403(b)(7) Distribution Request

Transcription

1 403(b)(7) Distribution Request Complete this form to request a distribution from your Wells Fargo Funds 403(b)(7) account. If you have questions, call We are available 24 hours a day, 7 days a week. P.O. Box 8266 Boston, MA wellsfargofunds.com 1 ACCOUNT INFORMATION (PLEASE PRINT) Name of account owner (first, middle initial, last) Social Security number Date of birth (mm/dd/yyyy) U.S. residential street address City State ZIP code U.S. mailing address (if different than U.S. residential street address) City State ZIP code Name of employer sponsoring 403(b)(7) account Daytime phone (account owner) Evening phone (account owner) Note: If the address above is different than the address currently listed on our records, we will update all accounts under the Social Security number to reflect this new address. All future correspondence will be sent to the new address until you advise us otherwise. Distributions to a new address will require your signature to be Medallion Guaranteed in section 9 of this form if requested within 15 days of the address change. Account(s) to be distributed: 2 REASON FOR DISTRIBUTION The distribution(s) should be made from: Fund and account number(s) The distribution(s) should be made from ALL 403(b)(7) accounts with the Social Security number listed above. Marital status: Married Single Attainment of age 59½ (still employed by the employer sponsoring the 403(b)(7) account). Retirement or termination of employment. I state under penalty of perjury that I am not currently employed by the employer listed in section 1 of this form and that I separated from employment with such employer prior to January 1, My retirement or termination of employment occurred after January 1, 2009, and I acknowledge that my former employer must sign this form in section 10 to acknowledge this distribution. Termination of plan. Permanent disability (as defined under Section 72(m)(7) of the Internal Revenue Code). Beneficiary distribution (if you are a beneficiary of this account). Complete the information below and have your signature Medallion Guaranteed in section 9 of this form. Name of beneficiary (first, middle initial, last) or entity Beneficiary s Social Security/ Date of birth (mm/dd/yyyy) taxpayer ID number (if applicable) U.S. residential street address City State ZIP code Daytime phone Evening phone Relationship to 403(b)(7) owner Date of death of the 403(b)(7) owner (mm/dd/yyyy) 3 PAYMENT AMOUNT If you have more than one 403(b)(7) account, call us at to discuss your options for required minimum distributions. Full distribution of my entire vested account balance as a lump sum. Partial distribution of $ or % from my vested account balance. Note: If balance in account is less than the amount requested, the entire account balance will be redeemed. Calculate my required minimum distribution based on the IRS life expectancy tables. 403BDIS ( Rev 01-12/15) Page 1 of 4

2 4 PAYMENT FREQUENCY If a payment frequency is not selected, your distribution will be processed as a one-time request. One-time distribution processed upon receipt. Monthly, beginning (specify month and date): Quarterly, to be paid in March, June, September, and December (specify date of month): Annually, on (specify month and date): Note: Unless specified above, periodic distributions will be made on the 25th day of the month. If the date falls on a weekend or holiday, your distribution will occur on the next business day. If the next business day falls in the next month, the distribution will occur on the previous business day. If payment frequency of annually is selected and no month is listed, redemptions will be made in December. 5 TAX WITHHOLDING The custodian is required by law to withhold 20% for federal income tax from payments eligible for rollover unless you elect a direct rollover of the eligible portion of your distribution to an IRA or another qualified plan. Read the enclosed Special Tax Notice Regarding Plan Payments before completing this section. If you have questions concerning this notice or the effect of your distribution election, contact your tax advisor. A. If your distribution is eligible for direct rollover,* check one of these boxes (if a box is not checked, this form will be returned to you for completion): I want my distribution paid as a direct rollover. (Complete section 6 of this form.) I want my distribution paid to me. I understand that 20% of the distribution will be withheld for federal income tax. I want my distribution paid to me. Withhold % (at least 20% of the distribution amount) from my payment for federal income tax. *For a definition of the term direct rollover, see the enclosed Special Tax Notice Regarding Plan Payments. B. If your distribution is not eligible for direct rollover,** check one of these boxes: Do not withhold federal income tax from my payment. I elect to have % federal income tax withheld from my payment (must be 10% or greater). **For a definition of payments that would not be eligible for direct rollover, see the enclosed Special Tax Notice Regarding Plan Payments. Important state tax withholding information: Certain states require us to withhold state income tax from your distribution. If you reside in a state that requires withholding, we will withhold state income tax in accordance with the respective state s rules. Contact your tax advisor or your state tax authority for questions specific to your situation. Note: If no withholding election is indicated, IRS regulations require that 10% federal tax withholding be taken from your distributions. We encourage you to consult your accountant or tax advisor regarding your 403(b)(7) distributions. Even if you elect not to have federal income tax withheld, you are liable for payment of federal income tax on the taxable portion of your distributions. You may be subject to tax penalties under the estimated tax payment rules if your payments of estimated tax and withholding are not adequate. 6 DIRECT ROLLOVER INFORMATION Complete this section only if you elected a direct rollover. I elect a direct rollover to my existing Wells Fargo Funds IRA: Fund and account number (or write New Account if new) Note: If you are opening a new account, complete and submit a Wells Fargo Funds IRA Application with this form. I elect a direct rollover to (check one): An IRA. (Complete the information below.) An employer-sponsored plan (401(k), 403(b)(7), 457(b) governmental, defined contribution). (Contact the plan administrator to verify that the plan accepts rollovers, and complete the information below.) A Medallion Guarantee is required in section 9 of this form. Name of IRA custodian or plan Account number (if applicable) Mailing address City State ZIP code Page 2 of 4

3 7 PAYMENT METHOD Complete this section only if you did NOT elect a direct rollover. A Medallion Guarantee may be required to process your request. Refer to section 9 of this form to determine if a Medallion Guarantee is required. I would like this distribution invested in another non-ira Wells Fargo Funds account. (To invest in an existing Wells Fargo Funds account, indicate the account number and owner(s) below. To invest in a new Wells Fargo Funds account, complete the Wells Fargo Funds New Account Application and include it with this form.) Fund and account number (or write New Account if new) Account owner(s) Include a preprinted, voided check for the electronic funds transfer (EFT) or wire payment method to ensure accurate bank account information. Note: Checks must be preprinted with your name and address. We cannot accept starter or counter checks. I would like this distribution to be paid to me by check and sent to the mailing address listed in section 1 of this form. I would like this distribution to be paid to me by check and mailed to the temporary address listed below. (A Medallion Guarantee is required in section 9 of this form.) Mailing address City State ZIP code I would like this distribution to be sent via EFT to the bank account indicated on the attached preprinted, voided check. I understand that this service is governed by the terms and conditions explained in the prospectus and that the proceeds will normally arrive at my bank within two banking days. I would like a one-time distribution to be paid by wire transfer. Wire the proceeds of this distribution request to the bank account indicated on the attached preprinted, voided check. I understand that a wire fee will be deducted from the account balance. 8 SPOUSE S CONSENT Check with your employer to determine if the spouse s signature (if applicable) and notary are required. I consent to the distribution requested by my spouse. I agree to release and discharge the fund and its transfer agent and its associates, the custodian, the plan administrator, and the employer from all liability for acting pursuant to this consent. Signature of participant s spouse Print name Date WITNESS TO SPOUSE S CONSENT Notary public State of County of Signed and sworn before me on this day of, 20. Signature of notary public Notary seal/stamp My commission expires: Page 3 of 4

4 9 PARTICIPANT AUTHORIZATION AND SIGNATURE I certify that this distribution meets the qualifications specified in the plan document. If I have requested a distribution or direct rollover from the plan, I have read the Special Tax Notice Regarding Plan Payments, attached hereto (unless previously provided to me by the plan administrator/employer), and request the distribution or direct rollover from the retirement plan designated on this form. To complete this distribution request, you must sign and date here. If you terminated employment before January 1, 2009, the employer sponsoring the 403(b)(7) does not need to sign. I wish to waive the 30-day notice period in order for my distribution or direct rollover to be processed immediately. I also understand that for complete liquidations, I may be charged a $10 liquidation fee by redeeming sufficient shares from my account. I certify that the information I have provided on this form and all future information I will provide with respect to my account is true, complete, and correct. Signature of 403(b)(7) owner (or beneficiary signature, if applicable) Print name Date Medallion Guarantee (if applicable) HAVE YOUR SIGNATURE MEDALLION GUARANTEED FOR ANY DISTRIBUTION THAT IS: Sent to an address that is not on file or to a new address prior to the expiration of the 15-day hold. Made payable by check to someone other than or in addition to you. Sent to a bank account if you are not a registered owner of the bank account. More than $100,000 and sent to a bank account that is not currently on file with Wells Fargo Funds. Purchased into another Wells Fargo Funds mutual fund account if you are not a registered owner of the account. Made payable to you as beneficiary. A Medallion Guarantee may be obtained from any eligible guarantor institution, as defined by the Securities and Exchange Commission. These institutions include banks, savings associations, credit unions, and brokerage firms that participate in the Medallion Program. The bar-coded stamp with the words MEDALLION GUARANTEED must be stamped near each signature being guaranteed. The guarantee must appear with the name of the guarantor institution and the signature of an individual authorized on behalf of the guarantor institution. Note that a notary public stamp or seal is not acceptable. 10 EMPLOYER AUTHORIZATION AND SIGNATURE If your plan is subject to ERISA, if your distribution is for a reason other than termination of employment, or if your distribution is due to termination of employment and you terminated employment on or after January 1, 2009, the employer sponsoring the 403(b)(7) must sign. This plan is subject to ERISA. Legal plan administrator s authorization. I hereby authorize the plan s custodian to make a distribution from the plan. This plan is not subject to ERISA. Plan administrator or employer confirmation is required unless employee certified former status in section 2 of this form. As plan administrator/employer, I hereby certify that if a distribution is requested, the reason for the distribution checked in section 2 of this form is true. Name of plan administrator or employer (please print) Signature of legal plan administrator at your employer Print name Date Wells Fargo Asset Management (WFAM) is a trade name used by the asset management businesses of Wells Fargo & Company. Wells Fargo Funds Management, LLC, a wholly owned subsidiary of Wells Fargo & Company, provides investment advisory and administrative services for Wells Fargo Funds. Other affiliates of Wells Fargo & Company provide subadvisory and other services for the funds. The funds are distributed by Wells Fargo Funds Distributor, LLC, Member FINRA, an affiliate of Wells Fargo & Company Page 4 of 4

5 Special Tax Notice Regarding 403(b) Plan Payments If you have questions about this form, call This notice contains important information you will need before you decide how to receive your 403(b) plan benefits and explains how you can continue to defer federal income tax on your retirement savings in your 403(b) plan. P.O. Box 8266 Boston, Massachusetts wellsfargofunds.com This notice is provided to you because all or part of the payment that you will soon receive from the 403(b) plan may be eligible for rollover by you to a Traditional IRA, Roth IRA, or eligible employer plan. A rollover is a payment by you of all or part of your benefit to another plan or IRA. When a payment is rolled to a Traditional IRA or an eligible employer plan, you will continue to postpone taxation of that benefit until it is paid to you. When a payment is rolled (converted) to a Roth IRA, any pretax amount will generally be taxed in the year in which you receive the payment from this plan. Your payment cannot be rolled over to 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. 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 403(b) plan. Check with the administrator of the plan that is to receive your rollover prior to making the rollover. 1 SUMMARY There are two ways in which 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, Roth IRA, another 403(b) plan, or another eligible employer plan that will accept it (DIRECT ROLLOVER); or 2. The payment can be PAID TO YOU. If you choose a DIRECT ROLLOVER to a Traditional IRA or eligible employer plan: 1. Your payment will not be taxed in the current year, and no income tax will be withheld. 2. 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 SIMPLE IRA or a Coverdell Education Savings Account. 3. 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 403(b) plan. If you choose a DIRECT ROLLOVER (CONVERSION) to a Roth IRA: 1. Your payment will generally be taxed in the year in which the payment is made from this plan. 2. No income tax is required to be withheld. However, you and the plan administrator of this plan are permitted to enter into a voluntary withholding agreement with respect to an eligible rollover distribution that is directly rolled over from this plan to a Roth IRA. 3. For taxable years beginning before January 1, 2010, you cannot have modified adjusted gross income (MAGI) that exceeds $100,000 or be married and file a separate tax return. The plan administrator of this plan is not responsible for assuring your eligibility with these requirements. 4. You may elect to delay the payments of taxes on payments received from this plan in 2010 that you subsequently convert to a Roth IRA by including the payment amount ratably in your income for 2011 and 2012 tax years. You should consult your tax advisor if you are interested in rolling over (converting) distributions from this plan to a Roth IRA. If you choose to have a plan payment that is eligible for rollover PAID TO YOU: 1. You will receive only 80% of the payment, because the payor is required to withhold 20% of the payment and send it to the IRS as income tax withholding to be credited against your taxes. 2. The taxable amount of your payment will be taxed in the current year unless you roll it over to a Traditional IRA or another eligible employer plan. If you convert the payment to a Roth IRA, the taxable amount converted will generally be taxed in the current year. If you receive the payment before age 59½ and you do not roll or convert the payment, you may have to pay an additional 10% tax. 3. You can roll over all or part of the payment by paying it to your Traditional IRA, to your Roth IRA, or to an eligible employer plan that accepts your rollover within 60 days after you receive the payment. Amounts rolled over to a Traditional IRA or eligible employer plan will not be taxed until you take it out of the Traditional IRA or the eligible employer plan. 4. 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% that was withheld. If you roll over only the 80% that you received, you will be taxed on the 20% that was withheld and was not rolled over. TAXNOTE ( Rev 00-02/16) Page 1 of 5 Continued on next page

6 1 SUMMARY (continued) 5. If you want to convert 100% of the payment to a Roth IRA, you must find other money to replace the 20% that was withheld. If you convert only the 80% that you received, not only will you be taxed on 100% of the payment, but if you receive the payment before age 59½, you may have to pay an additional 10% tax on the 20% not converted. To convert, you must meet applicable conversion eligibility requirements. See IRS Publication 590, Individual Retirement Arrangements, for more information on Roth IRAs (including conversion eligibility requirements). 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 payor. Please Note: This notice is intended to be used in conjunction with your 403(b) retirement plan and may not fully address issues applicable to other types of retirement plans in which you participate. 2 MORE INFORMATION I. Payments That Can and Cannot Be Rolled Over Payments from your 403(b) 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. Alternatively, subject to applicable eligibility requirements, you may be able to convert eligible rollover distributions to a Roth IRA. Payments from your 403(b) plan cannot be rolled over to a SIMPLE IRA or a Coverdell Education Savings Account. The following types of payments cannot be rolled over (or converted): 1. Payments Spread Over Long Periods.You cannot roll over (or convert) 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), Your lifetime and your beneficiary s lifetime (or a period measured by your joint life expectancies), or A period of ten years or more. 2. Required Minimum Payments. Beginning when you reach age 70½ or retire, whichever is later, a certain portion of your payment cannot be rolled over (or converted) because it is a required minimum distribution that must be paid to you. 3. Hardship Distributions. A hardship distribution cannot be rolled over (or converted). 4. Corrective Distributions. A distribution that is made to correct a failed nondiscrimination test or because legal limits on certain contributions were exceeded cannot be rolled over. 5. Loans Treated as Distributions. The amount of a plan loan that becomes a taxable deemed distribution because of a default cannot be rolled over (or converted). However, a loan offset amount is eligible for rollover (or conversion), as discussed in Part IV below. II. Direct Rollover A DIRECT ROLLOVER is a direct payment of the amount of your 403(b) plan benefits to a Traditional IRA or an eligible employer plan that will accept it. You can choose a DIRECT ROLLOVER of all or any portion of your payment that is an eligible rollover distribution, as described in Part I above. You are not taxed on any portion of your payment for which you choose a DIRECT ROLLOVER until you later take it out of the Traditional IRA or an eligible employer plan. In addition, no income tax withholding is required for any portion of your 403(b) plan benefits for which you choose a DIRECT ROLLOVER. DIRECT ROLLOVER to a Traditional IRA. You can open a Traditional IRA to receive the direct rollover. If you choose to have your payment made directly to a Traditional IRA, contact an IRA sponsor (usually a financial institution) to find out how to have your payment made in a direct rollover to a Traditional IRA at that institution. If you are unsure of how to invest your money, you can temporarily establish a Traditional IRA to receive the payment. However, in choosing a Traditional IRA, you may wish to make sure that the Traditional IRA you choose will allow you to move all or part of your payment to another Traditional IRA at a later date, without penalties or other limitations. See IRS Publication 590, Individual Retirement Arrangements, for more information on Traditional IRAs (including limits on how often you can roll over between IRAs). DIRECT ROLLOVER to a Plan. If you are employed by a new employer that has an eligible employer plan and you want a direct rollover to that plan, ask the custodian or plan administrator of that plan whether it will accept your rollover. An eligible employer plan is not legally required to accept a rollover. Even if your new employer s plan does not accept a rollover, you can choose a DIRECT ROLLOVER to a Traditional IRA. If the employer plan accepts your rollover, the plan may provide restrictions on the circumstances under which you may later receive a distribution of the rollover amount or may require spousal consent to any subsequent distribution. Check with the plan administrator of that plan before making your decision. DIRECT ROLLOVER of a Series of Payments. If you receive a payment that can be rolled over to a Traditional IRA or an eligible employer plan that will accept it and it is paid in a series for fewer than ten years, your choice to make or not make a DIRECT ROLLOVER for a payment will apply to all later payments in the series until you change your election. You are free to change your election for any later payment in the series. Page 2 of 5 Continued on next page

7 2 MORE INFORMATION (continued) III. Direct Conversion DIRECT CONVERSION to a Roth IRA. You can open a Roth IRA to receive the direct conversion. If you choose to have your payment made directly to a Roth IRA, contact an IRA sponsor (usually a financial institution) to find out how to have your payment made in a direct conversion to a Roth IRA at that institution. Once these assets are converted to a Roth IRA, you cannot subsequently roll them back to an employer-sponsored plan or to a Traditional IRA. Once converted to a Roth IRA, these assets may be rolled over only to another Roth IRA. However, if you discover that you were ineligible to make a conversion to a Roth IRA, you may recharacterize the contribution pursuant to Internal Revenue Code Section 408A(d)(6). See IRS Publication 590, Individual Retirement Arrangements, for more information on Roth IRAs (including conversion eligibility requirements and for limits on how often you can roll over between IRAs). IV. Payment Paid to You If your payment can be rolled over (see Part I) and the payment is made to you in cash, it is subject to 20% income tax withholding. The payment is taxed in the year in which you receive it unless, within 60 days, you roll it over to a Traditional IRA or an eligible employer plan that accepts rollovers. If you do not roll it over, special tax rules may apply. Income Tax Withholding: Mandatory Withholding. If any portion of your payment can be rolled over under Part I and you do not elect to make a DIRECT ROLLOVER or DIRECT CONVERSION, the custodian is required by law to withhold 20% of that amount. This amount is sent to the IRS as federal income tax withholding. For example, if you can roll over a payment of $10,000, only $8,000 will be paid to you because the custodian must withhold $2,000 as income tax. However, when you prepare your income tax return for the year, unless you make a rollover within 60 days (see Sixty-Day Rollover Option below), you must report the full $10,000 as a payment from the 403(b) plan. You must report the $2,000 as tax withheld, and it will be credited against any income tax you owe for the year. Voluntary Withholding. If any portion of your payment is taxable but cannot be rolled over under Part I, the mandatory withholding rules described above do not apply. In this case, you may elect not to have withholding apply to that portion. If you do nothing, 10% will be taken out of this portion of your payment for federal income tax withholding. To elect out of withholding, request an election form and related information. If any portion of your payment is directly converted to a Roth IRA, no income tax is required to be withheld. However, you and the plan administrator of this plan are permitted to enter into a voluntary withholding agreement with respect to an eligible rollover distribution that is directly rolled over from this plan to a Roth IRA. Sixty-Day Rollover Option. If you receive a payment that can be rolled over under Part I, you can still decide to roll over all or part of it to a Traditional IRA or an eligible employer plan that accepts rollovers. If you decide to roll over, you must contribute the amount of the payment you received to a Traditional IRA or an eligible employer plan within 60 days after you receive the payment. The portion of your payment that is rolled over will not be taxed until you take it out of the Traditional IRA or the eligible employer plan. You can roll over up to 100% of your payment that can be rolled over under Part I, including an amount equal to the 20% that was withheld. If you choose to roll over 100%, you must find other money within the 60-day period to contribute to the Traditional IRA or the eligible employer plan to replace the 20% that was withheld. On the other hand, if you roll over only the 80% that you received, you will be taxed on the 20% that was withheld. Example: The portion of your payment that can be rolled over under Part I is $10,000, and you choose to have it paid to you. You will receive $8,000, and $2,000 will be sent to the IRS as income tax withholding. Within 60 days after receiving the $8,000, you may roll over the entire $10,000 to a Traditional IRA or eligible employer plan. To do this, you roll over the $8,000 you received from the eligible employer plan, and you will have to find $2,000 from other sources (your savings, a loan, etc.). In this case, the entire $10,000 is not taxed until you take it out of the Traditional IRA or eligible employer plan. If you roll over the entire $10,000, you may get a refund of the $2,000 withheld when you file your income tax return. If, on the other hand, you roll over only $8,000, the $2,000 you did not roll over is taxed in the year it was withheld. When you file your income tax return, you may get a refund of part of the $2,000 withheld. (However, any refund is likely to be larger if you roll over the entire $10,000.) Sixty-Day Conversion Option. If you receive a payment that can be rolled over under Part I, you can still decide to convert all or part of it to a Roth IRA. If you decide to convert, you must contribute the amount of the payment you received to a Roth IRA within 60 days after you receive the payment. You can convert up to 100% of your payment that can be converted under Part I, including an amount equal to the 20% that was withheld. If you choose to convert 100%, you must find other money within the 60-day period to contribute to the Roth IRA to replace the 20% that was withheld. On the other hand, if you convert only the 80% that you received, you not only will be taxed on 100% of the payment, but if you receive the payment before age 59½, you may have to pay an additional 10% tax on the 20% not converted. Page 3 of 5 Continued on next page

8 2 MORE INFORMATION (continued) Additional 10% Tax If You Are Under Age 59½. If you receive a payment before you reach age 59½ and do not roll it over or convert it, then, in addition to the regular income tax, you may have to pay an extra tax equal to 10% of the taxable portion of the payment. The additional 10% tax does not apply to your payment if it is: 1. Paid to you because you separate from service with your employer during or after the year you reach age 55, 2. Paid because you retire due to disability, 3. Paid to you as equal (or almost equal) payments over your life or life expectancy (or your and your beneficiary s lives or life expectancies), 4. Used to pay certain medical expenses, 5. Paid to a beneficiary upon your death, 6. Paid to an alternate payee pursuant to a qualified domestic relations order (see Section V), or 7. A distribution of 403(b) elective deferrals and you are a qualified reservist. See IRS Form 5329 for more information on the additional 10% tax. Retired Public Safety Officer. Eligible retired public safety officers are allowed to withdraw pretax assets tax-free from their government retirement plans (including qualified plans, 403(a) arrangements, 403(b) plans, and 457 plans) as long as distributions are paid directly from the plan to insurers for either qualified health insurance premiums or the purchase of long-term care insurance for the participant, his or her spouse, or his or her dependents. These distributions, which must be due to disability or attainment of normal retirement age, are limited annually to the lesser of the amount paid by the participant for qualified insurance premiums or the amount prescribed in Internal Revenue Code. You cannot receive these payments directly. Consult your tax advisor to determine if you qualify as a public safety officer as defined in the Pension Protection Act of 2006 and determine if your payments qualify. Repayment of Qualified Reservist Distribution. Qualified reservist distributions of elective 403(b) deferrals are available to certain qualified reservists. Qualified reservist distributions may be repaid to an individual retirement plan (that is, an IRA) within the time frame prescribed by the Internal Revenue Code. Consult your tax advisor about your eligibility to receive qualified reservist distributions. Repayment of Plan Loans. If your employment ends and you have an outstanding loan from your 403(b) plan, the custodian may reduce (or offset ) your balance in the 403(b) plan by the amount of the loan you have not repaid. The amount of your loan offset is treated as a distribution to you at the time of the offset and will be taxed unless you roll over an amount equal to the amount of your loan offset to another eligible employer plan or a Traditional IRA within 60 days of the date of the offset. If the amount of your loan offset is the only amount you receive or is treated as having received, no amount will be withheld from it. If you receive other payments of cash or property from the 403(b) plan, the 20% withholding amount will be based on the entire amount paid to you, including the amount of the loan offset. The amount withheld will be limited to the amount of other cash or property paid to you. Although a distribution from your account may not be subject to the 10% tax because of one of the exceptions above, the distribution may cause your entire account to be immediately taxable to you if the distribution does not occur after certain events such as death, disability, retirement, attaining age 59½, or hardship (in the case of salary reduction amounts). Accordingly, you should consult your tax advisor before making any withdrawals from your 403(b) plan. V. Surviving Spouses, Alternate Payees, and Other Beneficiaries In general, the rules summarized above that apply to payments to employees also apply to payments to surviving spouses of employees and to spouses or former spouses who are alternate payees. You are an alternate payee if your interest in the 403(b) plan results from a qualified domestic relations order, which is an order issued by a court, usually in connection with a divorce or legal separation. If you are a surviving spouse or an alternate payee, you may choose to have a payment that can be rolled over as described in Part I paid in a DIRECT ROLLOVER to a Traditional IRA or to an eligible employer plan or paid to you. If you have the payment paid to you, you can keep it or roll it over yourself to a Traditional IRA or an eligible employer plan. If you are a surviving spouse or an alternate payee, you may choose to have a payment that can be converted as described in Part I paid in a DIRECT CONVERSION to a Roth IRA or paid to you. If you have the payment paid to you, you can keep it or roll it over yourself to a Roth IRA. Thus, you have the same choices as the employee. If you are a beneficiary other than the surviving spouse, you may have the option to choose a direct rollover to an Inherited Traditional IRA or you may have the option to choose a direct conversion (subject to eligibility requirements) to an Inherited Roth IRA. You cannot roll over the payment yourself or to an eligible employer plan. The IRA accepting the transfer must be designated as an Inherited IRA under which benefits must be distributed in accordance with the applicable required minimum distribution rules. In general, distributions from the Inherited IRA must either be paid to you in full within five years of the employee s death or in installment based on your life expectancy beginning by December 31 of the year following the year of the employee s death. The benefits cannot be rolled over again from the rollover IRA. Payments received by you will generally be taxable. Check with the plan administrator to see if this rollover/conversion option is available under this plan. If you are a surviving spouse, an alternate payee, or another beneficiary, your payment is generally not subject to the additional 10% tax described in Section IV, even if you are younger than age 59½. Page 4 of 5 Continued on next page

9 3 HOW TO OBTAIN ADDITIONAL INFORMATION This notice summarizes only the federal (not state or local) tax rules that may apply to your payment. The rules described are complex and contain many conditions and exceptions that are not included in this notice. Therefore, you may want to consult with a professional tax advisor before you take a payment of your benefits from your 403(b) plan. You can also find more specific information on the tax treatment of payments from qualified employer plans in IRS Publication 575, Pension and Annuity Income, and IRS Publication 590, Individual Retirement Arrangements. These publications are available from your local IRS office, on the IRS s Web site at or by calling TAX-FORM. Wells Fargo Asset Management (WFAM) is a trade name used by the asset management businesses of Wells Fargo & Company. Wells Fargo Funds Management, LLC, a wholly owned subsidiary of Wells Fargo & Company, provides investment advisory and administrative services for Wells Fargo Funds. Other affiliates of Wells Fargo & Company provide subadvisory and other services for the funds. The funds are distributed by Wells Fargo Funds Distributor, LLC, Member FINRA, an affiliate of Wells Fargo & Company Page 5 of 5