Additional Taxes Attributable to IRAs, OMB No. 1545-0203

Other Qualified Retirement Plans, Annuities,

Modified Endowment Contracts, and MSAs

Form 5329

Department of the Treasury

Internal Revenue Service

Attachment

Sequence No. 29

(Under Sections 72, 530, 4973, and 4974 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 

13

Enter your excess contributions from line 16 of your 1999 Form 5329. If zero, go to line 15

13

14 14

If your traditional IRA contributions for 2000 are less than your

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

15

Taxable 2000 distributions from your traditional IRAs

15

2000 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 2000. 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 other than

an education IRA), annuity contract, or modified endowment contract before you reached age 591⁄2. If you received a

Form 1099-R that incorrectly indicates an early distribution (with no known exception to the additional tax) or you

received a Roth IRA distribution, you also may have to complete this part. See page 2 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 54 4

For Paperwork Reduction Act Notice, see page 4 of separate instructions. Cat. No. 13329Q Form 5329 (2000)

Apt. no.

Part I

Part II

If you only owe the 10% tax on early distributions, you may be

able to report this tax directly on Form 1040 without filing Form

5329. See Who Must File on page 1 of the instructions.

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 retirement plan, you

may have to include 25% of that amount on line 4 instead of 10%. See page 3 of the instructions.

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6

7

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Tax on Certain Taxable Distributions From Education (Ed) IRAs

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

Taxable distributions from your Ed IRAs, from Form 8606, line 30

9

10

Taxable distributions not subject to additional tax. See page 3 of the instructions

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 54

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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 2000 than is allowable or you had an excess

contribution on line 16 of your 1999 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,

2000 (including contributions for 2000 made in 2001). Also include this amount on Form 1040, line 54 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.

2000
Form 5329 (2000) 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 54 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 Medical Savings Accounts (MSAs)

Enter the excess contributions from line 40 of your 1999 Form 5329. If zero, go to line 39

Tax due. Enter 6% (.06) of the smaller of line 40 or the value of your MSAs on December 31,

2000. Also include this amount on Form 1040, line 54

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39

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Part VII

Part VI

Part V

34

35

Tax on Excess Contributions to Education (Ed) IRAs

Enter the excess contributions from line 32 of your 1999 Form 5329. If zero, go to line 31

If the contributions to your Ed IRAs in 2000 were less than the

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

36

37

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35

39

40

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43

44

36

37

38

If the contributions to your MSAs for 2000 are less than the maximum

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

Taxable 2000 distributions from your MSAs, from Form 8853, line 8

Add lines 35 and 36

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

Excess contributions for 2000. 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 MSAs in 2000 than is allowable or you had an

excess contribution on line 40 of your 1999 Form 5329.

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

an IRA other than an Ed IRA or Roth IRA).

Part IV Tax on Excess Contributions to Roth IRAs

Enter your excess contributions from line 24 of your 1999 Form 5329. If zero, go to line 23

If your Roth IRA contributions for 2000 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 2000 than is allowable or you had an excess contribution

on line 24 of your 1999 Form 5329.

20 2000 distributions from your Roth IRAs, from Form 8606, line 17

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 2000. 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, 2000

(including contributions for 2000 made in 2001). Also include this amount on Form 1040, line 54

25

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25

19

20

Complete this part if the contributions to your Ed IRAs in 2000 were more than is allowable or you had an excess

contribution on line 32 of your 1999 Form 5329.

28 2000 distributions from your Ed IRAs, 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

27

28

31 Excess contributions for 2000. See page 4 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 Ed IRAs on December 31,

2000. Also include this amount on Form 1040, line 54 33

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Form 5329 (2000)

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