IRA CHARITABLE ROLLOVER - Jewish Community Federation

IRA CHARITABLE ROLLOVER - 2011
MEMORANDUM OF INSTRUCTION
TO:
FROM:
Name & Address of Pension Administrator
DATE:
RE:
Name & Address of Donor/IRA Owner
Request for Charitable Distribution from Individual Retirement
Account #
This Memorandum and IRA distribution request form constitute my request that you make a direct
charitable distribution from my Individual Retirement Account #
as provided by the Tax Relief, Unemployment Insurance Reauthorization, and Job Creation Act of 2010.
Please ensure that your documentation and communication with me make clear that this distribution is not
taxable income to me, though it counts toward the annual minimum distribution requirement. It is my
intention that this transfer qualify for exclusion during the 2011 tax year. Therefore, it is imperative this
distribution be postmarked no later than December 31, 2011.
Please either issue a check or wire funds as follows:
(1) Please issue a check in the amount of $ payable to the Jewish Community
Federation of San Francisco, the Peninsula, Marin and Sonoma Counties at the address below:
Jewish Community Federation of San Francisco,
the Peninsula, Marin and Sonoma Counties
ATTN: Tamara Wallenstein
121 Steuart Street
San Francisco, CA 94105
EIN: 94-1156533
(2) Please wire $ as follows:
Bank:
Account:
First Republic Bank
Jewish Community Federation of San Francisco,
111 Pine Street the Peninsula, Marin and Sonoma Counties
San Francisco, CA 94111
ATTN: Tamara Wallenstein
Tel. (415) 981- 3181
121 Steuart Street
San Francisco, CA 94105
Account No. 800-0079-4736 EIN: 94-1156533
ABA No. 321081669

Memo to IRA Administrator
Page 2 of 2
In your transmittal to the Federation, please list my name and address as the donor of record in connection
with this transfer, along with a copy of this memo. I would appreciate receiving a copy of the transmittal
letter or other confirmation of the distribution.
If you require a copy of the Federation’s IRS tax determination letter as a public charity, please contact
Tamara Wallenstein at (415) 512-6217 or other Federation staff.
I have designated this transfer to the Federation for its:
(If multiple designations, specify percentage or amount)
_____ Annual Campaign %
_____ Unrestricted Endowment Fund %
_____ Early Childhood Education Initiative %
_____ Senior Transportation Initiative %
_____ Community-wide Scholarship Funds %
_____ Other restricted endowment fund (specify):
Thank you for your assistance in this matter.
Sincerely,
Donor/IRA Owner
cc:
Tamara Wallenstein
Jewish Community Federation
121 Steuart Street
San Francisco, CA 94105
Phone: (415) 512-6217
Fax: (415) 495-6635
tamaraw@sfjcf.org