Clvoio

(CORRECTED

‘TRUSTEE'S or ISSUER'S name, street ad

idress, city, state, and ZIP code

1 Regular SEP contributions
made m 1986 and 1987 for

OMB No.1545:0747

1986

2 Regular IRA or DEC
contributions made in 1986
and 1987 for 1986

Individual
Retirement
Arrangement
Information

TRUSTEE'S or ISSUER'S Federal identification nol

PARTICIPANT'S social security number

3 Rollover IRA, SEP, or DEC cohtributions

Copy C
For Trustee or

PARTICIPANT'S name (first, middle, last)

Street address

City, state, and ZIP code

4 Life insurance cost included in

Box 1 or 2

Issuer
For Paperwork

Reduction Act
Notice and
instructions for

completing this
form, see

‘Account number (optional)

Instructions for
Forms 1099,
11098, 5498, 1096,
and W-2G.

Form 5498

voi

(CORRECTED

Department of the Treasury -

Internal Revenue Service

‘TRUSTEE'S or ISSUER'S name, street ad

dress, city, state, and ZIP code

1 Regular SEP contributions
mae in 1986 and 1987 for

OMB No. 1545-0747

2 Regular IRA or DEC
contributions made in 1986
and 1987 for 1986

1986

Individual
Retirement
Arrangement
Information

TRUSTEE'S or ISSUER'S Federal identification no

PARTICIPANT'S social security number

3 Rollover IRA, SEP, or DEC cohtributions

Copy C
For Trustee or

PARTICIPANT'S name (first, middle, last)

Street address

City, state, and ZIP code

4 Life insurance cost included in

Box 1 or 2

Issuer

For Paperwork
Reduction Act
Notice and
instructions for

completing this
form, see

‘Account number (optional)

Instructions for
Forms 1099,
1098, 5498, 1096,
and W-2G.

Form 5498

Llvoip

[I corrECTED

Department of the Treasury -

Internal Revenue Service

TRUSTEE’S or ISSUER'S name, street adi

{dress, city, state, and ZIP code

1 Regular SEP contributions
made in 1986 and 1987 for
1986

OMB No.1545:0747

1986

2 Regular IRA or DEC
contributions made in 1986
and 1987 for 1986

Individual
Retirement
Arrangement
Information

‘TRUSTEE'S or ISSUER'S Federal identification no!

PARTICIPANT'S social security number

3 Rollover IRA, SEP, or DEC contributions

Copy C

PARTICIPANT'S name (first, middle, last)

Street address

City, state, and ZIP code

4 Life insurance cost included in

Box 1 or 2

For Trustee or
Issuer
For Paperwork

Reduction Act
Notice and

instructions for
completing this
form, see

‘Account number (optional)

Instructions for
Forms 1099,
L098, 5498, 1096,

and W-2G

Form 5498

Department of the Treasury -

Internal Revenue Service


Instructions to Participant

The information in Boxes 1, 2, 3, and 4 has been submitted
to the Internal Revenue Service by the trustee or issuer of
your individual retirement arrangement (IRA) or simplified
employee pension (SEP) to report regular or rollover
contributions made to your IRA or SEP. The boxes will also
show information submitted by your employer on
deductible voluntary employee contributions (DECs) made
by you to the employer's pension plan.

Box 1.—The amount shown is the contributions for 1986
made in 1986 and through April 15, 1987, to a SEP.

Box 2.—The amount shown is the contributions for 1986
made in 1986 and through April 15, 1987, to an IRA or
DEC plan.

Box 3.—This is the amount of any rollover you made in
1986. Rollovers cannot be deducted on your tax return.

Instructions to Participant

The information in Boxes 1, 2, 3, and 4 has been submitted
to the Internal Revenue Service by the trustee or issuer of
your individual retirement arrangement (IRA) or simplified
employee pension (SEP) to report regular or rollover
contributions made to your IRA or SEP. The boxes will also
show information submitted by your employer on
deductible voluntary employee contributions (DECs) made
by you to the employer's pension plan

Box 1.—The amount shown is the contributions for 1986
made in 1986 and through April 15, 1987, toa SEP.

Box 2.—The amount shown is the contributions for 1986
made in 1986 and through April 15, 1987, to an IRA or
DEC plan.

Box 3.—This is the amount of any rollover you made in
1986. Rollovers cannot be deducted on your tax return.

Instructions to Participant

The information in Boxes 1, 2, 3, and 4 has been submitted
to the Internal Revenue Service by the trustee or issuer of
your individual retirement arrangement (IRA) or simplified
employee pension (SEP) to report regular or rollover
contributions made to your IRA or SEP. The boxes will also
show information submitted by your employer on
deductible voluntary employee contributions (DECs) made
by you to the employer's pension plan.

Box 1.—The amount shown is the contributions for 1986
made in 1986 and through April 15, 1987, to a SEP.

Box 2.—The amount shown is the contributions for 1986
made in 1986 and through April 15, 1987, to an IRA or
DEC plan.

Box 3.—This is the amount of any rollover you made in
1986. Rollovers cannot be deducted on your tax return.

However, you must report any distribution you received
from a plan on the appropriate line of Form 1040. Any
amount of the distribution that was rolled over will be
subtracted from the distribution and not included in your
income.

Box 4.—For endowment contracts only, this is the amount
allocable to the cost of life insurance. Subtract this amount
from your allowable IRA contribution included in Box 1 or 2
to compute your allowable IRA deduction.

The trustee or issuer of the plan may use the other boxes on
this form to give you more information about your IRA, SEP,
or DEC.

You are not required to attach a copy of Form 5498 to your
income tax return. Keep this form for your records.

However, you must report any distribution you received
from a plan on the appropriate line of Form 1040. Any
amount of the distribution that was rolled over will be
subtracted from the distribution and not included in your
income.

Box 4.—For endowment contracts only, this is the amount
allocable to the cost of life insurance. Subtract this amount
from your allowable IRA contribution included in Box 1 or 2
to compute your allowable IRA deduction.

The trustee or issuer of the plan may use the other boxes on
this form to give you more information about your IRA, SEP,
or DEC.

You are not required to attach a copy of Form 5498 to your
income tax return. Keep this form for your records.

However, you must report any distribution you received
from a plan on the appropriate line of Form 1040. Any
amount of the distribution that was rolled over will be
subtracted from the distribution and not included in your
income.

Box 4.—For endowment contracts only, this is the amount
allocable to the cost of life insurance. Subtract this amount
from your allowable IRA contribution included in Box 1 or 2
to compute your allowable IRA deduction.

The trustee or issuer of the plan may use the other boxes on
this form to give you more information about your IRA, SEP,
or DEC.

You are not required to attach a copy of Form 5498 to your
income tax return. Keep this form for your records.


2428

Type or machine print TRUSTEE'S or ISSUER'S name, street address, city, state, |.
1d ZIP code |

CORRECTED For Official Use Only
Reguiar § EP contributions | OMB No. 1545-0747

spe 9 3986 and 1987 for
Individual
1986 Retirement

Arrangement
Informa’

Regular IRA or OI
tes made in 1986 |
ord 1887 or 1986 ]

a CopyA
For Internal
Revenue
Service Center
For Paperwork
Reduction Act
Notice and
instructions for
completing this
form, see
Instructions for
Forms 1099,
098, 5498, 1096,
and W-2G

of .
Form 5498. Do NOT Cut or Separate Forms on This Page Department of the Treasury - Internal Revenue Service

For Official Use Only
(OMB No. 1545-0747

Individual

1986 Retirement
Arrangement

Information

a CORRECTED

[ Type or machine print TRUSTEE’ or ISSUER'S name, street address, city, state,
and ZIP code

‘V2 Regular IRAorDEC
Contrbutions made in 1986 |
and 1987 for 1986

Copy A

For Internal
Revenue
Service Center
For Paperwork
Reduction Act
Notice and
instructions for
completing this
form, see
Instructions for
Forms 1099,
098, 5498, 1096,
and W-2G.

of the Tr ol I Re
Form 5498 Do NOT Cut or Separate Forms on This Page Department of the Treasury - internal Revenue Service

2428

Type or machine print TRUSTEE’S or ISSUER'S name, street at
d ZIP code

CORRECTED For Official Use Only

fegular SEP contributions |  OMBNo.1545-0747
mein 1966 and 1987 for |

| Individual

— 1986 Retirement
Arrangement

Information

er ariRA or DEC
butions made in 1986
1986 |

CopyA

For Internal
Revenue
Service Center
For Paperwork
Reduction Act
Notice and
instructions for
completing this

| Street address |.

City, state, and ZIP code form, see
| — Instructions for
bs a Forms 1099,
| Account number (optional) 11098, 5498, 1096,
L. z| and W-2G.
Form 5498 Department of the Treasury - Internal Revenue Service

Do NOT Cut or Separate Forms on This Page





(CORRECTED

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

1 Regular SEP contributions
made m 1986 and 1987 for

OMB No. 1545-0747

Street address

City, state, and ZIP code

Individual
1986 Retirement
2 Regular IRA or DEC Arrangement

contributions made in 1986
and 1987 for 1986 Information

TRUSTEE'S or ISSUER'S Federal identification no) PARTICIPANT'S social security number | 3 Rollover IRA, SEP, or DEC contributions

Copy B
PARTICIPANT'S name (first, middle, last) 4 Life insurance cost included in Box 1 or 2 For
Participant

The information in
Boxes 1, 2, 3, and

4is being
furnished to the
Internal Revenue

‘Account number (optional)

Service.

Form 5498

(-] CORRECTED

Department of the Treasury -

Internal Revenue Service

‘TRUSTEE'S or ISSUER'S name, street address, city, state, and ZIP code

1 Regular SEP contributions
made 1 1986 and 1987 for
1986

‘OMB No. 1545-0747

Street address

City, state, and ZIP code

Individual
1986 Retirement
2 Regular IRA or DEC Arrangement
ibuti de in 1986 .
and 1987 for 1586 Information
TRUSTEE’S or ISSUER'S Federal identification no] PARTICIPANT'S social security number | 3 Rollover IRA, SEP, or DEC contributions
Copy B
PARTICIPANT'S name (first, middle, last) 4 Life insurance cost included in Box 1 or 2 For
Participant

The information in
Boxes 1, 2, 3, and

‘4 is being
furnished to the
Internal Revenue

‘Account number (optional)

Service.

Form 5498

(| CORRECTED

Department of the Treasury -

Internal Revenue Service

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

1 Regular SEP contributions
made in 1986 and 1987 for
1986

OMB No.1545:0747

Individual
1 i) Retirement
2 Regular IRA or DEC Arrangement
tributi de in 1986

and 1987 for 1986 Information

‘TRUSTEE'S or ISSUER'S Federal identification no] PARTICIPANT'S social security number | 3 Rollover IRA, SEP, or DEC contributions:
Copy B
PARTICIPANT'S name (first, middle, last) 4 Life insurance cost included in Box 1 or 2 For
Participant

Street address

City, state, and ZIP code

The information in
Boxes 1, 2, 3, and

4 is being
furnished to the
Internal Revenue

‘Account number (optional)

Service.

Form 5498

Department of the Treasury

Internal Revenue Service