[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-1-en-105":3,"doc-seo-302986-105":53,"doc-detail-302986-en":127},{"code":4,"msg":5,"data":6},0,"success",[7,14,19,24,29,34,39,44,49],{"id":8,"doc_module":9,"doc_module_name":10,"category_name":11,"show_sort_weight":12,"slug":13},11,1,"Template","Presentations",90,"presentations",{"id":15,"doc_module":9,"doc_module_name":10,"category_name":16,"show_sort_weight":17,"slug":18},12,"Resumes",80,"resumes",{"id":20,"doc_module":9,"doc_module_name":10,"category_name":21,"show_sort_weight":22,"slug":23},14,"Invoices",70,"invoices",{"id":25,"doc_module":9,"doc_module_name":10,"category_name":26,"show_sort_weight":27,"slug":28},15,"Posters",60,"posters",{"id":30,"doc_module":9,"doc_module_name":10,"category_name":31,"show_sort_weight":32,"slug":33},16,"Social Media",50,"social-media",{"id":35,"doc_module":9,"doc_module_name":10,"category_name":36,"show_sort_weight":37,"slug":38},17,"Forms",40,"forms",{"id":40,"doc_module":9,"doc_module_name":10,"category_name":41,"show_sort_weight":42,"slug":43},18,"Letters",30,"letters",{"id":45,"doc_module":9,"doc_module_name":10,"category_name":46,"show_sort_weight":47,"slug":48},21,"Paper Templates",5,"papers-templates",{"id":50,"doc_module":9,"doc_module_name":10,"category_name":51,"show_sort_weight":4,"slug":52},158,"General","general-158",{"code":4,"msg":54,"data":55},"ok",{"site_id":56,"language":57,"slug":58,"title":59,"keywords":60,"description":61,"schema_data":62,"social_meta":120,"head_meta":122,"extra_data":124,"updated_unix":126},105,"en","roth-ira-conversion-form-1-conversion-election-and-tax-withholding-instructions","Roth IRA Conversion Form - 1 - Conversion Election and Tax Withholding Instructions","","Instructions for converting an existing Traditional IRA to a Roth IRA, including contract information, conversion election options (full or partial), and warnings about potential taxable events. The form requires recordkeeping of Roth conversions and annual contributions. It covers required processing if age 72 and provides choices for federal and state income tax withholding, including minimum federal withholding rules and opt-out guidance for eligible states.",{"@graph":63,"@context":119},[64,80,102],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":36,"@type":70,"position":76},"https://docshare.wps.com/template/forms/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/roth-ira-conversion-form-1-conversion-election-and-tax-withholding-instructions/302986/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/roth-ira-conversion-form-1-conversion-election-and-tax-withholding-instructions/302986.png","ImageObject",442,249,{"name":88,"@type":89},"Liam","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-10-06","2026-09-19",true,{"@type":98,"interactionType":99,"userInteractionCount":101},"InteractionCounter",{"@type":100},"ViewAction",7,{"@type":103,"mainEntity":104},"FAQPage",[105,111,115],{"name":106,"@type":107,"acceptedAnswer":108},"What must be done before requesting a Roth IRA conversion if the annuitant is over age 72?","Question",{"text":109,"@type":110},"If over age 72, a Required Minimum Distribution may need to be processed before requesting the Roth IRA conversion.","Answer",{"name":112,"@type":107,"acceptedAnswer":113},"What are the conversion election options on this form?",{"text":114,"@type":110},"Choose either a Full Roth IRA Conversion to convert the current balance or a Partial Roth IRA Conversion to establish a new contract with the specified amount.",{"name":116,"@type":107,"acceptedAnswer":117},"Can I choose not to withhold federal or state income tax for the conversion?",{"text":118,"@type":110},"Yes. You may elect federal withholding options, and if federal withholding is made, state withholding may be automatic for certain states; you may opt out if your state allows.","https://schema.org",{"og:url":78,"og:type":121,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":123,"canonical":78},"index,follow",{"doc_id":125,"site_id":56},302986,1790296376,{"code":4,"msg":5,"data":128},{"doc_id":125,"user_id":129,"nickname":88,"user_avatar":130,"doc_module":9,"category_id":35,"category_name":36,"doc_title":59,"doc_description":61,"doc_content":131,"file_id":132,"file_url":133,"file_type":134,"file_size":135,"view_count":101,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":73,"language":136,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":137,"faqs":138,"seo_title":139,"seo_description":61,"update_tm":140,"read_time":9},8796095461564,"https://ap-avatar.wpscdn.com/davatar_155a257f0dc6eb9ab79c44ca47cae57d","Instructions:  \nThis form should be used to convert your existing Traditional IRA to a Roth IRA.  \nPlease note:  \n• If you are over age 72, you may need to process a Required Minimum Distribution before requesting a Roth IRA conversion.  \n• You are responsible for maintaining records of your Roth IRA conversions and annual contributions for tax purposes.  \n1. CONTRACT INFORMATION  \nName of Annuitant  \nName of Contract Owner Social Security Number  \nStreet Address, City, State, Zip Telephone Number  \n Please check if this is an address different from our records.  \n2. CONVERSION ELECTION  \nPlease indicate the type of conversion you are requesting (Please check only one option):  \nFull Roth IRA Conversion: Convert the current balance of this existing IRA to a Roth IRA  \nPartial Roth IRA Conversion: Establish a new contract with this amount: $   \nPlease note: Conversion may result in a taxable event. Please consult with a qualified tax consultant before requesting this conversion to be sure it is appropriate for you.  \nFor full conversions and partial conversions with a new contract being established, a new business completed application will also need to be submitted along with this form.  \nOceanview Life and Annuity Company • PO Box 830 Grimes, IA 50111-0830 • Tel 888.295.3815 •[www.oceanviewlife.com](www.oceanviewlife.com)  \n\n| 3. INCOME TAX WITHHOLDING FORCONVERSION |  |\n| --- | --- |\n| FEDERAL WITHHOLDING – Please Check One (If no election is made, federal income tax will be withheld.) |  |\n| | Withhold 10%\u003Cbr>Withhold another amount: $   or  % Do not withhold federal income tax |\n| STATE WITHHOLDING If you reside in one of the following states – CA, DC, DE, GA, IA, KS, MA, ME, MI*, NE, NC OK, OR, VT, or VA – and federal income tax is withheld, we will automatically withhold state income tax. If your state allows, you may opt out. See the enclosed State Tax Withholding Information to determine if your state allows you to opt out. If you do not reside in one of the states previously listed, you may still elect to withhold UNLESS you live in AK, FL, NH, NV, SD, TN, TX, WA, WY. Please check one of the following boxes. |  |\n| | Do not withhold. I live in one of the states listed above, but my state allows me to opt out Withhold $   or  % |\n| *MICHIGAN RESIDENTS – Please [refer to](refer to www.michigan.gov/taxes for)[ ](refer to www.michigan.gov/taxes for)[www.michigan.gov/taxes](refer to www.michigan.gov/taxes for)[ for](refer to www.michigan.gov/taxes for) information regarding the MI W-4P form for tax withholding, or opt out information. If the MI W-4P is not returned, we are required to withhold state income tax.\u003Cbr>Notice: Federal law requires withholding a minimum of 10% Federal Income Tax from taxable distributions, unless you elect not to have taxes withheld or specify a different withholding amount. Withholding will only apply to that portion of your distribution that is includable in your income subject to Federal Income Tax. You may revoke this withholding election at any time by contacting Oceanview Life and Annuity Company in writing. Electing not to withhold at this time does not release the liability for payment of Federal and, if applicable, state Income Tax on the taxable portion of your payment. You may incur tax penalties if your withholding and tax payments are not adequate.\u003Cbr>Note: Oceanview Life and Annuity Company will not render tax advice. Please consult your tax advisor regarding your financial situation. |  |\n| 5. CERTIFICATION OF TAXPAYER IDENTIFICATION |  |\n| Under penalties of perjury, I certify that:\u003Cbr>1. The Social Security Number or Taxpayer Identification Number shown on this form is correct (or I am waiting for a number to be issued tome), and\u003Cbr>2. I am not subject to backup withholding because:\u003Cbr>(a) I am exempt from backup withholding, or\u003Cbr>(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 int","cbCaiqzs9uxgDtdY","https://ap.wps.com/l/cbCaiqzs9uxgDtdY","pdf",180180,"English","# Contract Information\n# Conversion Election\n## Income Tax Withholding for Conversion\n# Certification of Taxpayer Identification\n# Signature","[{\"question\":\"What must be done before requesting a Roth IRA conversion if the annuitant is over age 72?\",\"answer\":\"If over age 72, a Required Minimum Distribution may need to be processed before requesting the Roth IRA conversion.\"},{\"question\":\"What are the conversion election options on this form?\",\"answer\":\"Choose either a Full Roth IRA Conversion to convert the current balance or a Partial Roth IRA Conversion to establish a new contract with the specified amount.\"},{\"question\":\"Can I choose not to withhold federal or state income tax for the conversion?\",\"answer\":\"Yes. You may elect federal withholding options, and if federal withholding is made, state withholding may be automatic for certain states; you may opt out if your state allows.\"}]","Roth IRA Conversion Form - 1 - Conversion Election and Tax Withholding Instructions | PDF",1789799378]