Fidelity Investments Distribution Form Completed Form Examples and Samples
Find clear, filled-out examples and samples of the Fidelity Investments Distribution Form. Our detailed templates guide you on how to correctly fill out the form for various scenarios, such as IRA distributions, helping you avoid common mistakes.
Fidelity Investments Distribution Form Example – IRA Normal Distribution
How this form was filled:
This example demonstrates how to complete a Fidelity Investments Distribution Form for a one-time, normal distribution from a Traditional IRA. The account holder is over age 59 ½, avoiding early withdrawal penalties. The sample details personal information, a specific distribution amount, elections for federal and state tax withholding, and instructions for direct deposit.
Information used to fill out the document:
- Account Owner Name: Jane A. Smith
- Fidelity Account Number: 123-456789
- Account Type: Traditional IRA
- Date of Birth: 05/20/1961
- Address: 456 Oak Avenue, Anytown, USA, 12345
- Distribution Reason: Normal Distribution (Account holder is over age 59 ½)
- Gross Distribution Amount: $15,000.00
- Federal Income Tax Withholding: 10% ($1,500.00)
- State Income Tax Withholding: 5% ($750.00)
- Net Distribution Amount: $12,750.00
- Payment Method: Direct Deposit (EFT) to Checking Account
- Bank Name: Anytown Bank
- Bank Routing Number: 987654321
- Bank Account Number: 1122334455
- Signature: Jane A. Smith
- Signature Date: 10/26/2026
What this filled form sample shows:
- Clearly specifies a one-time distribution from a Traditional IRA.
- Indicates the reason as a Normal Distribution for an individual over age 59 ½.
- Includes specific elections for both federal and state tax withholding to manage tax liability.
- Demonstrates how to provide complete direct deposit information for secure and fast electronic funds transfer (EFT).
- Shows accurately completed owner information and signature sections, dated for 2026.
Form specifications and details:
| Form Name: | Fidelity Investments Distribution Form (IRA) |
| Use Case: | One-Time Normal Distribution for an Individual Over Age 59 ½ |
| Distribution Type: | One-Time (Non-Systematic) |
| Filing Method: | Mail, Fax, or Online Upload |
Created: February 25, 2026 05:40 PM
