‘OMB No. 1545-0747

Type or print | Individual Retirement
Trustee's or .
Issuer's Arrangement Information
name, address,

Hs" | copy c

fompere For trustee or issuer

Participant's social security | 1 IRA or SEP contributions
number

‘Type or print PARTICIPANT'S name, address, and ZIP code below

For Paperwork Reduction Act Notice and instructions for
completing this form, see Instructions for Form 1096.

Form 5498

Department of the Treasury—Internal Revenue Service

OMB No. 1545-0747

Type or print | Individual Retirement
Trustee’s or

Issuer's Arrangement Information
Zipcode, and”
Federal Copy C

ioe For trustee or issuer

Participant's social security | 1 IRA or SEP contributions
number

‘Type or print PARTICIPANT'S name, address, and ZIP code below

For Paperwork Reduction Act Notice and instructions for
completing this form, see Instructions for Form 1096.

Form 5498

Department of the Treasury—Internal Revenue Service

OMB_No. 1545-0747

Type or print | Individual Retirement
Trustee’s or .
Issuer's Arrangement Information
name, address,

Zip code, and | Cony C

Federal.
Kaontitying For trustee or issuer

Participant's social security | 1 IRA or SEP contributions
number

‘Type or print PARTICIPANT'S name, address, and ZIP code below

For Paperwork Reduction Act Notice and instructions for

completing this form, see Instructions for Form 1096.

Form 5498

Department of the Treasury—Internal Revenue Service


Instructions to Participant

The information in box 1 has been submitted to the Internal
Revenue Service by the trustee or issuer of your Individual Re-
tirement Arrangement (IRA) or Simplified Employee Pension
(SEP) to report contributions made to your IRA or SEP. The
amount may also represent information submitted by your em-
ployer on deductible employee contributions (DECs) made by
you to the employer's pension plan.

The amount in box 1 represents the contributions to the plan
during 1983, even though you may have designated some or all
of the payments for 1982. The amount should also include any
nondeductible rollover contributions made or arranged by you

(other than certain direct transfers between trustees) to the IRA
or SEP during 1983.

Do not deduct on your income tax return contributions includ-
ed in box 1 that you made during 1983 but designated for 1982
and deducted on your 1982 Form 1040, Also, do not deduct any
rollover contributions included in box 1. See the 1983 Form
1040 Instructions for information on how to figure your deduc-
tion for contributions to an IRA or SEP.

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

You are not required to attach a copy of Form 5498 to your
income tax return,

US. GOVERNMENT PRINTING OFFICE 198-263-102 E..# 362705514

Instructions to Participant

The information in box 1 has been submitted to the Internal
Revenue Service by the trustee or issuer of your Individual Re-
tirement Arrangement (IRA) or Simplified Employee Pension
(SEP) to report contributions made to your IRA or SEP. The
amount may also represent information submitted by your em-
ployer on deductible employee contributions (DECs) made by
you to the employer’s pension plan.

The amount in box 1 represents the contributions to the plan
during 1983, even though you may have designated some or all
of the payments for 1982. The amount should also include any
nondeductible rollover contributions made or arranged by you

(other than certain direct transfers between trustees) to the IRA
or SEP during 1983.

Do not deduct on your income tax return contributions includ-
ed in box 1 that you made during 1983 but designated for 1982
and deducted on your 1982 Form 1040. Also, do not deduct any
rollover contributions included in box 1. See the 1983 Form
1040 Instructions for information on how to figure your deduc-
tion for contributions to an IRA or SEP.

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

You are not required to attach a copy of Form 5498 to your
income tax return.

U.S, GOVERNMENT PRINTING OFFICE 1983-363-102 £1. 36-2705514

Instructions to Participant

The information in box 1 has been submitted to the Internal
Revenue Service by the trustee or issuer of your Individual Re-
tirement Arrangement (IRA) or Simplified Employee Pension
(SEP) to report contributions made to your IRA or SEP. The
amount may also represent information submitted by your em-
ployer on deductible employee contributions (DECs) made by
you to the employer's pension plan.

The amount in box 1 represents the contributions to the plan
during 1983, even though you may have designated some or all
of the payments for 1982. The amount should also include any
nondeductible rollover contributions made or arranged by you

(other than certain direct transfers between trustees) to the IRA
or SEP during 1983.

Do not deduct on your income tax return contributions includ-
ed in box 1 that you made during 1983 but designated for 1982
and deducted on your 1982 Form 1040. Also, do not deduct any
rollover contributions included in box 1, See the 1983 Form
1040 Instructions for information on how to figure your deduc-
tion for contributions to an IRA or SEP.

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

You are not required to attach a copy of Form 5498 to your
income tax return.

‘U.S. GOVERNMENT PRINTING OFFICE 1983-363-102 E.L¢ 36.2708514


‘Type or print
Trustee's or
Issuer's

name, address,
ZIP code, and
Federal
identifying
number

OMB No. 1545-0747

19

Individual Retirement
Arrangement Information
Copy A

For Internal Revenue
Service Center

For Official Use Only ]
Participant's social security | 1 IRA or SEP contributions
number
‘oO
Type or print PARTICIPANT'S name, address, and ZIP code below (Name must
align with arrow.)
me >

For Paperwork Reduction Act Notice and instructions for
completing this form, see Instructions for Form 1096.

Form 5498

‘Type or print
Trustee's or
Issuer's

name, address,
ZIP code, and
Federal
identifying
number

Department of the Treasury—-Internal Revenue Service

OMB No. 1545-0747

19

Individual Retirement
Arrangement Information
Copy A

For Internal Revenue
Service Center

Participant's social security [J 1 IRA or SEP contributions

number
‘oO
Type or print PARTICIPANT'S name, address, and ZIP code below (Name must
align with arrow.)
ime
For Paperwork Reduction Act Notice and instructions for
completing this form, see Instructions for Form 1096.
Form 5498 Department of the Treasury—Internal Revenue Service
1 OMB No, 1545-0747
For Official Use Only | 19.
Type or print ivi H
Trustee's or Individual Retirement ;
Issuer's Arrangement Information

name, address,
ZIP code, and
Federal
identifying
number

Copy A
For Internal Revenue
Service Center

security [| 1 IRA or SEP contributions

Type or print PARTICIPANT'S name, address, and ZIP code below (Name must
align with arrow.)
ime >

For Paperwork Reduction Act Notice and instructions for
completing this form, see Instructions for Form 1096.

i
Form 5498

Department of the Treasury—Internal Revenue Service




‘Type or print
Trustee's or
Issuer's

name, address,
ZIP code, and
Federal
identifying
number

OMB No. 1545-0747

Individual Retirement
Arrangement Information

Copy B
For Recipient's Records

Participant's social security | 1 IRA or SEP contributions
number

Type or print PARTICIPANT'S name, address, and ZIP code below

This information is being furnished to the Internal Revenue
Service. See back of this copy for instructions.

Form 5498

Department of the Treasury—Internal Revenue Service

Type or print
Trustee's or
Issuer's

name, address,
ZIP code, and
Federal
identifying
number

OMB_No. 1545-0747
19

Individual Retirement

Arrangement Information

Copy B
For Recipient’s Records

Participant's social security | 1 IRA or SEP contributions
number

‘Type or print PARTICIPANT'S name, address, and ZIP code below

This information is being furnished to the Internal Revenue
Service. See back of this copy for instructions.

Form 5498

Department of the Treasury—Internal Revenue Service

Type or print
Trustee's or
Issuer's

name, address,
ZIP code, and
Federal
identifying
number

OMB No. 1545-0747

Individual Retirement
Arrangement Information

Copy B
For Recipient's Records

Participant's social security | 1 IRA er SEP contributions
number

‘Type or print PARTICIPANT'S name, address, and ZIP code below

This information is being furnished to the Internal Revenue
Service. See back of this copy for instructions.

Form 5498

Department of the Treasury—Internal Revenue Service