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Summary Record of Traditional IRA(s) for 2018 Appendix A. Keep for Your Records

Name ______________________________________ I was covered not covered by my employer's retirement plan during the year. I became 591/2 on ______________________________________(month) (day) (year) I became 701/2 on ______________________________________(month) (day) (year) Contributions Name of traditional IRA Date Amount contributed for 2018 Check if rollover contribution Fair Market Value of IRA as of December 31, 2018, from Form 5498 1. 2. 3. 4. 5. 6. 7. 8. Total Total contributions deducted on tax return . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ Total contributions treated as nondeductible on Form 8606 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ Distributions Name of traditional IRA Date Amount of Distribution Reason (for example, retirement, rollover, conversion, withdrawal of excess contributions) Income earned on IRA Taxable amount reported on income tax return Nontaxable amount from Form 8606, line 13 1. 2. 3. 4. 5. 6. 7. 8. Total Basis of all traditional IRAs for 2018 and earlier years (from Form 8606, line 14) . . . . . . . . . . . . . $ Note. You should keep copies of your income tax return, and Forms W-2, 8606, and 5498. Page 52 Publication 590-A (2018)

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Page 53

Official source

Summary Record of Traditional IRA(s) for 2018 Appendix A. Keep for Your Records

Name ______________________________________ I was covered not covered by my employer's retirement plan during the year. I became 591/2 on ______________________________________(month) (day) (year) I became 701/2 on ______________________________________(month) (day) (year) Contributions Name of traditional IRA Date Amount contributed for 2018 Check if rollover contribution Fair Market Value of IRA as of December 31, 2018, from Form 5498 1. 2. 3. 4. 5. 6. 7. 8. Total Total contributions deducted on tax return . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ Total contributions treated as nondeductible on Form 8606 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ Distributions Name of traditional IRA Date Amount of Distribution Reason (for example, retirement, rollover, conversion, withdrawal of excess contributions) Income earned on IRA Taxable amount reported on income tax return Nontaxable amount from Form 8606, line 13 1. 2. 3. 4. 5. 6. 7. 8. Total Basis of all traditional IRAs for 2018 and earlier years (from Form 8606, line 14) . . . . . . . . . . . . . $ Note. You should keep copies of your income tax return, and Forms W-2, 8606, and 5498. Page 52 Publication 590-A (2018)