Form 8915 - Qualified Hurricane Retirement Plan Distributions And Repayments - 2006
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2OMB No. 1545-0074
8915
Qualified Hurricane Retirement
2006
Form
Plan Distributions and Repayments
Attachment
Department of the Treasury
Attach to Form 1040, Form 1040A, or Form 1040NR.
156
Sequence No.
Internal Revenue Service
Name. If married, file a separate form for each spouse required to file Form 8915. See instructions.
Your social security number
Home address (number and street, or P.O. box if mail is not delivered to your home)
Apt. no.
Fill in Your Address Only
If You are Filing This
Form by Itself and Not
City, town or post office, state, and ZIP code
With Your Tax Return
Part I
Total Distributions From All Retirement Plans (Including IRAs)
Complete this part only if you have qualified hurricane distributions for 2006 and the total of your qualified
hurricane distributions for 2005, if any, was less than $100,000 (see instructions).
Complete lines 1 through 5 of one column
before going to the next column
(a)
(b)
(c)
Total distributions
Qualified distributions
Allocation of column (b)
for 2006
(see instructions)
(see instructions)
Enter in columns (b) and (c) the amount, if any, from your
1
2005 Form 8915, line 4, column (b). If this amount is
$100,000 or more, do not complete this part, you have no
qualified hurricane distributions for 2006
2
Distributions from retirement plans
3
Distributions from traditional, SEP, and SIMPLE IRAs
4
Distributions from Roth IRAs
5
Totals. Add lines 1 through 4 in columns (a) and (b).
Complete column (c) only if line 5, column (b), is more than
100,000
00
$100,000
6
Subtract line 1 (in columns (b) and (c)) from $100,000
7
If you completed column (c), enter the excess of the amount on line 5, column (a), over the
amount on line 6, column (c). Otherwise, enter the excess of the amount on line 5, column (a),
over the sum of the amounts on lines 2 through 4 in column (b). Report these distributions under
the normal rules in accordance with the instructions for your tax return
7
Part II
Qualified Hurricane Distributions From Retirement Plans (other than IRAs)
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Did you enter an amount on line 2, column (b)?
No. Skip lines 8 through 11, and go to line 12.
Yes. If you completed line 2, column (c), enter that amount. Otherwise, enter the amount
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from line 2, column (b)
9
9
Enter the applicable cost of distributions, if any. See instructions
10
10
Subtract line 9 from line 8
11
If you elect NOT to spread the taxable amount over 3 years, check this box
and enter the amount from line 10. You must check this box if you check
11
the box on line 26. Otherwise, divide line 10 by 3.0
12
Enter the amount, if any, from your 2005 Form 8915, line 9. If you checked the box on that line,
12
enter -0-
13
13
Add lines 11 and 12
14
14
Enter the amount, if any, from your 2005 Form 8915, line 10
15
15
Enter the amount, if any, from your 2005 Form 8915, line 9
16
16
Subtract line 15 from line 14. If zero or less, enter -0-
17
Enter the total amount of any repayments you made before filing your 2006 tax return. But do
not include repayments made later than the due date (including extensions) for that return. See
17
instructions
18
18
Add lines 16 and 17
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Amount subject to tax in 2006. Subtract line 18 from line 13. 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
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8915
For Privacy Act and Paperwork Reduction Act Notice, see instructions.
Cat. No. 37726T
Form
(2006)
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