2022 IRA FAIR MARKET VALUATION

1. Complete one form per IRA Club account number

2. Due by Friday, January 27, 2023. Forms received after the due date incur a $175.00 late processing fee

The Fair Market Valuation is completed once per year to confirm or update a change in value of an asset. Please return the form to IRA Club by the due date to ensure proper reporting requirements of the IRS. Remember to submit the supporting documentation so we may process the information efficiently.

If you are 72 years and older and are required to take mandatory distributions (RMD) from a Traditional, SEP, or SIMPLE IRA account you are encouraged to seek advice from a tax preparer about how to value the assets in the account and how the estimated values may impact the RMD calculation.

Loans / Promissory Notes: Letter or current amortization schedule showing the principal and unpaid interest owed as of 12/31/2022.

Private LLCs, Limited Partnerships and Corporations: Letter, statement, or other record of information from the private company stating the value of your position as of 12/31/2022.

RealEstate: realtor.com© or zillow.com© screenshot of estimated value, a broker/agent opinion or county tax assessor's appraisal.

IRA-LLC: Letter listing all assets owned and their total value in the LLC. Also, a copy of the bank statementshowing the LLC checking account balance as of 12/31/2022.

PLEASE HAVE YOUR STATEMENTS ON HAND

Name*

First NameLast Name

IRA CLUB ACCOUNT NUMBER*

EMAIL ADDRESS*

example@example.com

PHONE NUMBER*

Format: (000) 000-0000.

Asset Type*

Owned Asset *

If Other Please Specify *

Estimated Fair Market Value*

YesNo

Asset Type*

Owned Asset (Name of Asset)*

If Other Please Specify *

Estimated Fair Market Value*

YesNo

Asset Type*

Owned Asset (Name of Asset)*

If Other Please Specify *

Estimated Fair Market Value*

YesNo

Asset Type*

Owned Asset (Name of Asset) *

If Other Please Specify *

Estimated Fair Market Value*

YesNo

Asset Type*

Owned Asset (Name of Asset) *

If Other Please Specify *

Estimated Fair Market Value*

YesNo

Asset Type*

Owned Asset (Name of Asset) *

If Other Please Specify *

Estimated Fair Market Value*

YesNo

Asset Type*

Owned Asset (Name of Asset) *

If Other Please Specify *

Estimated Fair Market Value*

YesNo

Asset Type*

Owned Asset (Name of Asset) *

If Other Please Specify *

Estimated Fair Market Value*

YesNo

Asset Type*

Owned Asset (Name of Asset) *

If Other Please Specify *

Estimated Fair Market Value*

YesNo

Asset Type*

Owned Asset (Name of Asset) *

If Other Please Specify *

Estimated Fair Market Value*

YesNo

Asset Type*

Owned Asset (Name of Asset) *

If Other Please Specify *

Estimated Fair Market Value*

YesNo

Asset Type*

Owned Asset (Name of Asset) *

If Other Please Specify *

Estimated Fair Market Value*

YesNo

Asset Type*

Owned Asset (Name of Asset) *

If Other Please Specify *

Estimated Fair Market Value*

YesNo

Asset Type*

Owned Asset (Name of Asset) *

If Other Please Specify *

Estimated Fair Market Value*

YesNo

Asset Type*

Owned Asset (Name of Asset) *

If Other Please Specify *

Estimated Fair Market Value*

Please upload the supporting documention*

Date*

Date

By signing below, I certify the information provided to IRA Club on this form is true and correct and that my valuation will be used for reporting purposes. I hereby direct IRA Club to update the value of my assets*

2022 IRA FAIR MARKET VALUATION

INSTRUCTIONS

ACCEPTABLE SUPPORTING DOCUMENTATION

ACCOUNT OWNER INFORMATION