Ira Rollover Authorization Form

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IRA Rollover Authorization

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Required for indirect rollovers only.

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Make checks payable to Scottrade.

Account Number

Name

Check Number

Check Amount

Total

Due to the important tax consequences of rolling over funds or property to an IRA, I am aware that I should consult a tax professional. I understand the

rollover rules and I am eligible to conduct this transaction. No part of this rollover contains required minimum distribution amounts. I assume full

responsibility for this rollover transaction and will not hold Scottrade, Inc. or its employees liable for any adverse consequences that may result. I hereby

irrevocably designate this contribution as a rollover contribution.

*SF2000*

Date

Signature of Account Holder

SF2000/3-15