Withdrawals – IRA One-Time
Use this form to make a one-time, tax-reportable distribution from a Traditional, Rollover, Roth, SEP, SIMPLE, or Inherited IRA.
Do NOT use this form for Fidelity Retirement Plan accounts, annuities, or nonretirement accounts, or for any IRA-to-IRA transfer.
Also do not use this form to purchase an investment in your IRA. Go to Fidelity.com/forms to find the appropriate form. Type on
screen or fill in using CAPITAL letters and black ink. If you need more room for information or signatures, use a copy of the relevant page.