Retirement Arrangement Information

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VOID CORRECTED 2828 Cat. No. 50010C Do NOT Cut or Separate ms on This Page Copy A Internal Revenue Service Center File with m 1096. Paperwork Reduction Act Notice and instructions for completing this form, see Instructions for ms 1099, 1098, 5498, and W-2G.

Trustees and Issuers, Please Note Specific information needed to complete this form and forms in the 1099 series is given in the Instructions for ms 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 May 31, 1994. But furnish fair market value information by January 31, 1994. File Copy A of this form with the IRS by May 31, 1994.

CORRECTED (if checked) Copy B Participant The information in boxes 1, 2, 3, and 4 is being furnished to the Internal Revenue Service. (Keep for your records.)

Instructions to Participant The information in boxes 1, 2, 3, and 4 is submitted to the Internal Revenue Service by the trustee or issuer of your individual retirement arrangement (IRA) to report regular or rollover contributions made to your IRA and the value of your IRA or simplified employee pension (SEP) account. If you or your spouse was an active participant in an employer s pension plan, your IRA contributions may not be deductible. See your m 1040 or 1040A instructions for details. Box 1. The amount shown is the contributions made in 1993 and through April 15, 1994, to an IRA. Box 2. This is the amount of any rollover, including a direct rollover, you made in 1993. You must report the total distribution you received from your IRA 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. But if you have ever made any nondeductible contributions to your IRA, use m 8606, Nondeductible IRA Contributions, IRA Basis, and Nontaxable IRA Distributions, to figure the taxable amount. If property was rolled over, see Pub. 590, s (IRAs). Box 3. 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. Box 4. This is the fair market value (FMV) of your account at the end of the year. However, if a decedent is shown as the participant on this form, it may be the FMV at 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. The trustee or issuer of the plan may use the other boxes on this form to give you more information about your IRA. example, if you were a Desert Shield/Storm participant and you made an IRA contribution for a prior year, DS, the year for which the contribution was made, and the amount of the contribution may be shown. You are not required to attach a copy of to your income tax return. Keep this form for your records. more information about IRAs, see Pub. 590.

VOID CORRECTED Copy C Trustee or Issuer Paperwork Reduction Act Notice and instructions for completing this form, see Instructions for ms 1099, 1098, 5498, and W-2G.