Form 5329 - Additional Taxes On Qualified Plans (Including Iras) And Other Tax-Favored Accounts - 2013 Page 2

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2
Form 5329 (2013)
Page
Part V
Additional Tax on Excess Contributions to Coverdell ESAs
Complete this part if the contributions to your Coverdell ESAs for 2013 were more than is allowable or you had an amount
on line 33 of your 2012 Form 5329.
26
Enter the excess contributions from line 32 of your 2012 Form 5329 (see instructions). If zero, go to line 31
26
27
If the contributions to your Coverdell ESAs for 2013 were less than the
maximum allowable contribution, see instructions. Otherwise, enter -0-
27
28
2013 distributions from your Coverdell ESAs (see instructions)
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28
29
29
Add lines 27 and 28
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30
Prior year excess contributions. Subtract line 29 from line 26. If zero or less, enter -0- .
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30
31
Excess contributions for 2013 (see instructions) .
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31
32
32
Total excess contributions. Add lines 30 and 31 .
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33
Additional tax. Enter 6% (.06) of the smaller of line 32 or the value of your Coverdell ESAs on
December 31, 2013 (including 2013 contributions made in 2014). Include this amount on Form
1040, line 58, or Form 1040NR, line 56 .
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33
Part VI
Additional Tax on Excess Contributions to Archer MSAs
Complete this part if you or your employer contributed more to your Archer MSAs for 2013 than is allowable or you had an
amount on line 41 of your 2012 Form 5329.
34
34
Enter the excess contributions from line 40 of your 2012 Form 5329 (see instructions). If zero, go to line 39
35
If the contributions to your Archer MSAs for 2013 are less than the
maximum allowable contribution, see instructions. Otherwise, enter -0-
35
36
36
2013 distributions from your Archer MSAs from Form 8853, line 8 .
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37
Add lines 35 and 36
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37
38
Prior year excess contributions. Subtract line 37 from line 34. If zero or less, enter -0- .
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38
39
39
Excess contributions for 2013 (see instructions) .
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40
40
Total excess contributions. Add lines 38 and 39 .
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41
Additional tax. Enter 6% (.06) of the smaller of line 40 or the value of your Archer MSAs on
December 31, 2013 (including 2013 contributions made in 2014). Include this amount on Form
1040, line 58, or Form 1040NR, line 56 .
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41
Part VII
Additional Tax on Excess Contributions to Health Savings Accounts (HSAs)
Complete this part if you, someone on your behalf, or your employer contributed more to your HSAs for 2013 than is
allowable or you had an amount on line 49 of your 2012 Form 5329.
42
Enter the excess contributions from line 48 of your 2012 Form 5329. If zero, go to line 47
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42
43
If the contributions to your HSAs for 2013 are less than the maximum
43
allowable contribution, see instructions. Otherwise, enter -0- .
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44
44
2013 distributions from your HSAs from Form 8889, line 16
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45
Add lines 43 and 44
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45
46
Prior year excess contributions. Subtract line 45 from line 42. If zero or less, enter -0- .
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46
47
47
Excess contributions for 2013 (see instructions) .
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48
Total excess contributions. Add lines 46 and 47 .
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48
49
Additional tax. Enter 6% (.06) of the smaller of line 48 or the value of your HSAs on December 31, 2013
(including 2013 contributions made in 2014). Include this amount on Form 1040, line 58, or Form 1040NR, line 56
49
Part VIII
Additional Tax on Excess Accumulation in Qualified Retirement Plans (Including IRAs)
Complete this part if you did not receive the minimum required distribution from your qualified retirement plan.
50
50
Minimum required distribution for 2013 (see instructions) .
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51
Amount actually distributed to you in 2013 .
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51
52
Subtract line 51 from line 50. If zero or less, enter -0-
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52
53
Additional tax. Enter 50% (.50) of line 52. Include this amount on Form 1040, line 58, or Form 1040NR, line 56
53
Under penalties of perjury, I declare that I have examined this form, including accompanying attachments, and to the best of my
Sign Here Only If You
knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which
preparer has any knowledge.
Are Filing This Form by
Itself and Not With Your
Tax Return
Your signature
Date
Print/Type preparer’s name
Preparer's signature
Date
PTIN
Paid
Check
if
self-employed
Preparer
Firm’s name
Firm's EIN
Use Only
▶
▶
Firm's address
Phone no.
▶
5329
Form
(2013)

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