com 5329 Return for Individual

Retirement Arrangement Taxes
(Under Sections 408(f), 409(c), 4973 and 4974 of the Internal Revenue Code)
Intcrnal Revenue Serves D Attach to Form 1040.

OMB No. 1545-0203

1983

Name Your social security number

Address (Number and street)

City or town, State and ZIP code

PART I.—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 allowable
as a deduction, and you have an excess contribution subject to tax, complete the following.

Excess contributions for 1983 (see instructions for line 1). Do not include this amount on Form 1040, line 25(a)
Earlier year excess contributions not previously eliminated (see instructions for line 2) .

ne

3 Contribution credit. (If your maximum allowable deduction for 1983 is more than your actual
contribution, enter the difference; otherwise enter zero. See instructions for line 3)

4 (a) 1983 distributions out of your account that are taxable

(b) 1982 tax year excess contributions (if any) withdrawn after the due date ‘(including extensions)
of your 1982 income tax return, and 1981 and earlier tax year excess contributions withdrawn in
1983 .

Do not enter ‘any wit withdrawn e: excess ‘contributions on line 4(b) if,i in the tax year (other than 1976 or

1977) that the excess contributions were made:

@ your total IRA contributions (other than rollover contributions) were more than $2,250 (or if
the total contributions for the year include employer contributions to a SEP, $2,250 increas-
ed by the lesser of the amount of the employer contributions to the SEP or $15, 000); or

@ you took a deduction for the excess contributions on your Form 1040.

Instead, enter these withdrawn excess contributions on line 4(a) of Form 5329 and also on line

16 of Form 1041

(c) Add lines 3 through 4(b)

5 Adjusted earlier year excess contributions (line on minus line 4(c) but not less than zero)

6 Total excess contributions (add lines 1 and5) .
7 Tax (6% of line 6 or 6% of the value of your IRA on the last day of ‘1983, whichever is smaller. ) Enter tax on Form: 1040, ‘line 55

PART 11.—Tax on Premature Distributions

If you received a distribution from your arrangement before you reached 59 1/2, complete lines 8, 9,
Also, enter the amount of the distribution on Form 1040, line 21.

10, and 11.

8 (a) 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 . :

(b) If in 1983 any part of your arrangement was invested in collectibles (see instructions for line 8()) include
10% of the cost of the collectible here . .

9 Enter 10% of the amount of the distributions from your ‘arrangement during they year ar (see instruction for line 9 for

items that are not considered taxable distributions) . .© ©... 1 ee ee ee

10 Enter 10% of the amount from your individual retirement savings accounts that you pledged as security fora loan .

11 Total tax (add lines 8(a) through 10). Enter here and on Form 1040, line 55. (See instructions for line 11 for credits against tax)

PART III.—Tax on Excess Accumulation in Individual Retirement Accounts and Annuities

12 Tax based on current year distribution method (see worksheet in Instructions) . . . . . 1...

13 Tax based on aggregate distribution method (see worksheet in Instructions) .

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, line 55 . .

Under penalties of perjury, | declare that | have examined this return, including accompanying schedules and statements, and to the best of my knowledge and
Please belief, it is true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
Sign
Here » Your signature » Date
. Preparer's Date Check if self- Preparer's social security no.
Paid signature employed > [] : :
Preparet’s |Fmsname (or El.No. > H
Use Only | yours, if self-employed)
and address ZIP code >

For Paperwork Reduction Act Notice, see page 1 of instructions.

Form 5329 (1983)