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Form 5329 Additional Taxes on Qualified Plans (Including IRAs) and Other Tax-Favored Accounts 2004. Summary: This is an example of Form 5329 (2004) with items included as described in the text. Additionally, these line items are completed:

Name of individual subject to additional tax. If married filing jointly, see page 1 of the instructions.” field contains Paul Jones
Your social security number” field contains 003-00-0000
Under “Part III: Additional Tax on Excess Contributions to Traditional IRAs”:
16. Total excess contributions. Add lines 14 and 15” field contains 500
17. Additional tax. Enter 6% (.06) of the smaller of line 16 or the value of your traditional IRAs on December 31, 2004 (including 2004 contributions made in 2005). Include this amount on Form 1040, line 59” field contains 30