SAMPLE REQUEST TO IRA PLAN ADMINISTRATOR

[Date]

 

[IRA Plan Administrator]

[Address]

 

 

RE: Request for Charitable Distribution from Individual Retirement Account

 

Dear Sir/Madam:

 

Please accept this letter as my request to make a direct charitable distribution from my Individual Retirement Account # [Account Number] as provided by the Tax Relief, Unemployment Insurance Reauthorization and Job Creation Act of 2010 and Sec. 408(d)(8) of the Internal Revenue Code of 1986, as amended.

 

Please issue a check in the amount of $______ payable to the organization at the address below:

 

The James Dick Foundation for the Performing Arts

PO Box 89

Round Top, TX 78954-0089

 

In your transmittal to the Foundation, please acknowledge my name and address as the donor of record in connection with this transfer. I also request to be copied on your transmittal.

 

If you have any questions or need to contact me, I can be reached at [telephone number].  Thank you for your assistance in this matter.

 

Sincerely,

 

 

[Name of Plan Owner]