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Federal Free Printable Form 5305-RB (Rev. April 2017) for 2023 Federal Roth Individual Retirement Annuity Endorsement

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Roth Individual Retirement Annuity Endorsement
Form 5305-RB (Rev. April 2017)

Form 5305-RB (Rev. April 2017) Department of the Treasury Internal Revenue Service Roth Individual Retirement Annuity Endorsement Do not file with the Internal Revenue Service (Under section 408A of the Internal Revenue Code) Name of issuer Check if this endorsement supersedes a prior Roth IRA ▶ endorsement . . . . . . . . . . . . This endorsement is made a part of the annuity contract to which it is attached, and the following provisions apply in lieu of any provisions in the contract to the contrary. The annuitant is establishing a Roth individual retirement annuity (Roth IRA) under section 408A to provide for his or her retirement and for the support of his or her beneficiaries after death. Article I Except in the case of a qualified rollover contribution described in section 408A(e) or a recharacterized contribution described in section 408A(d)(6), the issuer will accept only cash contributions up to $5,500 per year for 2013 through 2017. For individuals who have reached the age of 50 by the end of the year, the contribution limit is increased to $6,500 per year for 2013 through 2017. For years after 2017, these limits will be increased to reflect a cost-of-living adjustment, if any. Article II 1. The annual contribution limit described in Article I is gradually reduced to $0 for higher income levels. For an annuitant who is single or treated as single, the annual contribution is phased out between adjusted gross income (AGI) of $118,000 and $133,000; for a married annuitant filing jointly, between AGI of $186,000 and $196,000; and for a married annuitant filing separately, between AGI of $0 and $10,000. These phase-out ranges are for 2017. For years after 2017, the phase-out ranges, except for the $0 to $10,000 range, will be increased to reflect a cost-of-living adjustment, if any. Adjusted gross income is defined in section 408A(c)(3). 2. In the case of a joint return, the AGI limits in the preceding paragraph apply to the combined AGI of the annuitant and his or her spouse. Article III The annuitant’s interest in the contract is nonforfeitable and nontransferable. Article IV 1. The contract does not require fixed contributions. 2. Any dividends (refund of contributions other than those attributable to excess contributions) arising under the contract will be applied (before the close of the calendar year following the year of the dividend) as contributions toward the contract. Article V 1. If the annuitant dies before his or her entire interest in the contract is distributed to him or her and the annuitant’s surviving spouse is not the designated beneficiary, the remaining interest in the contract will be distributed in accordance with paragraph (a) below or, if elected or there is no designated beneficiary, in accordance with paragraph (b) below. (a) The remaining interest in the contract will be distributed, starting by the end of the calendar year following the year of the annuitant’s death, over the designated beneficiary’s remaining life expectancy, or a period no longer than such remaining life expectancy, as determined in the year following the death of the annuitant. Life expectancy is determined using the single life table in Regulations section 1.401(a)(9)-9. (b) The remaining interest in the contract will be distributed by the end of the calendar year containing the fifth anniversary of the annuitant’s death. 2. If the annuitant’s surviving spouse is the designated beneficiary, such spouse will then be treated as the annuitant. Article VI 1. The annuitant agrees to provide the issuer with all information necessary to prepare any reports required by sections 408(i) and 408A(d)(3)(E), Regulations sections 1.408-5 and 1.408-6, or other guidance published by the Internal Revenue Service (IRS). 2. The issuer agrees to submit to the IRS and annuitant the reports prescribed by the IRS. Article VII Notwithstanding any other articles which may be added or incorporated, the provisions of Articles I through IV and this sentence will be controlling. Any additional articles inconsistent with section 408A, the related regulations, or other published guidance will be invalid. Cat. No. 25871H Form 5305-RB (Rev. 4-2017) Form 5305-RB (Rev. 4-2017) Page 2 Article VIII This endorsement will be amended as necessary to comply with the provisions of the Code, the related regulations, and other published guidance. Other amendments may be made with the consent of the persons whose signatures appear on the contract. Article IX Article IX may be used for any additional provisions. If no other provisions will be added, draw a line through this space. If provisions are added, they must comply with applicable requirements of state law and the Internal Revenue Code and may not imply that they have been reviewed or pre-approved by the IRS. General Instructions Section references are to the Internal Revenue Code unless otherwise noted. Purpose of Form Form 5305-RB is a model annuity endorsement that meets the requirements of section 408A. However, only Articles I through VIII have been reviewed by the IRS. A Roth individual retirement annuity (Roth IRA) is established after the contract, which includes this endorsement, is fully executed by both the individual (annuitant) and the issuer. To make a regular contribution to a Roth IRA for a year, the IRA must be established no later than the due date (excluding extensions) of the individual’s income tax return for the year. The contract must be for the exclusive benefit of the annuitant and his or her beneficiaries. Do not file Form 5305-RB with the IRS. Instead, keep it with your records. Unlike contributions to traditional individual retirement arrangements, contributions to a Roth IRA are not deductible from the annuitant’s gross income; and distributions after 5 years that are made when the annuitant is 591/2 years of age or older or on account of death, disability, or the purchase of a home by a first-time homebuyer (limited to $10,000), are not includible in gross income. For more information on Roth IRAs, including the required disclosures the issuer must give the annuitant, see Pub. 590-A, Contributions to Individual Retirement Arrangements (IRAs), and Pub. 590-B, Distributions from Individual Retirement Arrangements (IRAs). Definitions Issuer. The issuer is the insurance company providing the annuity contract. The insurance company may use other terms besides “issuer” to refer to itself, such as, “company,” “insurer,” or “us.” Annuitant. The annuitant is the person who establishes the annuity contract. The insurance company may use other terms besides “annuitant” to refer to the person who establishes the annuity contract, such as, “owner,” “applicant,” “insured,” or “you.” Specific Instructions Article I. The annuitant may be subject to a 6% tax on excess contributions if (1) contributions to other individual retirement arrangements of the annuitant have been made for the same tax year, (2) the annuitant’s adjusted gross income exceeds the applicable limits in Article II for the tax year, or (3) the annuitant’s and spouse’s compensation is less than the amount contributed by or on behalf of them for the tax year. Article V. This article describes how distributions will be made from the Roth IRA after the annuitant’s death. Elections made pursuant to this article should be reviewed periodically to ensure they correspond to the annuitant’s intent. Under paragraph 2 of Article V, the annuitant’s spouse is treated as the owner of the Roth IRA upon the death of the annuitant, rather than as the beneficiary. If the spouse is to be treated as the beneficiary, and not the owner, an overriding provision should be added to Article IX. Article IX. Article IX and any that follow it may incorporate additional provisions that are agreed to by the annuitant and issuer to complete the contract. They may include, for example, definitions, investment powers, voting rights, exculpatory provisions, amendment and termination, removal of the issuer, issuer’s fees, state law requirements, beginning date of distributions, accepting only cash, treatment of excess contributions, prohibited transactions with the annuitant, etc. Attach additional pages if necessary. Form 5305-RB (Rev. 4-2017)
Extracted from PDF file 2021-federal-form-5305-rb.pdf, last modified September 2017

More about the Federal Form 5305-RB Individual Income Tax Tax Credit

We last updated the Roth Individual Retirement Annuity Endorsement in April 2022, and the latest form we have available is for tax year 2021. This means that we don't yet have the updated form for the current tax year. Please check this page regularly, as we will post the updated form as soon as it is released by the Federal Internal Revenue Service. You can print other Federal tax forms here.

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Form Sources:

The Internal Revenue Service usually releases income tax forms for the current tax year between October and January, although changes to some forms can come even later. We last updated Federal Form 5305-RB from the Internal Revenue Service in April 2022.

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Form 5305-RB is a Federal Individual Income Tax form. States often have dozens of even hundreds of various tax credits, which, unlike deductions, provide a dollar-for-dollar reduction of tax liability. Some common tax credits apply to many taxpayers, while others only apply to extremely specific situations. In most cases, you will have to provide evidence to show that you are eligible for the tax credit, and calculate the amount of the credit to which you are entitled.

About the Individual Income Tax

The IRS and most states collect a personal income tax, which is paid throughout the year via tax withholding or estimated income tax payments.

Most taxpayers are required to file a yearly income tax return in April to both the Internal Revenue Service and their state's revenue department, which will result in either a tax refund of excess withheld income or a tax payment if the withholding does not cover the taxpayer's entire liability. Every taxpayer's situation is different - please consult a CPA or licensed tax preparer to ensure that you are filing the correct tax forms!

Historical Past-Year Versions of Federal Form 5305-RB

We have a total of nine past-year versions of Form 5305-RB in the TaxFormFinder archives, including for the previous tax year. Download past year versions of this tax form as PDFs here:

2021 Form 5305-RB

Form 5305-RB (Rev. April 2017)

2020 Form 5305-RB

Form 5305-RB (Rev. April 2017)

2019 Form 5305-RB

Form 5305-RB (Rev. April 2017)

2018 Form 5305-RB

Form 5305-RB (Rev. March 2002)

2017 Form 5305-RB

Form 5305-RB (Rev. March 2002)

2016 Form 5305-RB

Form 5305-RB (Rev. March 2002)

Roth Individual Retirement Annuity Endorsement 2015 Form 5305-RB

Form 5305-RB (Rev. March 2002)

Roth Individual Retirement Annuity Endorsement 2012 Form 5305-RB

Form 5305-RB (Rev. March 2002)

Roth Individual Retirement Annuity Endorsement 2011 Form 5305-RB

Form 5305-RB (Rev. March 2002)

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