Sample Qualified Distribution Letter

Sample Letter of Instruction from Donor to IRA Provider



[NAME OF IRA PROVIDER]                                                                                               



Re:      Request for Qualified Charitable Distribution from Individual Retirement Account

Dear Sir or Madam:

Please accept this letter as my request to make a qualified charitable contribution from my Individual Retirement Account Number:

[insert account number]

under Sec. 1201 of the Pension Protection Act of 2006 (the PPA) and Sec. 408(d)(8) of the Internal Revenue Code, and made permanent under the Consolidated Appropriations Act of 2016. 

Please issue a check in the amount of $____________ payable to The Shoreline Church of San Clemente (Tax ID# 33-0908893) at the following address:

The Shoreline Church of San Clemente

211 Avenida Fabricante

San Clemente, CA 92672

In your transmittal to the church, please state my name and address as the donor of record in connection with this transfer, and copy me on your transmittal. It is my intention to have this transfer qualify during the current tax year. Therefore, it is imperative that this distribution be postmarked no later than December 31 of this tax year.

If you have any questions or concerns regarding this request, I can be reached at [PHONE AND EMAIL ADDRESSES].

Thank you for your prompt attention to and assistance with this matter.

Sincerely yours,