rom 5329 Return for Individual

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.

1980

Name

Your social security number

Address (Number and street)

City or town, State and ZIP code

[EE 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 1980 (see specific instruction forline1). . - 2 6 ee ee ee ee
2 Earlier year excess contributions not previously eliminated (see specific instructions for line 2)
3 Contribution credit. (If your maximum allowable deduction for 1980 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(b) 1976 and 1977 excess contributions (if any) withdrawn in 1980. . 2. 2. 2 ee

(c) 1978 and 1979 excess contributions (if any) withdrawn after the due date (including extensions) of your
1979 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year were more than $1,750 ($7,500 if SEP contributions) do not put the amount of your withdrawn excess
IRA contributions for that tax year on this line. . . - ee © eee ww ee
Note: If you took a deduction for the excess contributions described in (b) or (c), do not

enter any amount on lines (b) or (c).

(d) Add lines 3 through 4(c) 6 6 ee ee ee ee ee
5 Adjusted earlier year excess contributions (line 2 minus line 4(d) but not less than zero). « » © © + e ©
6 Total excess contributions (add lines land5). «© 6 ee ee ee ee ee ee ee
7 Excess contributions tax (6% of line 6 or 6% of the value of your IRA on the last day of 1980, whichever is
smaller). Enter tax on Form 1040, line 52... + ss

FEMME Tax on Premature Distributions

If you received a distribution from your arrangement before you reached age 591, complete the follow’

ing.

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 of the year. . - » + + + + + +

9 Enter 10% of the amount of the distributions from your arrangement during the year. » - . - + + +

Do NOT include any:

(a) 1980 excess contributions returned during the year or 1979 excess contributions returned in 1980 before
the filing date of your 1979 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 1980, if no deduction was allowed for the excess contributions or

(h) 1978 and 1979 excess contributions withdrawn after the due date (including extensions) of your 1979 in-
come tax return, see specific instructions for line 4(c).

10 Enter 10% of the amount from your individual retirement savings accounts that you pledged as security foraloan. . .» +» « «
11 Total tax (add amounts on lines 8, 9, and 10). Enter here and on Form 1040, line 52. (See specific instructions for credits against tax.) .

a

ESNSME Tax on Excess Accumulation in Individual Retirement Accounts and Annuities
See Part Ill of the Specific Instructions before completing this Part.

12 Tax based on current year distribution method (See worksheet in Instructions). . . 2 + 2 6 ee ee
13 Tax based on aggregate distribution method (See worksheet in Instructions). . . . + se 2 ee ee
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, line52. - - - + + + + + + +e ee
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 ail information of
" which preparer has any knowledge.
Sign
Here Dvax ‘signature an
Paid Preparer’s > Check if Preparer’s social security no.
Preparer’s | 20d date ployed p> C] i i
Firm's name (or. EI. No. i
Use Only | yours, if self-employed) > :
and address ZIP code D>
313-211-1 $x U.S, GOVERNMENT PRINTING OFFICE : 198—O-313-211 Form 5329 (1980)