Lvoip

L_] CORRECTED

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

1 Regular IRA contributions
made in 1990 and 1991 for
1990

$

2 Rollover IRA contributions

$

OMB No. 1545-0747

1990

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

Street address

City, state, and ZIP code

4 Fair market value of account

$

‘Account number (optional)

Copy C
For Trustee or
Issuer

For Paperwork
Reduction Act
Notice and
instructions for
completing this
form, see
Instructions for
Forms 1099,
1098, 5498,
and W-2G

Form 5498

Cvoip

Department of the Treasury - Internal Revenue Service

[ICORRECTED

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

1 Regular IRA contributions
made in 1990 and 1991 for
1990

(OMB No. 1545-0747

PARTICIPANT'S name

Street address

City, state, and ZIP code

4 Fair market value of account

$

Account number (optional)

Individual
$ 1990 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 Cc
$ For Trustee or
Issuer

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

Form 5498

Cvoip

[cCoRRECTED

Department of the Treasury

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

1 Regular IRA contributions
made in 1980 and 1991 for
1990

OMB No. 1545-0747

Internat Revenue Service

PARTICIPANT'S name

Street address

City, state, and ZIP code

‘4 Fair market value of account

$

‘Account number (optional)

Individual
$ 1990 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 C
$ For Trustee or
Issuer

For Paperwork
Reduction Act
Notice and
instructions for
completing this
form, see
Instructions for
Forms 1099,
1098, 5498,
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 1990
made in 1990 and through April 15, 1991, to an IRA.

Box 2.—This is the amount of any rollover you made in
1990. You must report the total distribution you received
from your IRA 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

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 1990
made in 1990 and through April 15, 1991, to an IRA.

Box 2.—This is the amount of any rollover you made in
1990. You must report the total distribution you received
from your IRA 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

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 1990
made in 1990 and through April 15, 1991, toan IRA.

Box 2.—This is the amount of any rollover you made in
1990. You must report the total distribution you received
from your IRA 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 (FMV) of your account
at the end of the year. However, if a decedent is shown as.
the participant on this form, it may be the FMV at date of
death. If a decedent’s name is shown as the participant and
the FMV shown is -0-, the executor or administrator of the
decedent's estate may request a date-of-death valuation
from the financial institution.

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.

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 !RA contribution included in Box 1 to
compute the amount allowable for your IRA deduction.

Box 4.—This is the fair market value (FMV) of your account
at the end of the year. However, if a decedent is shown as
the participant on this form, it may be the FMV at date of
death. if a decedent’s name is shown as the participant and
the FMV shown is -0-, the executor or administrator of the
decedent's estate may request a date-of-death valuation
from the financial institution.

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.

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 (FMV) of your account
at the end of the year. However, if a decedent is shown as
the participant on this form, it may be the FMV at date of
death. If a decedent's name is shown as the participant and
the FMV shown is -0-, the executor or administrator of the
decedent's estate may request a date-of-death valuation
from the financial institution.

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 Civoip

(_] CORRECTED

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

1 Regular IRA contributions
made in 1990 and 1991 for
1990

$

‘OMB No. 1545-0747

2 Rollover IRA contributions

$

4990

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

4 Fair market value of account

$

Street address

City, state, and ZIP code

‘Account number (optional)

Copy A

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

Form 5498

2828 Cvoip

[CORRECTED

Department of the Treasury - Internal Revenue Service

Do NOT Cut or Separate Forms on This Page

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

1 Regular IRA contributions
mage in 1990 and 1991 for
1990

$

2 Rollover IRA contributions

$

OMB No. 1545-0747

1990

Individual
Retirement
Arrangement
Information

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

3 Life msurance cost included in Box 1

$

‘Type or machine print PARTICIPANT'S name

4 Fair market value of account

Street address

City, state, and ZIP code

‘Account number (optional)

Copy A

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

Form 5498

2828 Cvoio

LI CORRECTED

Department of the Treasury - Internal Revenue Service

Do NOT Cut or Separate Forms on This Page

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

1 Regular IRA contributi
Tage in 1990 and 1991 for
1380

$

OMB No. 1545-0747

2 Rollover IRA contributions

$

4990

Individual
Retirement
Arrangement
Information

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

3 Life nsurance cost included in

$

Box 1

‘Type or machine print PARTICIPANT'S name

4 Fair market value of account

$

Street address

City, state, and ZIP code

‘Account number (optional)

Copy A

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

Form 5498

Department of the Treasury - Internal Revenue Service

Do NOT Cut or Separate Forms on This Page




[J CORRECTED (if checked)

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

1 Regular IRA contributions

‘OMB No. 1545-0747

made in 1990 and 1991 for
1990 Individual
$ 4990 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
4 Fair market value of account For

PARTICIPANT'S name

Participant

$ The information in
Street address Boxes 1, 2, 3, and
4is being
furnished to the
City, state, and ZIP code Internal Revenue
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

OMB No. 1545-0747

made in 1990 and 1991 for .
1990 Individual
$ 1990 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. 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
[_] CORRECTED (if checked)

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

1 Regular IRA contributions
made in 1990 and 1991 for

OMB No. 15450747

Street address

City, state, and ZIP code

$

Individual
$ 1990 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 4 Fair market value of account For
Participant

The information in

Boxes 1, 2, 3, and
‘4is being
furnished to the

Internal Revenue
Service.

‘Account number (optional)

Form 5498

Department of the Treasury - Internat Revenue Service