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 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 ©

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 1996 (see page 3 of the instructions). Do not include this amount on

Form 1040, line 23a or 23b

5

6

6 Earlier year excess contributions not previously eliminated (see page

3 of the instructions)

7 Contribution credit. If your actual contribution for 1996 is less than

your maximum allowable contribution, see page 3 of the instructions;

otherwise, enter -0- 7

8

8 1996 distributions from your IRA account that are includible in taxable

income

9 1995 tax year excess contributions (if any) withdrawn after the due

date (including extensions) of your 1995 income tax return, and 1994

and earlier tax year excess contributions withdrawn in 1996 9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

11

11

12 Total excess contributions. Add lines 5 and 11 12

13 Tax due. Enter the smaller of 6% (.06) of line 12 or 6% (.06) of the value of your IRA on the

last day of 1996. Also enter this amount on Form 1040, line 48 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 (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 2 of the instructions) 1

Distributions excepted from additional tax (see page 2 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 48 4

For Paperwork Reduction Act Notice, see page 1 of separate instructions. Cat. No. 13329Q Form 5329 (1996)

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

96
Form 5329 (1996) Page 2

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

14 Minimum required distribution (see page 3 of the 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 48 17

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

Acceleration Elections (see the instructions for Part IV)

1

2

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 ©

© ©

©

©

If you elected the discretionary method in 1987 or 1988 and wish to make an acceleration election beginning in 1996

under Temporary Regulations section 54.4981A-1T, Q&A 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 exception number

from page 4 of the instructions © 

20 Subtract line 19 from line 18

21 Enter the larger of the threshold amount or the 1996 recovery of the

grandfather amount (from Worksheet 1 or 2). See page 4 of the 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 page 4 of the 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 48

18

19

20

21

22

23

24

25

26

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