Please send completedfonn to:

Colorado National Bank C/0 Trust Division 700 17th Street, Suite I 00

IRA Distribution Request Form COLORADO

Denver, CO 80202N ATIONAL BANK Please complete each sectiou below: Phone: (888) 265 - 1225

USE THIS F ORM TO AUTHORIZE A DISTRIBUTION OR DIRECT R OLLOVER TO Ai'l EMPLOYER PLAi'l.

1. ACCOl:l.\'THOLDER 11\'FORl\IATION

Account # ----------------------- First Name ---------------------- Last Name ------------------------------------ ­

2. BE:'IEFICL-\RY L'IFOR.\IATIO:'I (Only required if Accountholdet· is deceased) Certified copy ofdeath certificate must either be onfile with Colorado National Bank orsubmitted with beneficiary distribution request.

Name ofbeneficiary (first, middle initial, last) Social Security number Date ofbirth (mm/dd/yyyy)

U.S. residential street address City State Zip code

Daytime phone Email Address

3 REASOK FOR DISTRIBl:TIOK (Select one type) Choose only one from Section 3 A -F below. For a withdrawal ofexcess contribution, skip to 3C. For a transfer pursuant to a divorce, skip to 3D. For transfer pursuant to death skip to 3E. For a distribution from a beneficiary IRA skip to 3F.

A. From a Traditional IRA, RoUover IRA, Inherited T raditional IRA, SEP-IRA, SARSEP-IRA or SIMPLE IRA Only: 0 l a. Normal Disttib ution (Code 7)

Use for any of the following when the taxpayer is age 59li2 or older: Normal Distribution, a distribution that will be rolled over to another IRA or an employer plan* within 60 days, an IRA revocation (within 7 days ofopening account), or a Roth IRA conversion or reconversion.

2a. Pr emature Disttibution, no known exception (Code 1) D Use for a distribution when the taxpayer has !!.2! reached age 59li2 and no known exception under Section 72(t) applies, including a distribution that will be rolled over to another IRA or an employer plan within 60 days when the taxpayer is younger than age 59li2, or for an IRA revocation when the taxpayer is younger than age 59li2.

D 2b. Prem ature Distribution from a SIMPLE IRA, no known exception (Code S) Use for a distribution from a SIMPLE IRA taken within 2 years ofthe date the fust contribution was made ifthe taxpayer has not reached age 59li2 and none ofthe exceptions under Section 72(t) apply.

D 3. Premature Disttibution, excep tion applies (Code 2) Use for a distribution when the taxpayer has .!!.!!! reached age 59li2 but an exceptionunder Section 72(t) applies or for a Roth IRA conversion or reconversion when the taxpayer is younger than age 59li2.

D 4. Disability Distribution (Code 3) Use for a distribution due to permanent disability within the meaning ofIRS Section 72(m)(7). Consult your tax advisor.

D 5. ~m (Sc.heduled ~ID). For one-time RMD amounts, please check "Normal" . For scheduled RMD, proceed to Section 3.

6. Dit·ect Rollover to an E mployer Plan * (Code G)D This option is not available for Inherited IRAs or for IRA-to-IRA movement ofmoney. Use only for a rollover to an employer plan.* Provide the Employer Plan Name and Address in the space below:

Employer Plan Name: Employer Plan Address:

*"Employerplan" means a qualified retirement plan such as a 401 (k), 403(b ), or 457(b) eligible deferred compensation plan.

B. From a R oth IRA or Inherited R oth IRA Only: l b. Qualified (Not·mal) Disttibution fr om a Roth IRA (Code Q)D Use for a distribution if the five-year holding period has been completed and the taxpayer has reached age 59li2, if the taxpayer is disabled, or for a distribution from an Inherited Roth IRA.

l c. Roth IRA Disttibution, exception applies (Code T)D Use for a distribution if it is not known ifthe five-year holding period has been completed and the taxpayer has reached age 59li2, ifthe taxpayer is disabled. or for a distribution from an Inherited Roth IRA.

2c. Prema ture Disttibution ft·om a Roth IRA (Code J)D Use for a distribution from a Roth IRA when Codes Q and T do not apply.

C. Withdrawal of Excess Distribution

Complete items 1-3 below (this section) ifyou want to withdraw an excess contribution from your IRA.

1. I am withdrawing the excess contribution I made on (insert date) for the tax year

The amount ofthe excess was $ My tax-filing deadline is/was (insert date)

D 2. Choose one:

The amount ofearnings I calculated was $ ---.,,....----..,=---:--.,....,...""'"'"'"'

Calculate earnings on my excess contribution for me. By checking this box, I accept the calculation method and earnings amount determined byD Colorado National Bank to be accurate. The earnings are calculated based on a pro rata portion of the total earnings accumulated for the period oftime

Distribution Authorization 2017 Page 1 of6 Colorado National Bank

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from the origjnal contribution. Colorado National Bank will use the IRS-approved calculation method as described in the IRS Final Regulations (Treas. Reg. 1.408-11) for contributions made for tax year 2004 and later.

3 . From an IRA (Choose only one option below):

This withdrawal is being made prior to the tax-filing deadline (including extensions) for the year in which the excess contribution was made. (Code 8/P)

This withdrawal is being made after the tax-filing deadline (which does not include extensions), and my tax return was filed in a timely manner. A withdrawal ofthe excess can still be made no later than six (6) months after the due date for filing the tax return, not including extensions. (Code 8/P)

Neither ofthe two choices above applies.*

* Ifyou are removing an excess amount after your tax-filing deadline, including any extensions you received or could have received automatically, then the distribution must be reported as a Code 1, 7, J or T, and earnings are not distributed.

D. Transfer Pursuant to Divorce Complete this section for transfers of interest from one IRA Accountholder spouse to another under a divorce decree or separation instrument. Note: Transfers of interest in an IRA from one spouse to another under a divorce decree or separation instrument are generally tax-free and are not reported to the IRS.

Please p1·ovide the following required info•·mation and documents: 1. Official divorce decree or separation instrument with judge' s signature.

2. Letter ofAuthorization and Instruction signed by both parties agreeing to specific asset division ifsettlement agreement is not current or not specific. 3 . Colorado National Bank IRA account number and telephone number for receiving party:

Name of R ecipient: IRA Account No:

D aytime Phone: Email:

4. Transfer ofAccount form (ifinterest is to be transferred to an IRA outside ofColorado National Bank).

5. IRA Distribution Request Form completed and signed by receiving party ifrecipient would like to take a distribution of the interest that has been transferred to a Colorado National Bank IRA after the divorce transfer has been processed. Note: Ifa distribution is made, the amount is subject to taxes and may be subject to a penalty.

E. Transfer Pursuant to Death Attach origjnal or certified death certificate.

Nou-Roth IRAs Oulv: Ifthe original owner died on or after April !" of the year following age 70 \1, (optional selection) :

I:J The o.-iginal holder did not remove their Requir ed Minimum Distr ibution in the year of deat h. Please dist.-ibute this amount to me. Please attach payment instructions for this amount. You may deposit this into an IRA. If the payment instructions are not attached, a check will be sent to the beneficiary's address of record.

Multiple Beneficiaries O nlv: Each beneficiary must complete a Colorado National Bank IRA Distribution form. Ifthe account holds positions/assets that cannot be distributed equitably in whole shares, attach a separate notarized Jetter of instruction stating the cash amount or specific assets each beneficiary \vill receive.

F. Dist.-ibution from a Beneficiary IRA Complete this section if you are the beneficiary ofa descendant's IRA and wish to take a d istribution.

I:J Single Life Expectancy Payments. I elect to deplete the account balance by taking payments over my single life expectancy.

I:J Please send me only the amount specified in Section 4 below.

4. Al\IOl:l\"T A.'ID l\IETHOD OF DISTRIBl:TIOK (Select one Distribution l\lethod) You may request a total distribution (closes the account), one-time, or scheduled distribution from your Colorado National Bank IRA. Ifyou want a cash distribution from positions other than your available sweep cash balance, please arrange to have the asset(s) liquidated and the proceeds delivered to your account at CNB. his important that you ensure that there is sufficient cash available in your account by the date ofdistribution because we will not be able to provide notification ofinsufficient funds before the scheduled date ofdistribution. A. One-Time Distribution

D Total d istribution ofmy entire account. (Distribute available cash, re-register remaining assets to me, and close account.)

D Distribute $ from my cash sweep balance.

0 In-kind distribution ofassets (indicate which assets to re-register below):

Asset Description Quantity/Shares

Note: Ifadditional space is needed, please attach a separate page.

B. Scheduled Distrib ution- for reoccurring distributions on a specified date.

D $Distribution amount:

Frequeucy (choose one) . Ifno payment frequency is selected. your d istribution will be processed as a one-time request.

I:J Monthly I:J Quarterly I:J Semi-Annual I:J Annual

Starting Date: Ending Date (optional) :

Distribution Authorization 2017 Page2 of6 Colorado National Bank

5. P A Yl\IKET :\IETHOD Select one payment methodA, B, or C below.

A. CJ Check- mail to address of record. Delive1-v Method: CJ Regular Mail CJ Express Mail ($25 fee applies)

CJ Check- mail to temporary address noted below. (Signature Guarantee Required.) Delivel)' Method : CJ Regular Mail CJ Express Mail ($25 fee applies)

Alternative Address: (Note: Medallion Guarantee required.) Address:

City:

CJ Check- made payable to (third party):

Delive1-v Method: CJ Regular Mail CJ Express Mail ($25 fee applies)

Address:

State: Zip :

(Note: Medallion Guarantee required.)

City: State: Zip :

B. (J ACH (For Periodic Distributions O nly)

CJ Checking CJ Savings

Attach a preprinted voided check/deposit slip here

C. CJ Wire (additional $30 fee)

Bank Information:

Bank Name:

Bank Address:

City: State: Zip:

Bank Routing No (ABA): (Must be 9 digits)

Banking Account Number:

Name on Bank Account:

6. TAX WITHHOLDIXG ELECTIONS Federal Withholding Election IRS regulations require this notice to be given to you each time your request a distribution from your IRA. The distribution(s) you receive from your IRA are subject to Federal Income Tax withholding, unless you elect not to have withholding apply. You may be liable for payment ofFederal Income Tax due on distribution(s)from your IRA, regardless ofwhether or not you elect to have taxes withheld. In addition, ifyourpayments ofestimated tax and withholding, ifany, are not adequate, you may be subject to tax penalties under estimated tax payment ntles. We urge you to consult with your tax advisor with respect to your election ofFederal Income Tax withholding. If an election is not made, we will withhold 10percent ofthe gross distribution amount. A minimum of10percent must be withheld ifa specific percentage or dollar amount is provided. Ifyou do not want Federal Income Tax withheld from yourdistribution(s), please select the first option below.

Please select one. H no selection is made, tans will automa tically b e withheld from the distlibution(s) at a r ate of 10%. (J DO NOT WITHHOLD federal income tax from my distribution(s) .

Withhold 10% for federal income taxes from my distribution(s).(J Withhold %(minimum 10%). (J

(J Withhold for Federal Income Taxes from my distribution(s). (minimum 100/o)

State Withholding Election You may be liable for payment ofState Income Tax on distribution(s)from your IRA, regardless ofwhether or not you elect to have taxes withheld. Ifan election is not made, we will withhold from your distribution according to your state ofresidence requirement. Colorado National Bankwill notprocess state withholding ifthe "DO NOT WITHHOLD" box is checked below for a voluntary withholding state or ifthe state withholding requirement is requestedfor a state where there is no such obligation. Note The state ofresidence determines the state withholding requirements and is determined by the account's legal address ofrecord. Ifthe state listed on the account is notyour legal state ofresidence, provide that information here.

State ofResidence - ifother than that listed in our records.

Please select one. H no selection is made, taxes will automatically be withheld based upon your state's minimum requirement (special sen i ces fees may apply). (J DO NOT WITHHOLD state income tax from my distribution(s).

(J Withhold my state' s minimum requirement.

(J Withhold this amount: % or $ (We will withhold at least your state's minimum amount .)

Distribution Authorization 2017 Page 3 of6 Colorado National Bank

ACK.,OWLEDG:\IE~T, AUTHORIZATIOK & ACCOl::\"THOLDER SIG~ATURE

I certify that I am theproper persou to receit>e pnymeut(s) from this IRA aud that all iuformatiou provided by me is true aud accurate. I certify that 110 tax advice has beeu giveu to me by Colorado Natioual Bauk. All decisious regardiug this withdrawal are my owu. I assume the respousibility for auy ad1>erse cousequeuces thatmay arise from this withdrawal aud agree the Colorado Nathmal B aukshall iu 110 way be held respousible.

Accountholder's Signature Month Day Year

X --------------------------------------­

Medallion Gu aJ"antee ** (if applicable) Upon completion, retut·n to:

Colorado National Bank C/0 Trust Division 700 1711o Street, Suite 2400 Denvet·, CO 80202

HAVE YOUR SIGNATURE :MEDALLION GUARANTEED FOR ANY DISTRIBUTION THAT IS : • Sent to an address that is not on file with CNB, such as a temporary address. • Check made payable to someone other than or in addition to you. • Sent to bank account ifyou are not a registered owner of the bank account.

**A Medalli<m Guarautee may be obtainedfrom an eligible instih1tion, as defined by the Securities and Exchange Commission. These institutions include banks, savings associations, credit unions, and brolooragefirms that participate in the Medallion Program. The bar-coded stamp with the words "MEDALLION GUARANTEE" must be stamped near the signah1re being guaranteed. The guarantee must appear with the name ofthe grantor instih1tion and the signah1re ofan individual authorized on behalfof the grantor institution. Note that a Notary Public stamp or seal is uot acceptable.

Distribution Authorization 2017 Page4 of6 Colorado National Bank

GENERAL Rules and Conditions Applicable to Withdrawal INFORMATION In order to ensure proper tax reporting you must supply all requested information. Distributions received from the IRA must be included in your

gross income except those that are attributable to Roth IRAs, nondeductible contributions, and amounts rolled back into an IRA, qualified plan, 403(a), 403(b), or governmental 457(b) plan.

DISTRIBUTION INFORMATION

IRA ACCOUNTHOLDER

INFORMATION

BENEFICIARY INFORMATION

DISTRIBUTION REASON

If you are establishing periodic distributions from your IRA, you must: 1. Take at least the minimum amount required by the Internal Revenue Code if you are age 70 ½ or older. 2. Continue receiving distributions in the instructed manner until: (a) you furnish Colorado National Bank with new written instructions, (b) your death, or (c) your account is depleted, whichever occurs first.

You are required to provide the requested information.

In the event of death of the IRA Accountholder, beneficiaries seeking distribution are required to provide the requested information. Before Colorado National Bank will process any beneficiary distribution request we must have a certified copy of the death certificate on file. A beneficiary may submit a death certificate at the time of their distribution request.

You are required to give the reason for taking a distribution from your IRA.

1. Normal Distribution. You may take distributions from your IRA at any time without incurring an IRS imposed premature distribution penalty if you are age 59 ½ and over. Distributions from IRAs are reported on IRS Form 1099R using Code 7. Roth IRA accounts are not subject to required minimum distribution requirements. For Roth IRA distributions, if you are over age 59 ½ and otherwise qualify; the distributions are not included in your gross income. Qualified Roth IRA distributions are reported on the IRS form 1099R using Code Q. Distributions to Roth IRA Accountholders over age 59 ½ are reported on the IRS Form 1099R using Code T, unless they are qualified distributions. If five years have passed since your initial Roth IRA contribution or conversion year, and either: (1) you are over age 59 ½, (2) your distribution is on account of death, or (3) you are disabled, then your distribution is a Qualified distribution.

Due to the fact that Colorado National Bank has already provided you with the IRA Disclosure Statement (which was part of your IRA establishment packet) you have the right to revoke your IRA within seven days of the date we signed your IRA Adoption Agreement. In the event you decide you want to revoke your account, you are entitled to receive either a full refund of the contribution you made to the Account or the current fair market value of the amount, if we have already invested your contribution pursuant to your instructions.

2. Premature Distribution With No Known Exception. If you are under age 59 ½ and take a distribution from your IRA, it will generally be considered a premature (early) distribution. Unless an exception to the penalty applies, you must pay the appropriate penalty tax to the IRS. IRA Accountholders who rollover a premature distribution into another IRA (or in some cases a Roth IRA) will not be subject to the premature distribution penalty. Payments made to pay medical expenses that exceed 10 percent of your adjusted gross income and distributions to pay for health insurance if you have separated from employment and have received unemployment compensation under a federal or state program for at least 12 weeks are exempt from the 10 percent tax; payments to cover certain qualifying education expenses and qualified first-time home purchases (up to a lifetime limit of $10,000) and qualified reservist distributions are all exempt from the 10 percent penalty. However, these distributions are reported to the IRS using Code 1, and you must file IRS Form 5329 to claim an exemption from the 10 percent penalty. You must include all earnings you receive from the Roth IRA in your gross income unless you receive qualifying distributions or roll the distribution back into a Roth IRA. You may take a distribution from a SIMPLE IRA at any time. However, if you are under age 59 ½, distributions taken during the first two years following the date your first SIMPLE IRA contribution was deposited into your SIMPLE IRA plan are generally subject to a 25 percent premature distribution penalty. Such distributions are reported on IRS Form 1099R using Code S.

3. Premature Distribution With Exception. If you are under 59 ½ and take “substantially equal periodic payments” (as defined in Internal Revenue Code (IRC) Section 72(t)(2)(A)(iv)) from your IRA, you may qualify for an exception to the premature distribution penalty. Once this payment series begins, generally, the payment schedule may not be altered for a period of five years (60 months) or attainment of age 59 ½, whichever is longer. Funds may not be added or subtracted from the account in any way, including contributions, transfers in or out, and distributions from the account other than the calculated payment once the payment period is complete. These distributions are reported to the IRS using Code 1

The account you are requesting this payment schedule for must have sufficient cash funds for the distribution. A missed payment not corrected by year’s end constitutes an alteration of the schedule and will terminate the exception. Please consult with a financial or tax professional before submitting this request.

4. Disability Distribution. For you to qualify for a penalty free withdrawal under the disability exception, your disability must meet two requirements: 1) it must render you unable to engage in any substantial gainful activity; and 2) it must be medically determined that the condition will last continuously for at least 12 months or lead to your death. Colorado National Bank may require proof of your disability to verify your ability to use this distribution penalty exception.

5. Required Minimum Distribution. IRAs (other than Roth IRAs) are subject to IRS required minimum distribution (RMD) rules starting when you attain age 70½. The initial distribution from the Account must begin no later than April 1st following the calendar year in which you attain age 70 ½ (referred to as the “required beginning date”). Waiting until April 1 of the following year will require you to take a second payment that year. Subsequent distributions must be withdrawn from the Account by December 31st of each year. Pursuant to IRS regulation, failure to withdraw the required distribution amount will result in an additional tax of 50% of the amount that should have been withdrawn in any given year. This penalty is in addition to ordinary income taxes you must pay to the federal and, if applicable, state government.

To calculate the required distribution amount, you divide the prior December 31st balance of the Account by a life expectancy factor found in the uniform lifetime table (see Regulation section 1.401(a)(9)-9). In the event your spouse is the sole beneficiary of the Account and he or she is more than 10 years younger than you, the required distribution amount is determined using the joint and last survivor table which may also be found in the Regulation section referenced above. If you have more than one Traditional IRA, you must calculate the RMD separately for each account. However, there is no requirement for you to withdraw the RMD amount from each account. As a result you may satisfy your distribution requirement by taking from one account an amount sufficient to cover all accounts.

6. Direct Rollover to an Employer Plan. If you qualify, you may rollover taxable IRA assets to your employer’s qualified plan, tax-sheltered annuity (403(b)), or 457 plan. The rules governing rollovers are very complex. You are advised to see a competent tax advisor if you have questions regarding eligibility to complete a rollover.

C. Withdrawal of Excess Distribution. If you have made an excess contribution to your IRA, you must take the appropriate steps to remove or redesignate the distribution. Depending on when you take the necessary corrective action and the amount of the excess contribution, you may have to pay the IRS either an excess contribution or early distribution penalty tax, or both. Code 1, 7, 8, or P (or a combination of these codes) will be applicable on IRS Form 1099R depending on the timing of the removal.

Distribution Authorization 2017 Page 5 of 6 Colorado National Bank

WITHHOLDING NOTICE

INFORMATION

(Form W-4P/OMB No. 1545-0415)

REVOKING WITHHOLDING

EXEMPTION

SIGNATURE

D. Transfer Pursuant to Divorce. A transfer may be made by an IRA Accountholder and a recipient under a transfer due to divorce. The following documents are required to process a divorce transfer: Official Divorce Decree signed by a judge referencing the settlement, IRA Application from receiving party (if they do not already have an IRA with the same registration) and the IRA Distribution Request Form from the releasing party.

E. Transfer Pursuant to Death. A transfer may be made by a beneficiary under a transfer due to death. If you are requesting a transfer as a beneficiary, you must furnish an original or certified death certificate. You must also furnish a Beneficiary IRA application if you are transferring the funds into a new Beneficiary IRA. Removing a final Required Minimum Distribution: This is a separate minimum distribution requirement unrelated to the annual Single Life Expectancy Payments election. Any outstanding Required Minimum Distributions must be removed before transferring from the decedent’s original Traditional, SEP or SIMPLE IRA account to your IRA (spouse only) or a Beneficiary IRA. Distribution from a Beneficiary IRA

F. Distribution from a Beneficiary IRA. You may take a distribution from a Beneficiary IRA at any time for any amount, up to the balance of the account. If you wish to request only the minimum required withdrawal, please indicate this in the optional Single Life Expectancy Payments selection box in section 3F of this form under Distribution from a Beneficiary IRA. Non-spouse Beneficiaries: Generally, we will use each non-spouse beneficiary’s date of birth when determining the correct IRS single life expectancy factor unless you direct us on this form to use the oldest non-spouse beneficiary’s date of birth for purposes of this calculation. Qualified trust as beneficiary: Qualified trusts may permit the trustee(s) to use the trust beneficiary’s age for purposes of calculating single life expectancy payments. If you have elected to use the trust beneficiary’s date of birth, please indicate this on the form. You must include all amounts you receive from the IRA in your gross income except amounts attributable to nondeductible contributions and amounts rolled back into an IRA, qualified plan, 403(b) or 457 plan.

Basic Information About Withholding From Pensions And Annuities. Generally, Federal income tax withholding applies to payments made from pension, profit sharing, stock bonus, annuity and certain deferred compensation plans, IRAs, and commercial annuities.

Purpose Of Form W-4P. Unless you elect otherwise, federal income tax will be withheld from payments from Individual Retirement Accounts (IRAs). You can use Form W-4P, or a substitute form, such as that contained on this form, furnished by Colorado National Bank, to instruct us to withhold no tax from your IRA payments (or to revoke this election).

Nonperiodic Payments. Payments from IRAs that are payable upon demand are treated as nonperiodic payments for Federal income tax purposes. Generally, nonperiodic payments must have income tax withheld at a rate not less than 10 percent. You can elect to have no income tax withheld from a nonperiodic payment (IRA payment) by filing Form W-4P or a substitute form with Colorado National Bank and checking the appropriate box on that form. Your election will remain in effect for any subsequent distribution unless you change or revoke it. For more information, please see Publication 505, Tax Withholding and Estimated Tax, and Publication 515, Withholding of Tax on Nonresident Aliens and Foreign Entities, available from most IRS offices.

The election to not have income tax withheld does not apply to any payments that are delivered outside of the U.S. or its possessions to a U.S. citizen or resident alien. Other recipients who have these payments delivered outside the U.S. or its possessions may choose not to have income tax withheld only if an individual completes Form W-8BEN. Certificate of Foreign Status of Beneficial Owner for United States Tax Withholding, or satisfies the documentation requirements as provided under the regulations.

Caution Remember that there are penalties for not paying enough tax during the year, through either withholding or estimated tax payments. New retirees should see Publication 505. It explains the estimated tax requirements and penalties in detail. You may be able to avoid quarterly estimated tax payments by having enough tax withheld from your IRA using Form W-4P. Revoking the Exemption from Withholding If you want to revoke your previously filed exemption from withholding, file another Form W-4P with Colorado National Bank and check the appropriate box on that form.

Your signature is required to certify that the information you have provided is true and correct and that you are aware of all the circumstances affecting this IRA withdrawal.

Distribution Authorization 2017 Page 6 of 6 Colorado National Bank