VOID CORRECTED

Regular IRA contributions

made in 1997 and 1998

for 1997

TRUSTEE’S or ISSUER’S name, street address, city, state, and ZIP code 1 IRA, SEP, or

SIMPLE

Retirement

Plan

Information

$

IRA, SEP, or SIMPLE

rollover contributions

2

$

TRUSTEE’S or ISSUER’S Federal identification no. PARTICIPANT’S social security number 3 Life insurance cost included in box 1

$

PARTICIPANT’S name 4 Fair market value of account

$

Street address (including apt. no.)

City, state, and ZIP code

Account number (optional)

Form 5498 Department of the Treasury - Internal Revenue Service

2828

Do NOT Cut or Separate Forms on This Page

Cat. No. 50010C

Copy A

For

Internal Revenue

Service Center

File with Form 1096.

For Paperwork

Reduction Act Notice

and instructions for

completing this form,

see the 1997

Instructions for

Forms 1099, 1098,

5498, and W-2G.

Form 5498

OMB No. 1545-0747

5 IRA

97

SEP SIMPLE

6 SEP contributions 7 SIMPLE contributions

$ $

Check

for
CORRECTED (if checked)

TRUSTEE’S or ISSUER’S name, street address, city, state, and ZIP code 1

$

IRA, SEP, or SIMPLE

rollover contributions

2

$

TRUSTEE’S or ISSUER’S Federal identification no. PARTICIPANT’S social security number 3 Life insurance cost included in box 1

$

PARTICIPANT’S name 4 Fair market value of account

$

Street address (including apt. no.)

City, state, and ZIP code

Account number (optional)

Form 5498 Department of the Treasury - Internal Revenue Service

For

Participant

Copy B

The information

in boxes 1 through

7 is being

furnished to the

Internal Revenue

Service.

(Keep for your records.)

Regular IRA contributions

made in 1997 and 1998

for 1997

Form 5498

OMB No. 1545-0747

97

IRA, SEP, or

SIMPLE

Retirement

Plan

Information

5 IRA SEP SIMPLE

6 SEP contributions 7 SIMPLE contributions

$ $
Instructions to Participant

The information in boxes 1 through 7 is submitted to the Internal

Revenue Service by the trustee or issuer of your individual retirement

arrangement (IRA), simplified employee pension (SEP), or savings

incentive match plan for employees (SIMPLE) to report contributions and

the fair market value of the account.

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.

If you or your spouse was an active participant in an employer’s

pension plan, your IRA contributions may not be deductible. See the

instructions for your income tax return for details.

Box 4.—This is the fair market value (FMV) of your IRA, SEP, or SIMPLE

account at the end of the year. However, if a decedent is shown as the

participant on this form, it may be the FMV on the date of death. If a

decedent’s name is shown as the participant and the FMV shown is zero,

the executor or administrator of the decedent’s estate may request a

date-of-death valuation from the financial institution.

Box 1.—Shows the regular IRA contributions for 1997 you made in 1997

and through April 15, 1998. These contributions may be deductible on

your income tax return.

Box 2.—Shows any rollover, including a direct rollover, you made in 1997

to your IRA, SEP, or SIMPLE. You must report the total distribution you

received from your plan 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, use

Form 8606, Nondeductible IRAs (Contributions, Distributions, and Basis)

to figure the taxable amount. If property was rolled over, see Pub. 590.

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,

SEPs, or SIMPLEs, see Pub. 590, and Pub. 560, Retirement Plans for

Small Business.

The trustee or issuer of the plan may use the other boxes on this form

to give you more information about your IRA, SEP, or SIMPLE. For

example, if you were an Operation Joint Endeavor (Bosnia Region)

participant and you made an IRA contribution for a prior year, box 7 may

show “JE” for Joint Endeavor, the year for which the contribution was

made, and the amount of the contribution.

Caution: If you are at least age 701⁄2, you must take minimum

distributions from your account. If you don’t, you may be subject to a

50% excise tax on the amount that should have been distributed. If you

inherited your IRA, certain minimum distribution rules apply. See Pub.

590, Individual Retirement Arrangements (IRAs, SEP-IRAs, and SIMPLE

IRAs), for minimum distribution methods.

Box 5.—Shows whether this Form 5498 is for your IRA, SEP, or SIMPLE.

Box 6.—Shows the SEP contributions made in 1997 on your behalf. Do

not deduct on your income tax return.

Box 7.—Shows the SIMPLE contributions made in 1997 on your behalf.

Do not deduct on your income tax return.
VOID CORRECTED

TRUSTEE’S or ISSUER’S name, street address, city, state, and ZIP code 1

$

IRA, SEP, or SIMPLE

rollover contributions

2

$

TRUSTEE’S or ISSUER’S Federal identification no. PARTICIPANT’S social security number 3 Life insurance cost included in box 1

$

PARTICIPANT’S name 4 Fair market value of account

$

Street address (including apt. no.)

City, state, and ZIP code

Account number (optional)

Form 5498 Department of the Treasury - Internal Revenue Service

For

Trustee

or Issuer

For Paperwork

Reduction Act

Notice and

instructions for

completing this

form, see the 1997

Instructions for

Forms 1099, 1098,

5498, and W-2G.

Copy C

Regular IRA contributions

made in 1997 and 1998

for 1997

Form 5498

OMB No. 1545-0747

97

IRA, SEP, or

SIMPLE

Retirement

Plan

Information

5 IRA SEP SIMPLE

6 SEP contributions 7 SIMPLE contributions

$ $

Check

for
Trustees and Issuers, Please Note—

Specific information needed to complete this

form and forms in the 1099 series is given in

the 1997 Instructions for Forms 1099, 1098,

5498, and W-2G. You can order those

instructions and additional forms by calling

1-800-TAX-FORM (1-800-829-3676).

Furnish Copy B of this form to the

participant by June 1, 1998. But furnish fair

market value information by February 2, 1998.

File Copy A of this form with the IRS by

June 1, 1998.