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 SEE OTHER SIDE FOR OPENING INSTRUCTIONS 9 9138769 $ 2b Taxable amount CORRECTED (if checked) 12 OMB No. 1545-0119 Date of payment 26 $ Form 1099-R CORRECTED (if checked) OMB No. 1545-0119 26
2-WIDE FORMAT
Form 1099-R
1 Gross distribution
2a Taxable amount
$
Distributions From Pensions,
not determined
Total
Annuities, Retirement or
Profit-Sharing Plans, IRAs,
distribution
1 Gross distribution
Insurance Contracts, etc.
FATCA filing 13
requirement
2a Taxable amount
$
2b Taxable amount
Total
Distributions From Pensions,
Annuities, Retirement or
PAYER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
Insurance Contracts, etc.
requirement
Date of payment
PAYER’S TIN
17X14 A $ 6 NUA in employer’s securities $ 4 Federal income tax withheld 5 Employee contrib./desig. Roth PAYER’S TIN not determined distribution 12 FATCA filing 13 Profit-Sharing Plans, IRAs,
3 Capital gain (included
RECIPIENT’S TIN
PAYER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
in box 2a)
Box 7b. If the IRA/SEP/SIMPLE box is checked, you’ve received a traditional IRA (other than
the contract is shown. It isn’t taxable when you receive it and shouldn’t be included in boxes
1 and 2a. When you receive periodic payments from the annuity contract, they’re taxable at
ALSO AVAILABLE IN 62144 code C is shown in box 7a, the amount shown in box 1 is a receipt of reportable death 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 distribution, see Traditional IRAs or Traditional SIMPLE IRAs and Roth IRAs or Roth SIMPLE IRAs, earlier. For a direct rollover, other than from a qualified 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 should be shown and you must enter zero (-0-) on the “Taxable amount” line of your
Box 7c. If the Trump account box is checked, you’ve received a distribution from a Trump
Boxes 8a and 8b. If you received an annuity contract as part of a distribution, the value of
Box 7d. Shows the earnings attributable to the distributed excess contributions made to a
Y— Qualified charitable distribution (QCD) claimed by taxpayer under section 408(d)(8).
contrib. or insurance premiums
$
IRA/SEP/SIMPLE
in box 2a)
$
7c Trump
account
6
4 Federal income tax withheld
excess contrib.
9a Percentage of total dist.
$
NUA in employer’s securities
contrib. or insurance premiums
%
2-WIDE FORMAT benefits that is taxable in part. shown in this box plus the amount in box 6, if any. your tax return for more information. distribution was a total distribution that closed out your account. payer Form W-4P or Form W-4R, as applicable. Q— Qualified distribution from a Roth IRA or Roth SIMPLE IRA. recharacterized in 2026. (under age 59½). T— Roth IRA or Roth SIMPLE IRA distribution, exception applies. U— Dividend distribution from ESOP under section 404(k). Note: This distribution isn’t eligible for rollover. combined arrangements. a Trump account), SEP, or SIMPLE distribution. Trump account. These earnings are subject to a 100% tax. included in box 1, the value of the contract as of the end of the year is shown. This in the annuity or life insurance contract is reported here. It is used to compute the taxable part of the dis
Trump account. These earnings are subject to a 100% tax.
9b Total employee contrib.
IRA/SEP/SIMPLE
7c Trump
account
7d Earnings on
excess contrib.
$
a Trump account), SEP, or SIMPLE distribution.
9a Percentage of total dist.
RECIPIENT’S name, street address (including apt. no.), city or town, state or province, country, and ZIP or foreign postal code
8b Percentage of annuity contract
%
9b Total employee contrib.
$
combined arrangements.
17X14 REMOVE THESE EDGES FIRST FOLD, CREASE AND TEAR ALONG PERFORATION account. and Pub. 575. and Pub. 969. FOLD, CREASE AND TEAR ALONG PERFORATION REMOVE THESE EDGES FIRST benefits that is taxable in part. shown in this box plus the amount in box 6, if any. your tax return for more information. distribution was a total distribution that closed out your account. payer Form W-4P or Form W-4R, as applicable. recharacterized in 2026. (under age 59½). $ Copy 2 $ 17 Local tax withheld account. www.irs.gov/Form1099R and Pub. 575. this form is shown in this box. $ $ $ 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
and Pub. 969.
11 1st year of desig. Roth contrib.
14 State tax withheld
15 State/Payer’s state no.
10 Amount allocable to IRR within 5 years
Account number (see instructions)
18 Name of locality
balance of a Trump account to an ABLE account of the account beneficiary in the year
P— Excess contributions plus earnings/excess deferrals (and/or earnings) taxable in 2025
11 1st year of desig. Roth contrib.
19 Local distribution
8— Excess contributions plus earnings/excess deferrals (and/or earnings) taxable in 2026.
Note: If code B is in box 7a and an amount is reported in box 10, see the Instructions
these distributions, see the instructions for your tax return. Also, certain distributions may be
Box 7a. The following codes identify the distribution you received. For more information on
is included in box 2a. If you didn’t receive a lump-sum distribution, the amount shown is the
4972. If you roll over the distribution to a designated Roth account in the same plan or to a
N— Recharacterized IRA contribution made for 2026 and recharacterized in 2026.
J— Early distribution from a Roth IRA or Roth SIMPLE IRA, no known exception
File this copy with your state, city, or
NUA attributable to employee contributions, which isn’t taxed until you sell the securities.
governmental section 457(b) plan, or an IRA. Also, a direct rollover of the entire
D— Annuity payments from nonqualified annuities that may be subject to tax under
E— Distributions under Employee Plans Compliance Resolution System (EPCRS).
17 Local tax withheld
6— Section 1035 exchange (a tax-free exchange of life insurance, annuity, qualified
unless you choose to include it in your gross income this year. See Pub. 575 and Form
$
H— Direct rollover of a designated Roth account distribution to a Roth IRA or
G— Direct rollover of a distribution to a qualified plan, a section 403(b) plan, a
K— Distribution of traditional IRA assets not having a readily available FMV.
Roth IRA or Roth SIMPLE IRA, see the instructions for box 2a. For a direct rollover to a Form 1099-R
16 State distribution
designated Roth account in the same plan or to a Roth IRA or Roth SIMPLE IRA, the NUA local income tax return, when required.
Copy 2
$
Department of the Treasury
18 Name of locality
PS3AR-BLANK-POP FROM: PSF4AR-BLANK Z 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. Traditional IRAs or traditional SIMPLE IRAs. For distributions from a traditional individual retirement arrangement (IRA) or a traditional SIMPLE IRA, 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 distributions from your
1— Early distribution, no known exception (in most cases, under age 59½).
Internal Revenue Service
1 Gross distribution
19 Local distribution
$
CORRECTED (if checked)
subject to an additional 10% tax. See the Instructions for Form 5329.
www.irs.gov/Form1099R
$
OMB No. 1545-0119
2a Taxable amount
File this copy with your state, city, or
A— May be eligible for 10-year tax option (see Form 4972).
$
2b Taxable amount
local income tax return, when required.
2— Early distribution, exception applies (under age 59½).
long-term care insurance, or endowment contracts).
Form 1099-R
Distributions From Pensions,
not determined
C— Reportable death benefits under section 6050Y .
Internal Revenue Service
Total
1 Gross distribution
Annuities, Retirement or
distribution
Profit-Sharing Plans, IRAs,
Department of the Treasury - Internal Revenue Service
Insurance Contracts, etc.
12
FATCA filing
(in most cases, under age 59½). 13
B— Designated Roth account distribution.
2a Taxable amount
requirement
the beneficiary reaches age 17.
26
$
SEE REVERSE SIDE FOR OPENING INSTRUCTIONS Important Tax Document Enclosed First-Class Mail SEE REVERSE SIDE FOR OPENING INSTRUCTIONS REMOVE SIDE EDGES FIRST 3— Disability. 4— Death. THEN FOLD AND TEAR THIS STUB ALONG PERFORATION for Form 5329. section 1411. TXE 1099R-E4CNB 2 3 1 or a previous year. Z Instructions for Recipient Form 1099-R. taxable amount in box 2a. See the instructions for your tax return. information on IRAs. excess contribution. your complete TIN to the IRS. to distinguish your account. self-employed. $ $ 8a Other PAYER’S TIN REMOVE SIDE EDGES FIRST 3— Disability. 7a Dist. code(s) 7b 9— Cost of current life insurance protection. 8b Percentage of annuity contract 3 Roth SIMPLE IRA. $ 7d Earnings on L— Loans treated as distributions. Date of payment or a previous year. $ 6 NUA in employer’s securities 7a Dist. code(s) 7b RECIPIENT’S TIN $ 5 Employee contrib./desig. Roth
M— Qualified plan loan offset.
Distributions From Pensions,
not determined
Total
F— Charitable gift annuity.
Annuities, Retirement or
Profit-Sharing Plans, IRAs,
5— Prohibited transaction.
distribution
7— Normal distribution.
FATCA filing 13
Insurance Contracts, etc.
section 1411.
requirement
Date of payment
for Form 5329.
4— Death.
RECIPIENT’S TIN
3 Capital gain (included
PAYER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
in box 2a)
$
4 Federal income tax withheld
6
1
PAYER’S TIN
$
5 Employee contrib./desig. Roth
NUA in employer’s securities
2
$
contrib. or insurance premiums
in box 2a)
3 Capital gain (included
THEN FOLD AND TEAR THIS STUB ALONG PERFORATION
IRA/SEP/SIMPLE
7c Trump
account
4 Federal income tax withheld
excess contrib.
9a Percentage of total dist.
contrib. or insurance premiums
IRA/SEP/SIMPLE
$
8a Other
%
9b Total employee contrib.
$
%
7c Trump
7d Earnings on
account
excess contrib.
$
9a Percentage of total dist.
RECIPIENT’S name, street address (including apt. no.), city or town, state or province, country, and ZIP or foreign postal code
8b Percentage of annuity contract
$
%
9b Total employee contrib.
%
Account number (see instructions)
RECIPIENT’S name, street address (including apt. no.), city or town, state or province, country, and ZIP or foreign postal code
$ 14 State tax withheld 11 1st year of desig. Roth contrib.
$ 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.
$ 17 Local tax withheld
www.irs.gov/Form1099R
This information is being furnished to the IRS.
Department of the Treasury
$ 16 State distribution
Internal Revenue Service
Copy B 18 Name of locality
$ 19 Local distribution
www.irs.gov/Form1099R
income tax withheld in box 4, attach this copy to your return.
This information is being furnished to the IRS.
Report this income on your federal tax return. If this form shows federal
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”
X Form 1099-R CORRECTED (if checked)
PAYER’S name, street address, city or town, state or province, country, and ZIP or foreign postal code, and telephone no.
1 Gross distribution
9139171 PAYER’S TIN $ 2a Taxable amount OMB No. 1545-0119 Distributions From
RECIPIENT’S TIN $ 2b Taxable amount 26 Pensions, Annuities,
Retirement or
not determined
Total Form 1099-R Profit-Sharing
in box 2a) distribution
3 Capital gain (included
$ 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.
$
$ $ 8a Other Instructions for Recipient 7a Dist. code(s) 7b IRA/SEP/SIMPLE $ 5 Employee contrib./desig. Roth amount” line of your tax return the amount shown in this box plus the
3. BEFORE DETACHING SLIDE FINGER UP BETWEEN MIDDLE PANEL AND ADDRESS PANEL TO REMOVE
6 NUA in employer’s securities
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 $ 9a Percentage of total dist. 18 15 Name of locality % $ 8b Percentage of annuity contract If a life insurance, annuity, qualified long-term care, or endowment amount in box 6, if any.
contrib. or insurance premiums
Account number (see instructions)
7c Trump
received it as periodic payments, nonperiodic payments, or a total
Copy B
account
distribution. Report the amount on Form 1040, 1040-SR, or 1040-NR
Generally, distributions from retirement plans (IRAs, qualified plans,
on the line for “IRA distributions” or "Pensions and annuities” (or the
If this is a total distribution from a qualified plan and you were born
section 403(b) plans, and governmental section 457(b) plans),
7d Earnings on
Report this income on your
excess contrib.
federal tax return. If this
before January 2, 1936 (or you’re the beneficiary of someone born
line for “Taxable amount”) and on Form 8606, as applicable. However,
insurance contracts, etc., are reported to recipients on Form 1099-R.
$
form shows federal income
before January 2, 1936), you may be eligible for the 10-year tax option.
this copy to your return.
Qualified plans and section 403(b) plans. If your annuity starting
tax withheld in box 4, attach
requirement
if this is a lump-sum distribution, see Form 4972. If you haven’t
State tax withheld
reached minimum retirement age, report your disability payments on
date is after 1997, you must use the simplified method to figure your
furnished to the IRS.
This information is being
See the Form 4972 instructions for more information.
the line for “Wages, salaries, tips, etc.” on your tax return. Also report
If you’re an eligible retired public safety officer who elected to
taxable amount if your payer didn’t show the taxable amount in box
on that line permissible withdrawals from eligible automatic
9b Total employee contrib.
exclude from income distributions from your eligible plan used to pay
%
2a. See the instructions for your tax return.
10 Amount allocable to IRR within 5 years
Traditional IRAs or traditional SIMPLE IRAs. For distributions from a
certain insurance premiums, the amount shown in box 2a hasn’t been
contribution arrangements and corrective distributions of excess
State/Payer’s state no.
Local tax withheld
traditional individual retirement arrangement (IRA) or a traditional 16
reduced by the exclusion amount. See the instructions for your tax
deferrals, excess contributions, or excess aggregate contributions
return for more information.
except if the distribution is of designated Roth contributions or your
$
State distribution
after-tax contributions or if you’re self-employed.
SIMPLE IRA, generally the payer isn’t required to compute the taxable
FOLD, CREASE AND TEAR ALONG PERFORATION
amount. See the instructions for your tax return to determine the
Box 2b. If the first box is checked, the payer was unable to determine
www.irs.gov/Form1099R
taxable amount. If you’re at least age 73, you must take minimum
$
the taxable amount and box 2a should be blank, except for a
an amount will be shown in this box and code 6 will be shown in box
determine the taxable amount. If the second box is checked, the
distribution was a total distribution that closed out your account.
$
7a. If a charge or payment was made against the cash value of an
should’ve been distributed. See Pub. 590-A and Pub. 590-B for more
distributions from your IRA (other than a Roth IRA or Roth SIMPLE Local distribution
Box 3. If you received a lump-sum distribution from a qualified plan
FIRST: REMOVE THESE EDGES
information on IRAs.
CORRECTED (if checked)
annuity contract or the cash surrender value of a life insurance
contract for the purchase of qualified long-term care insurance, an
$
amount will be shown in this box and code W will be shown in box 7a.
Roth IRAs or Roth SIMPLE IRAs. For distributions from a Roth IRA
and were born before January 2, 1936 (or you’re the beneficiary of
PAYER’S name, street address, city or town, state or province, country, and ZIP or foreign postal code, and telephone no.
1 Gross distribution
someone born before January 2, 1936), you may be able to elect to
or Roth SIMPLE IRA, generally the payer isn’t required to compute the
You need not report these amounts on your tax return. If code C is
treat this amount as a capital gain on Form 4972 (not on Schedule D
taxable amount. You must compute any taxable amount on Form
(Form 1040)). See the Form 4972 instructions. For a charitable gift
$ 2a Taxable amount IRA). If you don’t, you’re subject to an excise tax on the amount that 19 contract was transferred tax free to another trustee or contract issuer, traditional IRA or traditional SIMPLE IRA. It’s your responsibility to FOLD, CREASE AND TEAR ALONG PERFORATION FIRST: REMOVE THESE EDGES
shown in box 7a, the amount shown in box 1 is a receipt of reportable
8606. An amount shown in box 2a may be taxable earnings on an
Department of the Treasury - Internal Revenue Service
death benefits that is taxable in part.
annuity, report as a long-term capital gain as explained in the
excess contribution.
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 may have to treat the loan as a distribution and include all or part of checked. You may want to get one of the free publications from the your income tax return as tax withheld. Generally, if you receive Equipment
Loans treated as distributions. If you borrow money from a qualified
Instructions for Form 8949.
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
Box 4. Shows federal income tax withheld. Include this amount on
PAYER’S TIN
OMB No. 1545-0119
the taxable amount. In that case, the first box in box 2b should be
26
plan, section 403(b) plan, or governmental section 457(b) plan, you
$
the amount borrowed in your income. There are exceptions to this rule.
payments that aren’t eligible rollover distributions, you can change
Distributions From
IRS to help you figure the taxable amount. See Additional information
your withholding or elect not to have income tax withheld by giving
on the back of Copy 2. For an IRA distribution, see Traditional IRAs or
Pensions, Annuities,
the payer Form W-4P or Form W-4R, as applicable.
Traditional SIMPLE IRAs and Roth IRAs or Roth SIMPLE IRAs, earlier.
2b Taxable amount
Recipient’s taxpayer identification number (TIN). For your
RECIPIENT’S TIN
For a direct rollover, other than from a qualified plan, section 403(b)
If your loan is taxable, code L will be shown in box 7a. See Pub. 575. Retirement or
Box 5. Generally, this shows the employee’s investment in the contract
Form 1099-R
(after-tax contributions), if any, recovered tax free this year; the portion
not determined
Total
plan, or governmental section 457(b) plan to a designated Roth
protection, this form may show only the last 4 digits of your TIN (SSN, Profit-Sharing
that’s your basis in a designated Roth account; the part of premiums
account in the same plan or to a Roth IRA, zero should be shown and
to the IRS.
you must enter zero (-0-) on the “Taxable amount” line of your tax
in box 2a)
Account number. May show an account, policy, or other unique
distribution
paid on commercial annuities or insurance contracts recovered tax
free; the nontaxable part of a charitable gift annuity; or the investment
number the payer assigned to distinguish your account.
ITIN, ATIN, or EIN). However, the payer has reported your complete TIN Plans, IRAs,
return. If you roll over a distribution (other than a distribution from a
in a life insurance contract reportable under section 6050Y. This box
Insurance
Box 1. Shows the total amount distributed this year. The amount may
designated Roth account) from a qualified plan, section 403(b) plan, or
4 Federal income tax withheld
governmental section 457(b) plan to a designated Roth account in the
Roth SIMPLE IRA, a recharacterized IRA contribution; or you may have
same plan or to a Roth IRA, you must include on the “Taxable
(Continued on the back of Copy C.)
$
$
6 NUA in employer’s securities
5 Employee contrib./desig. Roth
7a Dist. code(s)
$
8a Other have been a direct rollover, a transfer or conversion to a Roth IRA or Contracts, etc. doesn’t show any IRA contributions. If the amount shown is your basis
$ 7b IRA/SEP/SIMPLE
contrib. or insurance premiums
Account number (see instructions)
7c Trump
account
Copy 2 13
Remove address panel below to view additional instructions on back of copy C
7d Earnings on
9a Percentage of total dist.
Date of payment
File this copy with
12 14 8b Percentage of annuity contract $ excess contrib.
your state, city, or
FATCA filing
11 1st year of desig. Roth contrib.
local income tax
return, when requirement $ State tax withheld
required. 10 Amount allocable to IRR within 5 years % $ 9b Total employee contrib.
$ 15
$ 17 State/Payer’s state no. %
$ Local tax withheld 16
$ State distribution
$ 18
www.irs.gov/Form1099R
Name of locality $
Form 1099-R
19 $ $ Local distribution
TXF 1099R-3ARP $ 1 Gross distribution Department of the Treasury - Internal Revenue Service • 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
2a Taxable amount
PAYER’S TIN
26
Distributions From
RECIPIENT’S TIN
2b Taxable amount
not determined
Retirement or
Profit-Sharing
distribution
Plans, IRAs,
in box 2a)
$
Insurance
$ 4 Federal income tax withheld Contracts, etc.
6 NUA in employer’s securities
$ 5 Employee contrib./desig. Roth
$ 8a Other 7a Dist. code(s) 7b IRA/SEP/SIMPLE $ contrib. or insurance premiums
Account number (see instructions)
7c Trump
Copy C 13 11 1st year of desig. Roth contrib. 9a Percentage of total dist. account 7d Earnings on
12 14 Instructions for Recipient (Continued) $ excess contrib. to tax under section 1411. Box 7d. Shows the earnings attributable to the distributed excess
Date of payment
For Recipient’s
Records FATCA filing E— Distributions under Employee Plans Compliance Resolution contributions made to a Trump account. These earnings are subject to a
requirement $ State tax withheld in a designated Roth account, the year you first made contributions to System (EPCRS). 100% tax.
8b Percentage of annuity contract
%
that account may be entered in box 11.
$ 15 $ F— Charitable gift annuity. Boxes 8a and 8b. If you received an annuity contract as part of a
9b Total employee contrib.
furnished to the IRS.
$ Box 6. If you received a lump-sum distribution from a qualified plan % distribution, the value of the contract is shown. It isn’t taxable when you
This information is being
17 State/Payer’s state no. G— Direct rollover of a distribution to a qualified plan, a section 403(b) receive it and shouldn’t be included in boxes 1 and 2a. When you
that includes securities of the employer’s company, the net unrealized
10 Amount allocable to IRR within 5 years
rollover of the entire balance of a Trump account to an ABLE
16
$ Local tax withheld appreciation (NUA) (any increase in value of such securities while in plan, a governmental section 457(b) plan, or an IRA. Also, a direct receive periodic payments from the annuity contract, they’re taxable at
the trust) is taxed only when you sell the securities unless you choose
to include it in your gross income this year. See Pub. 575 and Form
account of the account beneficiary in the year the beneficiary
than one person. You’ll need this information if you use the 10-year tax
State distribution
$ (keep for your records) 18 Name of locality $ $ $ $ 19 Local distribution H— Direct rollover of a designated Roth account distribution to a Roth that time. Your percentage is shown if the distribution is made to more • For use with ALL pressure seal forms
SEE REVERSE SIDE FOR OPENING INSTRUCTIONS Important Tax Document Enclosed 6— Section 1035 exchange (a tax-free exchange of life insurance, S— Early distribution from a SIMPLE IRA in first 2 years, no known account reported on this form is shown in this box. • Service agreements available
option (Form 4972). If you previously received an annuity contract as part
reaches age 17.
4972. If you roll over the distribution to a designated Roth account in
www.irs.gov/Form1099R
FROM:
of a distribution (or the contract was purchased through a direct rollover
the same plan or to a Roth IRA or Roth SIMPLE IRA, see the
instructions for box 2a. For a direct rollover to a designated Roth
IRA or Roth SIMPLE IRA.
from a plan account) and periodic payments from that annuity contract
J— Early distribution from a Roth IRA or Roth SIMPLE IRA, no known
account in the same plan or to a Roth IRA or Roth SIMPLE IRA, the
are included in box 1, the value of the contract as of the end of the year
is shown. This information may be provided to your plan administrator to
NUA is included in box 2a. If you didn’t receive a lump-sum
distribution, the amount shown is the NUA attributable to employee
determine any required distribution from that plan. If charges were made
exception (in most cases, under age 59½).
contributions, which isn’t taxed until you sell the securities.
for qualified long-term care insurance contracts under combined
K— Distribution of traditional IRA assets not having a readily available
FMV.
Box 7a. The following codes identify the distribution you received. For
below zero) in the annuity or life insurance contract is reported here.
• Our Most Popular Mid-Range Folder/Sealer Department of the Treasury - Internal Revenue Service L— Loans treated as distributions. arrangements, the amount of the reduction in the investment (but not W
more information on these distributions, see the instructions for your
tax return. Also, certain distributions may be subject to an additional
Box 9a. Your percentage is shown if a total distribution was made to
M—Qualified plan loan offset.
more than one person.
N— Recharacterized IRA contribution made for 2026 and
10% tax. See the Instructions for Form 5329.
recharacterized in 2026.
Box 9b. For a life annuity from a qualified plan or from a section 403(b)
1— Early distribution, no known exception (in most cases, under age
59½).
plan (with after-tax contributions), an amount may be shown for the
P— Excess contributions plus earnings/excess deferrals (and/or
employee’s total investment in the contract. It is used to compute the
2— Early distribution, exception applies (under age 59½).
taxable part of the distribution. See Pub. 575.
earnings) taxable in 2025 or a previous year.
Q— Qualified distribution from a Roth IRA or Roth SIMPLE IRA.
3— Disability.
4— Death.
Box 10. If an amount is reported in this box, see the Instructions for
Form 5329 and Pub. 575.
R— Recharacterized IRA contribution made for 2025 or a previous year
Box 11. The first year you made a contribution to the designated Roth
5— Prohibited transaction.
and recharacterized in 2026.
Box 12. If checked, the payer is reporting on this Form 1099 to satisfy its
exception (under age 59½).
annuity, qualified long-term care insurance, or endowment
Internal Revenue Code chapter 4 account reporting requirement under
contracts).
T— Roth IRA or Roth SIMPLE IRA distribution, exception applies.
7— Normal distribution.
FATCA. You may also have a filing requirement. See the Instructions for
U— Dividend distribution from ESOP under section 404(k).
Form 8938.
Note: This distribution isn’t eligible for rollover.
8— Excess contributions plus earnings/excess deferrals (and/or
Box 13. Shows the date of payment for reportable death benefits under
earnings) taxable in 2026.
W—Charges or payments for purchasing qualified long-term care
9— Cost of current life insurance protection.
section 6050Y.
Boxes 14–19. If state or local income tax was withheld from the
insurance contracts under combined arrangements.
distribution, boxes 16 and 19 may show the part of the distribution
A— May be eligible for 10-year tax option (see Form 4972).
B— Designated Roth account distribution.
subject to state and/or local tax.
Y— Qualified charitable distribution (QCD) claimed by taxpayer under
section 408(d)(8).
Note: If code B is in box 7a and an amount is reported in box 10,
• Works with ALL Pressure Seal Forms see the Instructions for Form 5329. Box 7b. If the IRA/SEP/SIMPLE box is checked, you’ve received a Additional information. You may want to see: Form W-4P, Form 4972,
C— Reportable death benefits under section 6050Y.
traditional IRA (other than a Trump account), SEP, or SIMPLE distribution.
Form 5329, Form 8606, Pub. 525, Pub. 560, Pub. 571, Pub. 575, Pub.
Box 7c. If the Trump account box is checked, you’ve received a
distribution from a Trump account.
590-A, Pub. 590-B, Pub. 721, Pub. 939, and Pub. 969.
D— Annuity payments from nonqualified annuities that may be subject
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