Sample IRA Designation of Beneficiary Form for Single IRA Trust

AuthorSeymour Goldberg
ProfessionSenior partner in the law firm of Goldberg & Goldberg, P.C., in Woodbury, New York
Pages152-153
152
SAMPLE IRA
DESIGNATION OF
BENEFICIARY FORM
FOR SINGLE IRA TRUST
(IRA PAYABLE TO SINGLE IRA TRUST)
Paul Gordon
100 Harvard Street
Northport, New York 11721
Social Securit y No. 088-45-4545
Date of Birth: 06/15/50
IRA Account No. 12345
PRIMARY BENEFICIARY
NAME: In the event that I am survived by my son, HAROLD GOR-
DON, then in that event the primary beneficiary of this I ndividual
Retirement Account shall be:
“PAUL GORDON IRREVOCABLE TRUST FOR THE
BENEFIT OF HAROLD GORDON, dated November 1, 2011,
between PAUL GORDON as Grantor and MA RTIN GORDON
as Trustee”
HAROLD GORDON, Date of Birth: 10/1/85
Percentage of Benefits: 100 percent
CONTINGENT BENEFICIARIES
In the event that my son, H AROLD GORDON, fails to survive me, t he
beneficiaries of this accou nt shall be:
goL88517_01_c01_p001-166.indd 152goL88517_01_c01_p001-166.indd 152 3/12/13 8:27 AM3/12/13 8:27 AM

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