Sample Request from Plan Owner to Administrator for Charitable Distribution from Ira

SAMPLE REQUEST FROM PLAN OWNER TO ADMINISTRATOR FOR CHARITABLE DISTRIBUTION FROM IRA

(Address of Plan Administrator)

RE: Request for Charitable Distribution from IRA

Dear Sir or Madam:

Please accept this letter as my request to make a direct charitable distribution from my IRA to the University of Texas at Austin.

Please issue a check in the amount of $______payable to The University of Texas at Austin and send it to:

Gift Planning - University Development Office P.O. Box 7458 Austin, Texas 78713-7458

UT Austin Tax Identification Number: 74-6000203

In your transmittal to UT Austin, please include my name and address as the donor of record in connection with this transfer. This gift should be designated to the (department, endowment name, program, etc.) at the University Please copy me on your transmittal.

I intend to have this transfer qualify for exclusion during the _____ tax year. Therefore, it is imperative this distribution be postmarked no later than December 31, _____.

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

Sincerely,

Plan Owner (address and zipcode)