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Printable Form 8889 Sugar Land Texas: What You Should Know
Payment Type: Direct Deposit Income (in the form of a check): No Monthly Payment Amount Received (in the form of a check or PayPal): 100% Amount due at payment completion: 0% Amount due at the end of each month: 0% Total amount due for the month: 100% If you are a beneficiary and are making any contributions to the account, please provide the following information: Signature of Beneficiary (if applicable) Full Name of Beneficiary Beneficiary Address (preferably with city/state) Beneficiary Telephone Number Social Security Number Date Beneficiary turns 18: 0/0 If you are an owner of the account and have not made a contribution, please provide the following information: Name of Beneficiary (if applicable) Company Name Beneficiary Address (preferably with city/state) Beneficiary Telephone Number Social Security Number Date Beneficiary turns 18: 0/0 Payment Type: None (no amounts owing at this time) This form will notify the taxpayer that the account has been approved for payment of health insurance and the amount of income tax that will be generated. Beneficiary Contact Name Address Age, Employer Type and Name If you are filing the Form 8889 for both spouses jointly, check box 1; if filing jointly, check box 2 The beneficiary must enter in box 1 what type of coverage is requested for himself/her. Check Box 2 to indicate that you are supporting the account, and you are providing the name(s) to receive the benefits. The beneficiary must enter the amount(s) he/she proposes to make in Boxes 3 (the portion), and 7 (the balance) of the Form 8889. The person making the request must enter the amount in Boxes 3 (the portion), and 8 (the balance). Sugar Land, TX — Official Website 2016 HSA Form 8889 and Instructions for HSA Apr 16, 2024 — The form is available online . If you are an HSA holder and have not filed another Form 8889 with the IRS in some time, do it now. It is easier to do now.
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