Form

Department of the Treasury

Internal Revenue Service

Qualified Hurricane Retirement

Plan Distributions and Repayments

OMB No. 1545-0074

 Attach to Form 1040, Form 1040A, or Form 1040NR.

Attachment

Sequence No. 156

Total Distributions From All Retirement Plans (Including IRAs) (See instructions.)

1

5 If you completed column (c), enter the excess of the amount on line 4, column (a), over $100,000.

Otherwise, enter the excess of the amount on line 4, column (a), over the amount on line 4,

column (b). Report these distributions under the normal rules in accordance with the instructions

for your tax return or, if applicable, on line 21 of this form

10

11

Part I

For Paperwork Reduction Act Notice, see instructions. Cat. No. 37726T Form 8915 (2005)

8915

Name. If married, file a separate form for each spouse required to file Form 8915. See instructions. Your social security number

5

10

Part II Qualified Hurricane Distributions From Retirement Plans (other than IRAs)

Amount subject to tax in 2005. Subtract line 10 from line 9. If zero or less, enter -0-. Include

this amount in the total on Form 1040, line 16b; Form 1040A, line 12b; or Form 1040NR,

line 17b

Enter the total amount of any repayments you made before filing your 2005 tax return. But do

not include repayments made later than the due date (including extensions) for that return.

See instructions

2005

 Fill in Your Address Only

If You are Filing This

Form by Itself and Not

With Your Tax Return

Home address (number and street, or P.O. box if mail is not delivered to your home)

City, town or post office, state, and ZIP code

Complete lines 1 through 4 of one column

before going to the next column

(a)

Total distributions

for 2005

(b)

Qualified distributions

(see instructions)

(c)

Allocation of column (b)

(see instructions)

Distributions from retirement plans

2 Distributions from traditional, SEP, and SIMPLE IRAs

3 Distributions from Roth IRAs

4 Totals. Add lines 1 through 3 in columns (a) and (b).

Complete column (c) only if line 4, column (b), is more than

$100,000 100,000

6 If you completed line 1, column (c), enter that amount. Otherwise, enter the amount from line 1,

column (b) 6

7 Enter the applicable cost of distributions, if any. See instructions 7

8 Subtract line 7 from line 6 8

9

9

11

If you elect NOT to spread the taxable amount over 3 years, check this box  

and enter the amount from line 8. You must check this box if you check

the box on line 17. Otherwise, divide line 8 by 3.0 

Apt. no.

00
Qualified Hurricane Distributions From Traditional, SEP, SIMPLE, and Roth IRAs

13

Did you receive a qualified hurricane distribution from a traditional, SEP, SIMPLE, or Roth IRA that

is required to be reported on Form 8606?

12

Form 8915 (2005)

Part III

Part IV

EIN 

Qualified Distributions for the Purchase or Construction of a Main Home

in a Hurricane Disaster Area

Complete this section only if you received a qualified distribution (as defined in the instructions) that you repaid, in

whole or in part, before March 1, 2006.

Date Preparer’s SSN or PTIN

Paid

Preparer’s

Use Only

Preparer’s

signature

Check if self-  employed 

 Firm’s name (or yours

if self-employed),

address, and ZIP code Phone no. ( )

Form 8915 (2005) Page 2

Yes. Go to line 13. No. Skip lines 13 and 14, and go to line 15.

13 Enter the amount, if any, from Form 8606, line 15b

14 Enter the amount, if any, from Form 8606, line 25b 14

15

If you completed line 2, column (c), enter that amount. Otherwise, enter the amount from line 2,

column (b). Do not include any amounts reported on Form 8606

15

16

17

18

16 Add lines 13, 14, and 15

If you elect NOT to spread the taxable amount over 3 years, check this box  

and enter the amount from line 16. You must check this box if you checked

the box on line 9. Otherwise, divide line 16 by 3.0

17

Enter the total amount of any repayments you made before filing your 2005 tax return. But do

not include any repayments made later than the due date (including extensions) for that return.

See instructions

18

Amount subject to tax in 2005. Subtract line 18 from line 17. If zero or less, enter -0-. Include this

amount in the total on Form 1040, line 15b; Form 1040A, line 11b; or Form 1040NR, line 16b

19

Before you begin: Complete Form 8606, Nondeductible IRAs, if required.

Did you receive a qualified distribution from a traditional, SEP, SIMPLE, or Roth IRA that is required

to be reported on Form 8606?

20

Yes. Complete lines 21 through 25 only if you had qualified distributions not required to be

reported on Form 8606.

No. Go to line 21.

21

Enter the total amount of qualified distributions you received for the purchase or construction of

a main home. Do not include any amounts reported on Form 8606. Also, do not include any

distributions you reported on line 6 or line 15. See instructions

21

22 Enter the applicable cost of distributions, if any. See instructions 22

23 Subtract line 22 from line 21 23

24

Enter the total amount of any repayments you made before March 1, 2006. Do not include any

repayments treated as qualified rollovers on Form 8606. See instructions

24

25 25 Taxable amount. Subtract line 24 from line 23

Please

Sign

Here

Under penalties of perjury, I declare that I have examined this form, including accompanying attachments, and to the best of my knowledge and

belief, it is true, correct, and complete.

Your signature Date

Note: You may be subject to an additional tax on the amount on line 25. See instructions.

● If the distribution is from an IRA, include this amount in the total on Form 1040, line 15b; Form 1040A, line 11b; or

Form 1040NR, line 16b.

● If the distribution is from a retirement plan (other than an IRA), include this amount in the total on Form 1040, line 16b;

Form 1040A, line 12b; or Form 1040NR, line 17b.

Signature. Complete only if you are filing this form by itself and not with your tax return.

Before you begin: Complete Form 8606, Nondeductible IRAs, if required.

19
Form 8915 (2005) Page 3

General Instructions

Section references are to the Internal

Revenue Code unless otherwise noted.

Purpose of Form

Use Form 8915 if you were adversely

affected by Hurricane Katrina, Rita, or

Wilma, and you received a distribution

that qualifies for favorable tax treatment.

Part I

Use Part I to figure your:

● Total distributions from all retirement

plans (including IRAs),

● Qualified distributions, and

● Distributions, other than qualified

hurricane distributions.

Parts II and III

Use Parts II and III to:

● Report any repayments of qualified

hurricane distributions, and

● Figure the taxable amount, if any, of

your qualified hurricane distributions.

Note. Distributions from retirement plans

(other than IRAs) are reported in Part II

and distributions from IRAs are reported

in Part III.

Part IV

Use Part IV of Form 8915 to:

● Report any repayments of qualified

distributions (not reported on Form

8606), and

● Figure the taxable amount, if any, of

your qualified distributions (not reported

on Form 8606).

File Form 8915 if either of the following

applies.

● You received a qualified hurricane

distribution from an eligible retirement

plan.

● You received a qualified distribution

for the purchase or construction of a

main home in the Hurricane Katrina,

Rita, or Wilma disaster area that you

repaid, in whole or in part, before

March 1, 2006.

Additional Information

See Pub. 4492, Information For

Taxpayers Affected by Hurricanes

Katrina, Rita, and Wilma, for more

details.

When and Where To File

File Form 8915 with your 2005 Form

1040, 1040A, or 1040NR. If you are not

required to file an income tax return but

are required to file Form 8915, sign

Form 8915 and send it to the Internal

Revenue Service at the same time and

place you would otherwise file Form

1040, 1040A, or 1040NR.

How Is a Qualified Hurricane

Distribution Taxed?

Generally, a qualified hurricane

distribution is included in your income in

equal amounts over 3 years. However, if

you elect, you can include the entire

distribution in your income in the year of

the distribution. If you received more

than one distribution during the year,

you must treat all distributions for that

year the same way. Any repayments

made before you file your return and by

the due date (including extensions),

reduce the amount of the distribution

included in your income.

A qualified hurricane distribution is any

distribution you received from an eligible

retirement plan if all of the following

conditions are met.

1. For a distribution made in 2005, the

distribution was made after:

a. August 24 for Hurricane Katrina.

b. September 22 for Hurricane Rita.

c. October 22 for Hurricane Wilma.

2. Your main home was located in a

hurricane disaster area listed below on

the date shown for that area.

a. August 28, 2005, for the Hurricane

Katrina disaster area. For this purpose,

that area includes the states of Alabama,

Florida, Louisiana, and Mississippi.

b. September 23, 2005, for the

Hurricane Rita disaster area. For this

purpose, that area includes the states of

Louisiana and Texas.

c. October 23, 2005, for the Hurricane

Wilma disaster area. For this purpose,

that area includes the state of Florida.

3. You sustained an economic loss

because of Hurricane Katrina, Rita, or

Wilma and your main home was in that

hurricane disaster area on the date in (2)

above for that hurricane. Examples of an

economic loss include, but are not

limited to (a) loss, damage to, or

destruction of real or personal property

from fire, flooding, looting, vandalism,

theft, wind, or other cause; (b) loss

related to displacement from your home;

or (c) loss of livelihood due to temporary

or permanent layoffs.

If (1) through (3) apply, you can

generally designate any distribution

(including periodic payments and

required minimum distributions) from an

eligible retirement plan as a qualified

hurricane distribution, regardless of

whether the distribution was made on

account of Hurricane Katrina, Rita, or

Wilma. Qualified hurricane distributions

are permitted without regard to your

need or the actual amount of your

economic loss.

A reduction or offset (after August 24,

2005, for Katrina; after September 22,

2005, for Rita, or after October 22, 2005,

for Wilma) of your account balance in an

eligible retirement plan in order to repay

a loan can also be designated as a

qualified hurricane distribution. See

Distribution of plan loan offsets below.

Limit. The total of your qualified

hurricane distributions from all plans is

limited to $100,000. If you have

distributions in excess of $100,000 from

more than one type of plan, such as a

401(k) plan and an IRA, you may allocate

the $100,000 limit among the plans any

way you choose.

Eligible retirement plan. An eligible

retirement plan can be any of the

following.

● A qualified pension, profit-sharing, or

stock bonus plan (including a 401(k)

plan).

● A qualified annuity plan.

● A tax-sheltered annuity contract.

● A governmental section 457 deferred

compensation plan.

● A traditional, SEP, SIMPLE, or Roth

IRA.

Distribution of plan loan offsets. A

distribution of a plan loan offset is a

distribution that occurs when, under the

terms of a plan, the participant’s

accrued benefit is reduced (offset) in

order to repay a loan. A distribution of a

plan loan offset amount can occur for a

variety of reasons, such as when a

participant terminates employment or

does not comply with the terms of

repayment. Plan loan offsets are treated

as actual distributions and are reported

on Form 1099-R, box 1.

Main home. Generally, your main home

is the home where you live most of the

time. A temporary absence due to

special circumstances, such as illness,

education, business, military service,

evacuation, or vacation, will not change

your main home.

● Report your qualified hurricane

distributions,

● Report that you received qualified

distributions for the purchase or

construction of a main home in the

Hurricane Katrina, Rita, or Wilma

disaster area that you repaid, in whole or

in part, before March 1, 2006.

Who Must File

Qualified Hurricane

Distribution

Also, qualified hurricane distributions

are not subject to the additional 10% tax

on early distributions.

Additional tax. Qualified hurricane

distributions are not subject to the

additional 10% tax (or the 25%

additional tax for certain distributions

from SIMPLE IRAs) on early distributions

and are not required to be reported on

Form 5329. However, any distributions

you received in excess of the $100,000

qualified hurricane distribution limit may

be subject to the additional tax.
Form 8915 (2005) Page 4

Exceptions. You cannot repay the

following types of distributions.

2. Required minimum distributions.

3. Periodic payments (other than from

an IRA) that are for:

a. A period of 10 years or more,

b. Your life or life expectancy, or

c. The joint lives or joint life

expectancies of you and your

beneficiary.

1. Qualified hurricane distributions

received as a beneficiary (other than a

surviving spouse).

You have 3 years from the day after

the date you received the distribution to

make a repayment. The amount of your

repayment cannot be more than the

amount of the original distribution.

Amounts that are repaid are treated as a

qualified rollover and are not included in

income. Also, for purposes of the

one-rollover-per-year limitation for IRAs,

a repayment to an IRA is not considered

a qualified rollover.

Include on Form 8915 any repayments

you make before filing your 2005 return.

Any repayments you make will reduce

the amount of qualified hurricane

distributions reported on your return for

2005. Do not include on your 2005 Form

8915 any repayments you make later

than the due date (including extensions)

for filing your 2005 return. If you make a

repayment in 2006 after you file your

2005 return, the repayment will reduce

the amount of your qualified hurricane

distributions included in income on your

2006 return, unless you are eligible to

amend your 2005 return. See Amending

Form 8915 on this page. Also, any

excess repayments you make for 2005

will be carried forward to your 2006

return.

Repayment of a Qualified

Distribution for the Purchase

or Construction of a Main

Home

If you received a qualified distribution to

purchase or construct a main home, you

can repay that distribution to an eligible

retirement plan after August 24, 2005

(Katrina), after September 22, 2005

(Rita), or after October 22, 2005 (Wilma),

and before March 1, 2006. For this

purpose, an eligible retirement plan is

any plan, annuity, or IRA to which a

qualified rollover can be made.

1. The distribution is a hardship

distribution from a 401(k) plan, a

hardship distribution from a

tax-sheltered annuity contract, or a

qualified first-time homebuyer

distribution from an IRA.

a. August 29 for Hurricane Katrina;

b. September 24 for Hurricane Rita;

c. October 24 for Hurricane Wilma.

3. The distribution was to be used to

purchase or construct a main home in

the Hurricane Katrina, Rita, or Wilma

disaster area that was not purchased or

constructed because of Hurricane

Katrina, Rita, or Wilma.

Amounts that are repaid before

March 1, 2006, are treated as a qualified

rollover and are not included in income.

For purposes of the one-rollover-peryear limitation for IRAs, a repayment to

an IRA is not considered a qualified

rollover.

A qualified distribution (or any portion

thereof) not repaid before March 1,

2006, may be taxable for 2005 and

subject to the additional 10% tax (or the

additional 25% tax for certain SIMPLE

IRAs) on early distributions.

You may be able to designate a

qualified distribution as a qualified

hurricane distribution if all of the

following apply.

1. The distribution was received in

2005:

a. After August 24 and before August

29 for Hurricane Katrina;

b. On September 23 for Hurricane

Rita; or

c. On October 23 for Hurricane Wilma.

2. The distribution (or any portion

thereof) is not repaid before March 1,

2006.

3. The distribution can otherwise be

treated as a qualified hurricane

distribution. See Qualified Hurricane

Distribution on page 3.

If, after filing your original return, you

make a repayment, the repayment may

reduce the amount of your qualified

hurricane distributions reported on that

return. Depending on when a repayment

is made, you may need to file an

amended tax return to refigure your

taxable income.

If you make a repayment by the due

date of your original return (including

extensions), include the repayment on

your amended 2005 Form 8915.

If you make a repayment after the due

date of your original return (including

extensions), include the repayment on

your 2006 Form 8915. However, you

may file an amended Form 8915 for

2005 if either of the following applies.

● You elected to include all of your

qualified hurricane distributions in

income (instead of over three years) on

your original return.

● The amount of the repayment exceeds

the amount of your qualified hurricane

distributions that are included in income

for 2006 and you choose to carry the

excess back to your 2005 tax return.

See the example below.

Example. You received a qualified

hurricane distribution in the amount of

$90,000 on October 15, 2005. You

choose to spread the $90,000 over 3

years ($30,000 in income for 2005, 2006,

and 2007). On November 19, 2006, you

make a repayment of $45,000. For 2006,

none of the qualified hurricane

distribution is included in income. The

excess repayment of $15,000

($45,000–$30,000) can be carried back

to 2005. Also, instead of carrying the

excess repayment back to 2005, you

can choose to carry it forward to 2007.

File Form 1040X, Amended U.S.

Individual Income Tax Return, to amend

a return you have already filed.

Generally, Form 1040X must be filed

within 3 years after the date the original

return was filed, or within 2 years after

the date the tax was paid, whichever is

later.

Specific Instructions

Name and social security number

(SSN). If you file a joint return, enter only

the name and SSN of the spouse whose

information is being reported on Form

8915. If both you and your spouse are

required to file Form 8915, file a

separate Form 8915 for each of you. If

you and your spouse are both filing

Forms 8915, the $100,000 limit on

qualified hurricane distributions and the

election to include all qualified hurricane

distributions in income are determined

separately for each spouse.

Part I—Total Distributions

From All Retirement Plans

Amending Form 8915 (including IRAs)

If you received a distribution from a

retirement plan (including an IRA), you

should receive a Form 1099-R. The

amount of the distribution should be

shown in Form 1099-R, box 1. Enter the

amounts from all your Forms 1099-R,

box 1, on the appropriate lines in

column (a).

Column (a)

Repayment of a Qualified

Hurricane Distribution

If you choose, you can generally repay

any portion of a qualified hurricane

distribution that is eligible for tax-free

rollover treatment to an eligible

retirement plan. Also, you can repay a

qualified hurricane distribution made on

account of hardship from a retirement

plan. However, see Exceptions below for

qualified hurricane distributions you

cannot repay.

Qualified Distribution for the

Purchase or Construction of

a Main Home

2. The distribution was received in

2005 after February 28 and before:

To be a qualified distribution, the

distribution must meet all of the

following requirements.
Form 8915 (2005) Page 5

Also include in column (b), if you

choose, any qualified distribution that is

eligible to be designated as a qualified

hurricane distribution (see Repayment of

a Qualified Distribution for the Purchase

or Construction of a Main Home on 

page 4).

Column (c)

Complete column (c), only if the total on

line 4, column (b), is more than

$100,000.

If the amount on line 4, column (b), is

more than $100,000, you will need to

make an allocation in column (c) of the

distribution(s) included in column (b).

This is because the total of your

qualified hurricane distributions cannot

exceed the $100,000 limit. If you have

distributions from more than one type of

retirement plan, such as an IRA and a

pension plan, you may allocate the

$100,000 limit among the plans any way

you choose.

Example 1. You received a

distribution from your Roth IRA in the

amount of $130,000 on October 1, 2005,

because of Hurricane Rita. You would

enter $130,000 on line 3, columns (a)

and (b). You would then enter $100,000

on line 3, column (c), since the

distribution is in excess of the $100,000

limit.

Example 2. Assume the same facts as

in Example 1, except on October 14,

2005, you also received a distribution

from your 401(k) plan in the amount of

$20,000 because of Hurricane Rita. You

would enter $20,000 on line 1, columns

(a) and (b). You will now need to make

an allocation in column (c) between the

two distributions, since the total on line

4, column (b), is $150,000. You can

choose to make the allocation in any

way, as long as the total in column (c)

does not exceed $100,000. You choose

to allocate $80,000 to your Roth IRA

distribution on line 3, column (c), and the

entire $20,000 to your 401(k) plan

distribution on line 1, column (c).

Line 5

If line 5 includes an amount distributed

for the purchase or construction of a

See the instructions for your tax return

for reporting all other distributions

included on line 5.

Part II—Qualified Hurricane

Distributions From

Retirement Plans (other than

IRAs)

Enter on line 7 your cost, if any. Your

cost is generally your net investment in

the plan. It does not include pre-tax

contributions. If there is an amount in

Form 1099-R, box 2a (taxable amount),

the difference between Form 1099-R,

box 1, and box 2a, is usually your cost.

Enter the difference on line 7.

If there is no amount in Form 1099-R,

box 2a, and the first box in box 2b is

checked, the issuer of Form 1099-R may

not have had all the facts needed to

figure the taxable amount. You may

want to get Pub. 575, Pension and

Annuity Income, to help figure your

taxable amount.

Also, see Pub. 575 if you use the

Simplified Method Worksheet to figure

the taxable amount of your periodic

payments and you designated some of

these payments as qualified hurricane

distributions.

Line 7

If you have a Form 1099-R

with both qualified hurricane

distributions and

non-qualified distributions,

you must separately calculate the cost

attributable to each distribution.

Line 9

If you do not check the box on line 9,

you must spread the amount on line 8

over 3 years. If you use this method to

figure the taxable amount of your

distributions, you cannot change it after

the due date (including extensions) for

your tax return.

If the taxpayer died during 2005 after

receiving a qualified hurricane

distribution, the distribution may not be

spread over 3 years. The entire

distribution must be reported on the tax

return of the deceased taxpayer.

Line 10

At any time during the 3-year period

after the date you received a qualified

hurricane distribution, you can repay any

portion of the distribution to an eligible

retirement plan that is permitted to

accept rollover contributions. You

cannot, however, repay more than the

amount of the original distribution. See

Repayment of a Qualified Hurricane

Distribution on page 4 for details.

Enter on line 10, the amount of any

repayments you made before filing your

2005 return. Do not include any

repayments made later than the due

date (including extensions) for that

return. If you repaid more than the

amount on line 9, the excess will be

carried forward to your 2006 tax return.

Repayments made after the due date of

your 2005 return (including extensions)

generally will be reported on your 2006

tax return. However, you may have to

file an amended return in certain

situations. See Amending Form 8915 on

page 4.

Example. You received a $90,000

qualified hurricane distribution on

November 7, 2005, from your 401(k) plan

because of Hurricane Wilma. On April 1,

2006, you repay $30,000 to an IRA. You

file your return on April 10, 2005. Since

the repayment was made before you

filed your return, and not later than the

due date (including extensions), you

would enter the $30,000 repayment on

line 10.

Part III—Qualified Hurricane

Distributions From

Traditional, SEP, SIMPLE,

and Roth IRAs

Complete Part III if you have an amount

entered on line 2, column (b), or line 3,

column (b).

Before completing this section,

complete Form 8606 if either of the

following applies.

● You received a qualified hurricane

distribution from a traditional, SEP, or

SIMPLE IRA, and you have a basis in

the IRA.

● You received a qualified hurricane

distribution from a Roth IRA.

For more information, see Form 8606

and its instructions.

Line 17

If you do not check the box on line 17,

you must spread the amount on line 17

over 3 years. If you use this method to

figure the taxable amount of your

distributions, you cannot change it after

the due date (including extensions) for

your tax return.

Include only those distributions you

wish to designate as qualified hurricane

distributions. See Qualified Hurricane

Distribution on page 3.

Column (b)

Enter on the appropriate lines in column

(b), any qualified hurricane distributions

(including periodic payments and

required minimum distributions) you

received in 2005 after:

● August 24 for Hurricane Katrina;

● September 22 for Hurricane Rita; and

● October 22 for Hurricane Wilma.

main home in the Hurricane Katrina,

Rita, or Wilma disaster area, but you did

not purchase or construct that home

because of Hurricane Katrina, Rita, or

Wilma, you may have to enter this

amount on line 21. See Part

IV—Qualified Distributions for the

Purchase or Construction of a Main

Home in a Hurricane Disaster Area on

page 6.

CAUTION

Complete Part II if you have an amount

entered on line 1, column (b).
Form 8915 (2005) Page 6

Enter on line 18, the amount of any

repayments you made before filing your

2005 return. Do not include any

repayments made later than the due

date (including extensions) for that

return. If you repaid more than the

amount on line 17, the excess will be

carried forward to your 2006 tax return.

Repayments made after the due date of

your 2005 return (including extensions)

generally will be reported on your 2006

tax return. However, you may have to

file an amended return in certain

situations. See Amending Form 8915 on

page 4.

Example. You received a $60,000

qualified hurricane distribution on

October 1, 2005, from your Roth IRA

because of Hurricane Katrina. On April 1,

2006, you repay $30,000 to your Roth

IRA. You file your return on April 10,

2006. Since the repayment was made

before you filed your return, and not

later than the due date (including

extensions), you would enter the

$30,000 repayment on line 18.

Part IV—Qualified

Distributions for the

Purchase or Construction of

a Main Home in a Hurricane

Disaster Area

Complete Part IV if you received a

qualified distribution for the purchase or

construction of a main home in the

Hurricane Katrina, Rita, or Wilma

disaster area that you repaid, in whole or

in part, before March 1, 2006.

If you are required to file Form 8606,

Nondeductible IRAs, complete that form

before you complete this section.

Line 21

Enter on line 21, your qualified

distributions (see Qualified Distribution

for the Purchase or Construction of a

Main Home on page 4).

Do not include any distributions you

designated as qualified hurricane

distributions reported on line 6 or line

15. Also, do not include any amounts

reported on Form 8606.

Line 22

Enter on line 22 your cost, if any. Your

cost is generally your net investment in

the plan. It does not include pre-tax

contributions. If there is an amount in

Form 1099-R, box 2a (taxable amount),

the difference between Form 1099-R,

box 1, and box 2a, is usually your cost.

See Publication 575, Pension and

Annuity Income, for more information

about figuring your cost in the plan.

In most cases, a hardship distribution

from a 401(k) plan or a tax-sheltered

annuity contract will not have any cost.

If you received a first-time homebuyer

distribution from an IRA, do not enter

any amount on line 22. Any cost or basis

in an IRA is figured on Form 8606 if you

made nondeductible contributions.

If you have a Form 1099-R

with both qualified

distributions and

non-qualified distributions,

you must separately calculate the cost

attributable to each distribution.

Line 24

At any time before March 1, 2006, you

can repay any portion of a qualified

distribution to an eligible retirement plan

that is permitted to accept qualified

Enter on line 24, the amount of any

repayments you make before March 1,

2006. Do not include any repayments

treated as qualified rollovers on

Form 8606.

Line 25

Most distributions from qualified

retirement plans (including IRAs) and

annuity contracts made to you before

you reach age 591⁄2 are subject to an

additional tax on early distributions and

are reported on Form 5329. Qualified

distributions for the purchase or

construction of a main home in a

qualified hurricane disaster area that

were not repaid to an eligible retirement

plan before March 1, 2006, may be

subject to this additional tax unless you

qualify for an exception. See the

instructions for Form 5329 for

information on exceptions to this tax.

Note. A qualified distribution for the

purchase or construction of a main

home made after August 24 and before

August 29 for Hurricane Katrina, on

September 23 for Hurricane Rita, or

October 23 for Hurricane Wilma, may be

treated as a qualified hurricane

distribution in certain circumstances.

See Repayment of a Qualified

Distribution for the Purchase or

Construction of a Main Home on page 4.

Paperwork Reduction Act Notice. We

ask for the information on this form to

carry out the Internal Revenue laws of

the United States. You are required to

give us the information. We need it to

ensure that you are complying with

these laws and to allow us to figure and

collect the right amount of tax.

You are not required to provide the

information requested on a form that is

subject to the paperwork reduction act

unless the form displays a valid OMB

control number. Books or records

relating to a form or its instructions must

be retained as long as their contents

may become material in the

administration of any Internal Revenue

law. Generally, tax returns and return

information are confidential, as required

by section 6103.

The average time and expenses

required to complete and file this form

will vary depending on individual

circumstances. For the estimated

averages, see the instructions for your

income tax return.

If you have suggestions for making

this form simpler, we would be happy to

hear from you. See the instructions for

your income tax return.

Line 18

At any time during the 3-year period

after the date you received a qualified

hurricane distribution, you can repay any

portion of the distribution to an eligible

retirement plan that is permitted to

accept rollover contributions. You

cannot, however, repay more than the

amount of the original distribution. See

Repayment of a Qualified Hurricane

Distribution on page 4 for details.

Line 20

If you check the “Yes” box, but are not

required to complete lines 21 through

25, you still must file Form 8915 to show

that you received a qualified distribution.

CAUTION

If the taxpayer died during 2005 after

receiving a qualified hurricane

distribution, the distribution may not be

spread over 3 years. The entire

distribution must be reported on the tax

return of the deceased taxpayer.

rollovers (see Repayment of a Qualified

Distribution for the Purchase or

Construction of a Main Home on page

4). You cannot, however, repay more

than the amount of the original

distribution.