Free 2008 Form 8915 - Federal

Form

8915

Qualified Hurricane Retirement Plan Distributions and Repayments
Attach to Form 1040, Form 1040A, or Form 1040NR.

OMB No. 1545-0074

Department of the Treasury Internal Revenue Service

Attachment Sequence No.

2008
156

Name. If married, file a separate form for each spouse required to file Form 8915. See instructions.

Your social security number Apt. no.

Fill in Your Address Only If You are Filing This Form by Itself and Not With Your Tax Return

Home address (number and street, or P.O. box if mail is not delivered to your home)

City, town or post office, state, and ZIP code

Part I Qualified Hurricane Distributions From Retirement Plans (other than IRAs)
1 Enter the amount, if any, from your 2006 Form 8915, line 11, only if you did not check the box on that line Enter the amount, if any, from your 2007 Form 8915, line 8 Enter the amount, if any, from your 2007 Form 8915, line 3 Subtract line 3 from line 2. If zero or less, enter -0Enter the total amount of any repayments you made before filing your 2008 tax return. But do not include repayments made later than the due date (including extensions) for that return. See instructions Add lines 4 and 5 Amount subject to tax in 2008. Subtract line 6 from line 1. If zero or less, enter -0-. Include this amount in the total on Form 1040, line 16b; Form 1040A, line 12b; or Form 1040NR, line 17b 2 3 4 1

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Part II Qualified Hurricane Distributions From Traditional, SEP, SIMPLE, and Roth IRAs
8 Enter the amount, if any, from your 2006 Form 8915, line 26, only if you did not check the box on that line Enter the amount, if any, from your 2007 Form 8915, line 17 Enter the amount, if any, from your 2007 Form 8915, line 12 Subtract line 10 from line 9. If zero or less, enter -0Enter the total amount of any repayments you made before filing your 2008 tax return. But do not include repayments made later than the due date (including extensions) for that return. See instructions Add lines 11 and 12 Amount subject to tax in 2008. Subtract line 13 from line 8. If zero or less, enter -0-. Include this amount in the total on Form 1040, line 15b; Form 1040A, line 11b; or Form 1040NR, line 16b 9 10 11 8

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Sign Here Only If You Are Filing This Form by Itself and Not With Your Tax Return

Under penalties of perjury, I declare that I have examined this form, including accompanying attachments, and to the best of my 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.

Your signature

Date Date Check if selfemployed EIN Phone no. Cat. No. 37726T ( ) Form Preparer's SSN or PTIN

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Preparer's signature Firm's name (or yours if self-employed), address, and ZIP code

For Privacy Act and Paperwork Reduction Act Notice, see instructions.

8915

(2008)