us internal revenue service: f1099r--1993

8/14/2019 US Internal Revenue Service: f1099r--1993

1/9

Employee contributionsor insurance premiums

CORRECTEDVOID9898OMB No. 1545-0119Gross distribution1PAYERS name, street address, city, state, and ZIP code Distributions From

Pensions, Annuities,Retirement orProfit-Sharing

Plans, IRAs,Insurance

Contracts, etc.

$2a Taxable amount

$

Total

distribution

Taxable amount

not determined

2b Copy A

RECIPIENTS identificationnumberPAYERS Federal identificationnumber 3 Capital gain (includedin box 2a) 4 Federal income taxwithheld

For

Internal RevenueService Center

$ $RECIPIENTS name Net unrealized

appreciation inemployers securities

65For PaperworkReduction Act

Notice andinstructions forcompleting this

form, seeInstructions for

Forms 1099,1098, 5498,and W-2G.

$$IRA/SEP

Distributioncode

7Street address (including apt. no.) 8 Other

%

Your percentage of total distribution9City, state, and ZIP code

%

State/Payers statenumber

11State income taxwithheld

10Account number (optional)

$13 Local income tax

withheld14 Name of locality

$

Department of the Treasury - Internal Revenue ServiceForm 1099-R

Do NOT Cut or Separate Forms on This Page

File with Form 1096.

Cat. No. 14436Q

12

15

State distribution

Local distribution

$

$

$


2/9

Payers, Please Note

Specific information needed to complete this form and otherforms in the 1099 series is given in the Instructions forForms 1099, 1098, 5498, and W-2G. A chart in thoseinstructions gives a quick guide to which form must be filedto report a particular payment. You can order thoseinstructions and additional forms by calling 1-800-TAX-FORM(1-800-829-3676).

Furnish Copies B and C of this form to the recipient byJanuary 31, 1994.

File Copy A of this form with the IRS by February 28,1994.


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CORRECTEDVOIDOMB No. 1545-0119Gross distribution1PAYERS name, street address, city, state, and ZIP code Distributions From



Contracts, etc.

$2a Taxable amount

$

Total

distribution

Taxable amount

not determined

2b




65

$$IRA/SEP

Distributioncode


%


%






$


12

15

State distribution

Local distribution

$

Copy 1

For

State, City,or Local

Tax Department

$

$


4/9


CORRECTED (if checked)OMB No. 1545-0119Gross distribution1PAYERS name, street address, city, state, and ZIP code Distributions From



Contracts, etc.

$2a Taxable amount

$

Total

distribution

Taxable amount

not determined

2b




65

$$IRA/SEP

Distributioncode


%


%






$


12

15

State distribution

Local distribution

$

Copy B

Report this

income on yourFederal tax

return. If thisform shows

Federal incometax withheld in

box 4, attachthis copy toyour return.

This information isbeing furnished to

the InternalRevenue Service.

$

$


5/9

Box 1.Shows the total amount you received this year. Theamount may have been a direct rollover or received as periodic

If you received a death benefit payment made by an employerbecause you are the beneficiary of a deceased employee and

the payment was not made from the employers pension,profit-sharing, or retirement plan, report this amount, less anyallowable death benefit exclusion, on Form 1040 on the line forOther income. See Pub. 525, Taxable and Nontaxable Income.

If an insurance contract has been transferred to anothertrustee, an amount will be shown in this box and Code 6 will beshown in box 7.

Instructions for RecipientGenerally, distributions from pensions, annuities, profit-sharingand retirement plans, IRAs, insurance contracts, etc., arereported to recipients on Form 1099-R.

Eligible Rollover Distribution.Before distributing an amountfrom a qualified plan eligible to be rolled over, the planadministrator must give you an explanation of your choices ofhow the distribution can be paid, including a direct rollover. SeePub. 575, Pension and Annuity Income (Including SimplifiedGeneral Rule), for more information.

IRAs.For distributions from an individual retirement

arrangement (IRA) or simplified employee pension (SEP),generally the payer is not required to compute the taxableamount. Therefore, the amounts in boxes 1 and 2a may be thesame. See Pub. 590, Individual Retirement Arrangements (IRAs),and Form 8606, Nondeductible IRA Contributions, IRA Basis,and Nontaxable IRA Distributions, to determine the taxableamount. If you are at least age 7012, distributions from your IRAmay be required. See Pub. 590.

Excess Distributions.If your distribution from a qualified planis more than $140,276, you may owe an excise tax. See Form5329, Return for Additional Taxes Attributable to QualifiedRetirement Plans (Including IRAs), Annuities, and ModifiedEndowment Contracts. This does not apply to beneficiariesexcept a surviving spouse who elected not to have the estatepay the excess accumulation tax.

Beneficiaries.If you receive a plan distribution as thebeneficiary of a deceased employee, you may be entitled to adeath benefit exclusion of up to $5,000. See Pub. 575.

(Continued on the back of Copy C.)

Box 2a.This part of the distribution is generally taxable.However, if there is no entry in this box, the payer may not haveall the facts needed to figure the taxable amount. In that case,the first box in box 2b should be marked. You may want to getone of the following publications from the IRS to help you figurethe taxable amount: Pub. 571, Tax-Sheltered Annuity Programsfor Employees of Public Schools and Certain Tax-ExemptOrganizations, Pub. 575, Pub. 590, Pub. 721, Tax Guide to U.S.Civil Service Retirement Benefits, or Pub. 939, Pension General

Rule (Nonsimplified Method). For an IRA distribution, see IRAson this page. For a direct rollover, zero should be shown andshould be entered on the Taxable income line of your taxreturn.

If this is a total distribution, you may be eligible for the 5- or10-year averaging method. See Form 4972 for more information.The 5- or 10-year averaging does not apply to IRAs ortax-sheltered annuities.

payments, as nonperiodic payments, or as a total distribution.Report this amount on Form 1040 or 1040A on the line for TotalIRA distributions or Total pensions and annuities (or the linefor Taxable amount), whichever applies, unless this is alump-sum distribution and you are using Form 4972, Tax onLump-Sum Distributions. However, if you have not reachedminimum retirement age, report your disability payments on theline for Wages, salaries, tips, etc. Also report on that linecorrective distributions of excess deferrals, excess contributions,or excess aggregate contributions.

Total Employee Contributions.If this is the first year of a life

annuity, you may see Total employee contributions on theform. Use that figure only if you choose to compute the taxablepart of the distribution using a method different from the methodused by the payer. See Pub. 575.


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Contracts, etc.

$2a Taxable amount

$

Total

distribution

Taxable amount

not determined

2b




65

$$IRA/SEP

Distributioncode


%


%






$


12

15

State distribution

Local distribution

$

This informationis being

furnished to theInternal

Revenue Service.

Copy C

For RecipientsRecords

(Keep for your records.)

$

$


7/9

If the IRA/SEP box is marked, you have received an IRA orSEP distribution.

Box 8.If you received an annuity contract as part of adistribution, the value of the contract is shown. It is not taxablewhen you receive it and should not be included in boxes 1 and2a. When you receive periodic payments from the annuitycontract, they are taxable at that time. If the distribution is madeto more than one person, the percentage of the annuity contract

distributed to you is also shown. You will need this information ifyou elect the special 5- or 10-year averaging method.

Box 9.If a total distribution was made to more than oneperson, the percentage you received is shown here.

Boxes 1015.If state or local income tax was withheld fromthe distribution, these boxes may be completed. Boxes 12 and15 may show the part of the distribution subject to applicablestate and/or local tax.

Box 2b.If an X is entered in the first checkbox, the payerwas unable to determine the taxable amount, and box 2a shouldbe blank unless this is an IRA distribution. If an X is entered inthe second checkbox, the distribution was a total distributionthat closed out your account.

Box 3.If you received a lump-sum distribution and you wereborn before 1-1-36, you may be able to elect to treat thisamount as a capital gain. See the Instructions for Form 4972.For a charitable gift annuity, this is the amount of any long-termcapital gain.

Box 4.This is the amount of Federal income tax withheld onthe distribution. Include this on your income tax return as taxwithheld, and, if box 4 shows an amount other than zero,attach Copy B to your return. Generally, if you will receivepayments next year that are not eligible rollover distributions,you can change your withholding or elect not to have income taxwithheld by giving the payer Form W-4P, Withholding Certificatefor Pension or Annuity Payments.

Box 5.Generally, this shows the employees investment in thecontract (after-tax contributions), if any, recovered tax free thisyear; the tax-free part of premiums paid on commercial annuitiesor insurance contracts; or the nontaxable part of a charitable giftannuity. This box does not show any contributions to an IRA orSEP.

Box 6.If you received a lump-sum distribution that includessecurities of the employers company, the net unrealized

appreciation (NUA) (any increase in value of such securities whilein the trust) is taxed only when you sell the securities unless youelect otherwise. See Pub. 575 and the Instructions for Form4972. If you did not receive a lump-sum distribution, the amountshown is the NUA attributable to employee contributions, whichis not taxed until you sell the securities.

Box 7.These codes identify the distribution you received:1Early (premature) distribution, no known exception (under age5912) (See Form 5329. For a rollover of the entire taxable part of

Instructions for Recipient (Continued) the distribution, do not file Form 5329. See Form 1040 or 1040Ainstructions.); 2Early (premature) distribution exception applies(under age 5912) (You need not file Form 5329.); 3Disability(You need not file Form 5329.); 4Death (You need not fileForm 5329.); 5Prohibited transactions; 6Section 1035exchange (a tax-free exchange of insurance contracts);7Normal distribution; 8Excess contributions plusearnings/excess deferrals (and/or earnings) taxable in 1993;9PS 58 costs (premiums paid by a trustee or custodian forcurrent insurance protection, taxable to you currently);PExcess contributions plus earnings/excess deferrals taxablein 1992; AQualifies for 5- or 10-year averaging; BQualifies

for death benefit exclusion; CQualifies for both A and B;DExcess contributions plus earnings/excess deferrals taxablein 1991; EExcess annual additions under section 415 (Reporton your tax return on the line for taxable pension or annuityincome. You need not file Form 5329.); FCharitable giftannuity; GDirect rollover to IRA (You need not file Form 5329.);HDirect rollover to qualified plan or tax-sheltered annuity (Youneed not file Form 5329.).


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Contracts, etc.

$2a Taxable amount

$

Total

distribution

Taxable amount

not determined

2b




65

$$IRA/SEP

Distributioncode


%


%






$


12

15

State distribution

Local distribution

$

Copy 2File this copy

with your state,city, or local

income taxreturn, when

required.

$

$


9/9


CORRECTEDVOIDOMB No. 1545-0119Gross distribution1PAYERS name, street address, city, state, and ZIP code Distributions From



Contracts, etc.

$2a Taxable amount

$

Total

distribution

Taxable amount

not determined

2b




65

$$IRA/SEP

Distributioncode


%


%






$


12

15

State distribution

Local distribution

$

Copy DFor Payer

$

$

For PaperworkReduction Act

Notice andinstructions forcompleting this

form, seeInstructions for

Forms 1099,1098, 5498,and W-2G.

us internal revenue service: f1099r--1993

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