Use this form if you are requesting a special $15,000 distribution from the Tax Deferral Plan.
In order to qualify, you must have participated in the Plan for no less than 60 months since you
last had a $0 balance in the Plan and you are not eligible for any other type of distribution.
The completed forms and accompanying documents can be mailed to us at the address on the application,
faxed to (801) 975-1342 (Attn: Marcy) or saved and emailed to iiwmailroom@compusysut.com.