IRA Distribution Form
Request from Plan Owner to Administrator for Charitable Distribution from an IRA to The Diocese of Kansas City-St. Joseph, MO for 2017 Tax Year
[Address of IRA Administrator]
RE: Request for Charitable Distribution from Individual Retirement Account
Dear Sir or Madam:
Please accept this letter as my request to make a direct charitable distribution from my Individual Retirement Account # __________________ as provided by the Sec. 1201 of the Pension Protection Act of 2006 and Sec. 408 (d) (8) of the Internal Revenue Code of 1986, as amended and extended.
Please issue a check in the amount of $________________________ payable to “The Diocese of Kansas City-St. Joseph, MO,” c/o Laura Gray at P.O. Box 419037, Kansas City, MO 64141. Please designate my gift for St. John Francis Regis Catholic Church; Kansas City, Mo. for the following ministry _______________________________________________________________________________.
In your transmittal of funds to the charity, please note my name and address as the donor of record in connection with this transfer and transmit a copy of this request form with your payment. Please copy me on your transmittal.
I intend that this transfer qualify for exclusion from income during the 2017 tax year. Therefore, it is imperative this distribution be postmarked no later than December 31, 2017. Please do not withhold any income tax from my distribution.
If you have any questions or need to contact me, I can be reached at (telephone # _______________________). Thank you for your assistance in this matter.
(Signature of Plan Owner)
Printed Name and Address: