Exhibit CC Form 5498 — Publication 1179

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IRA Contribution

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TRUSTEE’S/ISSUER’S name				1 IRA contributions (other than amounts in boxes 2–4, 8–10, 13a, and 14a) $					OMB No. 1545-0747 2026 Form 5498
Street address	Street address	Room/suite no.	Room/suite no.	Room/suite no.	Room/suite no.	Room/suite no.	Room/suite no.	Room/suite no.	Room/suite no.	Room/suite no.	Room/suite no.	Room/suite no.	Room/suite no.
Street address	Street address	Room/suite no.	Room/suite no.	2Rollover contributions $	2Rollover contributions $	2Rollover contributions $	2Rollover contributions $	2Rollover contributions $	2Rollover contributions $	2Rollover contributions $	2Rollover contributions $	2Rollover contributions $	2Rollover contributions $
City/town	City/town	City/town	City/town	City/town	City/town	City/town	City/town	City/town	City/town	City/town	City/town	City/town	City/town
City/town	City/town	City/town	City/town	3Roth IRA conversion amount $	3Roth IRA conversion amount $	3Roth IRA conversion amount $	3Roth IRA conversion amount $	3Roth IRA conversion amount $	4Recharacterized contributions $ 0.50 in	4Recharacterized contributions $ 0.50 in	4Recharacterized contributions $ 0.50 in	4Recharacterized contributions $ 0.50 in	4Recharacterized contributions $ 0.50 in
State/province	Country	ZIP/foreign code	ZIP/foreign code	ZIP/foreign code	ZIP/foreign code	ZIP/foreign code	ZIP/foreign code	ZIP/foreign code	ZIP/foreign code	ZIP/foreign code	ZIP/foreign code	ZIP/foreign code	ZIP/foreign code
TRUSTEE’S/ISSUER’S TIN 0.50 in	PARTICIPANT’S TIN 1.70 in	PARTICIPANT’S TIN 1.70 in	PARTICIPANT’S TIN 1.70 in	5FMV of account $	5FMV of account $	5FMV of account $	5FMV of account $	5FMV of account $	6Life insurance cost included in box 1 $	6Life insurance cost included in box 1 $	6Life insurance cost included in box 1 $	6Life insurance cost included in box 1 $	6Life insurance cost included in box 1 $
PARTICIPANT’S name	PARTICIPANT’S name	PARTICIPANT’S name	PARTICIPANT’S name	7 IRA		SEP		SIMPLE	SIMPLE		Roth IRA
PARTICIPANT’S name	PARTICIPANT’S name	PARTICIPANT’S name	PARTICIPANT’S name	8SEP contributions $	8SEP contributions $	8SEP contributions $	8SEP contributions $	8SEP contributions $	9SIMPLE contributions $ 0.33 in	9SIMPLE contributions $ 0.33 in	9SIMPLE contributions $ 0.33 in	9SIMPLE contributions $ 0.33 in	9SIMPLE contributions $ 0.33 in
Street address 0.33 in	Street address 0.33 in	Street address 0.33 in	Apt. no.	10Roth IRA contributions $	10Roth IRA contributions $	10Roth IRA contributions $	10Roth IRA contributions $	10Roth IRA contributions $	11Check if RMD for 2027	11Check if RMD for 2027	11Check if RMD for 2027	11Check if RMD for 2027	11Check if RMD for 2027
City/town	City/town	City/town	City/town	12aRMD date	12aRMD date	12aRMD date	12aRMD date	12aRMD date	12bRMD amount $	12bRMD amount $	12bRMD amount $	12bRMD amount $	12bRMD amount $
State/province	Country	ZIP/foreign code	ZIP/foreign code	13aPostponed/late contrib. $	13aPostponed/late contrib. $	13aPostponed/late contrib. $	13aPostponed/late contrib. $	13aPostponed/late contrib. $	13bYear	13cCode	13cCode	13cCode	13cCode
				14aRepayments $	14aRepayments $	14aRepayments $	14aRepayments $	14aRepayments $	14bCode	14bCode	14bCode	14bCode	14bCode
Account number (see instructions)	Account number (see instructions)	Account number (see instructions)	Account number (see instructions)	15aFMV of certain speciﬁed assets $	15aFMV of certain speciﬁed assets $	15aFMV of certain speciﬁed assets $	15aFMV of certain speciﬁed assets $	15aFMV of certain speciﬁed assets $	15bCode(s)	15bCode(s)	15bCode(s)	15bCode(s)	15bCode(s)

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Cat. No. 50010C

Department of the Treasury - Internal Revenue Service

2828 VOID CORRECTED

IRA Contribution

Information

TRUSTEE’S/ISSUER’S name				1 IRA contributions (other than amounts in boxes 2–4, 8–10, 13a, and 14a) $					OMB No. 1545-0747 2026 Form 5498
Street address	Street address	Room/suite no.	Room/suite no.	Room/suite no.	Room/suite no.	Room/suite no.	Room/suite no.	Room/suite no.	Room/suite no.	Room/suite no.	Room/suite no.	Room/suite no.	Room/suite no.
Street address	Street address	Room/suite no.	Room/suite no.	2Rollover contributions $	2Rollover contributions $	2Rollover contributions $	2Rollover contributions $	2Rollover contributions $	2Rollover contributions $	2Rollover contributions $	2Rollover contributions $	2Rollover contributions $	2Rollover contributions $
City/town	City/town	City/town	City/town	City/town	City/town	City/town	City/town	City/town	City/town	City/town	City/town	City/town	City/town
City/town	City/town	City/town	City/town	3Roth IRA conversion amount $	3Roth IRA conversion amount $	3Roth IRA conversion amount $	3Roth IRA conversion amount $	3Roth IRA conversion amount $	4Recharacterized contributions $	4Recharacterized contributions $	4Recharacterized contributions $	4Recharacterized contributions $	4Recharacterized contributions $
State/province	Country	ZIP/foreign code	ZIP/foreign code	ZIP/foreign code	ZIP/foreign code	ZIP/foreign code	ZIP/foreign code	ZIP/foreign code	ZIP/foreign code	ZIP/foreign code	ZIP/foreign code	ZIP/foreign code	ZIP/foreign code
TRUSTEE’S/ISSUER’S TIN	PARTICIPANT’S TIN	PARTICIPANT’S TIN	PARTICIPANT’S TIN	5FMV of account $	5FMV of account $	5FMV of account $	5FMV of account $	5FMV of account $	6Life insurance cost included in box 1 $	6Life insurance cost included in box 1 $	6Life insurance cost included in box 1 $	6Life insurance cost included in box 1 $	6Life insurance cost included in box 1 $
PARTICIPANT’S name	PARTICIPANT’S name	PARTICIPANT’S name	PARTICIPANT’S name	7 IRA		SEP		SIMPLE	SIMPLE		Roth IRA
PARTICIPANT’S name	PARTICIPANT’S name	PARTICIPANT’S name	PARTICIPANT’S name	8SEP contributions $	8SEP contributions $	8SEP contributions $	8SEP contributions $	8SEP contributions $	9SIMPLE contributions $	9SIMPLE contributions $	9SIMPLE contributions $	9SIMPLE contributions $	9SIMPLE contributions $
Street address	Street address	Street address	Apt. no.	10Roth IRA contributions $	10Roth IRA contributions $	10Roth IRA contributions $	10Roth IRA contributions $	10Roth IRA contributions $	11Check if RMD for 2027	11Check if RMD for 2027	11Check if RMD for 2027	11Check if RMD for 2027	11Check if RMD for 2027
City/town	City/town	City/town	City/town	12aRMD date	12aRMD date	12aRMD date	12aRMD date	12aRMD date	12bRMD amount $	12bRMD amount $	12bRMD amount $	12bRMD amount $	12bRMD amount $
State/province	Country	ZIP/foreign code	ZIP/foreign code	13aPostponed/late contrib. $	13aPostponed/late contrib. $	13aPostponed/late contrib. $	13aPostponed/late contrib. $	13aPostponed/late contrib. $	13bYear	13cCode	13cCode	13cCode	13cCode
				14aRepayments $	14aRepayments $	14aRepayments $	14aRepayments $	14aRepayments $	14bCode	14bCode	14bCode	14bCode	14bCode
Account number (see instructions)	Account number (see instructions)	Account number (see instructions)	Account number (see instructions)	15aFMV of certain speciﬁed assets $	15aFMV of certain speciﬁed assets $	15aFMV of certain speciﬁed assets $	15aFMV of certain speciﬁed assets $	15aFMV of certain speciﬁed assets $	15bCode(s)	15bCode(s)	15bCode(s)	15bCode(s)	15bCode(s)

Department of the Treasury - Internal Revenue Service