Form 5498-Qa - Able Account Contribution Information - 2017

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VOID
CORRECTED
2A2A
ISSUER'S name, street address, city or town, state or province, country, and
1 ABLE contributions
OMB No. 1545-2262
ZIP or foreign postal code
ABLE Account
2017
$
Contribution
2 Rollover contributions
Information
5498-QA
$
Form
Copy A
ISSUER’S federal identification no.
BENEFICIARY'S social security number
3 Cumulative contributions
4 Fair market value
$
$
For
Internal Revenue
BENEFICIARY'S name
5 Check if account opened
6 Basis of eligibility
Service Center
in 2017
File with Form 1096.
Street address (including apt. no.)
7 Code
For Privacy Act and
Paperwork Reduction
Act Notice, see the
City or town, state or province, country, and ZIP or foreign postal code
2017 General
Instructions for
Certain Information
Account number (see instructions)
Returns.
5498-QA
Form
Cat. No. 67556T
Department of the Treasury - Internal Revenue Service
Do Not Cut or Separate Forms on This Page — Do Not Cut or Separate Forms on This Page

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