Coverdell ESA Contribution Information Revision Date 10/25/2022

• Issuer: Treasury Department
• Section: Treasury Department

Form 5498-ESA

2024

Cat. No. 34011J

Coverdell ESA

Contribution

Information

Copy A

For

Internal Revenue

Service Center

Department of the Treasury - Internal Revenue Service

File with Form 1096.

OMB No. 1545-1815

For Privacy Act and

Paperwork Reduction

Act Notice, see the

2024 General

Instructions for

Certain Information

Returns.

7272 VOID CORRECTED

TRUSTEE’S or ISSUER’S name, street address, city or town, state or

province, country, and ZIP or foreign postal code

TRUSTEE’S/ISSUER’S TIN BENEFICIARY’S TIN

BENEFICIARY’S name

Street address (including apt. no.)

City or town, state or province, country, and ZIP or foreign postal code

Account number (see instructions)

1 Coverdell ESA contributions

$

2 Rollover contributions

$

Form 5498-ESA www.irs.gov/Form5498ESA

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