Additional Taxes Attributable to IRAs, Other OMB No. 1545-0203

Qualified Retirement Plans, Annuities, Modified

Endowment Contracts, and MSAs

Form 5329

Department of the Treasury

Internal Revenue Service

Attachment

Sequence No. 29

(Under Sections 72, 530, 4973, and 4974 of the Internal Revenue Code)

© Attach to Form 1040. See separate instructions.

Name of individual subject to additional tax. (If married filing jointly, see page 2 of the instructions.) Your social security number

Home address (number and street), or P.O. box if mail is not delivered to your home

City, town or post office, state, and ZIP code If this is an amended

return, check here ©

13

Excess contributions for 1998 (see page 4 of the instructions). Do not include this amount on

Form 1040, line 23

13

14 14

Earlier year excess contributions not previously eliminated (see page

4 of the instructions)

15

Contribution credit. If your actual contribution for 1998 is less than

your maximum allowable contribution, see page 4 of the instructions;

otherwise, enter -0-

15

1998 distributions from your traditional IRA accounts that are

includible in taxable income

1997 tax year excess contributions (if any) withdrawn after the due

date (including extensions) of your 1997 income tax return, and 1996

and earlier tax year excess contributions withdrawn in 1998

Add lines 11, 12, and 13

Adjusted earlier year excess contributions. Subtract line 14 from line 10. Enter the result, but

not less than zero

Tax on Early Distributions

Complete this part if a taxable distribution was made from your qualified retirement plan (including an IRA other than an education (Ed)

IRA), annuity contract, or modified endowment contract before you reached age 591⁄2 (or was incorrectly indicated as such on your

Form 1099-R—see instructions). Note: You must include the amount of the distribution on line 15b or 16b of Form 1040.

1 Early distributions included in gross income (see page 3 of the instructions) 1

Distributions excepted from additional tax (see page 3 of the instructions). Enter appropriate

exception number from instructions ©

2

2

3 Amount subject to additional tax. Subtract line 2 from line 1 3

4 Tax due. Multiply line 3 by 10% (.10). Enter here and on Form 1040, line 53 4

For Paperwork Reduction Act Notice, see page 6 of separate instructions. Cat. No. 13329Q Form 5329 (1998)

Apt. no.

Part I

Part II

If you are subject to the 10% tax on early distributions only, see Who Must File in the instructions

before continuing. You may be able to report this tax directly on Form 1040 without filing Form 5329.

Fill in Your Address Only

If You Are Filing This

Form by Itself and Not

With Your Tax Return ©

Caution: If any amount on line 3 was a distribution from a SIMPLE retirement plan, you must multiply that distribution by 25%

(.25) instead of 10%. See instructions for more information.

1998

5 5

6

7

8

6

7

8

Tax on Distributions From Ed IRAs Not Used for Educational Expenses

Complete this part if a distribution was made from your Ed IRA and was not used for educational expenses.

Note: You must include the amount of the distribution on line 15b of Form 1040.

Taxable amount from line 29 of Form 8606

9

10

Distributions excepted from additional tax (see page 4 of the instructions)

11

Amount subject to additional tax. Subtract line 6 from line 5

12

Tax due. Multiply line 7 by 10% (.10). Enter here and on Form 1040, line 53

9

10

11

12

Part III Tax on Excess Contributions to Traditional IRAs

Complete this part if, either in this year or in earlier years, you contributed more to your traditional IRAs than is or was allowable

and you have an excess contribution subject to tax.

Total excess contributions. Add lines 9 and 15 16

Tax due. Enter the smaller of 6% (.06) of line 16 or 6% (.06) of the value of your traditional IRAs

on the last day of 1998. Also enter this amount on Form 1040, line 53 17

Part IV Tax on Excess Contributions to Roth IRAs

Excess contributions for 1998 (see page 5 of the instructions)

Tax due. Enter the smaller of 6% (.06) of line 18 or 6% (.06) of the value of your Roth IRAs on

the last day of 1998. Also enter this amount on Form 1040, line 53

18

19

16

17

18

19
Form 5329 (1998) Page 2

Tax on Excess Accumulation in Qualified Retirement Plans

Minimum required distribution (see page 6 of the instructions) 31

Amount actually distributed to you 32

Subtract line 32 from line 31. If line 32 is more than line 31, enter -0- 33

Tax due. Multiply line 33 by 50% (.50). Enter here and on Form 1040, line 53 34

Under penalties of perjury, I declare that I have examined this form, including accompanying schedules and statements, and to the best of my knowledge

and belief, it is true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.

Your signature Date

Date Preparer’s social security no. Preparer’s

signature

Check if selfemployed ©

Firm’s name (or yours,

if self-employed) and

address

EIN ©

ZIP code ©

© ©

©

©

Signature. Complete ONLY if you are filing this form by itself and not with your tax return.

Please

Sign

Here

Paid

Preparer’s

Use Only

Tax on Excess Contributions to Medical Savings Accounts (MSAs)

Excess contributions for 1998 (see page 5 of the instructions). Do not include this amount on

Form 1040, line 25

Tax due. Enter the smaller of 6% (.06) of line 29 or 6% (.06) of the value of your MSAs on the

last day of 1998. Also enter this amount on Form 1040, line 53

26

34

22

30

20

21

Part VII

Part VI

Part V

22

23

Tax on Excess Contributions to Ed IRAs

Excess contributions for 1998 (see page 5 of the instructions)

Tax due. Enter the smaller of 6% (.06) of line 20 or 6% (.06) of the value of your Ed IRAs on

the last day of 1998. Also enter this amount on Form 1040, line 53

24

25

20

21

23

27

28

29

30

31

32

33

24

25

26

27

28

29

1997 excess contributions not previously eliminated (see page 5 of

the instructions)

Contribution credit. If your actual contribution for 1998 is less than

your maximum allowable contribution, see page 6 of the instructions;

otherwise, enter -0-

1998 distributions from your MSA account(s) that are includible in

taxable income

1997 tax year excess contributions (if any) withdrawn in 1998 after

the due date (including extensions) of your 1997 income tax return

Add lines 24, 25, and 26

Adjusted 1997 excess contributions. Subtract line 27 from line 23. Enter the result, but not less

than zero

Total excess contributions. Add lines 22 and 28

Complete this part if, either in 1998 or 1997, you or your employer contributed more to your MSAs than is or was allowable and

you have an excess contribution subject to tax.

Complete this part if you did not receive the minimum required distribution from your qualified retirement plan (including an IRA

other than an Ed IRA or Roth IRA).