Qualified Charitable Distribution Language

SAMPLE Instruction Letter from Plan Owner to IRA Administrator for a Qualified Charitable Distribution

___________ (Date)
________________(Name)
________________(Address)
________________(City, State, Zip)

Re: Request for a Qualified Charitable Distribution from my Individual Retirement Account

Dear IRA Administrator,

Please accept this letter as my request to make a direct charitable distribution from my Individual Retirement Account #________________________ as authorized by Section 408(d)(8) of the Internal Revenue Code and the Protecting Americans from Tax Hikes Act of 2015.

Please issue a check in the amount of $____________ payable to Los Altos Mountain View Community Foundation and mail it to their address:
Los Altos Mountain View Community Foundation
183 Hillview Avenue
Los Altos, CA 94022

These funds are to be used for ______________________________________________. Please make note of this with or on the check to the Foundation.

Los Altos Mountain View Community Foundation is a registered 501c3 tax-exempt organization whose Employer Identification Number (EIN) is 77-0273721.

My intention is to have this transfer be a Qualified Charitable Distribution that will qualify for exclusion from taxable income from ________(year). Therefore, it is imperative that this distribution be processed before December 31, _____.

Important: In your transmittal to the Foundation, please include my name and address as the donor of record in connection with this distribution. Please copy me on your transmittal.

If you have any questions or need to contact me, I can be reached at ___________________.

Thank you for your assistance and prompt attention to this matter.

Sincerely,
________________________________ (Signature)

________________________________(Name printed)