Form 5498-Esa - Coverdell Esa Contribution Information - 2013 Page 3

CORRECTED

TRUSTEE’S or ISSUER'S name, street address, city or town, province or

1 Coverdell ESA contributions

OMB No. 1545-1815

Coverdell ESA

state, country, and ZIP or foreign postal code

2013

Contribution

Information

2 Rollover contributions

5498-ESA

Form

Copy B

TRUSTEE’S/ISSUER’S federal identification no. BENEFICIARY'S social security number

For Beneficiary

BENEFICIARY'S name

The information

in boxes 1 and 2

is being furnished

Street address (including apt. no.)

to the Internal

Revenue Service.

City or town, province or state, country, and ZIP or foreign postal code

Account number (see instructions)

5498-ESA

Form

(keep for your records)

Department of the Treasury - Internal Revenue Service

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Parent category: Financial