Instructions For Form 8889 - Health Savings Accounts - 2005 Page 5
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2
3
4
5exception for the distribution. Enter
You are not required to provide the
Lines 15a and 15b
10% of the amount from line 14 on
information requested on a form that
line 15b.
is subject to the Paperwork Reduction
Additional 10% Tax
Act unless the form displays a valid
Example 2. You turned age 65 in
HSA distributions included in income
OMB control number. Books or
2005. You received distributions that
(line 14) are subject to an additional
records relating to a form or its
are included in income both before
10% tax unless one of the following
instructions must be retained as long
and after you turned age 65. Check
exceptions apply.
as their contents may become
the box on line 15a because the
Exceptions to the Additional
material in the administration of any
additional 10% tax does not apply to
10% Tax
Internal Revenue law. Generally, tax
the distributions made after the date
returns and return information are
The additional 10% tax does not
you turned age 65. However, the
confidential, as required by section
apply to distributions made after the
additional 10% tax does apply to the
6103.
account beneficiary —
distributions made on or before the
•
Dies,
date you turned age 65. Enter on line
The average time and expenses
•
Becomes disabled (see page 1), or
15b, 10% of the amount of these
required to complete and file this form
•
Turns age 65.
distributions included in line 14.
will vary depending on individual
circumstances. For the estimated
If any of the exceptions apply to
averages, see the instructions for
any of the distributions included on
Paperwork Reduction Act Notice.
your income tax return.
line 14, check the box on line 15a.
We ask for the information on this
Enter on line 15b only 10% (.10) of
If you have suggestions for making
form to carry out the Internal
any amount included on line 14 that
this form simpler, we would be happy
Revenue laws of the United States.
does not meet any of the exceptions.
to hear from you. See the instructions
You are required to give us the
for your income tax return.
Example 1. You turned age 63 in
information. We need it to ensure that
2005 and received a distribution from
you are complying with these laws
an HSA that is included in income. Do
and to allow us to figure and collect
not check the box on line 15a
the right amount of tax.
because you (the account
beneficiary) did not meet the age
-5-
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