Form F11434 "Mandatory State Income Tax Withholding Election for Periodic Withdrawals That Are Not Rollover Eligible - Tiaa"

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Download Form F11434 "Mandatory State Income Tax Withholding Election for Periodic Withdrawals That Are Not Rollover Eligible - Tiaa"

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MANDATORY STATE INCOME TAX WITHHOLDING ELECTION
FOR PERIODIC WITHDRAWALS THAT ARE NOT ROLLOVER ELIGIBLE
IMPORTANT INFORMATION
NEED HELP? 800-842-2252
Weekdays
PLEASE READ BEFORE FILLING OUT FORM
8 a.m. – 10 p.m. (ET)
State laws may require mandatory state income tax be withheld from your distributions. Our records indicate that
Saturday
you are a legal resident of one of the states listed in Section 3 of this form, and may therefore be subject to state
9 a.m. – 6 p.m. (ET)
withholding from your cash distributions. If your legal residence is not one of the states listed on this form, please
contact us to ensure you receive the proper withholding form. If you do not return a withholding form, TIAA is
Or visit TIAA.org.
required to withhold state income taxes at the state tax default rate shown on this form. Before making an election,
Have your ID and password
be sure to read any notes in Section 3 that may apply to your state of residence.
ready.
Please keep in mind:
1. Non-Rollover Eligible Payments are payments that cannot be rolled over to an IRA or other similar retirement plan.
2. There may be penalties for not paying enough state income tax during the year.
3. State tax withholding rates are always subject to change.
4. If you are a resident of Kansas and the distribution is from a Kansas Board of Regents plan, the distribution may
be exempt from tax; therefore, you may elect to have no withholding.
5. If you are a resident of North Carolina and the distribution is considered exempt under the Bailey/Emory/Patton
Settlement, the distribution may be exempt from tax; therefore, you may elect to have no withholding.
6. If you are a resident of Michigan and:
You (or your spouse if filing jointly) were born prior to 1946, all benefits from public sources (as defined by the
Michigan Department of Treasury) are exempt from Michigan state taxes. Benefits from private sources may be
subtracted for a single filer or married filer filing separately or if married filing a joint return for the current tax
year. Any private pension payment in excess of Michigan income limits is taxable.
You (or your spouse if filing jointly) were born during the period 1946 through 1952, a portion of all private
and public pension and annuity benefits may be subtracted from Michigan taxable income.
You (and your spouse) were born after 1952, all private and public pension and annuity benefits are fully
taxable and may not be subtracted from Michigan taxable income.
If you feel your distribution is not subject to state taxes then you may elect to have no withholding.
Be sure to read and fill out all necessary parts of this form to avoid any delay in the processing of your request.
You can change your withholding elections online by visiting TIAA.org 24 hours a day.
Any tax information included in this written or electronic communication was not intended or written to be used,
and it cannot be used by the taxpayer, for the purpose of avoiding any penalties that may be imposed on the
taxpayer by any governmental taxing authority or agency.
RETURN COMPLETED FORM(S) TO:
FAX:
STANDARD MAIL:
OVERNIGHT:
800-914-8922 (within U.S.)
TIAA
TIAA
704-595-5795 (outside U.S.)
P .O. Box 1268
8500 Andrew Carnegie Blvd.
Charlotte, NC 28201-1268
Charlotte, NC 28262
SEND US YOUR FORM ONLINE:
Log in to your account at TIAA.org. On the main menu, under “My Account, ” select the “Upload documents” link.
Within the “Shared Files” tab in “Message Center,” select the “Upload Files” button.
MOBILE UPLOAD:
Log in to your TIAA app, and click on “Message Center” from the top right menu.
Click on “Shared Files.”
In the bottom right corner, click on the upload icon and select the folder to upload to.
Follow the instructions to take a picture and upload your completed form.
F11434 (6/16)
MANDATORY STATE INCOME TAX WITHHOLDING ELECTION
FOR PERIODIC WITHDRAWALS THAT ARE NOT ROLLOVER ELIGIBLE
IMPORTANT INFORMATION
NEED HELP? 800-842-2252
Weekdays
PLEASE READ BEFORE FILLING OUT FORM
8 a.m. – 10 p.m. (ET)
State laws may require mandatory state income tax be withheld from your distributions. Our records indicate that
Saturday
you are a legal resident of one of the states listed in Section 3 of this form, and may therefore be subject to state
9 a.m. – 6 p.m. (ET)
withholding from your cash distributions. If your legal residence is not one of the states listed on this form, please
contact us to ensure you receive the proper withholding form. If you do not return a withholding form, TIAA is
Or visit TIAA.org.
required to withhold state income taxes at the state tax default rate shown on this form. Before making an election,
Have your ID and password
be sure to read any notes in Section 3 that may apply to your state of residence.
ready.
Please keep in mind:
1. Non-Rollover Eligible Payments are payments that cannot be rolled over to an IRA or other similar retirement plan.
2. There may be penalties for not paying enough state income tax during the year.
3. State tax withholding rates are always subject to change.
4. If you are a resident of Kansas and the distribution is from a Kansas Board of Regents plan, the distribution may
be exempt from tax; therefore, you may elect to have no withholding.
5. If you are a resident of North Carolina and the distribution is considered exempt under the Bailey/Emory/Patton
Settlement, the distribution may be exempt from tax; therefore, you may elect to have no withholding.
6. If you are a resident of Michigan and:
You (or your spouse if filing jointly) were born prior to 1946, all benefits from public sources (as defined by the
Michigan Department of Treasury) are exempt from Michigan state taxes. Benefits from private sources may be
subtracted for a single filer or married filer filing separately or if married filing a joint return for the current tax
year. Any private pension payment in excess of Michigan income limits is taxable.
You (or your spouse if filing jointly) were born during the period 1946 through 1952, a portion of all private
and public pension and annuity benefits may be subtracted from Michigan taxable income.
You (and your spouse) were born after 1952, all private and public pension and annuity benefits are fully
taxable and may not be subtracted from Michigan taxable income.
If you feel your distribution is not subject to state taxes then you may elect to have no withholding.
Be sure to read and fill out all necessary parts of this form to avoid any delay in the processing of your request.
You can change your withholding elections online by visiting TIAA.org 24 hours a day.
Any tax information included in this written or electronic communication was not intended or written to be used,
and it cannot be used by the taxpayer, for the purpose of avoiding any penalties that may be imposed on the
taxpayer by any governmental taxing authority or agency.
RETURN COMPLETED FORM(S) TO:
FAX:
STANDARD MAIL:
OVERNIGHT:
800-914-8922 (within U.S.)
TIAA
TIAA
704-595-5795 (outside U.S.)
P .O. Box 1268
8500 Andrew Carnegie Blvd.
Charlotte, NC 28201-1268
Charlotte, NC 28262
SEND US YOUR FORM ONLINE:
Log in to your account at TIAA.org. On the main menu, under “My Account, ” select the “Upload documents” link.
Within the “Shared Files” tab in “Message Center,” select the “Upload Files” button.
MOBILE UPLOAD:
Log in to your TIAA app, and click on “Message Center” from the top right menu.
Click on “Shared Files.”
In the bottom right corner, click on the upload icon and select the folder to upload to.
Follow the instructions to take a picture and upload your completed form.
F11434 (6/16)
MANDATORY STATE INCOME TAX WITHHOLDING ELECTION
FOR PERIODIC WITHDRAWALS THAT ARE NOT ROLLOVER ELIGIBLE
This page has been intentionally left blank.
F11434 (6/16)
MANDATORY STATE INCOME TAX WITHHOLDING ELECTION
FOR PERIODIC WITHDRAWALS THAT ARE NOT ROLLOVER ELIGIBLE
Page 1 of 2
1. PROVIDE YOUR INFORMATION
Print in uppercase using
black or dark blue ink.
First Name
Middle Initial
IMPORTANT: A full Social
Security Number/Taxpayer
Identification Number is
Last Name
Suffix
required to process your
request.
Social Security Number/
Taxpayer Identification Number
Contact Telephone Number
Extension
State of Legal Residence
Citizenship
(if not U.S.)
2. PROVIDE YOUR CONTRACT NUMBERS
Please indicate the contract
number to which your tax
TIAA Number
CREF Number
election will apply.
NOTE: The Plan and Sub
Plan numbers are for internal
ATA/Life Insurance Number
use only.
Plan Number
Sub Plan Number
Plan Name
F11434 (6/16)
MANDATORY STATE INCOME TAX WITHHOLDING ELECTION
FOR PERIODIC WITHDRAWALS THAT ARE NOT ROLLOVER ELIGIBLE
Page 2 of 2
3. WITHHOLDING ELECTION
Based on your state of legal
residence, state income
Arkansas
Married with 3
Massachusetts
0 exemptions
taxes will be withheld
allowances
Michigan
4.25%
from your payments at the
California
10% of federal
following rate, unless you
Nebraska
Married with
withholding
choose one of the available
3 allowances
options.
Delaware
5%
North Carolina
Single with
District of Columbia
No Withholding
0 allowances
PLEASE NOTE: Marital status
Georgia
Married with 3
Oklahoma
Married with
and allowances are only
allowances
3 allowances
an option for residents of
Iowa*
5%
Oregon
Single with
Arkansas, Georgia, Maine,
0 exemptions
Michigan, Nebraska, North
Kansas
No Withholding
Carolina, Oklahoma, Oregon
Vermont
Married with
Maine
Single with
and Vermont.
3 allowances
0 exemptions
Virginia
0 exemptions
Maryland
No Withholding
* Iowa residents: If you do
not make a state election
If you would like state withholding from your distribution in an amount OTHER THAN the state prescribed rate, please
and your payments are
check the appropriate box below and indicate your election.
less than $500 per month,
there will be no state
Marital Status:
withholding.
Single
Married (Does not apply to Massachusetts and Virginia)
Married Filing Separate (Applies Only to Geogia)
Head of Household (Applies Only to Arkansas, Georgia, Massachusetts and North Carolina)
Total number of withholding allowances
Withhold the following ADDITIONAL amount from each payment $
I choose the following percentage be withheld from the taxable portion of my payment
%
I choose NOT to have taxes withheld from my payment or my distribution is exempt. (For Iowa, Maine, Massachusetts
and Nebraska Only: You can elect no state withholding only if you have elected no federal withholding.)
4. YOUR SIGNATURE
This form will become effective with your next available payment. You may revoke this election at any time by filing a new
state income tax withholding election form with TIAA.
Under penalties of perjury, I certify that: (1) The number shown on this form is my correct taxpayer identification
number (or I am waiting for a number to be issued to me); and (2) I am not subject to backup withholding because:
(a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I
am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified
me that I am no longer subject to backup withholding; and (3) I am a U.S. citizen or other U.S. person; and (4) The
FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.
Note: Item 4 serves no purpose beyond required reproduction of the official Form W-9 language. Please disregard item 4.
Please sign your full legal
The Internal Revenue Service does not require your consent to any provision of this document other than the
name with suffix, if
certifications required to avoid backup withholding.
applicable, using black
or dark blue ink. Digital
Your Signature
Today’s Date
(mm/dd/yyyy)
signatures are not
2 0
/
/
accepted.
F11434 (6/16)
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