Letter to United Way of Central Indiana from Donor for IRA QCD

Thank you for choosing to request a direct distribution to United Way of Central Indiana from your traditional Individual Retirement Account (IRA).

Please complete the following form. Your responses will be sent to a member of the United Way team for review.

Questions? Contact Mike Caldwell at mike.caldwell@uwci.org.

Enter IRA Plan/Trustee Administrator Name:

Enter Last Four Digits of Account Number:

Standard Qualified Charitable Distribution (QCD) amount (up to $105,000):

Distribution of fund Charitable Gift Annuity (ACD) amount (up to $53,000):

Please read the following:

It is my intention that this gift comply with the "qualified charitable distribution" requirements of Section 408(d)(8) of the Internal Revenue Code. Accordingly, when payment is received from my trustee/administrator, please send me a contemporaneous written acknowledgement that includes the amount of my gift and states that no goods or services were transferred to me in consideration for this gift.

It is my intention that the transfer be a qualified charitable distribution for 2024. Please contact me should you have any questions.

I have read and understand the paragraph above.

Donor Full Name:

Donor Permanent Address:

Donor Phone Number:

Donor Email:

Contact Information