Page 5 - Pressure Seal Tax Catalog

Stock Pressure Seal 1099R
Stock Pressure Seal Multi-Purpose
FROM
FROM
SLIDE FINGER BETWEEN FRONT & MIDDLE PANEL TO OPEN
REMOVE SIDE EDGES FIRST
2. WITH THIS SIDE UP, SLIDE FINGER BETWEEN FRONT AND MIDDLE PANEL, SLIDE FINGER UP TO OPEN First-Class Mail
3. BEFORE DETACHING SLIDE FINGER UP BETWEEN MIDDLE PANEL AND ADDRESS PANEL TO REMOVE IMPORTANT TAX DOCUMENT ENCLOSED
SEE OTHER SIDE FOR OPENING INSTRUCTIONS OPENING INSTRUCTIONS SEE OTHER SIDE FOR IMPORTANT TAX DOCUMENT ENCLOSED First-Class Mail OPENING INSTRUCTIONS SEE OTHER SIDE FOR
FOLD, CREASE AND TEAR ALONG PERFORATION
REMOVE THESE EDGES FIRST
FIRST: REMOVE THESE EDGES FOLD, CREASE AND TEAR ALONG PERFORATION 62519 FOLD, CREASE AND TEAR ALONG PERFORATION FIRST: REMOVE THESE EDGES ALSO AVAILABLE IN FOLD, CREASE AND TEAR ALONG PERFORATION REMOVE THESE EDGES FIRST 1/2” SEE OTHER SIDE FOR OPENING INSTRUCTIONS V 8295589 $ 2b Taxable amount CORRECTED (if checked) 12 OMB No. 1545-0119 Date of payment 24 $ Form 1099-R CORRECTED (if checked) OMB No. 1545-0119
2-WIDE FORMAT
Form 1099-R
1 Gross distribution
2a Taxable amount
1/2”
$
not determined
Total
Distributions From Pensions,
Annuities, Retirement or
distribution
1 Gross distribution
Profit-Sharing Plans, IRAs,
Insurance Contracts, etc.
requirement
FATCA filing 13
2a Taxable amount
$
2b Taxable amount
Total
Annuities, Retirement or
PAYER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
Profit-Sharing Plans, IRAs,
Insurance Contracts, etc.
FATCA filing 13
Date of payment
PAYER’S TIN
17X14 E $ 3 Capital gain (included $ 4 Federal income tax withheld 5 Employee contributions PAYER’S TIN not determined distribution 12 requirement Distributions From Pensions, 24
PAYER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
RECIPIENT’S TIN
in box 2a)
Box 9a. If a total distribution was made to more than one person, the percentage
Box 9b. For a life annuity from a qualified plan or from a section 403(b) plan (with
included in boxes 1 and 2a. When you receive periodic payments from the annu-
combined arrangements, the amount of the reduction in the investment (but not
ALSO AVAILABLE IN 62144 Box 2a. This part of the distribution is generally taxable. If there is no entry in this box, the payer may not have all the facts needed to figure the taxable amount. In that case, the first box in box 2b should be checked. You may want to get one of the free publications from the IRS to help you figure the taxable amount. See Additional information on the back of Copy 2. For an IRA distribu- tion, see IRAs and Roth IRAs, earlier. For a direct rollover, other than from a qual- ified plan, section 403(b) plan, or governmental section 457(b) plan to a desig- nated Roth account in the same plan or to a Roth IRA, zero should be shown and you must enter zero (-0-) on the “Taxable amount” line of your tax return. If you roll over a distribution (other than a distribution from a designated Roth account) from a qualified plan, section 403(
ity contract, they’re taxable at that time. If the distribution is made to more than
shown. You’ll need this information if you use the 10-year tax option (Form 4972). 6 Net unrealized appreciation
If charges were made for qualified long-term care insurance contracts under in employer’s securities
Box 8. If you received an annuity contract as part of a distribution, the value of
one person, the percentage of the annuity contract distributed to you is also $
/Designated Roth contributions
3 Capital gain (included
the contract is shown. It isn’t taxable when you receive it and shouldn’t be
in box 2a)
below zero) in the annuity or life insurance contract is reported here.
4 Federal income tax withheld
/Designated Roth contributions
in employer’s securities
%
9b Total employee contributions
or insurance premiums
2-WIDE FORMAT in this box plus the amount in box 6, if any. tions for more information. the Instructions for Form 8949. that account may be entered in box 11. (under age 59½). T— Roth IRA distribution, exception applies. U— Dividend distribution from ESOP under section 404(k). Note: This distribution isn’t eligible for rollover. tracts under combined arrangements. SEP, or SIMPLE distribution. below zero) in the annuity or life insurance contract is reported here. you received is shown. 62506 reported on this form is shown in this box. also have a filing requirement. See the Instructions for Form 8938. Additional information. You may want to see: Form W-4P, Form 4972, Form 5329, Form 8606 Pub. 525, Taxable and Nontaxable Income Pub. 560, Retirement Plans for Small Business Pub. 571, Tax-Sheltered Annuity Plans Pub. 575, Pension and An
IRA/
SEP/
SIMPLE
9a Your percentage of total distribution
$
RECIPIENT’S name, street address (including apt. no.), city or town, state or province, country, and ZIP or foreign postal code
% $
9b Total employee contributions
17X14 REMOVE THESE EDGES FIRST FOLD, CREASE AND TEAR ALONG PERFORATION ble. See Pub. 575. and Pub. 575. 6050Y . local tax. FOLD, CREASE AND TEAR ALONG PERFORATION REMOVE THESE EDGES FIRST in this box plus the amount in box 6, if any. tions for more information. the Instructions for Form 8949. ble. that account may be entered in box 11. (under age 59½). T— Roth IRA distribution, exception applies. tracts under combined arrangements. loca $ Copy 2 SEP, or SIMPLE distribution. $ 17 Local tax withheld you received is shown. See Pub. 575. www.irs.gov/Form1099R 6050Y . local tax. $ $ 16 State distribution FOLD, CREASE AND TEAR ALONG PERFORATION REMOVE THESE EDGES FIRST $ 14 State tax withheld 15 State/Payer’s state no. $ 10 Amount allocable to IRR within 5 years
14 State tax withheld
11 1st year of desig. Roth contrib.
and Pub. 575. 15 State/Payer’s state no.
10 Amount allocable to IRR within 5 years
Account number (see instructions)
18 Name of locality
11 1st year of desig. Roth contrib.
J— Early distribution from a Roth IRA, no known exception (in most cases, under
N— Recharacterized IRA contribution made for 2024 and recharacterized in 2024.
P— Excess contributions plus earnings/excess deferrals (and/or earnings) taxable
E— Distributions under Employee Plans Compliance Resolution System (EPCRS).
19 Local distribution
K— Distribution of traditional IRA assets not having a readily available FMV. $
8— Excess contributions plus earnings/excess deferrals (and/or earnings) taxable
Box 7. The following codes identify the distribution you received. For more infor-
6— Section 1035 exchange (a tax-free exchange of life insurance, annuity, quali-
G— Direct rollover of a distribution to a qualified plan, a section 403(b) plan, a
D— Annuity payments from nonqualified annuities that may be subject to tax
H— Direct rollover of a designated Roth account distribution to a Roth IRA.
account in the same plan or to a Roth IRA, see the instructions for box 2a. For a
Note: If code B is in box 7 and an amount is reported in box 10, see the
the NUA is included in box 2a. If you didn’t receive a lump-sum distribution, the
File this copy with your state, city, or
distributions may be subject to an additional 10% tax. See the Instructions for
$
direct rollover to a designated Roth account in the same plan or to a Roth IRA,
17 Local tax withheld
Pub. 575 and Form 4972. If you roll over the distribution to a designated Roth
1— Early distribution, no known exception (in most cases, under age 59½).
mation on these distributions, see the instructions for your tax return. Also, certainl income tax return, when required.
16 State distribution
Copy 2
$
Department of the Treasury
18 Name of locality
PS3AR-BLANK-POP FROM: PSF4AR-BLANK W Instructions for Recipient Generally, distributions from retirement plans (IRAs, qualified plans,section 403(b) plans, and governmental section 457(b) plans), insurance contracts, etc., are reported to recipients on Form 1099-R. Qualified plans and section 403(b) plans. If your annuity starting date is after 1997, you must use the simplified method to figure your taxable amount if your payer didn’t show the taxable amount in box 2a. See the instructions for your tax return. IRAs. For distributions from a traditional individual retirement arrangement (IRA), simplified employee pension (SEP), or savings incentive match plan for employ- ees (SIMPLE), generally the payer isn’t required to compute the taxable amount. See the instructions for your tax return to determine the taxable amount. If you’re at least age 73, you must take minimum
Internal Revenue Service
amount shown is the NUA attributable to employee contributions, which isn’t Form 1099-R
1 Gross distribution
$
19 Local distribution
CORRECTED (if checked)
fied long-term care insurance, or endowment contracts).
A— May be eligible for 10-year tax option (see Form 4972).
www.irs.gov/Form1099R
$
OMB No. 1545-0119
2a Taxable amount
2— Early distribution, exception applies (under age 59½).
File this copy with your state, city, or
C— Reportable death benefits under section 6050Y .
$
governmental section 457(b) plan, or an IRA.
2b Taxable amount
local income tax return, when required.
not determined
Form 1099-R
Total
Distributions From Pensions,
Internal Revenue Service
1 Gross distribution
9— Cost of current life insurance protection.
Annuities, Retirement or
distribution
Department of the Treasury - Internal Revenue Service
B— Designated Roth account distribution.
Profit-Sharing Plans, IRAs,
12
FATCA filing
Insurance Contracts, etc.
Date of payment
2a Taxable amount
L— Loans treated as distributions. 13
requirement
SEE REVERSE SIDE FOR OPENING INSTRUCTIONS Important Tax Document Enclosed First-Class Mail SEE REVERSE SIDE FOR OPENING INSTRUCTIONS part. REMOVE SIDE EDGES FIRST Form 5329. 3— Disability. 4— Death. THEN FOLD AND TEAR THIS STUB ALONG PERFORATION in 2024. TXE 1099R-E4CNB 2 3 age 59½). 1 in 2023. K X Instructions for Recipient are reported to recipients on Form 1099-R. tax return. tion on IRAs. contribution. shown in box 7. See Pub. 575. the payer has reported your complete TIN to the IRS. payer assigned to distinguish your account. part. RECIPIENT’S name, street address (including apt. no.), city or town, state or province, country, and ZIP or foreign postal code M—Qualified plan loan offset. 1 % in 2023. $ $ 6 Net unrealized appreciation $ 7 Distribution code(s) RECIPIENT’S TIN $ 8 Other 5 Employee contributions 13 Date of payment
$
24
taxed until you sell the securities.
Total
Instructions for Form 5329.
F— Charitable gift annuity.
not determined
5— Prohibited transaction.
Distributions From Pensions,
Annuities, Retirement or
under section 1411.
7— Normal distribution.
distribution
Profit-Sharing Plans, IRAs,
FATCA filing
12
Insurance Contracts, etc.
requirement
age 59½).
PAYER’S TIN
3— Disability.
in 2024.
4— Death.
Form 5329.
RECIPIENT’S TIN
PAYER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
3 Capital gain (included
in box 2a)
$
4 Federal income tax withheld
PAYER’S TIN
$
6 Net unrealized appreciation
5 Employee contributions
2
in employer’s securities
/Designated Roth contributions
or insurance premiums
$
$
3
7 Distribution code(s)
3 Capital gain (included
in box 2a)
IRA/
THEN FOLD AND TEAR THIS STUB ALONG PERFORATION
8 Other
SEP/
REMOVE SIDE EDGES FIRST
SIMPLE
4 Federal income tax withheld
9a Your percentage of total distribution
$
PSE4CN-BLANK
/Designated Roth contributions
in employer’s securities
or insurance premiums
9b Total employee contributions
IRA/
% $
SEP/
SIMPLE
9a Your percentage of total distribution
$
9b Total employee contributions
% $
Account number (see instructions)
$ 14 State tax withheld 11 1st year of desig. Roth contrib. RECIPIENT’S name, street address (including apt. no.), city or town, state or province, country, and ZIP or foreign postal code %
$ 10 Amount allocable to IRR within 5 years
$ 17 Local tax withheld 15 State/Payer’s state no. Account number (see instructions)
$ 16 State distribution
18 Name of locality
19 Local distribution
$ 14 State tax withheld 11 1st year of desig. Roth contrib.
(keep for your records)
$ 10 Amount allocable to IRR within 5 years
$
Copy C For Recipient’s Records
15 State/Payer’s state no.
www.irs.gov/Form1099R
$ 17 Local tax withheld
This information is being furnished to the IRS.
$ 16 State distribution
Department of the Treasury
18 Name of locality
Internal Revenue Service
1/2” Copy B
$ 19 Local distribution
www.irs.gov/Form1099R
income tax withheld in box 4, attach this copy to your return.
Report this income on your federal tax return. If this form shows federal
This information is being furnished to the IRS.
1/2”
TXF 3AR-BLANK-POP TXF 4AR-BLANK
14” EZ-Fold Multi-Purpose 14” EZ-Fold Multi-Purpose TXE 1099R-E4CNB TXE 1099R-E4CNP
Blank - 3 Around Blank - 4 Around
Screen on Backer - Simplex Blank Backer - Simplex or Duplex 11” Blank V Fold - 4 Corner 11” Printed V Fold - 4 Corner Copies B,C,
Backer w/Instructions - Duplex 2, 2 Backer w/Instructions - Duplex
2-WIDE 2-WIDE
TXF 3AR-BLANK-POP-2W - 17” x 14” TXF 4AR-BLANK-2W - 17” x 14”
T Form 1099-R CORRECTED (if checked)
1 Gross distribution
PAYER’S name, street address, city or town, state or province, country, and ZIP or foreign postal code, and telephone no.
8295761 PAYER’S TIN $ 2a Taxable amount OMB No. 1545-0119 Distributions From
RECIPIENT’S TIN $ 2b Taxable amount 24 Pensions, Annuities,
Retirement or
not determined
Total Form 1099-R Profit-Sharing
3 Capital gain (included
in box 2a) distribution
$ 4 Federal income tax withheld Plans, IRAs, Pressure Seal
RECIPIENT’S name, street address (incl. apt. no.), city or town, state or province, country, and ZIP or foreign postal code
Insurance
2. WITH THIS SIDE UP, SLIDE FINGER BETWEEN FRONT AND MIDDLE PANEL, SLIDE FINGER UP TO OPEN
$
Contracts, etc.
3. BEFORE DETACHING SLIDE FINGER UP BETWEEN MIDDLE PANEL AND ADDRESS PANEL TO REMOVE
6 Net unrealized appreciation
in employer’s securities
$ 9a Your percentage of total distribution 7 Distribution code(s) SEP/ IRA/ $ 8 Other 5 Employee contributions than a distribution from a designated Roth account) from a qualified
Is it time to upgrade your pressure Form 1099-R 13 Date of payment 12 FATCA filing $ 11 1st year of desig. Roth contrib. $ $ 17 $ 14 $ Local tax withheld 18 15 Name of locality % $ 9b Total employee contributions have been a direct rollover, a transfer or conversion to a Roth IRA, a plan, section 403(b) plan, or governmental section 457(b) plan to a
/Designated Roth contributions or
insurance premiums

Account number (see instructions)
Instructions for Recipient
Box 1. Shows the total amount distributed this year. The amount may
Copy B
SIMPLE
recharacterized IRA contribution; or you may have received it as peri-
designated Roth account in the same plan or to a Roth IRA, you
Report this income on your
must include on the “Taxable amount” line of your tax return the
federal tax return. If this
Generally, distributions from retirement plans (IRAs, qualified plans, $
section 403(b) plans, and governmental section 457(b) plans), insur-
form shows federal income
odic payments, nonperiodic payments, or a total distribution. Report
this copy to your return.
the amount on Form 1040, 1040-SR, or 1040-NR on the line for “IRA
tax withheld in box 4, attach
ance contracts, etc., are reported to recipients on Form 1099-R.
State tax withheld
requirement
amount shown in this box plus the amount in box 6, if any.
If this is a total distribution from a qualified plan and you were
distributions” or "Pensions and annuities” (or the line for “Taxable
%
This information is being
furnished to the IRS.
amount”) and on Form 8606, as applicable. However, if this is a
Qualified plans and section 403(b) plans. If your annuity starting
born before January 2, 1936 (or you’re the beneficiary of someone
date is after 1997, you must use the simplified method to figure your
born before January 2, 1936), you may be eligible for the 10-year tax
taxable amount if your payer didn’t show the taxable amount in box
10 Amount allocable to IRR within 5 years
lump-sum distribution, see Form 4972. If you haven’t reached mini-
State/Payer’s state no.
option. See the Form 4972 instructions for more information.
mum retirement age, report your disability payments on the line for
2a. See the instructions for your tax return.
“Wages, salaries, tips, etc.” on your tax return. Also report on that
16
If you’re an eligible retired public safety officer who elected to
State distribution
line permissible withdrawals from eligible automatic contribution
exclude from income distributions from your eligible plan used to pay
IRAs. For distributions from a traditional individual retirement $
arrangement (IRA), simplified employee pension (SEP), or savings
www.irs.gov/Form1099R
arrangements and corrective distributions of excess deferrals, excess
certain insurance premiums, the amount shown in box 2a hasn’t
FOLD, CREASE AND TEAR ALONG PERFORATION
$
contributions, or excess aggregate contributions except if the distri-
incentive match plan for employees (SIMPLE), generally the payer
bution is of designated Roth contributions or your after-tax contribu-
tax return for more information.
your tax return to determine the taxable amount. If you’re at least age
tions or if you’re self-employed.
Box 2b. If the first box is checked, the payer was unable to deter-
73, you must take minimum distributions from your IRA (other than a
$
contract was transferred tax free to another trustee or contract issuer,
FIRST: REMOVE THESE EDGES
CORRECTED (if checked)
mine the taxable amount and box 2a should be blank, except for an
Roth IRA). If you don’t, you’re subject to an excise tax on the amount
$
that should’ve been distributed. See Pub. 590-A and Pub. 590-B for
IRA. It’s your responsibility to determine the taxable amount. If the
an amount will be shown in this box and code 6 will be shown in box
more information on IRAs.
second box is checked, the distribution was a total distribution that
PAYER’S name, street address, city or town, state or province, country, and ZIP or foreign postal code, and telephone no.
1 Gross distribution
7. If a charge or payment was made against the cash value of an
closed out your account.
annuity contract or the cash surrender value of a life insurance con-
Roth IRAs. For distributions from a Roth IRA, generally the payer
$ 2a Taxable amount isn’t required to compute the taxable amount. See the instructions for 19 Local distribution If a life insurance, annuity, qualified long-term care, or endowment been reduced by the exclusion amount. See the instructions for your FOLD, CREASE AND TEAR ALONG PERFORATION FIRST: REMOVE THESE EDGES
tract for the purchase of qualified long-term care insurance, an
isn’t required to compute the taxable amount. You must compute any
Department of the Treasury - Internal Revenue Service
Box 3. If you received a lump-sum distribution from a qualified plan
amount will be shown in this box and code W will be shown in box 7.
and were born before January 2, 1936 (or you’re the beneficiary of
taxable amount on Form 8606. An amount shown in box 2a may be
seal machine or add a back-up unit? RECIPIENT’S name, street address (incl. apt. no.), city or town, state or province, country, and ZIP or foreign postal code $ 3 Capital gain (included fied plan, section 403(b) plan, or governmental section 457(b) plan, Distributions From (Form 1040)). See the Form 4972 instructions. For a charitable gift Equipment
3-1/2”
You need not report these amounts on your tax return. If code C is
someone born before January 2, 1936), you may be able to elect to
taxable earnings on an excess contribution.
shown in box 7, the amount shown in box 1 is a receipt of reportable
OMB No. 1545-0119
PAYER’S TIN
24
treat this amount as a capital gain on Form 4972 (not on Schedule D
Loans treated as distributions. If you borrow money from a quali-
death benefits that is taxable in part.
$
you may have to treat the loan as a distribution and include all or part
annuity, report as a long-term capital gain as explained in the
Box 2a. This part of the distribution is generally taxable. If there is no
entry in this box, the payer may not have all the facts needed to fig-
Instructions for Form 8949.
Pensions, Annuities,
RECIPIENT’S TIN
2b Taxable amount
Box 4. Shows federal income tax withheld. Include this amount on
ure the taxable amount. In that case, the first box in box 2b should
be checked. You may want to get one of the free publications from
575.
your income tax return as tax withheld. Generally, if you receive pay-
of the amount borrowed in your income. There are exceptions to this Retirement or
the IRS to help you figure the taxable amount. See Additional infor-
Form 1099-R
not determined
Total
ments that aren’t eligible rollover distributions, you can change your
rule. If your loan is taxable, code L will be shown in box 7. See Pub. Profit-Sharing
mation on the back of Copy 2. For an IRA distribution, see IRAs and
tion, this form may show only the last four digits of your TIN (SSN,
withholding or elect not to have income tax withheld by giving the
Roth IRAs, earlier. For a direct rollover, other than from a qualified
payer Form W-4P or Form W-4R, as applicable.
in box 2a)
distribution
Recipient’s taxpayer identification number (TIN). For your protec- Plans, IRAs,
ITIN, ATIN, or EIN). However, the payer has reported your complete
plan, section 403(b) plan, or governmental section 457(b) plan to a
designated Roth account in the same plan or to a Roth IRA, zero
Insurance
TIN to the IRS. 4 Federal income tax withheld
$
Account number. May show an account, policy, or other unique Contracts, etc.
amount” line of your tax return. If you roll over a distribution (other
$
6 Net unrealized appreciation
in employer’s securities
number the payer assigned to distinguish your account. 5 Employee contributions
$ insurance premiums should be shown and you must enter zero (-0-) on the “Taxable (Continued on the back of Copy C.)
IRA/
7 Distribution code(s)
/Designated Roth contributions or
Account number (see instructions)
SEP/ 8 Other
SIMPLE
9a Your percentage of total distribution
Copy 2 13
5/14”
Remove address panel below to view additional instructions on back of copy C
Date of payment
$
12 14
File this copy with
11 1st year of desig. Roth contrib.
FATCA filing 9b Total employee contributions
your state, city, or
local income tax
return, when requirement $ State tax withheld
required. 10 Amount allocable to IRR within 5 years % $ %
$ 15
$ 17 State/Payer’s state no.
$ Local tax withheld 16
$ State distribution
$ 18
www.irs.gov/Form1099R
Form 1099-R
Name of locality $
19 $ $ Local distribution
TXF 1099R-3ARP $ 1 Gross distribution Department of the Treasury - Internal Revenue Service 6-7/8” • Small, medium and
CORRECTED (if checked)
PAYER’S name, street address, city or town, state or province, country, and ZIP or foreign postal code, and telephone no.
PS100 Medium Volume Pressure Seal Folder/Sealer RECIPIENT’S name, street address (incl. apt. no.), city or town, state or province, country, and ZIP or foreign postal code $ 3 Capital gain (included Total Form 1099-R Pensions, Annuities, long run folder/sealers
OMB No. 1545-0119
24
PAYER’S TIN
2a Taxable amount
Distributions From
RECIPIENT’S TIN
2b Taxable amount
not determined
Retirement or
Profit-Sharing
Plans, IRAs,
distribution
in box 2a)
$
Insurance
$ 4 Federal income tax withheld Contracts, etc.
6 Net unrealized appreciation
$ in employer’s securities 7 Distribution code(s) 5 Employee contributions
$ insurance premiums
/Designated Roth contributions or
IRA/
SEP/
Account number (see instructions)
8 Other
9a Your percentage of total distribution
Copy C 13 11 1st year of desig. Roth contrib. SIMPLE
$
12 14 Instructions for Recipient (Continued)
Date of payment
Records FATCA filing Box 5. Generally, this shows the employee’s investment in the con- A— May be eligible for 10-year tax option (see Form 4972). Box 8. If you received an annuity contract as part of a distribution, the
For Recipient’s
requirement $ State tax withheld tract (after-tax contributions), if any, recovered tax free this year; the % B— Designated Roth account distribution. value of the contract is shown. It isn’t taxable when you receive it and
%
9b Total employee contributions
shouldn’t be included in boxes 1 and 2a. When you receive periodic
$ 15 portion that’s your basis in a designated Roth account; the part of Note: If code B is in box 7 and an amount is reported in box 10, see
$
$ premiums paid on commercial annuities or insurance contracts the Instructions for Form 5329. payments from the annuity contract, they’re taxable at that time. If the
This information is being
furnished to the IRS.
10 Amount allocable to IRR within 5 years
17 State/Payer’s state no. distribution is made to more than one person, the percentage of the
recovered tax free; the nontaxable part of a charitable gift annuity; or
16
D— Annuity payments from nonqualified annuities that may be subject
$ Local tax withheld the investment in a life insurance contract reportable under section C— Reportable death benefits under section 6050Y. annuity contract distributed to you is also shown. You’ll need this infor-
mation if you use the 10-year tax option (Form 4972). If charges were
to tax under section 1411.
6050Y. This box doesn’t show any IRA contributions. If the amount
State distribution
$ (keep for your records) 18 Name of locality $ $ $ $ 19 Local distribution E— Distributions under Employee Plans Compliance Resolution System made for qualified long-term care insurance contracts under combined • For use with ALL pressure seal forms
shown is your basis in a designated Roth account, the year you first
made contributions to that account may be entered in box 11.
SEE REVERSE SIDE FOR OPENING INSTRUCTIONS Important Tax Document Enclosed 1— Early distribution, no known exception (in most cases, under age Q— Qualified distribution from a Roth IRA. Boxes 14–19. If state or local income tax was withheld from the distri- • Service agreements available
www.irs.gov/Form1099R
arrangements, the amount of the reduction in the investment (but not
below zero) in the annuity or life insurance contract is reported here.
(EPCRS).
FROM:
Box 6. If you received a lump-sum distribution from a qualified plan
F— Charitable gift annuity.
Box 9a. If a total distribution was made to more than one person, the
that includes securities of the employer’s company, the net unrealized
appreciation (NUA) (any increase in value of such securities while in
percentage you received is shown.
G— Direct rollover of a distribution to a qualified plan, a section 403(b)
Box 9b. For a life annuity from a qualified plan or from a section 403(b)
plan, a governmental section 457(b) plan, or an IRA.
plan (with after-tax contributions), an amount may be shown for the
the trust) is taxed only when you sell the securities unless you
H— Direct rollover of a designated Roth account distribution to a Roth
choose to include it in your gross income this year. See Pub. 575 and
IRA.
Form 4972. If you roll over the distribution to a designated Roth
taxable part of the distribution. See Pub. 575.
• Our Most Popular Mid-Range Folder/Sealer Department of the Treasury - Internal Revenue Service J— Early distribution from a Roth IRA, no known exception (in most employee’s total investment in the contract. It is used to compute the U
Box 10. If an amount is reported in this box, see the Instructions for
account in the same plan or to a Roth IRA, see the instructions for
cases, under age 59½).
box 2a. For a direct rollover to a designated Roth account in the
Form 5329 and Pub. 575.
same plan or to a Roth IRA, the NUA is included in box 2a. If you
K— Distribution of traditional IRA assets not having a readily available
Box 11. The first year you made a contribution to the designated Roth
didn’t receive a lump-sum distribution, the amount shown is the NUA
FMV.
account reported on this form is shown in this box.
L— Loans treated as distributions.
Box 12. If checked, the payer is reporting on this Form 1099 to satisfy
attributable to employee contributions, which isn’t taxed until you sell
the securities.
its Internal Revenue Code chapter 4 account reporting requirement
M—Qualified plan loan offset.
Box 7. The following codes identify the distribution you received. For
under FATCA. You may also have a filing requirement. See the
N— Recharacterized IRA contribution made for 2024 and recharacter-
more information on these distributions, see the instructions for your
Instructions for Form 8938.
ized in 2024.
tax return. Also, certain distributions may be subject to an additional
Box 13. Shows the date of payment for reportable death benefits under
P— Excess contributions plus earnings/excess deferrals (and/or earn-
10% tax. See the Instructions for Form 5329. 10-1/2”
section 6050Y.
ings) taxable in 2023.
bution, boxes 16 and 19 may show the part of the distribution subject
59½).
2— Early distribution, exception applies (under age 59½).
R— Recharacterized IRA contribution made for 2023 and recharacter-
to state and/or local tax.
ized in 2024.
Additional information. You may want to see:
3— Disability.
4— Death.
S— Early distribution from a SIMPLE IRA in first 2 years, no known
Form W-4P, Form 4972, Form 5329, Form 8606
5— Prohibited transaction.
exception (under age 59½).
Pub. 525, Taxable and Nontaxable Income
Pub. 560, Retirement Plans for Small Business
T— Roth IRA distribution, exception applies.
6— Section 1035 exchange (a tax-free exchange of life insurance,
annuity, qualified long-term care insurance, or endowment con-
U— Dividend distribution from ESOP under section 404(k).
Pub. 571, Tax-Sheltered Annuity Plans
tracts).
Note: This distribution isn’t eligible for rollover.
Pub. 575, Pension and Annuity Income
• Works with ALL Pressure Seal Forms 7— Normal distribution. W—Charges or payments for purchasing qualified long-term care insur- Pub. 590-A, Contributions to IRAs
Pub. 590-B, Distributions from IRAs
8— Excess contributions plus earnings/excess deferrals (and/or
ance contracts under combined arrangements.
Pub. 721, U.S. Civil Service Retirement Benefits
If the IRA/SEP/SIMPLE box is checked, you’ve received a traditional
earnings) taxable in 2024.
Pub. 939, General Rule for Pensions and Annuities
Pub. 969, HSAs and Other Tax-Favored Health Plans
IRA, SEP, or SIMPLE distribution.
9— Cost of current life insurance protection.
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