VOID CORRECTED

IRA contributions (other

than amounts in boxes

2–4 and 8–10)

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 IRA conversion amount

$

PARTICIPANT’S name 5 Fair market value of account

$

Street address (including apt. no.)

City, state, and ZIP code

Account number (see instructions)

Form 5498 Department of the Treasury - In

2828

Cat. No. 50010C

F

Form 5498

OMB No. 1545-0747

7 IRA SEP SIMPLE

8 SEP contributions 9 SIMPLE contributions

$ $

10 Roth IRA contributions

$

Roth IRA

Life insurance cost

included in box 1

6

$

Do Not Cut or Separate Forms on This Page — Do Not Cut or Separate Forms 

4 Recharacterized contributions

$

11 Check if RMD

for 2009

2008
CORRECTED (if checked)

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

TRUSTEE’S or ISSUER’S federal identification no. PARTICIPANT’S social security number

PARTICIPANT’S name

Street address (including apt. no.)

City, state, and ZIP code

Account number (see instructions)

Form 5498 Department of the Treasury - In

(keep for your records)

IRA contributions (other

than amounts in boxes

2–4 and 8–10)

1

$

2 Rollover contributions

$

3 Roth IRA conversion amount

$

5 Fair market value of account

$

Form 5498

OMB No. 1545-0747

7 IRA SEP SIMPLE

8 SEP contributions 9 SIMPLE contributions

$ $

10 Roth IRA contributions

$

Roth IRA

Life insurance cost

included in box 1

6

$

4 Recharacterized contributions

$

11 If checked, required

minimum distribution 

for 2009

2008
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, including any catch-up 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 (SEP,

SIMPLE, and Qualified Plans).

Box 6. For endowment contracts only, shows the amoun

of life insurance. Subtract this amount from your allowab

included in box 1 to compute your IRA deduction.

Box 5. Shows the fair market value of all investments in y

end. However, if a decedent’s name is shown, the amoun

FMV on the date of death. If the FMV shown is zero for a 

or administrator of the estate may request a date-of-deat

financial institution.

Box 1. Shows traditional IRA contributions for 2008 you made in 2008 and

through April 15, 2009. 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 2–4 and 8–10.

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

IRA, or a qualified rollover contribution to a Roth IRA, you made in 2008. It does

not show any amounts you converted from your traditional IRA, SEP IRA, or

SIMPLE 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 SEP IRA and

you did not roll over the total distribution, use Form 8606, Nondeductible IRAs,

to figure the taxable amount. If property was rolled over, see Pub. 590. For a

qualified rollover to a Roth IRA, also see Pub. 590.

Box 7. May show the kind of IRA reported on this Form 5

Box 8. Shows SEP contributions made in 2008, including 

2008 for 2007, but not including contributions made in 20

by your employer, do not deduct on your income tax retu

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

See Pub. 560.

Box 9. Shows SIMPLE contributions made in 2008. If ma

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

self-employed person (or partner), they may be deductibl

Box 10. Shows Roth IRA contributions you made in 2008 

2009. Do not deduct on your income tax return.

Instructions for Participant

Box 4. Shows amounts recharacterized from transferring 

contribution (plus earnings) from one type of IRA to anoth

Box 11. If the box is checked, you must take a required m

(RMD) for 2009. An RMD may be required even if the box 

amount, or offer to compute the amount, and date of the 

to you by January 31 either on Form 5498 (in the blank b

or in a separate statement. If you do not take the RMD fo

to a 50% excise tax on the amount not distributed. See P

Account number. May show an account or other unique number the trustee

assigned to distinguish your account.

Note. If you postponed making a contribution to your IRA, for example, due to a

designated disaster, or repaid a qualified reservist distribution, the box to the left

of box 10 should show a reason code, the amount of the contribution or

repayment, and the year to which the payment was credited, if applicable. Also,

certain catch-up contributions made into an IRA by certain eligible section

401(k) plan participants will be shown in the blank box. See Pub. 590 for more

information.

Box 3. Shows the amount converted from a traditional IR

IRA to a Roth IRA in 2008. Use Form 8606 to figure the t
VOID CORRECTED

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

TRUSTEE’S or ISSUER’S federal identification no. PARTICIPANT’S social security number

PARTICIPANT’S name

Street address (including apt. no.)

City, state, and ZIP code

Account number (see instructions)

Form 5498 Department of the Treasury - In

IRA contributions (other

than amounts in boxes

2–4 and 8–10)

1

$

2 Rollover contributions

$

3 Roth IRA conversion amount

$

5 Fair market value of account

$

Form 5498

OMB No. 1545-0747

7 IRA SEP SIMPLE

8 SEP contributions 9 SIMPLE contributions

$ $

10 Roth IRA contributions

$

Roth IRA

Life insurance cost

included in box 1

6

$

4 Recharacterized contributions

$

11 Check if RMD

for 2009

2008
Instructions for Trustees and Issuers

We provide general and specific form instructions

as separate products. The products you should

use for 2008 are the General Instructions for

Forms 1099, 1098, 5498, and W-2G and the 2008

Instructions for Forms 1099-R and 5498. To order

these instructions and additional forms, visit the

IRS website at www.irs.gov or call

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

Due dates. Furnish Copy B of this form to the

participant by June 1, 2009, but furnish fair

market value information and RMD if applicable

by February 2, 2009.

File Copy A of this form with the I

June 1, 2009. If you file electronical

have software that generates a file a

the specifications in Pub. 1220, Spe

Filing Forms 1098, 1099, 5498, and 

Electronically. IRS does not offer a 

option.

Caution: Because paper forms are scanned

during processing, you cannot file with the IRS

Forms 1096, 1098, 1099, or 5498 that you print

from the IRS website.

Need help? If you have questions a

on Form 5498, call the information 

customer service site toll free at 1-8

or 304-263-8700 (not toll free). For 

equipment, call 304-267-3367 (not t

hours of operation are Monday thro

from 8:30 a.m. to 4:30 p.m., Eastern