Additional Taxes on Qualified Plans OMB No. 1545-0203 5329 (Including IRAs) and Other Tax-Favored Accounts Form

Department of the Treasury

Internal Revenue Service

Attachment

Sequence No. 29

 Attach to Form 1040.

Name of individual subject to additional tax. If married filing jointly, see page 1 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

Enter your excess contributions from line 16 of your 2000 Form 5329. If zero, go to line 15

13

14 14

If your traditional IRA contributions for 2001 are less than your

maximum allowable contribution, see page 3. Otherwise, enter -0-

15

Taxable 2001 distributions from your traditional IRAs

15

2001 withdrawals of prior year excess contributions included on

line 9 (see page 3)

Add lines 10, 11, and 12

Prior year excess contributions. Subtract line 13 from line 9. If zero or less, enter -0-

Excess contributions for 2001 (see page 3). Do not include this amount on Form 1040, line 23

Tax on Early Distributions

Complete this part if a taxable distribution was made from your qualified retirement plan, including an IRA, or modified

endowment contract before you reached age 591⁄2. If you received a Form 1099-R that incorrectly indicates an early

distribution or you received a Roth IRA distribution, you also may have to complete this part. See page 1 of the

instructions.

1 Early distributions included in gross income. For Roth IRA distributions, see page 2 of the instructions 1

Early distributions not subject to additional tax. Enter the appropriate exception number from

page 2 of the instructions: 

2

2

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

4 Tax due. Enter 10% (.10) of line 3. Also include this amount on Form 1040, line 55 4

For Paperwork Reduction Act Notice, see page 4 of separate instructions. Cat. No. 13329Q Form 5329 (2001)

Apt. no.

Part I

Part II

If you only owe the 10% tax on early distributions and distribution code 1 is correctly

shown on Form 1099-R, you may be able to report this tax directly on Form 1040,

line 55, without filing Form 5329. See the instructions for Form 1040, line 55.

Fill in Your Address Only

If You Are Filing This

Form by Itself and Not

With Your Tax Return 

Caution: If any part of the amount on line 3 was a distribution from a SIMPLE IRA, you may have

to include 25% of that amount on line 4 instead of 10% (see page 2).

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Tax on Certain Taxable Distributions From Coverdell Education Savings Accounts (ESAs)

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

Taxable distributions from your Coverdell ESAs, from Form 8606, line 30

9

10

Taxable distributions not subject to additional tax (see page 2)

11

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

12

Tax due. Enter 10% (.10) of line 7. Also include this amount on Form 1040, line 55

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10

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Part III Tax on Excess Contributions to Traditional IRAs

Complete this part if you contributed more to your traditional IRAs for 2001 than is allowable or you had an excess

contribution on line 16 of your 2000 Form 5329.

Total excess contributions. Add lines 14 and 15 16

Tax due. Enter 6% (.06) of the smaller of line 16 or the value of your traditional IRAs on December 31,

2001 (including contributions for 2001 made in 2002). Also include this amount on Form 1040, line 55 17

16

17

Complete this part if you had a taxable amount on Form 8606, line 30.

Note: You must include the taxable amount of the distribution on Form 1040, line 15b or 16b.

2001

 See separate instructions.
Form 5329 (2001) Page 2

Tax on Excess Accumulation in Qualified Retirement Plans

Minimum required distribution (see page 4) 42

Amount actually distributed to you 43

Subtract line 43 from line 42. If zero or less, enter -0- 44

Tax due. Enter 50% (.50) of line 44. Also include this amount on Form 1040, line 55 45

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 SSN or PTIN Preparer’s

signature

Check if selfemployed

Firm’s name (or yours

if self-employed),

address, and ZIP code

EIN

Phone no.

 





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 Archer MSAs

Enter the excess contributions from line 40 of your 2000 Form 5329. If zero, go to line 39

Tax due. Enter 6% (.06) of the smaller of line 40 or the value of your Archer MSAs on

December 31, 2001. Also include this amount on Form 1040, line 55

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45

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39

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Part VII

Part VI

Part V

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35

Tax on Excess Contributions to Coverdell ESAs

Enter the excess contributions from line 32 of your 2000 Form 5329. If zero, go to line 31

If the contributions to your Coverdell ESAs in 2001 were less than the

maximum allowable contribution, see page 3. Otherwise, enter -0-

36

37

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35

39

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43

44

36

37

38

If the contributions to your Archer MSAs for 2001 are less than the

maximum allowable contribution, see page 4. Otherwise, enter -0-

Taxable 2001 distributions from your Archer MSAs, from Form 8853,

line 10

Add lines 35 and 36

Prior year excess contributions. Subtract line 37 from line 34. If zero or less, enter -0-

Excess contributions for 2001 (see page 4). Do not include this amount on Form 1040, line 25

Total excess contributions. Add lines 38 and 39

Complete this part if you or your employer contributed more to your Archer MSAs in 2001 than is allowable or you

had an excess contribution on line 40 of your 2000 Form 5329.

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

an IRA.

Part IV Tax on Excess Contributions to Roth IRAs

Enter your excess contributions from line 24 of your 2000 Form 5329. If zero, go to line 23

If your Roth IRA contributions for 2001 are less than your maximum

allowable contribution, see page 3. Otherwise, enter -0-

18 18

19

Complete this part if you contributed more to your Roth IRAs for 2001 than is allowable or you had an excess contribution

on line 24 of your 2000 Form 5329.

20 2001 distributions from your Roth IRAs (see page 3)

21 Add lines 19 and 20

22 Prior year excess contributions. Subtract line 21 from line 18. If zero or less, enter -0-

23 Excess contributions for 2001 (see page 3)

24 Total excess contributions. Add lines 22 and 23

Tax due. Enter 6% (.06) of the smaller of line 24 or the value of your Roth IRAs on December 31, 2001

(including contributions for 2001 made in 2002). Also include this amount on Form 1040, line 55

25

21

22

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25

19

20

Complete this part if the contributions to your Coverdell ESAs in 2001 were more than is allowable or you had an

excess contribution on line 32 of your 2000 Form 5329.

28 2001 distributions from your Coverdell ESAs, from Form 8606, line 28

29 Add lines 27 and 28 29

30 Prior year excess contributions. Subtract line 29 from line 26. If zero or less, enter -0- 30

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28

31 Excess contributions for 2001 (see page 3) 31

32 Total excess contributions. Add lines 30 and 31 32

33 Tax due. Enter 6% (.06) of the smaller of line 32 or the value of your Coverdell ESAs on December

31, 2001. Also include this amount on Form 1040, line 55 33

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Form 5329 (2001)

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