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HSA Contributions & Distributions:

Please only include amount paid by you with post-tax income. Employer contributions througha cafeteria plan do not qualify.
Tax Payer Spouse
H.S.A.Contribution $ $ Please send Form 5498-SA,H.S.A.Archer MSA, or Medicare Advantage MSA information.
Distributions from H.S.A. account listed on form 1099-SA..
  TAXPAYER SPOUSE
H.S.A.Distribution $ $ Please send Form 10998-SA,Distributions from an H.S.A.,Archer MSA, or Medicare Advantage MSA.
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