- 5329 Return for Individual

Retirement Arrangement Taxes 1978
eee er crue seme” | (Under Sections 408(f), 409(c), 4973 and 4974 of the Internal Revenue Code)
> Attach to Form 1040.

Name Your social security number

Address (Number and street)

City or town, State and ZIP code

File Form 5329 for 1978 only if you owe one or more of the taxes to be reported in Parts I, Il, or
III below. Form 5329 is no longer required to be filed for tax years beginning after December 31,
1977 by IRA owners to report their deduction for contributions or as an annual information return.

Excess Contributions Tax for Individual Retirement Arrangements

If you have contributed either this year or in prior years more to your arrangement than is
or was allowable as a deduction, and you have an excess contribution subject to tax, com-
plete the following. The tax figured on line 7 should be carried forward to Form 1040, line 53.

1 Excess contributions for 1978 (see specific instruction 1). . . 2. 1. ee ee ee ee ee
2 Prior year excess contributions not previously eliminated . . . . . 2. 2 we ee
3 Contribution credit. (If your maximum allowable deduction for 1978 is more than your actual
contribution enter the difference; otherwise enter zero. See specific instructions, line 3) .
4 (a) Current year distributions out of your account and included in your gross income .
(b) 1976 excess contributions (if any) withdrawn in 1978. . . . . 2... wee
(c) 1977 excess contributions (if any) withdrawn after the due date (including extensions)

of your 1977 income tax return. «© 2 6 ew ee ee ee ee ee
5 Adjusted prior year excess contributions (line 2 less total of lines 3 and 4(a), (b) and (c) but not less than zero)
6 Total excess contributions (add linesland5). . . 1 6 ee ee ee ee ee ee ee

7 Excess contributions tax (the lesser of 6% of line 6 or 6% of the value of your IRA on the last day of 1978).
Include tax on Form 1040, line53. . . . ee ee ee ee ew ee

HEI Tax on Premature Distributions
If you received a distribution from your arrangement before you reached age 5914, complete
the following. The tax figured on line 11 should be carried forward to Form 1040, line 53.

8 If you entered into a prohibited transaction as described in definition C, borrowed any amount from one of your
individual retirement arrangements, 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 ofthe year. . . . 2.» . 2 we

9 Enter 10% of the amount of the distributions from your arrangement during the year. Do NOT include any (a)
excess current year contributions returned during the year or excess contributions made in 1977 and returned to
you after 12-31-77 but before the filing date for your income tax return for 1977, (b) “rollover contributions”
to another retirement arrangement or plan, (c) amount distributed because of disability, (d) amount transferred
to a former spouse under a divorce decree, (e) amount from an arrangement for which you made an entry on
line 8, (f) amount distributed from an arrangement because it was pledged as security for a loan, or (g) 1976
excess contributions withdrawn in 1978 or 1977 excess contributions withdrawn after the due date (including

extensions) of your 1977 income tax return... + ee ee ee ee kl tae
10 Enter 10% of the amount from your individual retirement savings accounts that you pledged as security for
aloan ee ew ew
11 Total tax—include the total of lines 8, 9, and 10 here and on Form 1040, line 53. (See specific instructions for
credits against tax.). . . eee Po ee ee

HEEL Tax on Under-distributed Retirement Accounts and Annuities
See Part Ill of the Specific Instructions before completing this Part.

12 Tax based on current year distribution method (See worksheet in Instructions). . . . . 2. + 2. es ee
13 Tax based on aggregate distribution methods (See worksheet in Instructions). . . . 2. 1 2. ee a

14 Tax due, smaller of line 12 or 13, enter here and include on Form 1040, in your total for line 53 . _
Under penalties of perjury, | declare that 1 have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief it is true,

2 correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
cy
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(30| VW’ Your signature Date
a . Preparer’s Preparer’s social security no. | Check if self-
3 Paid signature H H employed p>» []
S| jPreparer’s |savs name (or Yours :
= irm’s ni iy a5 Ye
| Information | if Self-employed), > Et No. >
address and ZIP’ code Date b>
263-181-2

‘te US, GOVERNMENT PRINTING OFFICE : 1978—-O-263-181 Form 5329 1978)