us internal revenue service: f1099r--1996

8/14/2019 US Internal Revenue Service: f1099r--1996

1/12

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 identificationnumber

PAYERS 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

distribution

9aCity, state, and ZIP code

%

State/Payers state no.11State tax withheld10Account number (optional)

$13 Local tax withheld 14 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

$

$

$

$

$ $

$

Form 1099-R

9b Total employee contributions

$

96


2/12


3/12


CORRECTEDVOIDGross 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


%

City, state, and ZIP code



$


12

15

State distribution

Local distribution

$

Copy 1

ForState, City,

or LocalTax Department

$

$

$

$

$

$

OMB No. 1545-0119


distribution

9a

%

Form 1099-R


$

96


4/12


5/12


CORRECTED (if checked)

Gross distribution1PAYERS name, street address, city, state, and ZIP code Distributions FromPensions, Annuities,

Retirement orProfit-Sharing


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 thisincome on your

Federal taxreturn. If thisform shows

Federal incometax withheld in

box 4, attachthis copy toyour return.

This information isbeing furnished to

the InternalRevenue Service.

$

$

$

$ $

$

OMB No. 1545-0119


distribution

9a

%

Form 1099-R


$

96


6/12

Box 1.Shows the total amount you received this year. Theamount may have been a direct rollover or received as periodicpayments, as nonperiodic payments, or as a total distribution.Report this amount on your tax return on the line for Total IRAdistributions or Total pensions and annuities (or the line forTaxable amount), whichever applies, unless this is a lump-sumdistribution and you are using Form 4972, Tax on Lump-SumDistributions. However, if you have not reached minimumretirement age, report your disability payments on the line forWages, salaries, tips, etc. Also report on that line corrective

If you received a death benefit payment made by an employerbecause you are the beneficiary of a deceased employee andthe payment was not made from the employers pension,profit-sharing, or retirement plan, report this amount, less anyallowable death benefit exclusion, on your tax return on the linefor Other income. See Pub. 525, Taxable and NontaxableIncome.

If a life insurance, annuity, or endowment contract has beentransferred tax free to another trustee or contract issuer, anamount will be shown in this box and Code 6 will be shown inbox 7. You need not report this on your tax return.

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

IRAs.For distributions from an individual retirementarrangement (IRA) or simplified employee pension (SEP),generally the payer is not required to compute the taxableamount. Therefore, the amounts in boxes 1 and 2a will be thesame most of the time. See Pub. 590, Individual RetirementArrangements (IRAs), and Form 8606, Nondeductible IRAs(Contributions, Distributions, and Basis), to determine the taxableamount. If you are at least age 7012, you must take minimum

distributions from your IRA. If you dont, you may be subject to a50% excise tax on the amount that should have beendistributed. See Pub. 590.

Excess Distributions.If your distribution from a qualified planis more than $155,000, you may owe an excise tax. See Form5329, Additional Taxes Attributable to Qualified Retirement Plans(Including IRAs), Annuities, and Modified Endowment Contracts.This does not apply to beneficiaries except a surviving spousewho elected not to have the estate pay the excess accumulationtax.

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. Only one $5,000exclusion applies per decedent, and it must be divided amongall beneficiaries. See Pub. 575, Pension and Annuity Income(Including Simplified General Rule).

(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 GeneralRule (Nonsimplified Method). For an IRA distribution, see IRAson this page. For a direct rollover, zero should be shown, andyou must enter zero on the Taxable amount line of your taxreturn.

If this is a total distribution from a qualified plan and you wereat least age 5912 on the date of distribution (or you are thebeneficiary of someone who had reached age 59 12 or someone

born before 1936), you may be eligible for the 5- or 10-year taxoption. See Form 4972 for more information. The 5- or 10-yeartax option does not apply to IRAs or tax-sheltered annuities.

Box 2b.If the first checkbox is marked, the payer was unableto determine the taxable amount, and box 2a should be blankunless this is an IRA distribution. If the second checkbox ismarked, the distribution was a total distribution that closed outyour account.

distributions of excess deferrals, excess contributions, or excessaggregate contributions.


7/12


CORRECTED (if checked)Gross 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

$

This information isbeing furnished to

the InternalRevenue Service.

Copy C

For RecipientsRecords

(Keep for your records.)

$

$

$ $

$$

OMB No. 1545-0119


distribution

9a

%

Form 1099-R


$

96


8/12

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 contractdistributed to you is also shown. You will need this information ifyou elect the special 5- or 10-year tax option.

Box 9a.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 3.If you received a lump-sum distribution from a qualifiedplan and you were born before 1936 (or you are the beneficiaryof someone born before 1936), you may be able to elect to treatthis amount as a capital gain. See the Instructions for Form4972. For a charitable gift annuity, this is the amount of anylong-term capital 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 part of premiums paid on commercial annuities orinsurance contracts recovered tax free; or the nontaxable part ofa charitable gift annuity. This box does not show anycontributions to an IRA or SEP.

Box 6.If you received a lump-sum distribution from a qualifiedplan that includes securities of the employers company, the netunrealized appreciation (NUA) (any increase in value of suchsecurities while in the trust) is taxed only when you sell thesecurities unless you elect to include it in your gross income.See Pub. 575 and the Instructions for Form 4972. If you did notreceive a lump-sum distribution, the amount shown is the NUAattributable to employee contributions, which is not taxed until

you sell the securities.Box 7.These codes identify the distribution you received:1Early (premature) distribution, no known exception (in mostcases, under age 5912) (See Form 5329. For a rollover of theentire taxable part of the distribution, do not file Form 5329. Seethe instructions for your tax return.); 2Early (premature)distribution exception applies (under age 5912) (You need not fileForm 5329.); 3Disability (You need not file Form 5329.); 4Death (You need not file Form 5329.); 5Prohibited transaction;

Instructions for Recipient (Continued)

Box 9b.If this is the first year of a life annuity from a qualified

plan or from a tax-sheltered annuity (with after-tax contributions),the amount shown is your total investment in the contract. Use itif you choose to compute the taxable part of the distributionusing a method different from the method used by the payer.See Pub. 575.

6Section 1035 exchange (a tax-free exchange of lifeinsurance, annuity, or endowment contracts); 7Normaldistribution; 8Excess contributions plus earnings/excessdeferrals (and/or earnings) taxable in 1996; 9PS 58 costs(premiums paid by a trustee or custodian for current insuranceprotection, taxable to you currently); PExcess contributionsplus earnings/excess deferrals taxable in 1995; AMay beeligible for 5- or 10-year tax option (See Form 4972.); BMaybe eligible for death benefit exclusion; CMay be eligible forboth A and B; DExcess contributions plus earnings/excessdeferrals taxable in 1994; EExcess annual additions undersection 415 (Report on your tax return on the line for taxablepension or annuity income. You need not file Form 5329.);

FCharitable gift annuity; GDirect rollover to IRA (You neednot file Form 5329.); HDirect rollover to qualified plan ortax-sheltered annuity. (You need not file Form 5329.)


9/12


CORRECTED (if checked)Gross 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 2

File this copywith your state,

city, or localincome tax

return, whenrequired.

$

$

$ $

$$

OMB No. 1545-0119


distribution

9a

%

Form 1099-R


$

96


10/12


11/12


CORRECTEDVOIDGross 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 D

For Payer

$

$

For PaperworkReduction Act

Notice andinstructions forcompleting this

form, seeInstructions for

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

$ $

$$

OMB No. 1545-0119


distribution

9a

%

Form 1099-R


$

96


12/12

Payers, Please Note

Specific information needed to complete this form and otherforms in the 1099 series is given in the 1996 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, 1997.

File Copy A of this form with the IRS by February 28,1997.

Printed on recycled paper

us internal revenue service: f1099r--1996

Documents