OMB No. 1545-0074
                                      Additional Taxes on Qualified Plans 
Form  5329                  (Including IRAs) and Other Tax-Favored Accounts
Department of the Treasury                      Attach to Form 1040, 1040-SR, or 1040-NR.                                                      2022
                                                                                                                                               Attachment   
Internal Revenue Service        Go to www.irs.gov/Form5329 for instructions and the latest information.                                        Sequence No. 29
Name of individual subject to additional tax. If married filing jointly, see instructions.                                                 Your social security number 

                            Home address (number and street), or P.O. box if mail is not delivered to your home                                Apt. no.

Fill in Your Address Only   City, town or post office, state, and ZIP code. If you have a foreign address, also complete the spaces 
if You Are Filing This      below. See instructions.
Form by Itself and Not                                                                                                                     If this is an amended 
With Your Tax Return                                                                                                                       return, check here
                            Foreign country name                                             Foreign province/state/county                 Foreign postal code

If you only owe the additional 10% tax on the full amount of the early distributions, you may be able to report this tax directly on 
Schedule 2 (Form 1040), line 8, without filing Form 5329. See instructions.
Part I      Additional Tax on Early Distributions.        Complete this part if you took a taxable distribution (other than a qualified 
            disaster  distribution)  before  you  reached  age  59½  from  a  qualified  retirement  plan  (including  an  IRA)  or  modified 
            endowment contract (unless you are reporting this tax directly on Schedule 2 (Form 1040)—see above). You may also 
            have to complete this part to indicate that you qualify for an exception to the additional tax on early distributions or for 
            certain Roth IRA distributions. See instructions.
1      Early distributions includible in income (see instructions). For Roth IRA distributions, see instructions.                           1 
2      Early distributions included on line 1 that are not subject to the additional tax (see instructions).
       Enter the appropriate exception number from the instructions:                                 . . . .  .            . . . . .        2 
3      Amount subject to additional tax. Subtract line 2 from line 1 .                         . . . . . . .  .            . . . . .        3 
4      Additional tax. Enter 10% (0.10) of line 3. Include this amount on Schedule 2 (Form 1040), line 8  .                        .        4 
       Caution: If any part of the amount on line 3 was a distribution from a SIMPLE IRA, you may have  to 
       include 25% of that amount on line 4 instead of 10%. See instructions.
Part II     Additional Tax on Certain Distributions From Education Accounts and ABLE Accounts. Complete this part 
            if you included an amount in income, on Schedule 1 (Form 1040), line 8z, from a Coverdell education savings account 
            (ESA) or a qualified tuition program (QTP), or on Schedule 1 (Form 1040), line 8q, from an ABLE account.
5      Distributions included in income from a Coverdell ESA, a QTP, or an ABLE account                       .            . . . . .        5 
6      Distributions included on line 5 that are not subject to the additional tax (see instructions)                        . . . .        6 
7      Amount subject to additional tax. Subtract line 6 from line 5 .                         . . . . . . .  .            . . . . .        7 
8      Additional tax. Enter 10% (0.10) of line 7. Include this amount on Schedule 2 (Form 1040), line 8  .                        .        8 
Part III    Additional Tax on Excess Contributions to Traditional IRAs. Complete this part if you contributed more to your 
            traditional IRAs for 2022 than is allowable or you had an amount on line 17 of your 2021 Form 5329.
9      Enter your excess contributions from line 16 of your 2021 Form 5329. See instructions. If zero, go to line 15                        9 
10     If  your  traditional  IRA  contributions  for  2022  are  less  than  your  maximum
       allowable contribution, see instructions. Otherwise, enter -0-  .                       . . . . .   10 
11     2022 traditional IRA distributions included in income (see instructions) .                    . .   11 
12     2022 distributions of prior year excess contributions (see instructions) .                    . .   12 
13     Add lines 10, 11, and 12 .  . . .      .  .  . . .   .    .                         . . . . . . . . .  .            . . . . .        13 
14     Prior year excess contributions. Subtract line 13 from line 9. If zero or less, enter -0- .                         . . . . .        14 
15     Excess contributions for 2022 (see instructions) .    .   .                         . . . . . . . . .  .            . . . . .        15 
16     Total excess contributions. Add lines 14 and 15 .     .   .                         . . . . . . . . .  .            . . . . .        16 
17     Additional tax. Enter 6% (0.06) of the smaller of line 16 or the value of your traditional IRAs on December 
       31, 2022 (including 2022 contributions made in 2023). Include this amount on Schedule 2 (Form 1040), line178
Part IV     Additional Tax on Excess Contributions to Roth IRAs.                                   Complete this part if you contributed more to your Roth 
            IRAs for 2022 than is allowable or you had an amount on line 25 of your 2021 Form 5329.
18     Enter your excess contributions from line 24 of your 2021 Form 5329. See instructions. If zero, go to line 23                        18 
19     If your Roth IRA contributions for 2022 are less than your maximum allowable
       contribution, see instructions. Otherwise, enter -0-  .   .                         . . . . . . .   19 
20     2022 distributions from your Roth IRAs (see instructions) .                           . . . . . .   20 
21     Add lines 19 and 20  .   .  . . .      .  .  . . .   .    .                         . . . . . . . . .  .            . . . . .        21 
22     Prior year excess contributions. Subtract line 21 from line 18. If zero or less, enter -0- .                        . . . . .        22 
23     Excess contributions for 2022 (see instructions) .    .   .                         . . . . . . . . .  .            . . . . .        23 
24     Total excess contributions. Add lines 22 and 23 .     .   .                         . . . . . . . . .  .            . . . . .        24 
25     Additional tax. Enter 6% (0.06) of the smaller of line 24 or the value of your Roth IRAs on December 31, 
       2022 (including 2022 contributions made in 2023). Include this amount on Schedule 2 (Form 1040), line                               825 
For Privacy Act and Paperwork Reduction Act Notice, see your tax return instructions.                                      Cat. No. 13329Q     Form 5329 (2022) 

Form 5329 (2022)                                                                                                              Page 2 
Part V    Additional  Tax  on  Excess  Contributions  to  Coverdell  ESAs.            Complete  this  part  if  the  contributions  to  your 
          Coverdell ESAs for 2022 were more than is allowable or you had an amount on line 33 of your 2021 Form 5329.
26   Enter the excess contributions from line 32 of your 2021 Form 5329. See instructions. If zero, go to line 31     26 
27   If  the  contributions  to  your  Coverdell  ESAs  for  2022  were  less  than  the 
     maximum allowable contribution, see instructions. Otherwise, enter -0-  .      .    27 
28   2022 distributions from your Coverdell ESAs (see instructions)         . . . . .    28 
29   Add lines 27 and 28   . .       . . . .     . . .     . . . .      .   . . . . . .  .   .    . . . .    .        29 
30   Prior year excess contributions. Subtract line 29 from line 26. If zero or less, enter -0- . . . . .    .        30 
31   Excess contributions for 2022 (see instructions) .      . . .      .   . . . . . .  .   .    . . . .    .        31 
32   Total excess contributions. Add lines 30 and 31 .       . . .      .   . . . . . .  .   .    . . . .    .        32 
33   Additional  tax.  Enter  6%  (0.06)  of  the  smaller of  line  32  or the  value  of  your  Coverdell  ESAs  on 
     December 31, 2022 (including 2022 contributions made in 2023). Include this amount on Schedule 2
     (Form 1040), line 8 . . .       . . . .     . . .     . . . .      .   . . . . . .  .   .    . . . . .           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 2022 than is allowable or you had an amount on line 41 of your 2021 Form 5329. 
34   Enter the excess contributions from line 40 of your 2021 Form 5329. See instructions. If zero, go to line 39     34 
35   If the contributions to your Archer MSAs for 2022 are less than the maximum
     allowable contribution, see instructions. Otherwise, enter -0- .       . . . . .    35 
36   2022 distributions from your Archer MSAs from Form 8853, line 8          . . . .    36 
37   Add lines 35 and 36   . .       . . . .     . . .     . . . .      .   . . . . . .  .   .    . . . .    .        37 
38   Prior year excess contributions. Subtract line 37 from line 34. If zero or less, enter -0- . . . . .    .        38 
39   Excess contributions for 2022 (see instructions) .      . . .      .   . . . . . .  .   .    . . . .    .        39 
40   Total excess contributions. Add lines 38 and 39 .       . . .      .   . . . . . .  .   .    . . . .    .        40 
41   Additional  tax.  Enter  6%  (0.06)  of  the smaller  of  line  40 or  the  value  of  your  Archer  MSAs  on
     December 31, 2022 (including 2022 contributions made in 2023). Include this amount on Schedule 2
     (Form 1040), line 8 . . .       . . . .     . . .     . . . .      .   . . . . . .  .   .    . . . .    .        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  2022  than  is  allowable  or  you  had  an 
          amount on line 49 of your 2021 Form 5329.
42   Enter the excess contributions from line 48 of your 2021 Form 5329. If zero, go to line 47     . . .    .        42 
43   If  the  contributions  to  your  HSAs  for  2022  are  less  than  the  maximum 
     allowable contribution, see instructions. Otherwise, enter -0- .       . . . . .    43 
44   2022 distributions from your HSAs from Form 8889, line 16          .   . . . . .    44 
45   Add lines 43 and 44   . .       . . . .     . . .     . . . .      .   . . . . . .  .   .    . . . .    .        45 
46   Prior year excess contributions. Subtract line 45 from line 42. If zero or less, enter -0- . . . . .    .        46 
47   Excess contributions for 2022 (see instructions) .      . . .      .   . . . . . .  .   .    . . . .    .        47 
48   Total excess contributions. Add lines 46 and 47 .       . . .      .   . . . . . .  .   .    . . . .    .        48 
49   Additional tax. Enter 6% (0.06) of the  smaller of line 48  or     the value of your HSAs on December 31, 
     2022 (including 2022 contributions made in 2023). Include this amount on Schedule 2 (Form 1040), line 8          49 
Part VIII Additional Tax on Excess Contributions to an ABLE Account. Complete this part if contributions to your ABLE 
          account for 2022 were more than is allowable.
50   Excess contributions for 2022 (see instructions)  .     . . .      .   . . . . . .  .   .    . . . .    .        50 
51   Additional  tax.  Enter  6%  (0.06)  of  the smaller  of  line  50 or  the  value  of  your  ABLE  account  on
     December 31, 2022. Include this amount on Schedule 2 (Form 1040), line 8  .      .  .   .    . . . .    .        51 
Part IX   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.
52   Minimum required distribution for 2022 (see instructions)  .       .   . . . . . .  .   .    . . . .    .        52
53   Amount actually distributed to you in 2022 .    .     . . . .      .   . . . . . .  .   .    . . . .    .        53
54   Subtract line 53 from line 52. If zero or less, enter -0- . .      .   . . . . . .  .   .    . . . .    .        54 
55   Additional tax. Enter 50% (0.50) of line 54. Include this amount on Schedule 2 (Form 1040), line 8  .            55
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                                                                                                                         Form 5329 (2022)