a voluntary withholding state (listed above). Withhold $ from my distribution. Nonwithholding states:

Alaska, Florida, Hawaii, Nevada, New Hampshire, Puerto Rico, South Dakota, Tennessee, Texas, Washington, and Wyoming. You are not allowed to withhold any state taxes for this distribution.

Mandatory withholding state with exception:

Maryland. Lord Abbett will withhold the required amount mandated by your state’s income tax bureau automatically if the distribution is eligible for rollover, and the participant chooses not to roll over these funds. If the amount selected by the participant is not eligible for rollover, the participant may elect withholding.

Optional: I reside in a mandatory withholding state with exception. Withhold $ from my distribution. 3

STEP 6: DISTRIBUTION SERVICES (Choose either A, B, or C.) A. Forward a check to the address registered on this account. B. Forward distribution proceeds directly to participant’s bank:

ACH: funding in two or three business days (no fees charged)

Wire: funding the next business day (bank fees may apply) Banking Instructions: Enter your bank information from your personal checking or savings account:

Bank account type: Checking Savings

Nine-digit routing (ABA) number:

Bank account number:

Bank account registration name (include all registration names): C. Transfer or roll over to another custodian or trustee of a qualified plan, non-governmental 457(b) plan, or IRA. (This requires that you provide a letter of acceptance, with mailing and payment instructions, from the successor trustee or custodian.) Receiving Trustee or Custodian Information:

Plan Name (IRA or employer-sponsored plan) Account Number Trustee, Custodian, or Insurer Name (First Name, MI, Last Name) Address to Send Proceeds City State Zip Code

STEP 7: PARTICIPANT SIGNATURE (required for 403(b) plans only) I hereby attest that the preceding facts and declarations are correct.

/ /

Participant Signature Date

STEP 8: AUTHORIZED SIGNATURE(s) (required)

I hereby consent to the participant’s elections as stated above. Employer Name

/ /

Authorized Name (First Name, MI, Last Name) in the capacity of plan sponsor or trustee Date

/ /

Authorized Signature in the capacity of plan sponsor or trustee Phone Number Date Note: If your banking instructions have changed, this form needs to have a Medallion Signature Guarantee to avoid a 15-day hold on redemptions. STEP 9: MEDALLION SIGNATURE GUARANTEE (or Signature Guarantee) (if required) A Medallion Signature Guarantee is required only if you:

■ are requesting a distribution over $100,000 per fund or

■ are requesting a distribution to be deposited to a bank account not currently on file or if the bank account has been updated within the last 15 days or

■ are requesting a distribution to be mailed to a plan sponsor or participant whose address is not currently on file or has changed in the last 30 days. Medallion Signature Guarantees must cover the amount of the requested transaction. There are several different guarantee amounts, so it is important to acquire a guarantee amount equal to or greater than the amount of the transaction(s).

To obtain a Medallion Signature Guarantee, sign this form in the presence of an authorized person at a broker/dealer firm or at another financial institution, such as a bank or trust company. A notarization from a notary public does not meet Medallion Signature Guarantee requirements. Please place Medallion Signature Guarantee here.

Routing (ABA) number Account number

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Special Tax NoTice RegaRdiNg plaN paymeNTS

(Alternative to IRS Safe Harbor Notice for Participant) This notice (revised January 2011) explains how you can continue to defer federal income tax on your retirement plan savings in the Plan and contains important information you will need before you decide how to receive your Plan benefits. All references to “the Code” are references to the Internal Revenue Code of 1986, as amended. This notice summarizes only the federal (not state or local) tax rules that apply to your distribution. Because these rules are complex and contain many conditions and exceptions which we do not discuss in this notice, you may need to consult with a professional tax advisor before you receive your distribution from the Plan. A. tYpeS of plAn DiStRibutionS

Eligibility for rollover. The Code classifies distributions into two types: (1) distributions you may roll over (“eligible rollover distributions”) and (2) distributions you may not roll over. See “Distributions not eligible for rollover” below. You also may receive a distribution under which part of the distribution is an eligible rollover distribution and part is not eligible for rollover. A rollover is a payment by you or the Plan Administrator of all or part of your benefit to another plan or IRA that allows you to continue to postpone taxation of that benefit until it is paid to you (except for a rollover from a pretax account to a Roth IRA, described in the last paragraph of Section B below). The Plan Administrator will assist you in identifying which portion of your distribution is an eligible rollover distribution and which portion is not eligible for rollover. Plans that may accept a rollover. You may roll over an eligible rollover distribution (other than Roth 401(k) plan deferrals and earnings) either to a Roth IRA, to a traditional IRA, or to an eligible employer plan that accepts rollovers. An “eligible employer plan” includes a plan qualified under Code

§401(a), including a 401(k) plan, profit sharing plan, defined benefit plan, stock bonus plan (including an ESOP), or money purchase plan; a §403(a) annuity plan; a 403(b) plan; and an eligible §457(b) plan maintained by a governmental employer (governmental 457 plan). Special rules apply to the rollover of aftertax contributions and of Roth 401(k) deferrals. See “Aftertax contributions and Roth 401(k) plan deferrals” below. YOU MAY NOT ROLL OVER ANY DISTRIBUTION TO A SIMPLE IRA OR A COVERDELL EDUCATION SAVINGS ACCOUNT (FORMERLY KNOWN AS AN EDUCATIONAL IRA). Deciding where to roll over a distribution. An eligible employer plan is not legally required to accept a rollover. Before you decide to roll over your payment to another employer plan, you should find out whether the plan accepts rollovers and, if so, the types of distributions it accepts as a rollover. Even if a plan accepts rollovers, it might not accept rollovers of certain types of distributions, such as aftertax amounts. If this is the case, and your distribution includes aftertax amounts, you may wish instead to roll your distribution over to an IRA or to split your rollover amount between the employer plan in which you will participate and an IRA. You also should find out about any documents you must complete before a receiving plan or IRA sponsor will accept a rollover. If an employer plan accepts your rollover, the plan may restrict subsequent distributions of the rollover amount or may require your spouse’s consent for any subsequent distribution. A subsequent distribution from the plan that accepts your rollover also may be subject to different tax treatment than distributions from this Plan. Check with the administrator of the plan that is to receive your rollover regarding subsequent distributions and taxation of the amount you will roll over, prior to making the rollover. Distributions not eligible for rollover. An eligible rollover distribution means any distribution to you of all or any portion of your account balance under the Plan except: (1) a distribution that is part of a series of substantially equal periodic payments; (2) a required minimum distribution; (3) a hardship distribution; (4) an ESOP dividend; (5) a corrective distribution; (6) a loan treated as a distribution; (7) life insurance cost; (8) 90-day automatic enrollment withdrawals; or (9) ESOP prohibited allocations.

Substantially equal periodic payments. You may not roll over a distribution if it is part of a series of substantially equal payments made at least once a year and which will last for: (1) your lifetime (or your life expectancy), (2) your lifetime and your beneficiary’s lifetime (or life expectancies), or (3) a period of 10 years or more.

Required minimum distributions. Beginning in the year in which occurs the later of your retirement or your attainment of age 701 2, the Code may require the Plan to make “required minimum distributions” to you. You may not roll over the required minimum distributions. Special rules apply if you own more than 5% of the employer.

Hardship distributions. A hardship distribution is not eligible for rollover. ESOP dividends. Cash dividends paid to you on employer stock held in an employee stock ownership plan cannot be rolled over. Corrective distributions. A distribution from the Plan to correct a failed nondiscrimination test or because legal limits on certain contributions were exceeded cannot be rolled over.

Loans treated as taxable “deemed” distributions. The amount of a Plan loan that becomes a taxable deemed distribution because of a default cannot be rolled over. However, a loan offset amount is eligible for rollover, as discussed in Part C below. Ask the Plan Administrator if distribution of your loan qualifies for rollover treatment.

Life insurance cost. The cost of life insurance paid by the Plan. 90-day automatic enrollment withdrawals. Contributions made under special automatic enrollment rules that you request to withdraw within 90 days of enrollment.

ESOP prohibited allocations. Amounts treated as distributed because of a prohibited allocation of S corporation stock under an ESOP. (Also, there generally will be adverse tax consequences if you roll over a distribution of S corporation stock to an IRA.) 5

Aftertax contributions and Roth 403(b) plan deferrals. Aftertax/rollover into an IRA. You may roll over your aftertax contributions to an IRA (including a Roth IRA) either directly or indirectly. The Plan Administrator will assist you in identifying how much of your payment is the taxable portion and how much is the aftertax portion. If you roll over aftertax contributions to an IRA, it is your responsibility to keep track of, and report to the IRS on the applicable forms, the amount of these aftertax contributions. This will enable you to determine the nontaxable amount of any future distributions from the IRA. Once you roll over your aftertax contributions to an IRA, you may NOT later roll over those amounts to an employer plan, but may roll over your aftertax contributions to another IRA. Aftertax/rollover into an employer plan. You may DIRECTLY roll over aftertax contributions from the Plan to another qualified plan (including a defined benefit plan) or to a 401(k) plan if the other plan will accept the rollover and provides separate accounting for amounts rolled over, including separate accounting for the aftertax employee contributions and earnings on those contributions. You may NOT roll over aftertax contributions from the Plan to a §403(a) annuity plan, or to a governmental 457 plan. If you want to roll over your aftertax contributions to an employer plan that accepts these rollovers, you cannot have the aftertax contributions paid to you first. You must instruct the Plan Administrator to make a direct rollover on your behalf. Also, you may not first roll over aftertax contributions to an IRA and then roll over that amount into an employer plan. Roth 403(b) plan deferrals. You may roll over an eligible rollover distribution that consists of Roth deferrals and earnings (whether or not it is a

“qualified” Roth distribution) either: (1) by a direct rollover to another Roth 401(k) plan, or to a Roth 403(b) plan, provided the Roth 401(k) plan or the Roth 403(b) plan will accept the rollover; or (2) by a direct or 60-day rollover to a Roth IRA. Alternatively, you can roll over the taxable portion of a nonqualified Roth distribution by a 60-day rollover to a Roth 401(k) plan or to a 403(b) plan. See Section C, “Taxation of Roth deferrals” and “60-day rollover option” below.

If you roll over a Roth deferral account to a Roth IRA, the amount you roll over will become subject to the tax rules that apply to the Roth IRA. In general, these tax rules are similar to those described elsewhere in this notice, but differences include:

■ ■ All of your Roth IRAs will be considered for purposes of determining whether you have satisfied the five-year rule to enable you to receive a qualified distribution from the Roth IRA (counting from January 1 of the year for which your first contribution was made to any of your Roth IRAs).

■ ■ You will not be required to take a distribution from the Roth IRA during your lifetime, and you must keep track of the aggregate amount of the aftertax contributions in all of your Roth IRAs (in order to determine your taxable income for later Roth IRA payments that are not qualified distributions).

■ ■ Eligible rollover distributions from a Roth IRA can only be rolled over to another Roth IRA. 30-day notice period/waiver. After receiving this notice, you have at least 30 days to consider whether to receive your distribution or have the distribution directly rolled over. If you do not wish to wait until this 30-day notice period ends before your election is processed, you may waive the notice period by making an affirmative election indicating whether or not you wish to make a direct rollover. Your distribution then will be processed in accordance with your election as soon as practical after the Plan Administrator receives your election. b. DiRect RolloveR

Direct rollover process. You may elect a direct rollover of all or any portion of an eligible rollover distribution. If you elect a direct rollover, the Plan Administrator will pay the eligible rollover distribution directly to your IRA or to another eligible employer plan (or, in the case of a distribution of Roth deferrals, to a Roth IRA, a Roth 401(k) plan, or a Roth 403(b) plan) which you have designated. Alternatively, for the cash portion of your distribution, if any, the Plan Administrator may give you a check negotiable by the trustee or custodian of the recipient eligible employer plan or IRA. To complete the direct rollover, you must deliver the check to that trustee/custodian. A direct rollover amount is not subject to taxation at the time of the rollover, unless the direct rollover is from a pretax account to a Roth IRA. Except for a direct rollover of a pretax amount to a Roth IRA, the taxable portion of your direct rollover will be taxed later when you take it out of the IRA or the eligible employer plan. Depending on the type of plan, the later distribution may be subject to different tax treatment than it would be if you received a taxable distribution from this Plan. If you elect a direct rollover, your election form must include identifying information about the recipient IRA or plan. Treatment of periodic distributions. If your Plan distribution is a series of payments over a period of less than 10 years, each payment is an eligible rollover distribution. Your election to make a direct rollover will apply to all payments unless you advise the Plan Administrator of a change in your election. The Plan might not let you choose a direct rollover if your distributions for the year are less than $200. The $200 limit may apply separately to Roth distributions and non-Roth account distributions. Splitting a distribution/small distributions. If your distribution exceeds $500, you may elect a direct rollover of only a part of your distribution, provided the portion directly rolled over is at least $500. If your distribution is $500 or less, you must elect either a direct rollover of the entire amount or payment of the entire amount.

Automatic rollover of certain distributions. If your distribution is an eligible rollover distribution and the Plan will distribute your account balance

(without your consent as required by the Plan), you still may elect whether to receive or to roll over the distribution. The Plan may distribute your account without your consent in limited circumstances (e.g., if your vested account balance does not exceed $5,000 [disregarding any amounts in your account as a result of a prior rollover to the Plan]). The Plan Administrator will provide you with a distribution notice and/or election forms that will advise you whether the Plan will distribute your account without your consent. If the Plan does distribute without your consent, you still may elect whether to receive the distribution or to directly roll over the distribution to another plan or to an IRA (subject to the exception for distributions less than $200 discussed above). If you do not make an election either to receive or to roll over the distribution, the Plan Administrator will roll over the distribution to an IRA in your name. You can transfer these IRA funds at any time to another IRA you designate. The Plan Administrator, in the distribution election forms, will provide you with information regarding the financial institution sponsoring this IRA. Taxation of direct rollover of pretax distribution to Roth IRA. If you directly roll over a pretax distribution to a Roth IRA, the taxable portion of the distribution is subject to taxation for the taxable year in which the distribution occurs (except that a special taxation rule applies to distributions during 2010 that you roll over to a Roth IRA, under which the distribution can be subject to taxation ratably during 2011 and 2012). After you roll over a pretax distribution to a Roth IRA, later payments from the Roth IRA that are qualified distributions will not be taxed (including earnings after the rollover). A qualified distribution from a Roth IRA is a payment made after you are age 591 2 (or after your death or disability, or as a qualified first-time homebuyer distribution of up to $10,000) and after you have had a Roth IRA for at least five years. In applying this five-year rule, you count from January 1 of the year for which your first contribution was made to a Roth IRA. Payments from the Roth IRA that are not qualified distributions will be taxed to the extent of earnings after the rollover, including the 10% additional income tax on early distributions (unless an exception applies). You do not have to take required minimum distributions from a Roth IRA during your lifetime. For more information, see IRS Publication 590, Individual Retirement Arrangements (IRAs).

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c. DiStRibutionS You Receive

Taxation of eligible rollover distributions. The taxable portion of an eligible rollover distribution which you elect to receive is taxable to you in the year you receive it unless, within 60 days following receipt, you roll over the distribution to an IRA or to another eligible employer plan. Taxation of Roth deferrals. If your distribution includes Roth (aftertax) 403(b) plan deferrals, the taxation of the Roth deferrals depends on whether or not the distribution is a qualified distribution. For a distribution of Roth deferrals to be a qualified distribution, you must have satisfied two requirements:

(1) the distribution must occur on or after the date you attain age 591 2, on or after the date of your death, or on account of your being disabled; and (2) the distribution must occur after the end of the fifth calendar year beginning with the first calendar year for which you made Roth deferrals to the Roth 403(b) plan. If the distribution of Roth deferrals is a qualified distribution, then neither the deferrals nor the earnings distributed on the deferrals will be taxable to you. If the distribution is not a qualified distribution, then the portion of the distribution representing your Roth deferrals will not be taxable to you, but the portion of the distribution representing earnings on the Roth deferrals will be taxable to you in the year you receive the distribution, unless you elect a direct rollover as described in Section B above, or within 60 days following receipt, you roll over the distribution to a Roth IRA, or you roll over the earnings on the Roth deferrals to a qualified plan or to a 403(b) plan, as explained under “60-day rollover option” below. Withholding on eligible rollover distributions. The taxable portion of your eligible rollover distribution is subject to 20% federal income tax withholding. You may not waive this withholding. For example, if you elect to receive a taxable eligible rollover distribution of $5,000, the Plan will pay you only $4,000 and will send to the IRS $1,000 as income tax withholding. You will receive a Form 1099-R from the Plan reporting the full $5,000 as a distribution from the Plan. The $1,000 withholding amount applies against any federal income tax you may owe for the year. The direct rollover is the only means of avoiding this 20% withholding.

60-day rollover option. The direct rollover explained in Section B above is not the only way to make a rollover. If you receive payment of an eligible rollover distribution, you still may roll over all or any portion of the distribution to an IRA (including a Roth IRA) or to another eligible employer plan that accepts rollovers, except to the extent the distribution consists of Roth deferrals and earnings on the Roth deferrals. You may roll over the Roth deferrals and earnings on the Roth deferrals to a Roth IRA, or you may roll over only the taxable earnings (if any) on the Roth deferrals (but not the Roth deferrals) to a Roth 401(k) plan or to a 403(b) plan. If you decide to roll over the distribution, you must make the rollover within 60 days of your receipt of the payment. The portion of your distribution which you elect to roll over generally is not subject to taxation until you receive distributions from the IRA or eligible employer plan. However, see “Taxation of direct rollover of pretax distribution to Roth IRA,” above. You may roll over 100% of your eligible rollover distribution even though the Plan Administrator has withheld 20% of the distribution for income tax withholding. If you elect to roll over 100% of the distribution, you must obtain other money within the 60-day period to contribute to the IRA or eligible employer plan to replace the 20% withheld. If you elect to roll over only the 80% which you receive, the 20% withheld will be subject to taxation. Example. Assume the taxable portion of your eligible rollover distribution is $5,000, and you do not elect a direct rollover. The Plan pays you $4,000, withholding $1,000 for income taxes. However, assume within 60 days after receiving the $4,000 payment, you decide to roll over the entire $5,000 distribution. To make the rollover, you will roll over the $4,000 you received from the Plan, and you will contribute $1,000 from other sources (your savings, a loan, etc.). In this case, you will not have any tax liability with respect to the Plan distribution. The Plan will report a $5,000 distribution for the year, and you will report a $5,000 rollover. When you file your income tax return, you may receive a refund of the $1,000 withheld. If you roll over only the

$4,000 paid from the Plan, the $1,000 you do not roll over is taxable. In addition, the $1,000 you do not roll over may be subject to a 10% penalty tax. See

“10% penalty tax if you are under age 591 2” below. When you file your income tax return, you still may receive an income tax refund, but the refund likely will be smaller because $1,000 of the distribution is taxable. Generally, the 60-day rollover deadline cannot be extended. However, the IRS has the limited authority to waive the deadline under certain extraordinary circumstances, such as when external events prevented you from completing the rollover by the 60-day rollover deadline. To apply for a waiver, you must file a private letter ruling request with the IRS. Private letter ruling requests require the payment of a nonrefundable user fee. For more information, see IRS Publication 590, Individual Retirement Arrangements (IRAs). Withholding on distributions not eligible for rollover. The 20% withholding described above does not apply to any taxable portion of your distribution that is



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