Free 2008 Form 8930 - Federal

Form

8930

Qualified Disaster Recovery Assistance 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
164

Name. If married, file a separate form for each spouse required to file Form 8930. 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

Total Distributions From All Retirement Plans (Including IRAs) (See instructions.)
Complete lines 1 through 4 of one column before going to the next column
(a) Total distributions for 2008 (b) Qualified distributions (see instructions) (c) Allocation of column (b) (see instructions)

1 2 3 4

Distributions from retirement plans Distributions from traditional, SEP, and SIMPLE IRAs Distributions from Roth IRAs Totals. Add lines 1 through 3 in columns (a) and (b). Complete column (c) only if line 4, column (b), is more than $100,000 If you completed column (c), enter the excess of the amount on line 4, column (a), over $100,000. Otherwise, enter the excess of the amount on line 4, column (a), over the amount on line 4, column (b). Report these distributions under the normal rules in accordance with the instructions for your tax return or, if applicable, on line 21 of this form

100,000

00

5

5

Part II Qualified Disaster Recovery Assistance Distributions From Retirement Plans (other than IRAs)

6

If you completed line 1, column (c), enter that amount. Otherwise, enter the amount from line 1, column (b) Enter the applicable cost of distributions, if any. See instructions Subtract line 7 from line 6 If you elect NOT to spread the taxable amount over 3 years, check this box and enter the amount from line 8. You must check this box if you check the box on line 17. Otherwise, divide line 8 by 3.0 Enter 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 Amount subject to tax in 2008. Subtract line 10 from line 9. 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
Cat. No. 37744P

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7 8 9

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Form

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

8930

(2008)

Form 8930 (2008)

Page

2

Before you begin: Complete Form 8606, Nondeductible IRAs, if required.

Part III
12

Qualified Disaster Recovery Assistance Distributions From Traditional, SEP, SIMPLE, and Roth IRAs

13 14 15 16 17

Did you receive a qualified disaster recovery assistance distribution from a traditional, SEP, SIMPLE, or Roth IRA that is required to be reported on Form 8606? Yes. Go to line 13. No. Skip lines 13 and 14, and go to line 15. Enter the amount, if any, from Form 8606, line 15b Enter the amount, if any, from Form 8606, line 25b If you completed line 2, column (c), enter that amount. Otherwise, enter the amount from line 2, column (b). Do not include any amounts reported on Form 8606 Add lines 13, 14, and 15 If you elect NOT to spread the taxable amount over 3 years, check this box and enter the amount from line 16. You must check this box if you checked the box on line 9. Otherwise, divide line 16 by 3.0

13 14 15 16

17

Enter the total amount of any repayments you made before filing your 2008 tax return. But do not include any repayments made later than the due date (including extensions) for that return. See instructions 19 Amount subject to tax in 2008. Subtract line 18 from line 17. 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 Before you begin: Complete Form 8606, Nondeductible IRAs, if required.

18

18 19

Part IV

Qualified Distributions for the Purchase or Construction of a Main Home in a Midwestern Disaster Area
Complete this section only if you received a qualified distribution (as defined in the instructions) that you repaid, in whole or in part, before March 4, 2009.

20

Did you receive a qualified distribution from a traditional, SEP, SIMPLE, or Roth IRA that is required to be reported on Form 8606? Yes. Complete lines 21 through 25 only if you had qualified distributions not required to be reported on Form 8606. No. Go to line 21.

21

Enter the total amount of qualified distributions you received for the purchase or construction of a main home. Do not include any amounts reported on Form 8606. Also, do not include any 21 distributions you reported on line 6 or line 15. See instructions 22 22 Enter the applicable cost of distributions, if any. See instructions 23 23 Subtract line 22 from line 21 24 Enter the total amount of any repayments you made before March 4, 2009. Do not include any 24 repayments treated as qualified rollovers on Form 8606. See instructions 25 25 Taxable amount. Subtract line 24 from line 23 If the distribution is from an IRA, include this amount in the total on Form 1040, line 15b; Form 1040A, line 11b; or Form 1040NR, line 16b. If the distribution is from a retirement plan (other than an IRA), include this amount in the total on Form 1040, line 16b; Form 1040A, line 12b; or Form 1040NR, line 17b. Note: You may be subject to an additional tax on the amount on line 25. See instructions.

Sign Here Only If You Are Filing This Form by Itself and Not With Your Tax Return Paid Preparer's Use Only
Preparer's signature Firm's name (or yours if self-employed), address, and ZIP code

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 Check if selfemployed EIN Phone no. (

Date Preparer's SSN or PTIN

) Form

8930

(2008)