Overview
Work History
Education
Skills
IRA Distribution (Basic)
Section 1: Your Wells Fargo Advisors Account Information
Section 2: Distribution Amount
Section 3: Frequency of Your Distribution
Section 4: Tax Withholding
State Taxes
Section 5: Receiving Your Funds
Section 6: Saving Your Instructions
Section 7: Signature and Acknowledgment
Section 8: Submit your Completed Form via Secure Email, or Mail For Non-Electronic Signature(s)
Informational Page - Keep for your records, do not return
Additional information regarding Required Minimum Distributions
Additional information regarding standing instructions
Account Information
Distribution Amount
Frequency Of Distribution
Tax Withholding
Receiving Funds
Standing Instructions - Establish
Submission Instructions
Important Information
Timeline
Generic

Katelyn Heasley

Lakewood

Overview

21
21
years of professional experience

Work History

Childcare Lead Teacher

Interlake Child Care
Seattle, WA
07.2025 - Current
  • Developed and implemented age-appropriate lesson plans to foster children's cognitive and emotional growth.
  • Led classroom management strategies, ensuring a positive learning environment for all students.
  • Mentored junior staff, providing guidance on effective teaching techniques and classroom engagement.
  • Collaborated with parents to discuss child development and address individual needs effectively.
  • Assessed children's progress through regular evaluations, adapting curriculum to meet diverse learning styles.
  • Supported students'' social-emotional development by creating a nurturing and inclusive atmosphere in the classroom.
  • Enhanced student comprehension by incorporating hands-on learning activities and group projects.
  • Collaborated with colleagues to develop interdisciplinary lesson plans that connected various subjects.
  • Implemented effective classroom management techniques to maintain a positive learning environment.
  • Increased parental involvement through regular communication and parent-teacher conferences, fostering strong home-school partnerships.
  • Organized extracurricular activities and field trips to enhance classroom learning experiences.
  • Participated in professional development opportunities to stay current with educational trends and best practices, applying this knowledge to continuously improve instruction in the classroom.
  • Established clear expectations for behavior and academic performance, holding students accountable for meeting these standards.
  • Guided students to develop social, emotional and physical skills.
  • Collaborated with teachers, parents and administrators to facilitate positive outcomes for students.
  • Implemented age-appropriate curricula to meet needs of young learners.
  • Organized activities to teach preschool children foundational learning skills such as letters and numbers.
  • Organized and supervised large and small group activities.
  • Planned and executed activities to stimulate physical, social and intellectual growth.
  • Established positive relationships with students and families.

Benefits hub coach

Green River college
Auburn, Washington
09.2024 - 05.2025
  • Facilitated student access to financial resources and benefits by providing personalized coaching and support, enhancing their ability to navigate complex systems and improve their financial well-being.
  • Assisted clients in setting and achieving personal and professional goals.
  • Encouraged clients to find creative solutions to problems and maintain motivation.
  • Developed relationships with clients to provide ongoing support and encouragement.
  • Analyzed client feedback to adjust coaching sessions accordingly.
  • Compiled information and input into Apricot database.

Data coordinator

YouthCare
Seattle, Wa
07.2023 - 07.2024
  • Coordinated and managed data collection, analysis, and reporting processes to support program evaluation and strategic decision-making at YouthCare, ensuring data accuracy and integrity across all organizational platforms.
  • Collaborated with other departments to enforce data accuracy and enhance productivity.
  • Applied data validation procedures to support and enforce data integrity.
  • Sorted and processed incoming reports before putting data into processing software.
  • Verified accuracy of data before transcribing.
  • Located and corrected data entry errors and reported to management.

WRC Reading Tutor

Americorp
Lakewood, WA
09.2022 - 07.2023
  • Tutor elementary students in grades K-5 individually to improve reading skills for those below grade level.
  • Implement the Reading Power Program to enhance literacy development among students.
  • Provide weekly data analysis to evaluate the effectiveness of the reading initiatives.
  • Conducted assessments to determine comprehensive understanding of materials.
  • Taught reading comprehension and writing tactics to improve reading and writing skills.
  • Structured activities for interactive learning, reading understanding and fluency skills.
  • Tracked learning progress to optimize tutoring methods and help students achieve goals.
  • Worked with k-5 grade students on reading comprehension.
  • Identified learning needs and implemented fun and engaging learning activities to help students advance.
  • Maintained detailed files and created charts to track student progress.
  • Provided positive feedback often to encourage continued reading success.

COVID Scheduler

Crisis Connections
Lakewood, WA
01.2021 - 08.2022
  • Manage incoming calls and provide accurate COVID-19 information to the public.
  • Coordinate and schedule vaccination appointments efficiently.
  • Update and maintain medical records with vaccination details.

Cashier and Customer Service

Dollar Tree
Lakewood, WA
07.2020 - 01.2021
  • Processed various payment methods, including checks, debit/credit cards, and cash, ensuring accurate and efficient transactions.
  • Assisted customers in locating products and maintained a clean and organized front area to enhance the shopping experience.
  • Helped customers complete purchases, locate items, and join reward programs.
  • Greeted customers entering store and responded promptly to customer needs.
  • Welcomed customers and helped determine their needs.
  • Restocked and organized merchandise in front lanes.
  • Worked flexible schedule and extra shifts to meet business needs.
  • Counted money in cash drawers at beginning and end of shifts to maintain accuracy.
  • Built relationships with customers to encourage repeat business.
  • Assisted customers with returns, refunds and resolving transaction issues.
  • Stocked, tagged and displayed merchandise as required.
  • Operated cash register to record transactions accurately and efficiently.
  • Handled cash with high accuracy and took care to check bills for fraud.
  • Maintained current knowledge of store promotions and highlighted sales to customers.

AmeriCorps Member

Communities In Schools
Lakewood, WA
09.2019 - 05.2020
  • Managed casework for high school students, addressing attendance, academic performance, behavior, and social-emotional needs while coordinating basic necessities such as food and clothing.
  • Conducted data entry and facilitated college preparation initiatives to support students' educational advancement.
  • Organized and detail-oriented with a strong work ethic.
  • Completed paperwork, recognizing discrepancies and promptly addressing for resolution.
  • Proved successful working within tight deadlines and a fast-paced environment.
  • Applied effective time management techniques to meet tight deadlines.

Merchandiser

SAS Retail Services
Tacoma, WA
08.2018 - 09.2019
  • Executed comprehensive store resets for Fred Meyer, ensuring optimal product placement and improved customer navigation.
  • Collaborated with team members to implement merchandising strategies that aligned with Fred Meyer's brand guidelines and promotional objectives.
  • Verified products appeared at correct locations in proper quantities.
  • Updated pricing and signage to complete product displays and educate customers.
  • Inspected merchandise for quality and arranged proper display location on floor.
  • Completed efficient store resets to prepare store for special promotions and seasonal updates.
  • Answered customer questions regarding store merchandise, department information, and pricing.

Cashier/Customer Service

Walmart Supercenter
Humble, TX
10.2017 - 05.2018
  • Managed cash transactions efficiently and accurately, ensuring a seamless checkout experience for customers.
  • Maintained organized and clean front-end areas while assisting with inventory and stocking tasks to support store operations.
  • Worked with floor team and managers to meet wide range of customer needs.
  • Encouraged customers to make additional purchases by highlighting current deals and keeping lane well-stocked.
  • Processed refunds and exchanges in accordance with company policy.

Team Member/Cashier

Jack in the Box
Lakewood, CO
02.2017 - 09.2017
  • Processed customer transactions efficiently and accurately while maintaining a high standard of customer service.
  • Assisted in food preparation, conducted regular inventory checks, and ensured cleanliness and organization of the workspace.
  • Broke down boxes and cartons, disposing of refuse in proper cardboard receptacles.
  • Worked scheduled shifts and remained available to work during coworker absences, holidays, and busy periods.
  • Developed strong cooperative relationships with coworkers and managers.
  • Learned all required tasks quickly to maximize performance.
  • Worked different stations to provide optimal coverage and meet production goals.

Sales and Cashier

D AND D ARCHERY
Gorst, WA
04.2005 - 05.2016
  • Managed cash transactions and performed accurate bank deposits to ensure financial integrity and accountability.
  • Conducted inventory management, including stocking and organizing products to maintain optimal store operations.
  • Assisted with administrative tasks, such as handling multi-line phone systems and utilizing Microsoft software for record-keeping.
  • Answered questions about store policies and addressed customer concerns.
  • Addressed customer needs and made product recommendations to increase sales.
  • Responded promptly to requests for assistance, spills and customer inquiries.
  • Conducted inventory counts by adding each item in stock and documenting in computer system.
  • Set up new sales displays each week with fresh merchandise.

Education

High School Diploma -

Renaissance High School
Bremerton, WA
03.2009

Skills

Classroom management

Lesson planning

Child development

Curriculum design

Data analysis

Parent communication

Social-emotional learning

Conflict resolution

Community engagement

Student progress tracking

Performance evaluation

Professional development participation

Parent-teacher communication

Classroom organization

CPR training

Age-appropriate activities

Project-based learning

Art and music integration

Outdoor learning

Child assessment

Teamwork

Problem-solving

Teamwork and collaboration

Strong work ethic and dependable

Attention to detail

Child CPR and first aid

Reliability

Active listening

Detail-oriented

Relationship building

Play-based learning

Data entry

Clear and direct communication

Self motivation

Interpersonal skills

Goal setting

IRA Distribution (Basic)

  • Use this form to request cash distributions from your IRA via electronic funds transfer, check, or transfer to another Wells Fargo Advisors brokerage account. Your distribution will be reported to the IRS based on your date of birth and the type of IRA you have with us (e.g., Traditional, Roth, etc.) when using this form. Review IRS Publication 590-B or visit IRS.gov for more information regarding IRA distributions. The Wells Fargo Clearing Services (WFCS) IRA Disclosure Statement and Custodial Agreement provides the terms and conditions of the account and information about the IRA Custodian.
  • A response is required for all fields unless otherwise instructed.
  • Use IRA Distribution form (592294) if you:
  • Want to take your distribution in the form of securities
  • Want to send money via a FedWire
  • Want us to report your distribution as a disability exception
  • Want us to report your distribution as a transfer to a qualified retirement plan (e.g., 401(k))
  • This form should not be used for certain types of distributions. You should use the specified forms below when appropriate:
  • Substantially Equal Periodic Payments based on IRC 72(t): Complete the SEPP/72(t) Distribution Request form.
  • Convert a Traditional IRA to a Roth IRA: Complete the Roth Conversion form.
  • Remove an excess contribution or recharacterize a contribution: Complete the IRA Recharacterization or Removal of Excess Contribution form.
  • Death Claim: Complete the IRA Beneficiary Claim form.

Section 1: Your Wells Fargo Advisors Account Information

  • This information is located on your statement.
  • Account Name
  • Account Number
  • Check here if your account is a Roth IRA and your first Roth contribution (or the Roth conversion) was made more than five years ago.

Section 2: Distribution Amount

  • Select one option. If more than one is selected, we will process the first selected option based on the order listed.
  • Total Account Balance.
  • Fees may apply. Please ensure all non-cash securities in your account have been liquidated prior to submitting this form.
  • Annual Required Minimum Distribution (RMD)
  • We will calculate your RMD based on the December 31 account balance of the previous calendar year, less any distributions already taken from this Wells Fargo Advisors account, and divide the required amount using the frequency specified below. If your account was not at Wells Fargo Advisors as of December 31 last year, please attach your year-end statement and provide the total account balance as of December 31.
  • Total Account Balance as of December 31: $
  • Specific Amount $
  • If the amount entered reduces the balance below the account termination fee and the fee applies, the request will be processed for the total account balance.
  • Dividends and/or Interest. Only available for recurring payments.

Section 3: Frequency of Your Distribution

  • We will process the distribution as a one-time payment upon receipt of the form if no frequency is selected. If the start date entered has passed, we will send an immediate one-time payment and begin recurring payments on the next scheduled date.
  • Once
  • Weekly
  • Bi-weekly
  • Monthly (once a month)
  • Monthly (last business day)
  • Quarterly
  • Annually
  • Start Date (mm/dd/yyyy)
  • End Date (mm/dd/yyyy) (Optional)

Section 4: Tax Withholding

  • If you do not complete this section or select a percentage less than the minimum federal or state withholding, we will withhold the federal and state required minimum taxes and use the state listed in your account registration.
  • Make an election in both the Federal Taxes and State Taxes sections. You should consult with your tax advisor before making your elections.
  • All IRA distributions are considered 'non-periodic' payments by the IRS. To opt out of federal or state withholding, enter a '0' for your withholding rate.
  • Federal Taxes (W-4R | OMB No. 1545-0074)
  • You cannot elect out of the 10% mandatory withholding if you have not supplied the IRA Custodian with your correct SSN or TIN and a 'residence address' within the United States.
  • For non-periodic payments, the default withholding rate is 10%. You can choose to have a different rate by entering a rate between 0% and 100% on Line 1. Generally, you can't choose less than 10% for payments to be delivered outside the United States and its territories.
  • 1. Complete this line if you would like a rate of withholding that is different from the default withholding rate. See the instructions and the Marginal Rate Tables below for additional information.
  • Enter the rate as a whole number (no decimal) %

State Taxes

  • Withholding is required in some states if federal withholding applies unless you specifically elect out. State taxes will be withheld based on the state listed on your account registration. If you elect an amount that does not meet your state's requirements, the minimum state withholding will be applied. Please visit https://www.wellsfargoadvisors.com/irastatetax to view your state's specific withholding rules.
  • Residents of CA or VT: If you elect to withhold federal taxes, the state withholding minimum rate for CA is 10% of the federal withholding amount, or for VT is 30% of federal withholding amount. See examples below:
  • CA - If you request a $100 distribution and elect 15% for federal withholding, then the minimum for state withholding for CA would be 1.5% of the gross distribution or $1.50 unless you opt out of state tax withholding (10% of 15% is 1.5%).
  • VT - If you request a $100 distribution and elect 15% for federal withholding, then the minimum for state withholding for VT would be 4.5% of the gross distribution or $4.50 unless you opt out of state tax withholding (30% of 15% is 4.5%).
  • Residents of MI: If you elect out, you are certifying your distribution is not taxable because you were born before 1946 or you believe that you will not have a balance due on your MI-1040.
  • Residents of CT: If you've opted out of state tax withholding or elected an amount to withhold for partial or scheduled distributions, you are electing withholding code 'E', as defined by Connecticut's form CT-W4P.
  • Withhold State income tax of: %
  • Connecticut Perjury Declaration: I declare under penalty of law that I have examined this certificate and, to the best of my knowledge and belief, it is true, complete, and correct. I understand that the penalty for reporting false information is a fine of not more than $5,000, imprisonment for not more than five years, or both (as defined by the state of Connecticut on the CT-W4P).
  • (See last page for Additional Tax Withholding Information.)

Section 5: Receiving Your Funds

  • Select only one of the following methods.
  • Deposit electronically via ACH/Money Transfer to a Checking or Savings Account.
  • Complete ACH/Money Transfer information below. For a non-Wells Fargo Bank checking or savings account, proof of ownership is required (such as a voided check or savings deposit slip).
  • ABA Routing Number (9 digits)
  • Account Number
  • Financial Institution Name
  • Bank Account Title or Name
  • Account Type
  • Checking
  • Savings
  • Journal to an internal non-IRA brokerage account.
  • Account Name

Section 6: Saving Your Instructions

  • If you do not check the opt-out box, the instructions on this form will override any prior standing instructions on file (including tax withholding).
  • For your convenience, the above payment method and tax withholding instructions will be saved for future use unless you check the box below. Establishing standing instructions will allow you to request a distribution from your IRA at any time without having to sign additional paperwork. Your distribution will be processed using the above payment method and tax withholding instructions. Requests to send funds to someone other than the account owner will require new instructions.
  • I do NOT wish to establish standing instructions.

Section 7: Signature and Acknowledgment

  • By signing below, you agree and certify to the following:
  • You are the proper party to request payment(s) from this IRA and that all information provided is true and accurate.
  • You have read and understand this document in its entirety.
  • No legal or tax advice has been provided to you by the IRA Custodian or any of its past, present, or future affiliates, subsidiaries, or agents.
  • The IRA Custodian is directed to take all actions necessary with respect to this transaction.
  • The IRA Custodian shall in no way be held responsible, and you expressly assume responsibility, for:
  • Any tax implication, or
  • Adverse consequences which may arise as a result from this transaction.
  • The IRA Custodian and any of its past, present, or future affiliates, subsidiaries, and agents may reasonably rely on your certification without further investigation or inquiry and shall not be liable for any misrepresentation of fact.
  • The tax withholding election only applies to the distribution referenced on this form and does not revoke or change any separate distribution instructions on file.
  • Signature of IRA Holder, POA, Attorney-In-Fact or Beneficiary
  • Signature
  • Printed Name
  • Date

Section 8: Submit your Completed Form via Secure Email, or Mail For Non-Electronic Signature(s)

  • Ensure all sections are complete and that the form is signed and dated. Include a voided check if transferring to a non-Wells Fargo account.
  • 1. Scan or take photos of your completed forms.
  • Include your Wells Fargo Advisors account number on each document.
  • Documents must be clear, legible, and include all pages.
  • 2. Select www.wellsfargo.com/senddocument to sign onto your account and access the Message Center.
  • 3. Choose Attach Documents. Find your file and select Open to attach it, then select Send. Please note that attachments cannot be larger than 25 MB.
  • Mail: Wells Fargo Advisors, MAC N9160-01P PO Box 77046, Minneapolis, MN 55480-9902
  • If you need assistance, please call 1-800-TRADERS (1-800-872-3377).
  • To have money deposited via ACH/Money Transfer into Non-Wells Fargo Bank Accounts:
  • Attach proof of ownership (voided check, pre-printed deposit slip, etc.) here.
  • Please verify that the account and routing transit numbers are correct.
  • Starter checks will not be accepted.

Informational Page - Keep for your records, do not return

  • Important Information Regarding Your Distribution
  • Reporting your distribution to the IRS
  • Your distribution will be reported to the IRS based on the date of birth we have on file for you and your account type.
  • If your account type is...
  • If you are Age 59½ or over, we’ll report your distribution as…
  • If you are under age 59½, we’ll report your distribution as…
  • Traditional or SEP IRA
  • Normal
  • There is no 10% additional tax for this distribution.
  • Early
  • This distribution may be subject to a 10% additional tax unless an exception applies (list below).
  • Roth IRA - 5 year waiting period has been met
  • Qualified
  • Distributions are tax-free and not included in gross income when your Roth has been funded for more than five years and you are at least age 59½, or as a result of your death, disability, or using the first-time homebuyer exception.
  • Non-Qualified
  • You may owe ordinary income tax and a 10% additional tax on a distribution of earnings, exception to 10% additional tax may apply (See list below and Distributions from a Roth IRA).
  • Roth IRA - 5 year waiting period has NOT been met
  • You may owe ordinary income tax but not the 10% additional tax on a distribution of earnings (See Distributions from a Roth IRA below).
  • Inherited IRA
  • Death Distribution
  • Distributions from an Inherited IRA are not subject to the 10% additional tax, regardless of the beneficiary’s age. See below for information on RMDs. To transfer proceeds from a deceased IRA owner’s account to an Inherited IRA, complete the Beneficiary Claim form (588194).
  • There are exceptions to the 10% additional tax for Early or Pre-59½ distributions, including the following:
  • 1) Death;
  • 2) Disability;
  • 3) Unreimbursed medical expenses;
  • 4) Health insurance premiums if unemployed;
  • 5) Qualified higher education expenses;
  • 6) Qualified first-time homebuyer;
  • 7) Qualified reservist distribution;
  • 8) Qualified child birth or adoption expense; and
  • 9) Certain qualified disaster distributions defined by the IRS.
  • Please review IRS Publication 590-B or consult your tax or legal advisor for a full list of exceptions.
  • Distributions from a Roth IRA
  • When taking a non-qualified distribution from a Roth IRA, contributions are generally distributed first and are tax free, while earnings may be taxable and you may be subject to the 10% additional tax, unless an exception applies. Special rules apply to conversions and rollovers. Refer to Ordering Rules for Distributions in IRS Publication 590-B to determine tax implications.

Additional information regarding Required Minimum Distributions

  • The SECURE Act 2.0 changed the RMD age to 73 for individuals that attained age 72 after December 31, 2022. Generally, Traditional and SEP IRA owners must begin taking annual required minimum distributions (RMD) upon reaching their required beginning date (RBD). The RBD is generally April 1 of the year following the year the IRA owner reaches RMD age. RMD age is generally the year the IRA owner turned age 73 (if born after 1950), 72 (if born after 6/30/1949), or 70½ (born before 7/1/1949).
  • If you have an Inherited IRA you may be required to take a RMD. RMDs are generally based on your life expectancy using a divisor from the IRS Single Life Table and the prior year-end IRA value, on a term-certain basis. Term-certain means that one is subtracted from the original divisor in each subsequent year. These RMDs, if necessary, will begin the year following the death of the IRA owner. Consult with IRS.gov or a tax advisor for information about the calculation of RMDs.

Additional information regarding standing instructions

  • Standing instructions are withdrawals verbally authorized by you. If you DO NOT want the information used on this form to be used as standing instructions, you will need to check the box in Section 6 of this form. Once standing distributions have been established, a new distribution form needs to be completed and signed by you when changes are made to the method or tax withholding election. Only one standing distribution form may be in effect at a time, and a separate form is needed for each of your IRAs. Only one set of instructions is allowed per IRA.
  • This information may answer some of your questions, but it is not intended as a comprehensive analysis of this complex topic. Wells Fargo Advisors periodically provides information to clients concerning planning. No one should infer that because of this service, Wells Fargo Advisors assumes any fiduciary duties. In addition, such services should not be relied upon as your only source of information. Competent tax and legal advice should always be obtained.

Account Information

False

Distribution Amount

0, 0, 0, False

Frequency Of Distribution

True, False, False, False, False, False, False

Tax Withholding

10, 0

Receiving Funds

Check

Standing Instructions - Establish

False

Submission Instructions

Mail, Wells Fargo Advisors, MAC N9160-01P, Minneapolis, MN, 55480-9902

Important Information

Normal, Early, Death, Disability, Unreimbursed medical expenses, Health insurance premiums if unemployed, Qualified higher education expenses, Qualified first-time homebuyer, Qualified reservist distribution, Qualified child birth or adoption expense, Certain qualified disaster distributions defined by the IRS

Timeline

Childcare Lead Teacher

Interlake Child Care
07.2025 - Current

Benefits hub coach

Green River college
09.2024 - 05.2025

Data coordinator

YouthCare
07.2023 - 07.2024

WRC Reading Tutor

Americorp
09.2022 - 07.2023

COVID Scheduler

Crisis Connections
01.2021 - 08.2022

Cashier and Customer Service

Dollar Tree
07.2020 - 01.2021

AmeriCorps Member

Communities In Schools
09.2019 - 05.2020

Merchandiser

SAS Retail Services
08.2018 - 09.2019

Cashier/Customer Service

Walmart Supercenter
10.2017 - 05.2018

Team Member/Cashier

Jack in the Box
02.2017 - 09.2017

Sales and Cashier

D AND D ARCHERY
04.2005 - 05.2016

High School Diploma -

Renaissance High School