Prohibited Transaction Investment Review

This form should be completed and submitted each time your Self-Directed IRA LLC makes an investment.
A. IRA OWNER IDENTIFICATION
Full Name(*)
Please enter your full name.

Phone Number(*)
Please enter your phone number in xxx-xxx-xxxx format.

E-mail Address(*)
Please enter your e-mail address.

B. INVESTMENT DECRIPTION
Provide name or type of investment in which you wish to invest (real estate, LLC, limited partnership, business entity, etc.)
Investment Description:(*)
Please describe the investment.

C. QUESTIONNAIRE
1. Will you be lending funds to a lineal descendant or investing jointly with a lineal descendant who will use their personal funds in the investment?
In general, the IRS has restricted certain transactions between the IRA and a “disqualified person”. The definition of a “disqualified person” (Internal Revenue Code Section 4975(e)(2)) extends into a variety of related party scenarios, but generally includes the retirement account holder and any of his/her ancestors or lineal descendants of the holder (i.e. parents, children, spouse, daughter-in-law, or son-in-law), and entities in which the retirement account holder or a disqualified person holds a controlling or management interest. Furthermore, Internal Revenue Code Section 4975(c)(1)(D) and (E) outlines rules that relate to self-dealing or conflict of interest transactions that involves an investment that could directly or indirectly personally benefit a disqualified person. The self-dealing or conflict of interest prohibited transaction rules have the broadest application especially when it comes to hedge fund type investments. brothers, sisters, aunts, uncles, cousins, step-brothers, step-sisters, and friends are NOT treated as “Disqualified Persons”.
(*)
Please select Yes or No.

If yes: Please contact us at 800-472-1043 to discuss further.
If yes: How are you related to the family member?  (Write “self” if yourself):
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If investing jointly, what is the percentage of ownership:
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2. If investing in a company, do you or any lineal descendant own any personal units/shares in the company?
(*)
Please select Yes or No.

If yes: How are you related to the family member? (Write “self” if yourself):
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What is the percentage of ownership?
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Please contact us at 800-472-1043 to discuss further.
3. If investing in a non-publicly traded company, are you or any lineal descendant employed by the company?
(*)
Please select Yes or No.

If yes: Please contact us at 800-472-1043 to discuss further.
If yes: How are you related to the family member? (Write “self” if yourself):
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What position is held?
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4. Are you or any lineal descendant the main decision-maker or majority owner of the company your self-directed IRA or IRA LLC is investing in?
(*)
Please select Yes or No.

If yes: Please contact us at 800-472-1043 to discuss further.
If yes: How are you related to the family member? (Write “self” if yourself):
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5. Will you or any lineal descendant be receiving any personal gain directly or indirectly as a result of your IRA investment?
(*)
Please select Yes or No.

If yes: Please contact us at 800-472-1043 to discuss further.
If yes: How are you related to the family member? (Write “self” if yourself):
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Please explain:
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6. Will you be investing in any real estate or other transaction with lineal descendants and/or will the transaction directly or indirectly involve or personally benefit you or any “disqualified person”?
(*)
Please select Yes or No.

If yes: Please contact us at 800-472-1043 to discuss further.
7. Will you be required to personally guarantee any loan obligation involving your self-directed IRA investment? Please note using a credit card is not permitted in connection with any self-directed IRA investment.
(*)
Please select Yes or No.

If yes: Please contact us at 800-472-1043 to discuss further.
8. If purchasing precious metals or coins, please be sure to review the rules set forth in the following link regarding the purchase and possession of IRS approved precious metals and coins:
http://www.irafinancialgroup.com/preciousmetals.php

I have reviewed the rules on buying and holding IRS approved precious metals and coins pursuant to IRC 408(m).
(*)
Please select Yes or No.

Please contact us at 800-472-1043 to discuss further.
9. Will you or any disqualified person be personally receiving any income, use, or receiving any personal benefit, direct or indirect from the self-directed IRA investment?
(*)
Please select Yes or No.

If Yes: Please contact us at 800-472-1043 to discuss further.
10. Will you or any disqualified person be providing any services in connection with the self-directed IRA investment, whether compensated or not?
(*)
Please select Yes or No.

If Yes: Please contact us at 800-472-1043 to discuss further.
11. Will your self-directed IRA investment involve the following:
• Income from the operations of an active trade or business through a passsthrough entity (i.e. LLC or partnership), such as a restaurant.
• Using margin on a stock purchase.
• Nonrecourse leverage to purchase real estate (a nonrecourse loan is a loan not personally guaranteed by the plan participant. Only a nonrecourse loan can be used, as a recourse loan (a loan personally guarantee by the plan participant) would trigger a prohibited transaction under IRC Section 4975.
(*)
Please select Yes or No.

If Yes, please be advised that the transaction may give rise to the unrelated business taxable income tax and you should consult with your tax advisor for further details.
12. Additional comments and/or explanations:
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D. SIGNATURE
IRA Owner Signature
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Date

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