IRA Distribution

Mail to:

T.Rowe Price

P.O. Box 17302

Baltimore, MD 21297-1302

Express delivery only:

T.Rowe Price Mail Code 17302

4515 Painters Mill Road

Owings Mills, MD 21117-4903

Owner Information

Complete a separate form per IRA type.

Check IRA type:

 Traditional  Roth  Rollover  Roth Rollover

Check if IRA assets are held in a brokerage account:

 Brokerage. It is your responsibility to ensure that sufficient funds

are available in your sweep account to cover the amount of the

requested distribution.

Name Social Security Number (SSN)

Phone Date of Birth (mm/dd/yyyy)

Distribution Information

Check one reason for distribution:

 Age 59½ or over at the time of the distribution.

 Under age 59½. Additional tax for early withdrawal may apply. The

IRS has created several exceptions to the additional tax (e.g., distributions

upon the account holder’s disability). See IRS Publication 590 and

Instructions for Form 5329 and speak with your tax professional for further

details regarding the exceptions that may be available to you.

 Direct rollover to an eligible employer-sponsored retirement plan.

Verify rollover acceptance with the receiving plan administrator. Not

for proceeds directed to an IRA held with another institution.

 Correction of excess contribution (after tax filing deadline, including

extension). A 6% penalty on the excess amount may apply.

 Required minimum distribution

Go to Section 3. NOTE: This

calculation does not include assets at other institutions or assets

held in an inherited IRA at T. Rowe Price.

Amount

The distribution will be one payment unless you complete Section 2B. If

“specified years” is the systematic calculation method, leave the amount blank,

as the amount will vary.

Fund Name Account Number Amount

 All  $*  %  Shares

 For more funds, check this box and attach a separate page.

NOTE: Dollar balances may fluctuate daily with the market. If the dollar

amount is close to the total balance, provide percent or share amount instead.

Frequency

Check one:  Monthly  Quarterly  Semiannually  Annually

Start Month and Year (mm/yyyy) Day of Month

†

(Defaults to 20th, if blank)

 10  15  20

†

NOTE: If a weekend or holiday, processed on the next business day.

Systematic calculation method. Check one:

 Fixed amount provided in Section 2A.

 Specified years:

You should confirm that this number does not

exceed the time limits prescribed by law. The systematic distribution

will include all IRAs of the same type.

RMD



Most RMDs can be requested by phone or on the Web.

visit troweprice.com/rmd

RMD calculations include all IRAs of the same type held at T. Rowe Price.

Distributions will be taken proportionately from your applicable IRA

accounts, with brokerage account distributions taken from the sweep

account. For brokerage accounts, if securities must be sold in order to

accommodate a cash distribution from the sweep account, ensure your

trades are placed in time for settlement to take place before the RMD date.

Do not complete this section if the assets are held in an inherited IRA.

Complete the IRA Claim & Distribution for Beneficiaries form.

Check one:

 Distribute only current year RMD now.

 Systematic RMD program (the RMD program will remain on file unless

canceled or deferred).

Check a Frequency:

 Monthly  Quarterly  Semiannually  Annually

Start Month and Year (mm/yyyy)

Day of Month

†

(Defaults to 20th, if blank)

 10  15  20

†

NOTE: If a weekend or holiday, processed on the next business day.

Spouse information. If your spouse is on file as the sole primary

beneficiary, confirm his or her date of birth. To add or change

beneficiaries, attach the IRA Beneficiary form.

Spouse’s Name Date of Birth (mm/dd/yyyy)

Transfer or rollover assets. If assets were moved from another financial

institution to this IRA during the current year, check one:

 RMD satisfied prior to the transfer or rollover or from other IRA assets.

 RMD not satisfied prior to transfer or rollover. Calculate the RMD for

the assets on the attached other financial institution prior year-end

statement

and distribute based on the instructions provided above.

This monitor indicates that the process can be done online.

This stamp indicates that a signature guarantee is required.

This paper clip indicates that you may need to attach documentation.

✓ Use this form to:

• Request a distribution from an individual retirement account (IRA),

including direct rollover and required minimum distribution (RMD).

✗ Do not use this form to:

• Withdraw an excess contribution before your tax filing deadline. Use

the IRA Excess Contribution Withdrawal form.

• Request any IRA to IRA transfer. Contact the receiving institution for

transfer instructions.

• Transfer an IRA due to divorce. Complete the IRA Divorce Transferform.

• Request a qualified charitable distribution. Use the Qualified

Charitable Distribution—IRA form.

• Claim an inheritance from an IRA or request a distribution from an inherited

IRA. Use the IRA Claim & Distribution for Beneficiaries form.

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Payment Options

A check will be mailed to the address on file unless you check a box below.

 Invest in a T. Rowe Price taxable account.

 New account. Complete the Mutual Fund New Account form.

 Existing account.

Account Number Fund Name

 For more accounts, check this box and attach a page.

 Electronic funds transfer (EFT). Money will be sent via Automated

Clearing House (ACH) unless you check the box marked wire. If over

$250,000 per fund, it will be sent via wire. Your bank may also charge

a wire fee.

 Wire. Not for systematic distributions. $5 fee if less than $5,000.

Distributions are sent to the bank on file unless you check below.

 New bank account. Signature guarantee may be required.

Enclose a voided check or a letter signed by the bank on

bank letterhead, which provides the account number,

registration, and ACH instructions.

 Checking account or  Savings account

 Add this bank to my account for future transactions. If a bank

is on file, replace it.

 Issue a check to your employer sponsored retirement plan, an

alternate address, and/or payee. This form will not facilitate an IRA to

IRA transfer. Contact the receiving institution to initiate an IRA to IRA transfer.

Signature guarantee

is required unless you are requesting a direct rollover.

(Indirect rollovers to another IRA require a signature guarantee.)

Payee Name

Account Number (Cannot be SSN) Account/Plan Type*

Address

City State ZIP Code

* Provide your most recent statement from the other financial institution

to expedite a direct rollover to an eligible employer-sponsored plan.

Income Tax Withholding

For each distribution form you submit, please review and complete the

attached IRS Form W-4R, Withholding Certificate for Nonperiodic Payments

and Eligible Rollover Distributions, located at the end of the IRA Distribution

form. If we do not receive a properly completed, signed, and dated IRS

Form W-4R with your distribution request, we will withhold federal income

tax at the rate of 10% on the amount of the distribution, unless you are a

nonresident alien.

State income tax will be withheld from your distribution under the applicable

state law if your address of record is in a state that defaults to withholding. If

you elect a direct rollover to an eligible employer-sponsored retirement plan, you

understand that income taxes will not be withheld.

 CHECK THIS BOX IF YOU ARE TAKING A QUALIFIED

DISTRIBUTION FROM A ROTH IRA: Federal and state income tax

will not be withheld. Generally, a qualified distribution is tax-free if

taken at least five years after the year of your first Roth IRA contribution

and you’ve reached age 59½, become totally disabled, died, or meet the

requirements for first-time home purchase. If you are unsure whether

your distribution is a qualified distribution from a Roth IRA, please

consult with your tax professional.

Special rule for foreign addresses and/or nonresident aliens. If your

address on record is outside the United States, or its possessions, we must

withhold federal income tax as described below:

• If you are a U.S. citizen or other U.S. person as described on IRS Form

W-9, we must withhold federal income tax at a rate of 10%. You may not

elect out of this withholding requirement. You may use Form W-4R to elect a

withholding percentage greater than 10%.

• If you are a nonresident alien, you are required to complete and submit

IRS Form W-8BEN (or, if applicable, an IRS Form W-8BEN-E). This form

identifies you as a nonresident alien and may allow you to elect out of

the 30% default withholding applicable to nonresident aliens or elect a

reduced rate of withholding (if your country has a treaty with the U.S. that

permits reduced withholding).

NOTE: IRS forms are available at irs.gov or by calling 800-TAX-FORM.

Signatures

If requesting a distribution, by signing this form, I certify the following:

• The information and elections made above are true and accurate. I authorize

T. Rowe Price to act upon my instructions provided on the form.

• If I am requesting a direct rollover to an eligible employer-sponsored

retirement plan, I certify that the amount being distributed is eligible to be

rolled over, and I understand that federal or state income taxes will not be

withheld from my distribution.

• I have received and reviewed IRS Form W-4R, of which a copy was provided

when I received this T. Rowe Price form.

• If I am of RMD age, I understand that I am responsible for calculating and

withdrawing my RMD amounts under Internal Revenue Code Section

401(a)(9). I hereby indemnify and hold T. Rowe Price Trust Company, its

parent and affiliates, successors, and employees harmless from any and all

liability should I fail to receive the correct RMD amount in any calendar year.

Account Owner

Sign Below

Signature guarantee is required if:

• Distribution is sent to a bank where the IRA owner is not one of the

bank owners

• Payable to someone other than the owner

• Requesting an indirect rollover to another IRA (not required for direct

rollovers to a qualified plan)

• Mailed to an address other than the address on file

• Invested in an account not owned by the owner

Signature and Date Required

Owner Date (mm/dd/yyyy)

Bank Account Owner

Sign Below

To add a new bank on file, owners of the bank account who are not the

IRA owner must sign here. If the IRA owner is not one of the bank owners,

Signature and Date Required

Bank Account Owner Date (mm/dd/yyyy)

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Signature Guarantee

You can obtain the Medallion signature guarantee from most banks,

savings institutions, or broker-dealers. We cannot accept guarantees from

notaries public or non-Medallion guarantors. The level of coverage provided

by the guarantor’s stamp must cover the dollar amount of the transaction

or it may be rejected.

Medallion Signature Guarantee—Place Medallion Stamp Below

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Form W-4R

2024

Withholding Certificate for Nonperiodic Payments and

Eligible Rollover Distributions

Department of the Treasury

Internal Revenue Service

Give Form W-4R to the payer of your retirement payments.

OMB No. 1545-0074

1a First name and middle initial Last name

Address

City or town, state, and ZIP code

1b Social security number

Your withholding rate is determined by the type of payment you will receive.

• For nonperiodic payments, the default withholding rate is 10%. You can choose to have a different rate by entering a rate between

0% and 100% on line 2. Generally, you can’t choose less than 10% for payments to be delivered outside the United States and its

territories.

• For an eligible rollover distribution, the default withholding rate is 20%. You can choose a rate greater than 20% by entering the rate

on line 2. You may not choose a rate less than 20%.

See page 2 for more information.

Complete this line if you would like a rate of withholding that is different from the default withholding

rate. See the instructions on page 2 and the Marginal Rate Tables below for additional information.

Enter the rate as a whole number (no decimals) . . . . . . . . . . . . . . . . . .

Sign

Here

Your signature (This form is not valid unless you sign it.) Date

General Instructions

Section references are to the Internal Revenue Code.

Future developments. For the latest information about any

future developments related to Form W-4R, such as

legislation enacted after it was published, go to

www.irs.gov/FormW4R.

Purpose of form. Complete Form W-4R to have payers

withhold the correct amount of federal income tax from your

nonperiodic payment or eligible rollover distribution from an

employer retirement plan, annuity (including a commercial

annuity), or individual retirement arrangement (IRA). See

page 2 for the rules and options that are available for each

type of payment. Don’t use Form W-4R for periodic

payments (payments made in installments at regular

intervals over a period of more than 1 year) from these plans

or arrangements. Instead, use Form W-4P, Withholding

Certificate for Periodic Pension or Annuity Payments. For

more information on withholding, see Pub. 505, Tax

Withholding and Estimated Tax.

Caution: If you have too little tax withheld, you will generally

owe tax when you file your tax return and may owe a penalty

unless you make timely payments of estimated tax. If too

much tax is withheld, you will generally be due a refund

when you file your tax return. Your withholding choice (or an

election not to have withholding on a nonperiodic payment)

will generally apply to any future payment from the same

plan or IRA. Submit a new Form W-4R if you want to change

your election.

2024 Marginal Rate Tables

You may use these tables to help you select the appropriate withholding rate for this payment or distribution. Add your income

from all sources and use the column that matches your filing status to find the corresponding rate of withholding. See page 2

for more information on how to use this table.

Single

Married filing separately

Total income

over—

Tax rate for every

dollar more

$0 0%

14,600 10%

26,200 12%

61,750 22%

115,125 24%

206,550 32%

258,325 35%

623,950* 37%

If married filing separately, use $380,200 instead for this 37% rate.

Married filing jointly

Qualifying surviving spouse

Total income

over—

Tax rate for every

dollar more

$0 0%

29,200 10%

52,400 12%

123,500 22%

230,250 24%

413,100 32%

516,650 35%

760,400 37%

Head of household

Total income

over—

Tax rate for every

dollar more

$0 0%

21,900 10%

38,450 12%

85,000 22%

122,400 24%

213,850 32%

265,600 35%

631,250 37%

For Privacy Act and Paperwork Reduction Act Notice, see page 3.

Cat. No. 75085T

Form W-4R (2024)

Page 2

General Instructions (continued)

Nonperiodic payments—10% withholding. Your payer

must withhold at a default 10% rate from the taxable amount

of nonperiodic payments unless you enter a different rate on

line 2. Distributions from an IRA that are payable on demand

are treated as nonperiodic payments. Note that the default

rate of withholding may not be appropriate for your tax

situation. You may choose to have no federal income tax

withheld by entering “-0-” on line 2. See the specific

instructions below for more information. Generally, you are

not permitted to elect to have federal income tax withheld at

a rate of less than 10% (including “-0-”) on any payments to

be delivered outside the United States and its territories.

Note: If you don’t give Form W-4R to your payer, you

don’t provide an SSN, or the IRS notifies the payer that you

gave an incorrect SSN, then the payer must withhold 10% of

the payment for federal income tax and can’t honor requests

to have a lower (or no) amount withheld. Generally, for

payments that began before 2024, your current withholding

election (or your default rate) remains in effect unless you

submit a Form W-4R.

Eligible rollover distributions—20% withholding.

Distributions you receive from qualified retirement plans (for

example, 401(k) plans and section 457(b) plans maintained

by a governmental employer) or tax-sheltered annuities that

are eligible to be rolled over to an IRA or qualified plan are

subject to a 20% default rate of withholding on the taxable

amount of the distribution. You can’t choose withholding at a

rate of less than 20% (including “-0-”). Note that the default

rate of withholding may be too low for your tax situation. You

may choose to enter a rate higher than 20% on line 2. Don’t

give Form W-4R to your payer unless you want more than

20% withheld.

Note that the following payments are not eligible rollover

distributions for purposes of these withholding rules:

• Qualifying “hardship” distributions;

• Distributions required by federal law, such as required

minimum distributions;

• Generally, distributions from a pension-linked emergency

savings account;

• Eligible distributions to a domestic abuse victim;

• Qualified disaster recovery distributions;

• Qualified birth or adoption distributions; and

• Emergency personal expense distributions.

See Pub. 505 for details. See also Nonperiodic payments—

10% withholding above.

Payments to nonresident aliens and foreign estates. Do

not use Form W-4R. See Pub. 515, Withholding of Tax on

Nonresident Aliens and Foreign Entities, and Pub. 519, U.S.

Tax Guide for Aliens, for more information.

Tax relief for victims of terrorist attacks. If your disability

payments for injuries incurred as a direct result of a terrorist

attack are not taxable, enter “-0-” on line 2. See Pub. 3920,

Tax Relief for Victims of Terrorist Attacks, for more details.

Specific Instructions

Line 1b

For an estate, enter the estate’s employer identification

number (EIN) in the area reserved for “Social security

number.”

Line 2

More withholding. If you want more than the default rate

withheld from your payment, you may enter a higher rate on

line 2.

Less withholding (nonperiodic payments only). If

permitted, you may enter a lower rate on line 2 (including

“-0-”) if you want less than the 10% default rate withheld

from your payment. If you have already paid, or plan to pay,

your tax on this payment through other withholding or

estimated tax payments, you may want to enter “-0-”.

Suggestion for determining withholding. Consider using

the Marginal Rate Tables on page 1 to help you select the

appropriate withholding rate for this payment or distribution.

The tables are most accurate if the appropriate amount of

tax on all other sources of income, deductions, and credits

has been paid through other withholding or estimated tax

payments. If the appropriate amount of tax on those sources

of income has not been paid through other withholding or

estimated tax payments, you can pay that tax through

withholding on this payment by entering a rate that is greater

than the rate in the Marginal Rate Tables.

The marginal tax rate is the rate of tax on each additional

dollar of income you receive above a particular amount of

income. You can use the table for your filing status as a

guide to find a rate of withholding for amounts above the

total income level in the table.

To determine the appropriate rate of withholding from the

table, do the following. Step 1: Find the rate that

corresponds with your total income not including the

payment. Step 2: Add your total income and the taxable

amount of the payment and find the corresponding rate.

If these two rates are the same, enter that rate on line 2.

(See Example 1 below.)

If the two rates differ, multiply (a) the amount in the lower

rate bracket by the rate for that bracket, and (b) the amount

in the higher rate bracket by the rate for that bracket. Add

these two numbers; this is the expected tax for this

payment. To get the rate to have withheld, divide this

amount by the taxable amount of the payment. Round up to

the next whole number and enter that rate on line 2. (See

Example 2 below.)

If you prefer a simpler approach (but one that may lead to

overwithholding), find the rate that corresponds to your total

income including the payment and enter that rate on line 2.

Examples. Assume the following facts for Examples 1 and 2.

Your filing status is single. You expect the taxable amount of

your payment to be $20,000. Appropriate amounts have

been withheld for all other sources of income and any

deductions or credits.

Example 1. You expect your total income to be $62,000

without the payment. Step 1: Because your total income

without the payment, $62,000, is greater than $61,750 but

less than $115,125, the corresponding rate is 22%. Step 2:

Because your total income with the payment, $82,000, is

greater than $61,750 but less than $115,125, the

corresponding rate is 22%. Because these two rates are the

same, enter “22” on line 2.

Example 2. You expect your total income to be $43,700

without the payment. Step 1: Because your total income

without the payment, $43,700, is greater than $26,200 but

less than $61,750, the corresponding rate is 12%. Step 2:

Because your total income with the payment, $63,700, is

Form W-4R (2024)

Page 3

greater than $61,750 but less than $115,125, the

corresponding rate is 22%. The two rates differ. $18,050 of

the $20,000 payment is in the lower bracket ($61,750 less

your total income of $43,700 without the payment), and

$1,950 is in the higher bracket ($20,000 less the $18,050 that

is in the lower bracket). Multiply $18,050 by 12% to get

$2,166. Multiply $1,950 by 22% to get $429. The sum of

these two amounts is $2,595. This is the estimated tax on

your payment. This amount corresponds to 13% of the

$20,000 payment ($2,595 divided by $20,000). Enter “13” on

line 2.

Privacy Act and Paperwork Reduction Act Notice. We ask

for the information on this form to carry out the Internal

Revenue laws of the United States. You are required to

provide this information only if you want to (a) request

additional federal income tax withholding from your

nonperiodic payment(s) or eligible rollover distribution(s); (b)

choose not to have federal income tax withheld from your

nonperiodic payment(s), when permitted; or (c) change a

previous Form W-4R (or a previous Form W-4P that you

completed with respect to your nonperiodic payments or

eligible rollover distributions). To do any of the

aforementioned, you are required by sections 3405(e) and

6109 and their regulations to provide the information

requested on this form. Failure to provide this information

may result in inaccurate withholding on your payment(s).

Failure to provide a properly completed form will result in

your payment(s) being subject to the default rate; providing

fraudulent information may subject you to penalties.

Routine uses of this information include giving it to the

Department of Justice for civil and criminal litigation, and to

cities, states, the District of Columbia, and U.S.

commonwealths and territories for use in administering their

tax laws. We may also disclose this information to other

countries under a tax treaty, to federal and state agencies to

enforce federal nontax criminal laws, or to federal law

enforcement and intelligence agencies to combat terrorism.

You are not required to provide the information requested

on a form that is subject to the Paperwork Reduction Act

unless the form displays a valid OMB control number. Books

or records relating to a form or its instructions must be

retained as long as their contents may become material in

the administration of any Internal Revenue law. Generally,

tax returns and return information are confidential, as

required by section 6103.

The average time and expenses required to complete and

file this form will vary depending on individual

circumstances. For estimated averages, see the instructions

for your income tax return.

If you have suggestions for making this form simpler, we

would be happy to hear from you. See the instructions for

your income tax return.