Form Hsa 02 PDF Details

Form Hsa 02 is a form that is used to report the sale or exchange of certain property. This form is used to report the sale or exchange of depreciable and nondepreciable personal property, other than inventory and stocks, for which you received a Form 1099-B, Proceeds From Broker and Barter Exchange Transactions. You must also use this form to report any gain or loss on the sale or exchange of patents, copyrights, commodities contracts, and foreign currency transactions. This form must be filed by the due date for your income tax return, including extensions. For more information about Form Hsa 02 and its requirements, please consult your tax advisor.

Below is the information about the PDF you were seeking to fill in. It will show you the length of time you'll need to complete form hsa 02, exactly what fields you will need to fill in, etc.

QuestionAnswer
Form NameForm Hsa 02
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other nameschase bank beneficiary form, chase beneficiary, chase add beneficiary, chase account beneficiary

Form Preview Example

Health Savings Account

With HSA Debit Card

Designation of Beneficiary for Health Savings Account

Health Savings Account #: 397 _ _ _ _ _ _ _ _ _

Account Holder Name: __________________________, _______________________, _____

 

(Last)

(First)

(MI)

Mailing Address:

 

 

 

Street:

_______________________________________________________

Apt. #:

_______________________________________________________

City:

________________________

State: ___________

 

Zip Code:

__________-_____________

 

 

Daytime Telephone #: ___________________ SS#: ______ - _____ - ___________

Beneficiary Designation

Please list one or more primary beneficiaries for your Health Savings Account (HSA) referenced above or any successor to this HSA, indicating the beneficiary percentage that should be provided to each primary beneficiary in the event of your death (the percentages should add to 100%). If a primary beneficiary should predecease you, his or her interest, as well as the interests of his or her heirs, will terminate completely and the percentage share of the surviving primary beneficiaries will be increased on a pro-rata basis. If you do not designate beneficiaries, or if the total percentage designated for your beneficiaries is less than 100% of your HSA, the remaining HSA funds will become part of your estate after your death. Please refer to your Health Savings Custodial Account Agreement for more detailed provisions regarding beneficiaries. This beneficiary designation is effective upon receipt by Chase and unless otherwise specified cancels all previous designations on file with Chase.

Primary Beneficiary 1

Name:

___________________________

Relationship:

_________________________

Address:

______________________

Social Security #

_______ -

____ - _______

 

______________________

 

 

 

City:

___________________________

State, Zip Code

_______

_________ - ______

Telephone #:

___________________________

Beneficiary %

_______

 

 

 

 

 

Primary Beneficiary 2

 

 

 

 

 

 

 

Name:

___________________________

Relationship:

_________________________

Address:

______________________

Social Security #

_______ -

____ - _______

 

______________________

 

 

 

City:

___________________________

State, Zip Code

_______

_________ - ______

Telephone #:

___________________________

Beneficiary %

_______

 

 

 

 

 

Primary Beneficiary 3

 

 

 

 

 

 

 

Name:

___________________________

Relationship:

_________________________

Address:

______________________

Social Security #

_______ -

____ - _______

 

______________________

 

 

 

City:

___________________________

State, Zip Code

_______

_________ - ______

Telephone #:

___________________________

Beneficiary %

_______

 

HSA-02 09/20/06

Health Savings Account

With HSA Debit Card

Designation of Beneficiary for Health Savings Account, continued

Contingent beneficiaries will receive your HSA assets in the event that all of your primary beneficiaries predecease you. Please list one or more contingent beneficiaries, together with the percentage of your HSA assets that each should receive (the percentages you list for all contingent beneficiaries should sum to 100%).

Contingent Beneficiary 1

Name:

___________________________

Relationship:

_________________________

Address:

______________________

Social Security #

_______ -

____ - _______

 

______________________

 

 

 

City:

___________________________

State, Zip Code

_______

_________ - ______

Telephone #:

___________________________

Beneficiary %

_______

 

 

 

 

 

Contingent Beneficiary 2

 

 

 

 

 

 

 

Name:

___________________________

Relationship:

_________________________

Address:

______________________

Social Security #

_______ -

____ - _______

 

______________________

 

 

 

City:

___________________________

State, Zip Code

_______

_________ - ______

Telephone #:

___________________________

Beneficiary %

_______

 

SPOUSAL CONSENT:

Your spouse’s signature is required below if you are married, have your legal residence in any community or marital property state (Arizona, California, Idaho, Louisiana, Nevada, New Mexico, Texas, Washington or Wisconsin) and you have designated someone other than, or in addition to, your spouse as beneficiary. If you do not obtain your spouse’s signature, you warrant none is required:

X__________________________________________________

_________________

Spouse’s Signature

Date Signed

____________________________________________________

 

Print Name

 

Please forward this completed form to:

JPMorgan Chase Bank, N.A.

HSA Operations

P.O. Box 30207

Tampa, FL 33630-3207

For questions about account beneficiary matters, please contact HSA Member Services at 866-524-2483.

X

_____

 

 

Signature of Account Holder

 

 

Date Signed

HSA-02 09/20/06

How to Edit Form Hsa 02 Online for Free

Creating the chase add beneficiary form is not hard with this PDF editor. Keep up with the next actions to get the document ready in no time.

Step 1: Choose the "Get Form Here" button.

Step 2: So, you are on the form editing page. You may add content, edit current data, highlight certain words or phrases, put crosses or checks, add images, sign the form, erase unneeded fields, etc.

The PDF file you are going to create will cover the following areas:

stage 1 to completing chase bank beneficiary form

Include the demanded particulars in the Primary Beneficiary, Name, Address, City, Relationship, Social Security, State Zip Code, Telephone, Beneficiary, Primary Beneficiary, Name, Address, City, Relationship, and Social Security part.

Finishing chase bank beneficiary form stage 2

It is vital to write down specific information within the area Contingent Beneficiary, Name, Address, City, Relationship, Social Security, State Zip Code, Telephone, Beneficiary, Contingent Beneficiary, Name, Address, City, Relationship, and Social Security.

Filling out chase bank beneficiary form step 3

As part of space SPOUSAL CONSENT Your spouses, X Spouses Signature, Date Signed, Print Name, Please forward this completed form, JPMorgan Chase Bank NA HSA, For questions about account, X Signature of Account Holder, and X Date Signed, specify the rights and obligations.

Finishing chase bank beneficiary form part 4

Step 3: Choose the "Done" button. At that moment, it is possible to transfer your PDF document - download it to your device or deliver it by means of electronic mail.

Step 4: It could be simpler to create copies of your form. There is no doubt that we won't display or view your particulars.

Watch Form Hsa 02 Video Instruction

Form Hsa 02 isn’t the one you’re looking for?

Related Documents

  • Form Hud 92544

    "... This warranty will not be limited to any rights or privileges that the purchaser owners or their successors, transferees may have under other laws or instruments. It shall also survive any conveyance of title or ..."

  • Form Hsmv 82101

    "... This box is for ordering replacement titles. If you do not receive the title within 20 days, the fee will be charged. ..."

  • Form Hud 52665

    "... Form hud 52665201 This form can be copied on local office copiers. It is also used by receiving public housing agencies pha to bill their monthly pha. The privacy act states that the department housing ..."

  • Form Hud 92541

    "... Property address, street code, tate zip code fh phone number Site analysis information must be completed for all new properties. If yes, attach letter of modification loma or letter of revision loma. ..."

Please rate Form Hsa 02

1 Votes

Related Resources

If you believe this page is infringing on your copyright, please familiarize yourself with and follow our DMCA notice and takedown process - click here to proceed .