b"5498 PRE-PRINTED FORMSIndividual Laser Packs5498 (IRS CONTRIBUTION INFORMATION)2828 VOID CORRECTED DETACH BEFORE MAILINGMANUFACTURED ON OCR LASER BOND PAPER USING HEAT RESISTANT INKSTRUSTEES or ISSUERS name, street address, city or town, state orthan amounts in boxesOMB No. 1545-0747province, country, and ZIP or foreign postal code 1 IRA contributions (other 24, 810, 13a, and 14a) IRA $ 2024 Contribution 2 Rollover contributions Information$ Form 54983 Roth IRA conversion4 RecharacterizedCopy Aamount contributionsTRUSTEES or ISSUERS TIN PARTICIPANTS TIN $ 5 FMV of account $ 6 Life insurance cost included inInternal Revenue For box 1 Service Center$ $ File with Form 1096.PARTICIPANTS name 7IRA SEP SIMPLE8 SEP contributions 9 SIMPLE contributionsRoth IRA$ $ For Privacy Act Street address (including apt. no.) 10 Roth IRA contributions 11 Check if RMD for 2025 and Paperwork $ Reduction Act City or town, state or province, country, and ZIP or foreign postal code 12a RMD date 12b RMD amount Notice, see theCORRECTED (if checked)$ 2024 General Instructions for DETACH BEFORE MAILINGMANUFACTURED ON OCR LASER BOND PAPER USING HEAT RESISTANT INKSTRUSTEES or ISSUERS name, street address, city or town, state or 13a Postponed/late contrib.1 IRA contributions (other than amounts in boxes13b Year13c CodeOMB No. 1545-0747Certain IRA province, country, and ZIP or foreign postal code $ 24, 810, 13a, and 14a) Information14a Repayments $ 14b Code 2024Returns. Contribution $ 2 Rollover contributions InformationAccount number (see instructions) 15a assets $ 15b Code(s) Form 54983 Roth IRA conversion4 RecharacterizedCopy B$ amount contributionsForm5498 TRUSTEES or ISSUERS TIN41-0852411PARTICIPANTS TINwww.irs.gov/Form5498$ Department of the Treasury - Internal Revenue Service$Do Not Cut or Separate Forms on This PageDo Not Cut or Separate Forms on This Page For 5 FMV of account 6 Life insurance cost included in box 1 Participant$ $PARTICIPANT'Sname,stretadres,cityortown,stateorprovince,country,andZIPorforeignpostalcode 7IRA SIMPLE2828 VOID CORRECTED 8 SEP contributionsSEP 9 SIMPLE contributionsRoth IRA This information TRUSTEES or ISSUERS name, street address, city or town, state or1 IRA contributions (otherOMB No. 1545-0747$ is being $ furnished to province, country, and ZIP or foreign postal code than amounts in boxes10Roth IRA contributions 11distribution for 2025 IRAthe IRS.24, 810, 13a, and 14a) If checked, required minimum $ $ 2024 Contribution 12a RMD date 12b RMD amount2 Rollover contributions Form 5498 $ Information$ 13a Postponed/late contrib. 13b Year13c Code3 Roth IRA conversion4 Recharacterized14b Code Copy Aamount $14a RepaymentscontributionsTRUSTEES or ISSUERS TIN PARTICIPANTS TIN $ $ For 5 FMV of account $ 6 Life insurance cost included inInternal Revenue Account number (see instructions) $ 15a assets box 1 15b Code(s) Service Center$ File with Form 1096.PARTICIPANTS nameForm5498 7IRA SEP$ SIMPLE Department of the Treasury - Internal Revenue Service8 SEP contributions 9 SIMPLE contributionsRoth IRA(keep for your records) www.irs.gov/Form5498 For Privacy Act $ $ and Paperwork Street address (including apt. no.) 10 Roth IRA contributions 11 Check if RMD for 2025 Reduction Act $ Notice, see the City or town, state or province, country, and ZIP or foreign postal code 12a RMD date 12b RMD amount 2024 General province, country, and ZIP or foreign postal code $ CORRECTED (if checked)$ 13c CodeInstructions forCertainTRUSTEES or ISSUERS name, street address, city or town, state or 13a Postponed/late contrib.1 IRA contributions (other than amounts in boxes13b Year OMB No. 1545-0747Information 14a Repayments 24, 810, 13a, and 14a) Returns. Contribution IRA $ 14b Code 2024 Information$ 2 Rollover contributionsAccount number (see instructions) 15a assets $ 15b Code(s) Form 54983 Roth IRA conversion4 RecharacterizedCopy B$ amount contributionsForm5498 TRUSTEES or ISSUERS TIN PARTICIPANTS TIN $ Department of the Treasury - Internal Revenue ServiceL58A 41-0852411 5170 www.irs.gov/Form5498 $5 FMV of account 6 Life insurance cost included inFor box 1 Participant$ $PARTICIPANT'Sname,stretadres,cityortown,stateorprovince,country,andZIPorforeignpostalcode 7 8IRA SIMPLE This information SEP contributionsSEP 9 SIMPLE contributionsRoth IRA is being $ $ furnished to 10 Roth IRA contributions 11 If checked, required minimumthe IRS.$ distribution for 202512a RMD date 12b RMD amount$13a Postponed/late contrib. 13b Year13c Code$14a Repayments 14b Code$Account number (see instructions) 15a assets 15b Code(s)$Form5498 L58B (keep for your records) 5171 www.irs.gov/Form5498 Department of the Treasury - Internal Revenue ServiceRequired Envelope:APEX: DWMR or DWMRSTFP: 77771 or 77772APEX - Sheets per packTFP - Forms per pack50s500s100s1000sFORM DESCRIPTIONL58AL58A5005170N/A5498 Federal Copy A1 Page Equals 2 FormsL58BL58B50051715171B5498 Participant Copy B1 Page Equals 2 Forms15"