Additional Taxes Attributable to Qualified OMB No. 1545-0203

Retirement Plans (Including IRAs), Annuities,

and Modified Endowment Contracts

Form 5329

Department of the Treasury

Internal Revenue Service

Attachment

Sequence No. 29

(Under Sections 72, 4973, 4974 and 4980A of the Internal Revenue Code)

© Attach to Form 1040. See separate instructions.

Name of individual subject to additional tax. (If married filing jointly, see 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 ©

Tax on Excess Contributions to Individual Retirement Arrangements

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

an excess contribution subject to tax.

5

Excess contributions for 1993 (see instructions). Do not include this amount on Form 1040, line

24a or 24b

5

6

6 Earlier year excess contributions not previously eliminated (see

instructions)

7 Contribution credit. (If your actual contribution for 1993 is less than

your maximum allowable contribution, see instructions; otherwise,

enter -0-.) 7

8

8 1993 distributions from your IRA account that are includible in taxable

income

9 1992 tax year excess contributions (if any) withdrawn after the due

date (including extensions) of your 1992 income tax return, and 1991

and earlier tax year excess contributions withdrawn in 1993 9

10 Add lines 7, 8, and 9 10

Adjusted earlier year excess contributions. (Subtract line 10 from line 6. Enter the result, but not

less than zero.)

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11

12 Total excess contributions (add lines 5 and 11) 12

13 Tax due. (Enter the smaller of 6% of line 12 or 6% of the value of your IRA on the last day of

1993.) Also enter this amount on Form 1040, line 51 13

Tax on Early Distributions

Complete this part if a taxable distribution was made from your qualified retirement plan (including an IRA), annuity contract, or

modified endowment contract before you reached age 591⁄2. Note: You must include the amount of the distribution on line 16b or

17b of Form 1040 or on the appropriate line of Form 4972.

1 Early distributions included in gross income. See instructions 1

Distributions excepted from additional tax. See instructions. (Enter appropriate No. for exception

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 51 4

For Paperwork Reduction Act Notice, see page 1 of separate instructions. Cat. No. 13329Q Form 5329 (1993)

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 amount 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
Form 5329 (1993) Page 2

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

14 Minimum required distribution (see instructions) 14

15 Amount actually distributed to you 15

16 Subtract line 15 from line 14. If line 15 is more than line 14, enter -0- 16

17 Tax due (multiply line 16 by 50% (.50)). Enter here and on Form 1040, line 51 17

Tax on Excess Distributions From Qualified Retirement Plans (Including IRAs)

Acceleration Elections (see the instructions for Part IV)

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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

E.I. No. ©

ZIP code ©

© ©

©

©

If you elected the discretionary method in 1987 or 1988 and wish to make an acceleration election beginning in 1993

under Temp. Regs. section 54.4981A-1T b-12, check here © .

If you previously made an acceleration election and wish to revoke that election, check here © .

Part IV

Part III

Complete Column A for regular distributions. Complete Column B for lump-sum distributions.

Column A

Regular

Distributions

Column B

Lump-Sum

Distributions

18 Total amount of regular retirement or lump-sum distributions

19 Amount excluded from additional tax. (Enter appropriate No. for exception

from instructions © )

20 Subtract line 19 from line 18

21 Enter the greater of the threshold amount or the 1993 recovery of the

grandfather amount (from Worksheet 1 or 2). See instructions

22 Excess distributions. (Subtract line 21 from line 20. If less than zero,

enter -0-)

23 Tentative tax. (Multiply line 22 by 15% (.15))

24 Early distributions tax offset. See instructions

25 Subtract line 24 from line 23

26 Tax due. (Combine columns (a) and (b) of line 25.) Enter here and on Form 1040, line 51

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19

20

21

22

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25

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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

Printed on recycled paper