Landscape, Irrigation Lawn Sprinkler Trusts
Defined Contribution Pension Plan
Death Benefit Application
______
Complete all applicable sections and return pages 1-3 to: Southern California Pipe Trades Administrative Corporation
Defined Contribution Department
501 Shatto Place, 5th Floor
Los Angeles, CA 90020
Save “Your Rollover Options”Special Tax Notices for your records.(800) 595-7473OR(213) 385-6161
YOU ARE ENCOURAGED TO CONSULT WITH A TAX EXPERT BEFORE MAKING YOUR ELECTION.
SECTION 1—PARTICIPANT INFORMATION
Participant Name
Date of DeathSocial Security Number
PLEASE ATTACH A COPY OF THE DEATH CERTIFICATE
SECTION 2—BENEFICIARY INFORMATION
Beneficiary Name
RelationshipSocial Security NumberDate of Birth
Street Address (the address to which payments to you and Form 1099-R should be sent)
City, State, ZIPip CodePhone Number
If this is a foreign address, additional forms are required. Contact the Southern California Pipe Trades Administrative Corporation for more information.
SECTION 3—PAYMENT OPTIONS FOR SPOUSE BENEFICIARIES(SELECT A or OR B))
[m1]
Pay the benefit due me as follows:
A DIRECT ROLLOVER TO IRA(NOT AVAILABLE FOR ROTH IRAs)
Choose one of the following options:
Rollover to a Traditional IRA
Rollover to a ROTH IRA (subject to current taxes—complete withholding elections in Sections 5 and 6)
Rollover to a Qualified Employer Plan
OR
DIRECT ROLLOVER TO QUALIFIED EMPLOYER PLAN
IRA OR QUALIFIED PLAN INFORMATION
Any part of my account in the retirement plan above which is eligible for rollover should be directly rolled over to my IRA or qualified employer plan, as I have indicated in this section. (Portion to be rolled over must be more than $500 if transferring less than 100% of amount eligible for rollover.)
NAME AND ACCOUNT # OF IRA OR NEW EMPLOYER PLAN:
MAILING ADDRESS OF PAYEE - ADDRESS WHERE CHECK SHOULD BE MAILED
CAPACITY OF PAYEE: Trustee Custodian (Check one)
B ISSUE CHECK DIRECTLY TO ME (Subject to tax withholding-complete withholding elections in Sections 5 and 6)
FEDERAL TAX WITHHOLDING: Any part of your distribution that is eligible for rollover is subject to 20% federal withholding
STATE TAX WITHHOLDING: California state tax will be withheld according to the rules and rates in effect at the time of your distribution.
CHECK ONLY ONE:
I do I do not want to have state income tax withheld from the taxable portion of my distribution.
C LIFE ANNUITY OPTION
I understand that if the normal form of distribution is a Life Annuity (no minimum number of payments guaranteed)
[m2]
SECTION 4—PAYMENT ELECTION FOR NON-SPOUSE BENEFICIARIES(Select A or B)
A DIRECT ROLLOVER TO AN INHERITED IRA
Choose one of the following options:
Rollover to an Inherited Traditional IRA
Rollover to an Inherited ROTH IRA (subject to current taxes—complete withholding elections in Sections 5 and 6)
INHERITED IRA INFORMATION
Any part of my account in this Defined Contribution Fund which is eligible for rollover should be directly rolled over to my INHERITERD IRA, as I have indicated in this section.
NAME AND ACCOUNT # OF IRA:
MAILING ADDRESS OF PAYEE - ADDRESS WHERE CHECK SHOULD BE MAILED
B ISSUE CHECK DIRECTLY TO ME (Subject to tax withholding—complete Sections 5 and 6)
SECTION 5—FEDERAL TAX WITHHOLDING
- Roth IRA Rollover. If you elected to roll over your balance to a Roth IRA in Section 3 or Section 4 above, federal withholding is not mandatory.
I want ______% or $______withheld for federal income tax.
I do NOT want to have federal income tax withheld from my benefit payment.
Note that if you elect federal income tax withholding on a rollover to a Roth IRA, you will receive a second 1099-R for the withholding amount. If you are under age 59 ½ and you elect withholding on a rollover to a Roth IRA the withheld amount may be subject to a 10% federal early distribution penalty and a state tax penalty where applicable. Consult with your tax advisor to understand the tax implications for you.
B. Direct Payment to You. If you elected to have a check made payable to you in Section 3 or Section 4 above, any part of your distribution that is eligible for rollover is subject to mandatory 20% federal withholding.
In addition to the mandatory 20% federal withholding I want ______% or $______withheld for federal income tax.
SECTION 6—STATE TAX WITHHOLDING
STATE TAX WITHHOLDING: CA State tax will be withheld according to the rules and rates in effect at the time of your distribution. CHECK ONLY ONE:
I do I do NOT want to have CA state income tax withheld from my benefit payments.
A ISSUE CHECK DIRECTLY TO ME
I understand that I have the option not to have federal income taxes withheld from my distribution. I understand that certain states, including California, require income tax withholding unless I elect not to have taxes withheld. I ELECT TO
withhold not withholdFEDERAL income tax AND TO
withhold not withholdSTATE income tax.
If you make no election in this section, tax will be withheld.
SECTION 75—NOTICE TO ALL PAYEES REGARDING WITHHOLDING
PLEASE NOTE: Even if you elect not to have income taxes withheld, you are liable for the payment of taxes due on the taxable portion of your payment. You may also be subject to tax penalties under the Estimated Tax Payment rules if your payment of estimated tax and withholding are not adequate.
SECTION 86—WAIVER OF THIRTY DAY NOTIFICATION AND WAITING PERIOD
The IRS requires a thirty-day waiting period following receipt of the enclosed Notice “Your Rollover Options” IRS Special Tax Notices. The purpose of this waiting period is to allow Plan Participants sufficient time to review tax options before taking a distribution. You have the opportunity to waive this period.
I received the Notice “Your Rollover Options” Special Tax Notices on (mm/dd/yy) , and
CHECK ONLY ONE: I understand that the distribution will not be processed before thirty days have elapsed.
I understand the explanation of options and choose to waive the thirty-day waiting period.
Signing below and marking neither box will constitute your waiver of the thirty-day waiting period.
SECTION 97—BENEFICIARY DISTRIBUTION CONSENT
I have read and understand the attached “Your Special Tax NoticesRollover Options” Notice enclosed. In addition, I understand that it is my responsibility to obtain all necessary information from the IRA institution for a direct rollover. I certify that (i) this information is correct and (ii) the IRA will accept a direct rollover whether in cash or in kind (i.e. property other than cash). I acknowledge that I have been advised to consult a tax advisor regarding any tax consequences this distribution may have.
I have read and understand all the notices presented and if I had any questions, I have asked them of the Plan Administrator and/or the Trustees and have received acceptable answers. Upon payment in full of my benefit (account) in the plan, I release the Plan Administrator, the Trustees and my Employer from and against any and all claims I may have or hereafter claim to have against said Administrator, Trustee or Employer, but only with respect to my interest in said Plan. Nothing contained in this release is intended to relieve any fiduciary of an obligation or duty under ERISA, or to violate the provisions of Section 410 of ERISA.
I understand that if the vested value of my benefit is less than $1,000 and I do not return this Distribution Election Form within 30 days, I may automatically be paid a lump sum payment in cash and all required (federal and state) income taxes will be withheld.
I hereby authorize payment or retention of my vested account balance as indicated above.
I HAVE ATTACHED A CERTIFIED COPY OF THE DEATH CERTIFICATE.
X
Signature of Beneficiary Date
- RETURN pages 1-3 to the Southern California Pipe Trades Administrative Corporation (address on page 1).
- SAVE pages 5-810for your records.
THIS PAGE INTENTIONALLY LEFT BLANK
SPECIAL TAX NOTICE REGARDING PLAN PAYMENTS
(Safe harbor explanation for plans qualified under IRC § 401(a), § 403(a) annuity plans, or § 403(b) tax sheltered annuities, issued as IRS Notice 2002-3)
This notice explains how you can continue to defer federal income tax on your retirement savings in your retirement plan (the "Plan") and contains important information you will need before you decide how to receive your Plan benefits.
This notice is provided to you by your Plan Administrator (your “Plan Administrator”), because all or part of the payment that you will soon receive from the Plan may be eligible for rollover by you or your Plan Administrator to a traditional IRA or an eligible employer plan. 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. Your payment cannot be rolled over to a Roth IRA, a SIMPLE IRA, or a Coverdell Education Savings Account (formerly known as an education IRA). An "eligible employer plan" includes a plan qualified under section 401(a) of the Internal Revenue Code, including a 401(k) plan, profit-sharing plan, defined benefit plan, stock bonus plan, and money purchase plan; a section 403(a) annuity plan; a section 403(b) tax-sheltered annuity; and an eligible section 457(b) plan maintained by a governmental employer (governmental 457 plan).
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. You should also find out about any documents that are required to be completed before the receiving plan will accept a rollover. Even if a plan accepts rollovers, it might not accept rollovers of certain types of distributions, such as after-tax amounts. If this is the case, and your distribution includes after-tax amounts, you may wish instead to roll your distribution over to a traditional IRA or split your rollover amount between the employer plan in which you will participate and a traditional IRA. 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 may also be subject to different tax treatment than distributions from this Plan. Check with the administrator of the plan that is to receive your rollover prior to making the rollover.
If you have additional questions after reading this notice, you can contact your Plan Administrator.
SUMMARY
There are two ways you may be able to receive a Plan payment that is eligible for rollover:
(1) Certain payments can be made directly to a traditional IRA that you establish or to an eligible employer plan that will accept it and hold it for your benefit ("DIRECT ROLLOVER"); or
(2)The payment can be PAID TO YOU.
If you choose a DIRECT ROLLOVER:
Your payment will not be taxed in the current year and no income tax will be withheld.
You choose whether your payment will be made directly to your traditional IRA or to an eligible employer plan that accepts your rollover. Your payment cannot be rolled over to a Roth IRA, a SIMPLE IRA, or a Coverdell Education Savings Account because these are not traditional IRAs.
The taxable portion of your payment will be taxed later when you take it out of the traditional 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 choose to have a Plan payment that is eligible for rollover PAID TO YOU:
You will receive only 80% of the taxable amount of the payment, because the Plan Administrator is required to withhold 20% of that amount and send it to the IRS as income tax withholding to be credited against your taxes.
The taxable amount of your payment will be taxed in the current year unless you roll it over. Under limited circumstances, you may be able to use special tax rules that could reduce the tax you owe. However, if you receive the payment before age 59 1/2, you may have to pay an additional 10% tax.
You can roll over all or part of the payment by paying it to your traditional IRA or to an eligible employer plan that accepts your rollover within 60 days after you receive the payment. The amount rolled over will not be taxed until you take it out of the traditional IRA or the eligible employer plan.
If you want to roll over 100% of the payment to a traditional IRA or an eligible employer plan, you must find other money to replace the 20% of the taxable portion that was withheld. If you roll over only the 80% that you received, you will be taxed on the 20% that was withheld and that is not rolled over.
Your Right to Waive the 30-Day Notice Period.
Generally, neither a direct rollover nor a payment can be made from the plan until at least 30 days after your receipt of this notice. Thus, after receiving this notice, you have at least 30 days to consider whether or not to have your withdrawal 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 withdrawal will then be processed in accordance with your election as soon as practical after it is received by the Plan Administrator.
MORE INFORMATION
I. PAYMENTS THAT CAN AND CANNOT BE ROLLED OVER
II. DIRECT ROLLOVER
III. PAYMENT PAID TO YOU
IV. SURVIVING SPOUSES, ALTERNATE PAYEES, AND OTHER BENEFICIARIES
RETAIN FOR YOUR RECORDS
I. PAYMENTS THAT CAN AND CANNOT BE ROLLED OVER
Payments from the Plan may be "eligible rollover distributions." This means that they can be rolled over to a traditional IRA or to an eligible employer plan that accepts rollovers. Payments from a plan cannot be rolled over to a Roth IRA, a SIMPLE IRA, or a Coverdell Education Savings Account. Your Plan administrator should be able to tell you what portion of your payment is an eligible rollover distribution.
After-tax Contributions. If you made after-tax contributions to the Plan, these contributions may be rolled into either a traditional IRA or to certain employer plans that accept rollovers of the after-tax contributions. The following rules apply:
a.Rollover into a Traditional IRA. You can roll over your after-tax contributions to a traditional IRA either directly or indirectly. Your plan administrator should be able to tell you how much of your payment is the taxable portion and how much is the after-tax portion.
If you roll over after-tax contributions to a traditional IRA, it is your responsibility to keep track of, and report to the Service on the applicable forms, the amount of these after-tax contributions. This will enable the nontaxable amount of any future distributions from the traditional IRA to be determined.
Once you roll over your after-tax contributions to a traditional IRA, those amounts CANNOT later be rolled over to an employer plan.
b.Rollover into an Employer Plan. You can roll over after-tax contributions from an employer plan that is qualified under Code section 401(a) or a section 403(a) annuity plan to another such plan using a direct rollover if the other plan provides separate accounting for amounts rolled over, including separate accounting for the after-tax employee contributions and earnings on those contributions. You can also roll over after-tax contributions from a section 403(b) tax-sheltered annuity to another section 403(b) tax-sheltered annuity using a direct rollover if the other tax-sheltered annuity provides separate accounting for amounts rolled over, including separate accounting for the after-tax employee contributions and earnings on those contributions. You CANNOT roll over after-tax contributions to a governmental 457 plan. If you want to roll over your after-tax contributions to an employer plan that accepts these rollovers, you cannot have the after-tax contributions paid to you first. You must instruct the Plan Administrator of this Plan to make a direct rollover on your behalf. Also, you cannot first roll over after-tax contributions to a traditional IRA and then roll over that amount into an employer plan.
The following types of payments cannot be rolled over:
a.Payments Spread over Long Periods. You cannot roll over a payment if it is part of a series of equal (or almost equal) payments that are made at least once a year and that will last for:
your lifetime (or a period measured by your life expectancy), or
your lifetime and your beneficiary's lifetime (or a period measured by your joint life expectancies), or
a period of 10 years or more.
b.Required Minimum Payments. Beginning when you reach age 70 1/2 or retire, whichever is later, a certain portion of your payment cannot be rolled over because it is a "required minimum payment" that must be paid to you. Special rules apply if you own more than 5% of your employer.
c. Hardship Distributions. A hardship distribution cannot be rolled over.