L)voio LI CORRECTED

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

1 Regular IRA, SEP, or DEC
contributions made in 1985
for 1984

OMB No.1545-0747

1985

2 Regular IRA, SEP, or DEC
contributions made in 1985
and 1986 for 1985

Individual
Retirement
Arrangement
Information

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

3 Rollover IRA, SEP, or DEC contributions

Copy C
For Trustee or

PARTICIPANT'S name (first, middle, last)

Street address

City, state, and ZIP code

4 Life insurance cost included in

Box 2

Issuer
For Paperwork

Reduction Act
Notice and

instructions for
completing this
form, see

‘Account number (optional)

Instructions for
Form 1099 Series,
1098, 5498, and
1096.

Form 5498

L]voip = [| CORRECTED

Department of the Treasury

Internal Revenue Service

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

1 Regular IRA, SEP, or DEC
contributions made in 1985
for 1984

OMB No. 1545-0747

1985

2 Regular IRA, SEP, or DEC
contributions made in 1985
and 1986 for 1985,

Individual
Retirement
Arrangement
Information

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

3 Rollover IRA, SEP, or DEC contributions

Copy C
For Trustee or

PARTICIPANT'S name (first, middle, last)

Street address

City, state, and ZIP code

4 Life insurance cost included in

Box 2

Issuer
For Paperwork

Reduction Act
Notice and
instructions for

completing this
form, see

‘Account number (optional)

Instructions for
Form 1099 Series,
1098, 5498, and
1096.

Form 5498

[lvoi = [CORRECTED

Department of the Treasury -

Internal Revenue Service:

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

ular IRA, SEP, or DEC.
gontribytions made in 1985

‘OMB No. 1545-0747

Street address

City, state, and ZIP code

for 1984 Individual
1 985 Retirement
2 Regular IRA, SEP, or DEC Arrangement
ut de in 1985 ;
and 1986 for 1985 Information
TRUSTEE'S or ISSUER'S Federal identification no] PARTICIPANT'S social security number | 3 Rollover IRA, SEP, or DEC contributions Copy C
For Trustee or
PARTICIPANT'S name (first, middle, last) 4 Life insurance cost included in Box 2 Issuer

For Paperwork

Reduction Act
Notice and
instructions for

completing this
form, see

‘Account number (optional)

Instructions for
Form 1099 Series,
1098, 5498, and
1096.

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) or Simplified
Employee Pension (SEP) to report regular or rollover
contributions made to your IRA or SEP. The boxes may also
show information submitted by your employer on
deductible employee contributions (DEC’s) made by you to
the employer's pension plan.

Box 1.—The amount shown is the contributions made
during 1985 that you designated as a contribution for
1984. Do not deduct the amount shown in Box 1 on your
1985 tax return. This amount should have been. included in
the deduction on your 1984 tax return.

Box 2.—The amount shown is the contributions made in
1985 through April 15, 1986, for 1985. Deduct this
amount on your 1985 tax return.

°U.S. GOVERNMENT PRINTING OFFICE:

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) or Simplified
Employee Pension (SEP).to report regular or rollover
contributions made to your IRA or SEP. The boxes may also
show information submitted by your employer on
deductible employee contributions (DEC’s) made by you to
the employer's pension plan.

Box 1.—The amount shown is the contributions made
during 1985 that you designated as a contribution for
1984. Do not deduct the amount shown in Box 1 on your
1985 tax return. This amount should have been included in
the deduction on your 1984 tax return.

Box 2.—The amount shown is the contributions made in
1985 through April 15, 1986, for 1985. Deduct this
amount on your 1985 tax return.

* U.S. GOVERNMENT PRINTING OFFICE:

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) or Simplified
Employee Pension (SEP) to report regular or rollover
contributions made to your IRA or SEP. The boxes may also
show information submitted by your employer on
deductible employee contributions (DEC’s) made by you to
the employer's pension plan.

Box 1.—The amount shown is the contributions made
during 1985 that you designated as a contribution for
1984. Do not deduct the amount shown in Box 1 on your
1985 tax return. This amount should have been included in
the deduction on your 1984 tax return.

Box 2.—The amount shown is the contributions made in
1985 through April 15, 1986, for 1985. Deduct this
amount on your 1985 tax return.

© U.S. GOVERNMENT PRINTING OFFICE:

Box 3.—This is the amount of any rollover you made in
1985. Rollovers cannot be deducted on your tax return.
However, you must report any distribution you received.
from a plan on the appropriate line of Form 1040. Any
amount of the distribution that was rolled over will be
subtracted from the distribution and not included in your
income.

Box 4.—For endowment contracts only, this is the amount
allocable to the cost of life insurance. You cannot deduct
this amount on your tax return.

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 DEC.

You are not required to attach a copy of Form 5498 to your
income tax return. Keep this form for your records.

1984-423-260 B.T. NO. 43-1110209

Box 3.—This is the amount of any rollover you made in
1985. Rollovers cannot be deducted on your tax return.
However, you must report any distribution you.received
from a plan on the appropriate line-of Form 1040. Any
amount of the distribution that was rolled over will be
subtracted from the distribution and not included in your
income.

Box 4.—For endowment contracts only, this is the amount
allocable to the cost of life insurance. You cannot deduct
this amount’on your tax return.

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 DEC.

You are not required to attach a copy of Form 5498 to your
income tax return: Keep this form for your records.

1984-423-260 E.I. NO, 43-1110209

“Box 3.—This is the amount of any rollover you made in

1985. Rollovers cannot be deducted on your tax return.
However, you must report any distribution you received
from a plan on the appropriate line of Form 1040. Any
amount of the distribution that was rolled over will be
subtracted from the distribution and not included in your
income.

Box 4.—For endowment contracts only, this is the amount
allocable to the cost of life insurance. You cannot deduct
this amount on your tax return.

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 DEC.

You are not required to attach a copy of Form 5498 to your
income tax return. Keep this form for your records.

1984-423-260 E.I. NO. 43-1110209


2828 E]vo

1D [-] CORRECTED

For Official Use Only

E Type or machine print TRUSTEE’S or ISSUER'S name, street address, city, state,

T Regular IRA, SEP. or DEC
contributions made in 1985
for 1984

‘OMB No.1545-0747

| and ZIP code a
Individual
1 = 19) 85 Retirement
(2 Regular IRA, SEP, or DEC. Arrangement
ibuti 1d 1985 :
“Gnd 1986 for 1985 Information
"PARTICIPANT'S social security number | 3 Rollover IRA, SEP, or DEC contributions CopyA
- 3 - _ _ For Internal
@ Life surance cost cluded in Revenue

fests

ity, state, and ZIP code

[ Type or machine print PARTICIPANT'S name (first, middle, last)

Service Center
For Paperwork

Reduction Act
Notice and

instructions for
completing this
form, see

} Account number (optional)
i
q

Instructions for.
Form 1099 Series,

| 1098, 5498, and
1096.

Form 5498

2628 vol

Do NOT Cut or Separate Forms on This Page

ID [-] CORRECTED

For Official Use Only

Department of the Treasury - Internal Revenue Service

P Type or machine print TRUSTEE’S or ISSUER'S name, street address, city, state,

1 Regular IRA, SEP, or DEC

OMB No.1545-0747

[errr
City, state, and ZIP code

te _
} Account number (optional)

a

and ZIP code contributions made in 1985 a
E for 1984 Individual
— 4 985 Retirement
2 Regular IRA SEP. or DEG. Arrangement

ributions made in ;
I Snd 1986 for 1985. Information
F TRUSTEE'S or ISSUER'S Federal dentification no] PARTICIPANT'S social security number||3 Rollover IRA, SEP, or DEC contributions Copy A
i _ ceescenthe cs oo. —_ 7 For Internal
Type or machine print PARTICIPANT'S name (first, middle, last) “4 Life insurance cost included in Box 2 _ Revenue
Service Center
ha For Paperwork
Reduction Act
Street address © Notice and

instructions for
completing this
form, see
Instructions for
‘| Form 1099 Series,
1098, 5498, and
1096.

: s
Form 5498 Do NOT Cut or Separate Forms on This Page Department of the Treasury - Internal Revenue Service
2626 CORRECTED For Official Use Only

and ZIP code

Type or machine print TRUSTEE'S or ISSUER'S name. street address, city, state, J. 1 Regular IRA, SEP, or DEC |

contributions made in 1985
for 1984

‘2 Regular IRA, SEP, or DEC.
contributions made in 1985
and 1986 for 1985

OMB No. 1545-0747
Individual
1985 Retirement
Arrangement

Information

TRUSTEE'S or ISSUER'S Federal identification 1

3 Rollover IRA, SEP, or DEC contributions,

. Copy A
For Internal

/Street adaress

a sor
City, state, and ZIP code

Type or machine print PARTICIPANT'S name (first, middle, last)

4 Life insurance cost included in Box 2”

Revenue
Service Center
For Paperwork

Reduction Act
Notice and

instructions for
completing this
form, see

“Account number (optional)

Form 5498

Instructions for
|| Form 1099 Series,
1098, 5498, and

1096.

Department of the Treasury - Internal Revenue Service




[_] CORRECTED

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

Regular iRA, SEP. or DEC
conicbutions made in 1985
for 1984

OMB No. 1545-0747

individual

30

1985 Retirement
2 Regular IRA, SEP, or DEG, 5 Arrangement
and 1986 for 1985 Information

TRUSTEE’S ar ISSUER'S Federal dentfvction no] PARTICIPANT'S sacial security number | 3 Rollover IRA, SEP, or DEC contributions
Copy B
PARTICIPANT'S name (Hust, middle, last) 4 Life insurance cost included in Box 2 For
Participant

Street address

City. state, and ZIP code

The information in
Boxes 1, 2, 3,and

Account number (optional)

4s being
furnished to the
Internal Revenue

Service.

For 5498

|] CORRECTED

Department of the Treasury -

Internal Revenue Service

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

1 Regular IRA, SEP, or DEC.
gontebutions made m 1985

OMB No. 1545-0747

for a Individual
q 985 Retirement
2 Regular iRA, SEP, or DEC Arrangement
tributions made m 1985 j
snd 1986 for 1985 Information
TRUSTEE Sor ISSUER'S Federal dentfication vo] PARTICIPANT'S social sccunty number | 3 Rollover IRA, SEP, or DEC contributions
Copy B
PARTICIPANT'S name (tust, middle, last) , 4 Life insurance cost included in Box 2 For

Street address

City. state, and ZIP code

Participant

The information in
Boxes 1, 2, 3, and

4 is being
furnished to the
Internal Revenue

‘Account number (optional)

Service.

Form 5498

(CORRECTED

Department of the Treasury -

Internal Revenue Service

TRUSTEE'S or ISSUER'S name, street addréss, city, state, and ZIP cove 1 Regular IRA, SEP, or DEC. ‘OMB No. 1545-0747
‘ contributions made in 1985
for 1984 3 Individual
1985 Retirement
2 Reguiar IRA, SEP, or DEC.

Contributions made in 1985, Arrangement
and 1986 for 1985 Information

TRUSTEE'S or ISSUER'S Federal ioentitication no] PARTIC!PANT’S social security number | 3 Rollover IRA, SEP, or DEC contributions
—_ Copy B
PARTICIPANT'S name (first, middle, last) 4 Life insurance cost cluded in Box 2 For

Street address

City, state, and ZIP code

Participant

The information in
Boxes 1, 2, 3, and

4is being
furnished to the
Internal Revenue

Account number (optional)

Service.

Form 5498

Department of the Treasury

Internal Revenue Service