fam 5 3 29 Return for Individual

‘OMB No. 1545-0203

Retirement Arrangement Taxes 1J 9 8 4
Department of the Treasury (Under Sections 408(f), 4973 and 4974 of the Internal Revenue Code)
Internal Revenue Service DP Attach to Form 1040. 28
Name Your social security number

‘Address (Number and street)

City or town, State and ZIP code

Excess Contributions Tax for Individual Retirement Arrangements
If you have contributed either this year or in earlier years more to your IRA than is or was allowable
as a deduction, and you have an excess contribution subject to tax, complete the following.

1 Excess contributions for 1984 (see instructions for line 1). Do not include this amount on Form 1040, line 26a .
2 Earlier year excess contributions not previously eliminated (see instructions for line 2) .

3 Contribution credit. (If your maximum allowable deduction for 1984 is more than your actual
contribution, see instructions for line 3, otherwise enter zero.)

4 (a) 1984 distributions out of your account that are taxable income .

(b) 1983 tax year excess contributions (if any) withdrawn after the due date ‘(including extensions)
of your 1983 income tax return, and 1982 and earlier tax year excess contributions withdrawn in
1984.

Do not enter any withdrawn é excess ‘contributions on ‘line 4(b) if, in the tax year (other than 1976 or

1977) that the excess contributions were made:

@ your total IRA contributions (other than rollover contributions) were more than $2,250 (or if
the total contributions for the year include employer contributions to a SEP, $2,250 increas-
ed by the lesser of the amount of the employer contributions to the SEP or $15, 000); or

@ you took a deduction for the excess contributions on your Form 1040.

Instead, enter these withdrawn excess contributions on line 4(a) of Form 5329 and also on line

16 of Form 1040.

(c) Add lines 3 through 4(b)

5 Adjusted earlier year excess contributions (line On minus line 4) but not less than zero)
6 Total excess contributions (add lines 1 and 5)
7 Tax (6% of line 6 or 6% of the value of your IRA on the last day of 1984, ‘whichever i is smaller. ) Enter tax on Form 1040, line 55

Part Il Tax on Premature Distributions

If you received a distribution from your arrangement before you reached age 592, complete lines 8, 9, 10, and

11. Also, enter the amount of the distribution on Form 1040, line 16.

8 (a) If you entered into a prohibited transaction as described in definition D (see instructions), borrowed any
amount from one of your individual retirement annuities, or pledged any part of one of your individual
retirement annuity contracts, enter 10% of the value of the account or annuity at the beginning of the year .

(b) If in 1984 any part of your arrangement was invested in collectibles (see instructions for line 8(b)) include
10% of the cost of the collectibles here . . .
9 Enter 10% of the amount of the distributions from your arrangement suing the year ‘(see instructions for line 9
for items that are not considered taxable distributions) .

10 Enter 10% of the amount from your individual retirement savings accounts that you pledged as security for aloan .

11 Total tax (add lines 8(a) through 10). Enter here and on Form 1040, line 55.

Aug © Tax on Excess Accumulation in In

lual Retirement Accounts and Annuities

12 Tax based on current year distribution method (see worksheet in instructions)
13 Tax based on aggregate distribution method (see worksheet in instructions)

14 Tax due. Enter amount from line 12 or, if aggregate distribution method is sis applicable, enter the smaller of line 12
or line 13. Also include this amount on Form 1040, line 55 .

Under penalties of perjury, ! declare that | have examined this return, including accompanying schedules and statements, and to the best of my knowledge and
Please belief, it is true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
Sign
Here |) vase D ome

. Preparer's Date Check if self- Preparer’s social security no.
Paid signature employed > [] t :
reparer’s a
im’s name (or :

Use Only | yours, if self-employed) E1No. > i

and address ZIP code >

For Paperwork Reduction Act Notice, see page 1 of instructions.

Form 5329 (1984)