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 C 8753442 $ 2b Taxable amount CORRECTED (if checked) 12 OMB No. 1545-0119 Date of payment 25 $ Form 1099-R CORRECTED (if checked) OMB No. 1545-0119
2-WIDE FORMAT
Form 1099-R
1 Gross distribution
2a Taxable amount
$
not determined
Distributions From Pensions,
Total
Annuities, Retirement or
distribution
1 Gross distribution
Profit-Sharing Plans, IRAs,
Insurance Contracts, etc.
2a Taxable amount
FATCA filing 13
requirement
$
2b Taxable amount
Total
Annuities, Retirement or
Profit-Sharing Plans, IRAs,
PAYER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
Insurance Contracts, etc.
FATCA filing 13
Date of payment
PAYER’S TIN
17X14 A $ 3 Capital gain (included 4 Federal income tax withheld 5 Employee contributions PAYER’S TIN not determined distribution 12 requirement Distributions From Pensions, 25
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)
distributed to you is also shown. You’ll need this information if you use the 10-year tax option
ALSO AVAILABLE IN 62144 code C is shown in box 7, 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
When you receive periodic payments from the annuity contract, they’re taxable at that time.
Box 8. If you received an annuity contract as part of a distribution, the value of the contract 6 Net unrealized appreciation
(Form 4972). If you previously received an annuity contract as part of a distribution (or the
If the distribution is made to more than one person, the percentage of the annuity contract
is shown. It isn’t taxable when you receive it and shouldn’t be included in boxes 1 and 2a. in employer’s securities
contract was purchased through a direct rollover from a plan account) and periodic
Y— Qualified charitable distribution (QCD) claimed by taxpayer under section 408(d)(8).
If the IRA/SEP/SIMPLE box is checked, you’ve received a traditional IRA, SEP, or
/Designated Roth contributions
3 Capital gain (included
in box 2a)
4 Federal income tax withheld
/Designated Roth contributions
in employer’s securities
9b Total employee contributions
or insurance premiums
% $
IRA/
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 2025. (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. SIMPLE distribution. contract was purchased through a direct rollover from a plan account) and periodic It is used to compute the taxable part of the distribution. See Pub. 575. Box 10. If an amount is reported in this box, see the Instructions for Form 5329 this form is shown in this box. requi
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
this form is shown in this box.
combined arrangements.
17X14 REMOVE THESE EDGES FIRST FOLD, CREASE AND TEAR ALONG PERFORATION reported here. received is shown. 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 2025. (under age 59½). $ Copy 2 $ 17 Local tax withheld 18 Name of locality 11 1st year of desig. Roth contrib. $ $ $ 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
received is shown.
14 State tax withheld
SIMPLE distribution.
and Pub. 969.
and Pub. 575.
15
10 Amount allocable to IRR within 5 years
reported here. State/Payer’s state no.
Account number (see instructions)
11 1st year of desig. Roth contrib.
19 Local distribution
Note: If code B is in box 7 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
8— Excess contributions plus earnings/excess deferrals (and/or earnings) taxable in 2025. www.irs.gov/Form1099R
account in the same plan or to a Roth IRA or Roth SIMPLE IRA, the NUA is included in box
N— Recharacterized IRA contribution made for 2025 and recharacterized in 2025.
choose to include it in your gross income this year. See Pub. 575 and Form 4972. If you roll
2a. If you didn’t receive a lump-sum distribution, the amount shown is the NUA attributable
Box 7. The following codes identify the distribution you received. For more information on
of the employer’s company, the net unrealized appreciation (NUA) (any increase in value of
File this copy with your state, city, or
J— Early distribution from a Roth IRA or Roth SIMPLE IRA, no known exception
D— Annuity payments from nonqualified annuities that may be subject to tax under
E— Distributions under Employee Plans Compliance Resolution System (EPCRS).
6— Section 1035 exchange (a tax-free exchange of life insurance, annuity, qualified
$
17 Local tax withheld
over the distribution to a designated Roth account in the same plan or to a Roth IRA or
G— Direct rollover of a distribution to a qualified plan, a section 403(b) plan, a
H— Direct rollover of a designated Roth account distribution to a Roth IRA or
K— Distribution of traditional IRA assets not having a readily available FMV.
Copy 2
Roth SIMPLE IRA, see the instructions for box 2a. For a direct rollover to a designated Roth local income tax return, when required.
$
16 State distribution
18 Name of locality
Department of the Treasury
PS3AR-BLANK-POP FROM: PSF4AR-BLANK B 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
such securities while in the trust) is taxed only when you sell the securities unless you Form 1099-R
Internal Revenue Service
1— Early distribution, no known exception (in most cases, under age 59½).
1 Gross distribution
19 Local distribution
to employee contributions, which isn’t taxed until you sell the securities.
CORRECTED (if checked)
$
$
subject to an additional 10% tax. See the Instructions for Form 5329.
www.irs.gov/Form1099R
2a Taxable amount
OMB No. 1545-0119
File this copy with your state, city, or
long-term care insurance, or endowment contracts). $
A— May be eligible for 10-year tax option (see Form 4972).
2— Early distribution, exception applies (under age 59½).
local income tax return, when required.
2b Taxable amount
not determined
C— Reportable death benefits under section 6050Y .
Internal Revenue Service
governmental section 457(b) plan, or an IRA.
Form 1099-R
Distributions From Pensions,
Total
1 Gross distribution
Annuities, Retirement or
Department of the Treasury - Internal Revenue Service
distribution
9— Cost of current life insurance protection.
Profit-Sharing Plans, IRAs,
FATCA filing
B— Designated Roth account distribution.
Insurance Contracts, etc.
12
2a Taxable amount
requirement
(in most cases, under age 59½). 13
$
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 7— Normal distribution. for Form 5329. TXE 1099R-E4CNB section 1411. 2 3 1 or a previous year. B Instructions for Recipient Form 1099-R. taxable amount in box 2a. See the instructions for your tax return. information on IRAs. excess contribution. reported your complete TIN to the IRS. to distinguish your account. self-employed. RECIPIENT’S name, street address (including apt. no.), city or town, state or province, country, and ZIP or foreign postal code L— Loans treated as distributions. Date of payment or a previous year. $ $ 6 Net unrealized appreciation $ 7 Distribution code(s) RECIPIENT’S TIN $ 8 Other 5 Employee contributions Date of payment
25
M— Qualified plan loan offset.
Total
not determined
F— Charitable gift annuity.
Distributions From Pensions,
Annuities, Retirement or
5— Prohibited transaction.
Roth SIMPLE IRA.
7— Normal distribution.
Profit-Sharing Plans, IRAs,
distribution
12
requirement
FATCA filing 13
section 1411.
Insurance Contracts, etc.
PAYER’S TIN
for Form 5329.
3— Disability.
4— Death.
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)
$
4 Federal income tax withheld
1
PAYER’S TIN
$
6 Net unrealized appreciation
5 Employee contributions
2
in employer’s securities
$
$
/Designated Roth contributions
or insurance premiums
in box 2a)
3
3 Capital gain (included
7 Distribution code(s)
8 Other
IRA/
THEN FOLD AND TEAR THIS STUB ALONG PERFORATION
SEP/
SIMPLE
REMOVE SIDE EDGES FIRST
4 Federal income tax withheld
%
$
9a Your percentage of total distribution
/Designated Roth contributions
in employer’s securities
9b Total employee contributions
or insurance premiums
% $
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
$ 14 State tax withheld 11 1st year of desig. Roth contrib.
19 Local distribution
(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.
Department of the Treasury
$ 16 State distribution
Internal Revenue Service
Copy B 18 Name of locality
$ 19 Local distribution
www.irs.gov/Form1099R
Report this income on your federal tax return. If this form shows federal
This information is being furnished to the IRS.
income tax withheld in box 4, attach this copy to your return.
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”
E 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
8755578 PAYER’S TIN $ 2a Taxable amount OMB No. 1545-0119 Distributions From
RECIPIENT’S TIN $ 2b Taxable amount 25 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
Insurance
RECIPIENT’S name, street address (incl. apt. no.), city or town, state or province, country, and ZIP or foreign postal code
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
$ 9a Your percentage of total distribution 7 Distribution code(s) SEP/ IRA/ $ 8 Other 5 Employee contributions designated Roth account) from a qualified plan, section 403(b) plan, or
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 $ 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 or governmental section 457(b) plan to a designated Roth account in the
insurance premiums

/Designated Roth contributions or
Account number (see instructions)
Box 1. Shows the total amount distributed this year. The amount may
Instructions for Recipient
Copy B
SIMPLE
Roth SIMPLE IRA, a recharacterized IRA contribution; or you may have
Generally, distributions from retirement plans (IRAs, qualified plans,
Report this income on your
same plan or to a Roth IRA, you must include on the “Taxable
amount” line of your tax return the amount shown in this box plus the
received it as periodic payments, nonperiodic payments, or a total
$
federal tax return. If this
distribution. Report the amount on Form 1040, 1040-SR, or 1040-NR
amount in box 6, if any.
form shows federal income
section 403(b) plans, and governmental section 457(b) plans),
requirement
insurance contracts, etc., are reported to recipients on Form 1099-R.
State tax withheld
tax withheld in box 4, attach
this copy to your return.
If this is a total distribution from a qualified plan and you were born
on the line for “IRA distributions” or "Pensions and annuities” (or the
%
Qualified plans and section 403(b) plans. If your annuity starting
This information is being
furnished to the IRS.
line for “Taxable amount”) and on Form 8606, as applicable. However,
before January 2, 1936 (or you’re the beneficiary of someone born
before January 2, 1936), you may be eligible for the 10-year tax option.
date is after 1997, you must use the simplified method to figure your
if this is a lump-sum distribution, see Form 4972. If you haven’t
taxable amount if your payer didn’t show the taxable amount in box
reached minimum retirement age, report your disability payments on
10 Amount allocable to IRR within 5 years
State/Payer’s state no.
See the Form 4972 instructions for more information.
2a. See the instructions for your tax return.
If you’re an eligible retired public safety officer who elected to
the line for “Wages, salaries, tips, etc.” on your tax return. Also report
16
on that line permissible withdrawals from eligible automatic
exclude from income distributions from your eligible plan used to pay
Traditional IRAs or traditional SIMPLE IRAs. For distributions from a
State distribution
traditional individual retirement arrangement (IRA) or a traditional $
contribution arrangements and corrective distributions of excess
deferrals, excess contributions, or excess aggregate contributions
www.irs.gov/Form1099R
SIMPLE IRA, generally the payer isn’t required to compute the taxable
FOLD, CREASE AND TEAR ALONG PERFORATION
certain insurance premiums, the amount shown in box 2a hasn’t been
$
reduced by the exclusion amount. See the instructions for your tax
amount. See the instructions for your tax return to determine the
after-tax contributions or if you’re self-employed.
Box 2b. If the first box is checked, the payer was unable to determine
If a life insurance, annuity, qualified long-term care, or endowment
taxable amount. If you’re at least age 73, you must take minimum Local distribution
the taxable amount and box 2a should be blank, except for a
IRA). If you don’t, you’re subject to an excise tax on the amount that
traditional IRA or traditional SIMPLE IRA. It’s your responsibility to
FIRST: REMOVE THESE EDGES
CORRECTED (if checked)
should’ve been distributed. See Pub. 590-A and Pub. 590-B for more
contract was transferred tax free to another trustee or contract issuer,
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
information on IRAs.
7. If a charge or payment was made against the cash value of an
distribution was a total distribution that closed out your account.
PAYER’S name, street address, city or town, state or province, country, and ZIP or foreign postal code, and telephone no.
1 Gross distribution
annuity contract or the cash surrender value of a life insurance
Roth IRAs or Roth SIMPLE IRAs. For distributions from a Roth IRA
Box 3. If you received a lump-sum distribution from a qualified plan
or Roth SIMPLE IRA, generally the payer isn’t required to compute the
contract for the purchase of qualified long-term care insurance, an
and were born before January 2, 1936 (or you’re the beneficiary of
$ 2a Taxable amount distributions from your IRA (other than a Roth IRA or Roth SIMPLE $ $ 19 except if the distribution is of designated Roth contributions or your return for more information. FOLD, CREASE AND TEAR ALONG PERFORATION FIRST: REMOVE THESE EDGES
Department of the Treasury - Internal Revenue Service
taxable amount. You must compute any taxable amount on Form
amount will be shown in this box and code W will be shown in box 7.
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 plan, section 403(b) plan, or governmental section 457(b) plan, you Distributions From Instructions for Form 8949. Equipment
someone born before January 2, 1936), you may be able to elect to
8606. An amount shown in box 2a may be taxable earnings on an
You need not report these amounts on your tax return. If code C is
shown in box 7, the amount shown in box 1 is a receipt of reportable
treat this amount as a capital gain on Form 4972 (not on Schedule D
excess contribution.
PAYER’S TIN
OMB No. 1545-0119
(Form 1040)). See the Form 4972 instructions. For a charitable gift
annuity, report as a long-term capital gain as explained in the
death benefits that is taxable in part.
Loans treated as distributions. If you borrow money from a qualified
25
Box 2a. This part of the distribution is generally taxable. If there is no
$
may have to treat the loan as a distribution and include all or part of
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
Pensions, Annuities,
the taxable amount. In that case, the first box in box 2b should be
your income tax return as tax withheld. Generally, if you receive
2b Taxable amount
RECIPIENT’S TIN
checked. You may want to get one of the free publications from the
the amount borrowed in your income. There are exceptions to this rule. Retirement or
IRS to help you figure the taxable amount. See Additional information
payments that aren’t eligible rollover distributions, you can change
Recipient’s taxpayer identification number (TIN). For your
on the back of Copy 2. For an IRA distribution, see Traditional IRAs or
your withholding or elect not to have income tax withheld by giving
protection, this form may show only the last four digits of your TIN
Form 1099-R
not determined
Total
the payer Form W-4P or Form W-4R, as applicable.
Traditional SIMPLE IRAs and Roth IRAs or Roth SIMPLE IRAs, earlier.
(SSN, ITIN, ATIN, or EIN). However, the payer has reported your
If your loan is taxable, code L will be shown in box 7. See Pub. 575. Profit-Sharing
For a direct rollover, other than from a qualified plan, section 403(b)
complete TIN to the IRS.
in box 2a)
distribution
plan, or governmental section 457(b) plan to a designated Roth
Plans, IRAs,
number the payer assigned to distinguish your account.
account in the same plan or to a Roth IRA, zero should be shown and
Insurance
4 Federal income tax withheld
Account number. May show an account, policy, or other unique Contracts, etc.
return. If you roll over a distribution (other than a distribution from a
$
$
6 Net unrealized appreciation
in employer’s securities
$ 5 Employee contributions you must enter zero (-0-) on the “Taxable amount” line of your tax (Continued on the back of Copy C.)
IRA/
insurance premiums
7 Distribution code(s)
/Designated Roth contributions or
SEP/ 8 Other
Account number (see instructions)
SIMPLE
Copy 2 13
9a Your percentage of total distribution
Remove address panel below to view additional instructions on back of copy C
$
Date of payment
File this copy with
12 14
11 1st year of desig. Roth contrib.
your state, city, or
FATCA filing 9b Total employee contributions
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 • 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
PAYER’S TIN
25
2a Taxable amount
Distributions From
RECIPIENT’S TIN
2b Taxable amount
not determined
Retirement or
Profit-Sharing
in box 2a)
distribution
Plans, IRAs,
$
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
$
Date of payment
12 14 Instructions for Recipient (Continued) If the IRA/SEP/SIMPLE box is checked, you’ve received a traditional
Records FATCA filing 9b Total employee contributions A— May be eligible for 10-year tax option (see Form 4972).
For Recipient’s
requirement $ State tax withheld Box 5. Generally, this shows the employee’s investment in the contract % B— Designated Roth account distribution. IRA, SEP, or SIMPLE distribution.
Note: If code B is in box 7 and an amount is reported in box 10,
(after-tax contributions), if any, recovered tax free this year; the portion
%
Box 8. If you received an annuity contract as part of a distribution, the
$
$ 15 that’s your basis in a designated Roth account; the part of premiums value of the contract is shown. It isn’t taxable when you receive it and
furnished to the IRS.
$ see the Instructions for Form 5329. shouldn’t be included in boxes 1 and 2a. When you receive periodic
This information is being
paid on commercial annuities or insurance contracts recovered tax
17 State/Payer’s state no. C— Reportable death benefits under section 6050Y.
10 Amount allocable to IRR within 5 years
in a life insurance contract reportable under section 6050Y. This box
$ Local tax withheld free; the nontaxable part of a charitable gift annuity; or the investment D— Annuity payments from nonqualified annuities that may be subject payments from the annuity contract, they’re taxable at that time. If the
16
distribution is made to more than one person, the percentage of the
doesn’t show any IRA contributions. If the amount shown is your basis
to tax under section 1411.
State distribution
$ (keep for your records) 18 Name of locality $ $ $ $ 19 Local distribution E— Distributions under Employee Plans Compliance Resolution annuity contract distributed to you is also shown. You’ll need this • For use with ALL pressure seal forms
information if you use the 10-year tax option (Form 4972). If you
www.irs.gov/Form1099R
in a designated Roth account, the year you first made contributions to
SEE REVERSE SIDE FOR OPENING INSTRUCTIONS Important Tax Document Enclosed 10% tax. See the Instructions for Form 5329. Q— Qualified distribution from a Roth IRA or Roth SIMPLE IRA. Box 11. The first year you made a contribution to the designated Roth • Service agreements available
previously received an annuity contract as part of a distribution (or the
System (EPCRS).
that account may be entered in box 11.
FROM:
F— Charitable gift annuity.
contract was purchased through a direct rollover from a plan account)
Box 6. If you received a lump-sum distribution from a qualified plan
and periodic payments from that annuity contract are included in box 1,
G— Direct rollover of a distribution to a qualified plan, a section 403(b)
the value of the contract as of the end of the year is shown. This
that includes securities of the employer’s company, the net unrealized
plan, a governmental section 457(b) plan, or an IRA.
appreciation (NUA) (any increase in value of such securities while in
information may be provided to your plan administrator to determine any
the trust) is taxed only when you sell the securities unless you choose
required distribution from that plan. If charges were made for qualified
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 Roth SIMPLE IRA.
amount of the reduction in the investment (but not below zero) in the
4972. If you roll over the distribution to a designated Roth account in
• Our Most Popular Mid-Range Folder/Sealer Department of the Treasury - Internal Revenue Service J— Early distribution from a Roth IRA or Roth SIMPLE IRA, no known long-term care insurance contracts under combined arrangements, the F
the same plan or to a Roth IRA or Roth SIMPLE IRA, see the
exception (in most cases, under age 59½).
annuity or life insurance contract is reported here.
instructions for box 2a. For a direct rollover to a designated Roth
Box 9a. If a total distribution was made to more than one person, the
K— Distribution of traditional IRA assets not having a readily available
FMV.
account in the same plan or to a Roth IRA or Roth SIMPLE IRA, the
percentage you received is shown.
Box 9b. For a life annuity from a qualified plan or from a section 403(b)
NUA is included in box 2a. If you didn’t receive a lump-sum
L— Loans treated as distributions.
plan (with after-tax contributions), an amount may be shown for the
distribution, the amount shown is the NUA attributable to employee
M—Qualified plan loan offset.
contributions, which isn’t taxed until you sell the securities.
employee’s total investment in the contract. It is used to compute the
taxable part of the distribution. See Pub. 575.
Box 7. The following codes identify the distribution you received. For
N— Recharacterized IRA contribution made for 2025 and
Box 10. If an amount is reported in this box, see the Instructions for
more information on these distributions, see the instructions for your
recharacterized in 2025.
tax return. Also, certain distributions may be subject to an additional
Form 5329 and Pub. 575.
P— Excess contributions plus earnings/excess deferrals (and/or
earnings) taxable in 2024 or a previous year.
account reported on this form is shown in this box.
1— Early distribution, no known exception (in most cases, under age
Box 12. If checked, the payer is reporting on this Form 1099 to satisfy its
59½).
R— Recharacterized IRA contribution made for 2024 or a previous year
Internal Revenue Code chapter 4 account reporting requirement under
and recharacterized in 2025.
2— Early distribution, exception applies (under age 59½).
3— Disability.
FATCA. You may also have a filing requirement. See the Instructions for
4— Death.
Form 8938.
S— Early distribution from a SIMPLE IRA in first 2 years, no known
exception (under age 59½).
Box 13. Shows the date of payment for reportable death benefits under
section 6050Y.
5— Prohibited transaction.
T— Roth IRA or Roth SIMPLE IRA distribution, exception applies.
6— Section 1035 exchange (a tax-free exchange of life insurance,
U— Dividend distribution from ESOP under section 404(k).
Boxes 14–19. If state or local income tax was withheld from the
Note: This distribution isn’t eligible for rollover.
annuity, qualified long-term care insurance, or endowment
distribution, boxes 16 and 19 may show the part of the distribution
contracts).
• Works with ALL Pressure Seal Forms 7— Normal distribution. W—Charges or payments for purchasing qualified long-term care subject to state and/or local tax.
insurance contracts under combined arrangements.
Additional information. You may want to see: Form W-4P, Form 4972,
8— Excess contributions plus earnings/excess deferrals (and/or
Form 5329, Form 8606, Pub. 525, Pub. 560, Pub. 571, Pub. 575, Pub.
earnings) taxable in 2025.
Y— Qualified charitable distribution (QCD) claimed by taxpayer under
section 408(d)(8).
590-A, Pub. 590-B, Pub. 721, Pub. 939, and Pub. 969.
9— Cost of current life insurance protection.
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