OMB No. 1545-0203

form 5329 Return for Individual | ome No. 2545-0203

Retirement Arrangement Taxes
Department of the Treasury | (Under Sections 408(f), 409(c), 4973 and 4974 of the Internal Revenue Code)
Internal Revenue Service > Attach to Form 1040.

1981

Name

Your social security number

Address (Number and street)

City or town, State and ZIP code

[GEER Excess Contributions Tax for Individual Retirement Arrangements

If you have contributed either this year or in earlier years more to your IRA than is or was allow-
able as a deduction, and you have an excess contribution subject to tax, complete the following.

1 Excess contributions for 1981 (see specific instructions for line 1). Do NOT include this amount on Form 1040, line 24. . . «
2 Earlier year excess contributions not previously eliminated (see specific instructions for line 2)
3 Contribution credit. (If your maximum allowable deduction for 1981 is more than your actual
contribution, enter the difference; otherwise enter zero. See specific instructions for line 3) .
4 (a) Current year distributions out of your account that are included in your gross income .
(b) 1976 and 1977 excess contributions (if any) withdrawn in 1981. . . - - - + =

(c) 1978 through 1980 excess contributions (if any) withdrawn after the due date (including extensions) of your
1980 income tax return. If your total IRA contributions (other than rollover contributions) for any one tax
year were more than $1,750 ($7,500 if there is an employer contribution to a SEP) do not put the amount
of your withdrawn excess IRA contributions for that tax year on this line; put amount on line 4(a)_.
Note: If you took a deduction for the excess contributions described in (b) or (¢), do not
enter any amount on lines (b) or (c); put amount on line 4(a).

(@) Add lines 3 through 4(C). 0 ee ee ee Le

5 Adjusted earlier year excess contributions (line 2 minus line 4(d) but not lessthan zero). . . - 2 + +

6 Total excess contributions (add lines 1 and 5) . a
7 Tax (6% of line 6 or 6% of the value of your IRA on the last day of 1981, whichever is smaller.) Enter tax on Form 1040, line 52

QE Tax on Premature Distributions
If you received a distribution from your arrangement before you reached 5914, complete lines 8, 9, 1

0, and 11.

Also, enter the amount of the distribution on Form 1040, line 15. (See note in definition D in the instructions.)

8 If you entered into a prohibited transaction as described in definition C, borrowed any amount from one of your
individual retirement annuities, or pledged any part of one of your individual retirement annuity contracts,
enter 10% of the value of the account or annuity at the beginning ofthe year. . . . - se e+

9 Enter 10% of the amount of the distributions from your arrangement duringthe year. « - « + + + + «+

Do NOT include any:

(a) 1981 excess contributions returned during the year or 1980 excess contributions returned in 1981 before
the filing date of your 1980 income tax return

(b) “Rollover contributions” to another retirement arrangement or plan

(c) Amount distributed because of disability

(d) Amount transferred to a former spouse under a divorce decree

(e) Amount from an arrangement for which you made an entry on line 8

(f) Amount distributed from an arrangement because it was pledged as security for a loan

(g) 1976 and 1977 excess contributions withdrawn in 1981, if no deduction was allowed for the excess contributions or

(h) 1978 through 1980 excess contributions withdrawn after the due date (including extensions) of your 1980
income tax return (see specific instructions for line 4(c)).

10 Enter 10% of the amount from your indi
11 Total tax (add amounts on lines and 10). Enter here and on Form 1040, line 52. (See specific instructions for credits against tax)

(ETA Tax on Excess Accumulation in Individual Retirement Accounts and Ann

ane

G

12 Tax based on current year distribution method (See worksheet in Instructions) . . . . + + + + + =
13 Tax based on aggregate distribution method (See worksheet in Instructions) . . . - - - + + eee
14 Tax due. Enter amount from line 12 or, if aggregate distribution method is applicable, enter the smaller of line

12 or line 13. Also include this amount on Form 1040, line 52.0. ee ss

Under penalties of perjury, | declare that | have examined this return, including accompanying schedules and statements, and to the best

Please of my knowledge and belief, it is true, ‘correct, and complete. Declaration of preparer (other than taxpayer) is based on alll information of
. which preparer has any knowledge.
Sign
Here Dvaz ‘signature Vox
; Dat Check if oy sod ity no.

Paid Prepares > ate Gheck if Preparers socal security no
Preparer’s ployed _ b> C) u !

Firm's name (or El. No. 7
Use Only | yours, if self-employed) >

and address ZIP code p>

For Paperwork Reduction Act Notice, see page 1 of Instructions.
343-191-1 ‘fk US. GOVERNMENT PRINTING OFFICE : 198-—O-343-191

Form 5329 1981)