[voip

(CORRECTED

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

1 Regular IRA contributions
made in 1989 and 1990 for

$

2 Rollover IRA contributions

$

OMB No. 1545-0747

1989

Individual
Retirement
Arrangement
Information

TRUSTEE'S or ISSUER'S Federal identification no] PARTICIPANT'S social security number

3 Life insurance cost included in

$

Box 1

PARTICIPANT'S name (first, middle, last)

Street address

City, state, and ZIP code

4 Fair market value of account

$

Copy C
For Trustee or
Issuer

For Paperwork
Reduction Act
Notice and
instructions for
completing this

form, see
Instructions for
Forms 1099,

Account number (optional)

1098, 5498, 1096,

and W-2G.

Form 5498

(voip

(CORRECTED

Department of the Treasury - Internal Revenue Service

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

1 Regular IRA contributions
mgd in 1989 and 1990 for

$

2 Rollover IRA contributions

$

‘OMB No. 1545-0747

1989

Individual
Retirement
Arrangement
Information

TRUSTEE'S or ISSUER'S Federal identification no] PARTICIPANT'S social security number

3 Life insurance cost included in

$

Box 1

Copy C
For Trustee or

PARTICIPANT'S name (first, middle, last)

Street address

, state, and ZIP code

4 Fair market value of account

$

Issuer

For Paperwork
Reduction Act

Notice and
instructions for
completing this

form, see
Instructions for
Forms 1099,

‘Account number (optional)

11098, 5498, 1096,
and W-2G.

Form 5498

Clvoio

(CORRECTED

Department of the Treasury -

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

1 Regular IRA contributions
mgd in 1989 and 1990 for

$

‘OMB No. 1545-0747

2 Rollover IRA contributions

1989

$

Internal Revenue Service

Individual
Retirement
Arrangement
Information

TTRUSTEE'S or ISSUER'S Federal identification no] PARTICIPANT'S social security number

3 Life insurance cost included in

$

Box 1

Copy C
For Trustee or

PARTICIPANT'S name (first, middle, last)

Street address

City, state, and ZIP code

‘4 Fair market value of account

$

Issuer

For Paperwork
Reduction Act

Notice and
instructions for
completing this

form, see
Instructions for
Forms 1099,

‘Account number (optional)

11098, 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) to report
regular or rollover contributions made to your IRA and the
value of your IRA or simplified employee pension (SEP)
account.

If you or your spouse were an active participant in an
employer's pension plan, your IRA contributions may not be
deductible. See your Form 1040 or 1040A instructions for
details.

Box 1.—The amount shown is the contributions for 1989
made in 1989 and through April 16, 1990, to an IRA.

Box 2.—This is the amount of any rollover you made in
1989. You must report any distribution you received from a
plan on the appropriate line of your income tax return.
Subtract the part of the distribution that was rolled over and

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) to report
regular or rollover contributions made to your IRA and the
value of your IRA or simplified employee pension (SEP)
account.

If you or your spouse were an active participant in an
employer's pension plan, your IRA contributions may not be
deductible. See your Form 2040 or 1040A instructions for
details.

Box 1.—The amount shown is the contributions for 1989
made in 1989 and through April 16, 1990, to an IRA.

Box 2.—This is the amount of any rollover you made in
1989. You must report any distribution you received from a
plan on the appropriate line of your income tax return.
Subtract the part of the distribution that was rolled over and

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) to report
regular or rollover contributions made to your IRA and the
value of your IRA or simplified employee pension (SEP)
account.

If you or your spouse were an active participant in an
employer’s pension plan, your IRA contributions may not be
deductible. See your Form 1040 or 1040A instructions for
details.

Box 1.—The amount shown is the contributions for 1989
made in 1989 and through April 16, 1990, to an IRA.

Box 2.—This is the amount of any rollover you made in
1989. You must report any distribution you received from a
plan on the appropriate line of your income tax return.
Subtract the part of the distribution that was rolled over and

enter the taxable remainder on the appropriate line of your
income tax return. If you have ever made any nondeductible
contributions to your IRA, see the instructions for Form
1040. If property was rolled over, see Publication 590,
Individual Retirement Arrangements (IRAs).

Box 3.—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 to
compute the amount allowable for your IRA deduction.

Box 4.—This is the fair market value of your account at the
end of the year.

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

You are not required to attach a copy of Form 5498 to your
income tax return. Keep this form for your records.For
more information about IRAs, see Pub. 590.

enter the taxable remainder on the appropriate line of your
income tax return. If you have ever made any nondeductible
contributions to your IRA, see the instructions for Form
1040. If property was rolled over, see Publication 590,
Individual Retirement Arrangements (!RAs).

Box 3.—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 te
compute the amount allowable for your IRA deduction.

Box 4.—This is the fair market value of your account at the
end of the year.

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

You are not required to attach a copy of Form 5498 to your
income tax returr. Keep this form for your records.For
more information about IRAs, see Pub. 590.

enter the taxable remainder on the appropriate line of your
income tax return. If you have ever made any nondeductible
contributions to your IRA, see the instructions for Form
1040. If property was rolled over, see Publication 590,
Individuai Retirement Arrangements (IRAs).

Box 3.—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 to
compute the amount allowable for your IRA deduction.

Box 4.—This is the fair market value of your account at the
end of the year.

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

You are not required to attach a copy of Form 5498 to your
income tax return. Keep this form for your records.For
more information about IRAs, see Pub. 590.


2828 [voi

[CORRECTED

For Official Use Only

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

1 Regular IRA contributions
made n 1989 and 1990 for

$

2 Rollover IRA contributions

$

1989

(OMB No. 1545-0747

Individual
Retirement
Arrangement
Information

TRUSTEE'S or ISSUER'S Federal identification no| PARTICIPANT'S social security number

3 Life insurance cost included in Box 1

$

‘Type or machine print PARTICIPANT'S name (first, middle, last)

4 Fair market value of account

‘Street address

City, state, and ZIP code

‘Account number (optional)

CopyA

For Internal
Revenue
Service Center
For Paperwork
Reduction Act
Notice and
instructions for
completing this
form, see
Instructions for
Forms 1099,
1098, 5498, 1096,
and W-2G.

Form 5498

2428 Civoip

Department of the Treasury - Internal Revenue Service

Do NOT Cut or Separate Forms on This Page

[CORRECTED

For Official Use Only

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

T Regular IRA contribution
made in 1989 and 1990 for
1589

$

2 Rollover IRA contributions

$

‘OMB No. 1545-0747

1989

Individual
Retirement
Arrangement
Information

‘TRUSTEE'S or ISSUER'S Federal identification no] PARTICIPANT'S social security number

3 Life insurance cost included in Box 1

$

‘Type or machine print PARTICIPANT'S name (first, middie, last)

4 Fair market value of account

$

CopyA

For Internal
Revenue
Service Center

For Paperwork
Reduction Act

Street address.

Notice and
instructions for
completing this

City, state, and ZIP code

form, see
Instructions for
Forms 1099,

‘Account number (optional)

11098, 5498, 1096,
and W-2G.

Form 5498

2ara Cvoip

Do NOT Cut or Separate Forms on This Page

[CORRECTED

Department of the Treasury -

For Official Use Only

Internal Revenue Service

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

1 Regular IRA contributions
main 1989 and 1990 for

2 Rollover IRA contributions

$

(OMB No. 1545-0747

1989

Individual
Retirement
Arrangement
Information

TRUSTEE'S or ISSUER'S Federal identification no] PARTICIPANT'S social security number

3 Life insurance cost included in Box 1

Copy A
For Internal

‘Type or machine print PARTICIPANT'S name (first, middle, last)

4 Fair market value of account

$

Revenue
Service Center
For Paperwork
Reduction Act

Street address

Notice and
instructions for
completing this

City, state, and ZIP code

form, see
Instructions for
Forms 1099,

‘Account number (optional)

11098, 5498, 1096,
and W-2G.

Form 5498

Department of the Treasury - Internal Revenue Service




(_] CORRECTED (if checked)

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

1 Regular IRA contributions
made in 1989 and 1990 for

OMB No. 1545-0747

1989 Individual
$ Retirement
2 Rollover IRA contributions Arrangement
Information
$
TRUSTEE’S or ISSUER'S Federal identification no] PARTICIPANT'S social security number | 3 Life insurance cost included in Box 1
$ Copy B
PARTICIPANT'S name (first, middle, last) 4 Fair market value of account For
Participant
$ The information in
Street address Boxes 1, 2, 3, and
_ 4is being
City, state, and ZIP code fumished to the
Service.
Account number (optional)
Form 5498 Department of the Treasury - Internal Revenue Service

[CORRECTED (if checked)

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

1 Regular IRA contributions
made in 1989 and 1990 for

OMB No. 1545-0747

Individual
$ Retirement
2 Rollover IRA contributions Arrangement
Information
$
TRUSTEE'S or ISSUER'S Federal identification no] PARTICIPANT'S social security number | 3 Life insurance cost included in Box 1
$ Copy B
PARTICIPANT'S name (first, middle, last) 4 Fair market value of account For
Participant
$ The information in
Street address Boxes 1, 2, 3, and
4is being
mish hi
City, state, and ZIP code jfumished to the
Service.
Account number (optional)
Form 5498 Department of the Treasury - Internal Revenue Service
(CORRECTED (if checked)

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

1 Regular IRA contributions
made in 1989 and 1990 for

‘OMB No. 1545-0747

Individual
$ Retirement
2 Rollover IRA contributions Arrangement
Information
$
TRUSTEE'S or ISSUER'S Federal identification no] PARTICIPANT'S social security number | 3 Life insurance cost included in Box 1
$ Copy B
PARTICIPANT'S name (first, middle, last) 4 Fair market value of account For
Participant
$ The information in
Street address Boxes 1, 2,3, and
4 is being
furnished to the
City, state, and ZIP code Internal Revenue
Service.
Account number (optional)
Form 5498 Department of the Treasury - Internal Revenue Service