Form 5498-Esa - Coverdell Esa Contribution Information - 2018 Page 4

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VOID
CORRECTED
TRUSTEE’S or ISSUER’S name, street address, city or town, state or
1 Coverdell ESA contributions
OMB No. 1545-1815
province, country, and ZIP or foreign postal code
Coverdell ESA
2018
$
Contribution
2 Rollover contributions
Information
5498-ESA
$
Form
Copy C
TRUSTEE’S/ISSUER’S TIN
BENEFICIARY’S TIN
For Trustee
BENEFICIARY’S name
For Privacy Act
and Paperwork
Reduction Act
Street address (including apt. no.)
Notice, see the
2018 General
City or town, state or province, country, and ZIP or foreign postal code
Instructions for
Certain
Information
Account number (see instructions)
Returns.
5498-ESA
Form
Department of the Treasury - Internal Revenue Service

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