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Department of the Treasury
Internal Revenue Service

Return for Additional Taxes Attributable to
Qualified Retirement Plans (Including IRAs),

Annuities, and Modified Endowment Contracts

(Under Sections 72, 4973, 4974 and 4980A of the Internal Revenue Code)
> Attach to Form 1040. See separate instructions.

OMB No, 1545-0203

1990

Attachment
Sequence No. 2!

Name of individual subject to penalty tax (Enter the name of one individual only. See the instructions for “Joint Returns.")

Your soclal security number

‘Address (number and street) (Enter P.O. box no. if mail is not delivered to street address.)

City or town, state, and ZIP code

Check this box if this is
an Amended Return & LJ

Excess Contributions Tax for Individual Retirement Arrangements (Section 4973)

Complete this part if, either in this year or in earlier years, you have contributed more to your IRA than is or was allowable and you have an

excess contribution subject to tax.

1 Excess contributions for 1990 (see instructions). Do not include this amount on Form 1040, line 24a or,

24b 1
2. Earlier year excess contributions not previously eliminated (see instructions) . 2
3 Contribution credit. (If your maximum allowable contribution for 1990 is more
than your actual contribution, see instructions for line 3; otherwise, enter
zero.) 3
4a 1990 distributions from your IRA account that are includible in taxable income 4a
b 1989 tax year excess contributions (if any) withdrawn after the due date
(including extensions) of your 1989 income tax return, and 1988 and earlier
tax year excess contributions withdrawn in 1990 . 4b
¢ Add lines 3 through 4b . Ac
5 Adjusted earlier year excess contributions (Subtract ‘ine 4c from line 2. Enter the result, but not less than
zero.) 5
6 Total excess contributions (add lines 1 and 5) . 6
7 Tax (Enter 6% of line 6 or 6% of the value of your IRA on the last sey of 1990, whichever i is s smaller. ) Enter
here and on Form 1040, line 52_. . . . 2... 7

Tax on Early Distributions (Section 72)

Complete this part if a taxable distribution was made from your qualified retirement plans (including IRAs), modified endowment contracts, or annuity
contracts before you reached age 59/2. Note: You must enter the amount of the distribution on the appropriate line (or lines) of Form

1040 or Form 4972.

8 Early distributions included in gross income attributable to:

a Qualified retirement plans (including IRAs). 8a

b Annuity contracts Co 8b

¢ Modifiedendowmentcontracts . 2... 1. ee ee 8c

d Prohibited transactions . . 8d

e Pledging of accounts as security . 8e

f Costofcollectibles . . . 8f

g Total distributions (add lines 8a through 8f) 8g
Note: include this amount on line 16b or 17b of Form 1040.

9 Exceptions to distributions subject to additional taxes (see instructions):

a Due to death (does not apply to modified endowment contracts) . 9a

b Due to total and permanent disability : 9b

c As part of a series of substantially equal lifetime periodic payments . . 9c
Lines 9d through 9f DO NOT apply to distributions from IRAs, annuities, or
modified endowment contracts.

d Due to separation from service in or after the year of reaching age 55 9d

e Distributions to the extent of deductible medical expenses . . 9e

f Made to an alternate payee under a qualified domestic relations order . ot

g Other (specify)....0........... 9

h Total amount excluded from additional tax (add lines 9a through 9g). 9h

10 Amount subject to additional tax (subtract line 9h from 8g). 10
11__ Total section 72 tax (multiply line 10 by 10% (.10)). Enter here and on Form 1040, line 52. 1

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

Form 5329 (1990)


Form 5329 (1990)

Page 2

Tax on Excess Accumulation in Qualified Retirement Plans (Including IRAs) (Section 4974)

12 Minimum required distribution 12
13 Amount actually distributed to you 13
14 Subtract line 13 from line 12. If line 13 is greater than line 12, enter zero 14
15 Tax due (multiply line 14 by 50% (.50)). Enter here and on Form 1040, line 52 15
Tax on Excess Distributions From Qualified Retirement Plans (Including IRAs) (Section 4980A)
Lines 16 through 19c are to be completed for regular distributions ONLY.
16 Enter the aggregate amount of regular retirement distributions 16
17a Enter the applicable threshold amount ($128,228 or $150,000) (see
instructions)... . ee ee ja
b 1990 recovery of grandfather amount (from Worksheet) . . . . 1. . - 17b
¢ Enter the greater of line 17a or 17b . 17c
18 Excess distributions (subtract line 17c from line 16) (if less than zero, enter -O-) . 18
19a Tentative tax (multiply line 18 by 15% (.15)) 19a
b Section 72(t) tax offset (see instructions) 19b
¢ Tax due (subtract line 19b from line 19a). Enter here and on Form 1040,line52. 0. . . 19¢
Lines 20 through 23c are to be completed for lump-sum distributions ONLY.
20 Enter the aggregate amount of your lump-sum distributions. . . 2 . . 20
21a Enter the applicable threshold amount ($641,140 or $750,000) (see
instructions)... ee ef
b 1990 recovery of grandfather amount (from Worksheet) . . . . . . . (21b
¢ Enter the greater of line 21a or21b . 21c
22 Excess distributions (subtract line 21c from line 20) (if less than zero, enter -O-) . 22
23a Tentative tax (multiply line 22 by 15% (.15)) . 23a
b Section 72(t) tax offset (see instructions) 23b
c Tax due (subtract line 23b from line 23a). Enter here and on Form 1040, line 52 . 23c

Acceleration Elections (see the instructions for Part IV, Worksheet 1)

1. Check here > Dit you elected the discretionary method in 1987 or 1988 and wish to make an acceleration election under Temp.

Regs. section 54.4981A-1T b-12.

2  Checkhere > [1 it you made an acceleration election in 1987, 1988, or 1989 and wish to revoke that election.
Note: /f you checked either 1 or 2 above, see the instructions for filing an amended return.

‘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, itis true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
Sign
Here » Your signature (Sign and date only if not attached to your income tax return.) > Date

. Preparer's Date heck if self: Preparer's social security
Paid . signature » ore yea im (oes instructions)
Preparer’s | Firm’sname (or

yours,
Use Only | ifseltemployed) and » ELLNo. >
address ZIP code_b

“%U.S.GPO:1990-0-266-351