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Get Form 5330 (Rev. October 2003). Return Of Excise Taxes Related To Employee Benefit Plans

79A, 4980, and 4980F of the Internal Revenue Code) Department of the Treasury Internal Revenue Service Filer tax year beginning , and ending , A Name of filer (see page 2 of the instructions) B Check applicable box and see instructions. Employer identification number (EIN) Social security number (SSN) Number, street, and room or suite no. (If a P.O. box, see page 2 of the instructions) City or town, state, and ZIP code Filer s identifying number C Name and address of plan spons.

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