VOID CORRECTED

IRA contributions (other

than amounts in boxes 2,

3, and 7–10)

TRUSTEE’S or ISSUER’S name, street address, city, state, and ZIP code 1

IRA

Contribution

Information

$

2 Rollover contributions

$

TRUSTEE’S or ISSUER’S Federal identification no. PARTICIPANT’S social security number 3 Roth conversion amount

$

PARTICIPANT’S name 4 Fair market value of account

$

Street address (including apt. no.)

City, state, and ZIP code

Account number (optional)

Form 5498 Department of the Treasury - Internal Revenue Service

2828

Do NOT Cut or Separate Forms on This Page

Cat. No. 50010C

Copy A

For

Internal Revenue

Service Center

File with Form 1096.

For Paperwork

Reduction Act Notice

and instructions for

completing this

form, see the

1998 Instructions for

Forms 1099, 1098,

5498, and W-2G.

Form 5498

OMB No. 1545-0747

6 IRA SEP SIMPLE

7 SEP contributions 8 SIMPLE contributions

$ $

1998

9 Roth IRA contributions 10 Ed IRA contributions

$ $

Roth IRA Roth conv. Ed IRA

Life insurance cost

included in box 1

5

$

CORRECTED (if checked)

TRUSTEE’S or ISSUER’S name, street address, city, state, and ZIP code 1

$

2 Rollover contributions

$

TRUSTEE’S or ISSUER’S Federal identification no. PARTICIPANT’S social security number 3 Roth conversion amount

$

PARTICIPANT’S name 4 Fair market value of account

$

Street address (including apt. no.)

City, state, and ZIP code

Account number (optional)

Form 5498 Department of the Treasury - Internal Revenue Service

For

Participant

Copy B

(Keep for your records.)

IRA contributions (other

than amounts in boxes 2,

3, and 7–10)

Form 5498

OMB No. 1545-0747

IRA

Contribution

Information

6

7 SEP contributions 8 SIMPLE contributions

$ $

1998

9 Roth IRA contributions 10 Ed IRA contributions

$ $

IRA SEP SIMPLE

This information

is being

furnished to

the Internal

Revenue

Service.

Life insurance cost

included in box 1

5

$

Roth IRA Roth conv. Ed IRA
The information on Form 5498 is submitted to the Internal Revenue

Service by the trustee or issuer of your individual retirement arrangement

(IRA) to report contributions and the fair market value of the account. For

information about IRAs, see Pub. 590, Individual Retirement

Arrangements (IRAs), and Pub. 560, Retirement Plans for Small Business.

Box 5. For endowment contracts only, shows the amount allocable to the

cost of life insurance. Subtract this amount from your allowable IRA

contribution included in box 1 to compute your IRA deduction.

Box 4. Shows the fair market value of your account at year end.

Box 1. Shows traditional IRA contributions for 1998 you made in 1998

and through April 15, 1999. These contributions may be deductible on

your Form 1040 or 1040A. However, if you or your spouse was an active

participant in an employer’s pension plan, these contributions may not be

deductible. This box does not include amounts in boxes 2, 3, and 7-10.

Box 2. Shows any rollover, including a direct rollover to a traditional IRA,

you made in 1998. Box 2 does not show any amounts you converted

from your traditional IRA to a Roth IRA. They are shown in box 3. See the

Form 1040 or 1040A instructions for information on how to report

rollovers. If you have ever made any nondeductible contributions to your

traditional IRA or simplified employee pension (SEP) and you did not roll

over the total distribution, use Form 8606, Nondeductible IRAs

(Contributions, Distributions, and Basis), to figure the taxable amount. If

property was rolled over, see Pub. 590.

Box 6. May show the kind of IRA reported on this Form 5498.

Box 7. Shows the SEP contributions made in 1998. If made by your

employer, do not deduct on your income tax return. If you made the

contributions as a self-employed person (or partner), they may be

deductible. See Pub. 560.

Box 8. Shows the savings incentive match plan for employees (SIMPLE)

contributions made in 1998. If made by your employer, do not deduct on

your income tax return. If you made the contributions as a self-employed

person (or partner), they may be deductible. See Pub. 560.

Box 10. Shows education IRA (Ed IRA) contributions made in 1998 on

your behalf. Do not deduct on your income tax return. If the total of all

contributions made to all your Ed IRAs this year exceeded $500, you

should withdraw the excess, plus earnings, generally by April 15, or you

may owe a penalty. You must keep track of your Ed IRA basis

(contributions and distributions). See Pub. 590.

Box 9. Shows Roth IRA contributions you made in 1998 and through

April 15, 1999. Do not deduct on your income tax return.

Box 3. Shows the amount converted (or rolled over) from a traditional IRA

or SEP to a Roth IRA in 1998. You must include one-fourth of the taxable

amount in your income each year for 4 years (1998 through 2001). Use

Form 8606 to figure the taxable amount.

Instructions to Participant
VOID CORRECTED

TRUSTEE’S or ISSUER’S name, street address, city, state, and ZIP code 1

$

2 Rollover contributions

$

TRUSTEE’S or ISSUER’S Federal identification no. PARTICIPANT’S social security number 3 Roth conversion amount

$

PARTICIPANT’S name 4 Fair market value of account

$

Street address (including apt. no.)

City, state, and ZIP code

Account number (optional)

Form 5498 Department of the Treasury - Internal Revenue Service

For

Trustee or Issuer

For Paperwork

Reduction Act

Notice and

instructions for

completing this

form, see the

1998 Instructions

for Forms 1099,

1098, 5498,

and W-2G.

Copy C

IRA contributions (other

than amounts in boxes 2,

3, and 7–10)

Form 5498

OMB No. 1545-0747

IRA

Contribution

Information

6

7 SEP contributions 8 SIMPLE contributions

$ $

1998

9 Roth IRA contributions 10 Ed IRA contributions

$ $

IRA SEP SIMPLE

$

Life insurance cost

included in box 1

5

Roth IRA Roth conv. Ed IRA
Trustees and Issuers, Please Note—

Specific information needed to complete this

form and forms in the 1099 series is given in

the 1998 Instructions for Forms 1099, 1098,

5498, and W-2G. You can order those

instructions and additional forms by calling

1-800-TAX-FORM (1-800-829-3676).

Due dates. For an education IRA (Ed IRA),

furnish Copy B of this form to the participant

by February 1, 1999. For all other types of

accounts, furnish Copy B by June 1, 1999,

but furnish fair market value information by

February 1, 1999.

File Copy A of this form with the IRS by

June 1, 1999.