Form 1099-R Distributions From Pensions, Annuities, Retirement or Pr

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about printing these tax forms.

9898

VOID

CORRECTED
1 Gross distribution

PAYER’S name, street address, city, state, and ZIP code

OMB No. 1545-0119

$

2008

2a Taxable amount

$

Form

2b Taxable amount
not determined
PAYER’S federal identification
number

RECIPIENT’S identification
number

RECIPIENT’S name

Street address (including apt. no.)

1st year of desig. Roth contrib.

Total
distribution

3 Capital gain (included
in box 2a)

4 Federal income tax
withheld

$

$

5 Employee contributions
/Designated Roth
contributions or
insurance premiums

6 Net unrealized
appreciation in
employer’s securities

$

$

7 Distribution
code(s)

City, state, and ZIP code

1099-R

IRA/
SEP/
SIMPLE

9a Your percentage of total
distribution
%
10 State tax withheld

1099-R

13 Local tax withheld

For Privacy Act
and Paperwork
Reduction Act
Notice, see the
2008 General
Instructions for
Forms 1099,
1098, 5498,
and W-2G.

$
%
9b Total employee contributions
$

11 State/Payer’s state no. 12 State distribution

14 Name of locality

15 Local distribution

$
$

Cat. No. 14436Q

Do Not Cut or Separate Forms on This Page

File with Form 1096.

$
$

$
$
Form

Copy A
For
Internal Revenue
Service Center

8 Other

$
$
Account number (see instructions)

Distributions From
Pensions, Annuities,
Retirement or
Profit-Sharing
Plans, IRAs,
Insurance
Contracts, etc.

Department of the Treasury - Internal Revenue Service

— Do Not Cut or Separate Forms on This Page

VOID

CORRECTED

PAYER’S name, street address, city, state, and ZIP code

1 Gross distribution

OMB No. 1545-0119

$

2008

2a Taxable amount

$

Form

2b Taxable amount
not determined
PAYER’S federal identification
number

RECIPIENT’S identification
number

RECIPIENT’S name

Street address (including apt. no.)

1st year of desig. Roth contrib.

Total
distribution

3 Capital gain (included
in box 2a)

4 Federal income tax
withheld

$

$

5 Employee contributions
/Designated Roth
contributions or
insurance premiums

6 Net unrealized
appreciation in
employer’s securities

$

$

7 Distribution
code(s)

City, state, and ZIP code

1099-R

IRA/
SEP/
SIMPLE

9a Your percentage of total
distribution
%
10 State tax withheld

13 Local tax withheld

$
$
Form

1099-R

Copy 1
For
State, City,
or Local
Tax Department

8 Other

$
%
9b Total employee contributions
$
11 State/Payer’s state no. 12 State distribution

$
$
Account number (see instructions)

Distributions From
Pensions, Annuities,
Retirement or
Profit-Sharing
Plans, IRAs,
Insurance
Contracts, etc.

$
$
14 Name of locality

15 Local distribution

$
$
Department of the Treasury - Internal Revenue Service

CORRECTED (if checked)
PAYER’S name, street address, city, state, and ZIP code

1 Gross distribution

OMB No. 1545-0119

$

2008

2a Taxable amount

$

Form

2b Taxable amount
not determined
PAYER’S federal identification
number

RECIPIENT’S identification
number

RECIPIENT’S name

Street address (including apt. no.)

1st year of desig. Roth contrib.

Total
distribution

3 Capital gain (included
in box 2a)

4 Federal income tax
withheld

$

$

5 Employee contributions
/Designated Roth
contributions or
insurance premiums

6 Net unrealized
appreciation in
employer’s securities

$

$

7 Distribution
code(s)

City, state, and ZIP code

1099-R

IRA/
SEP/
SIMPLE

9a Your percentage of total
distribution
%
10 State tax withheld

13 Local tax withheld

$
$
Form

1099-R

Copy B
Report this
income on your
federal tax
return. If this
form shows
federal income
tax withheld in
box 4, attach
this copy to
your return.

8 Other

$
%
9b Total employee contributions

This information is
being furnished to
the Internal
Revenue Service.

$
11 State/Payer’s state no. 12 State distribution

$
$
Account number (see instructions)

Distributions From
Pensions, Annuities,
Retirement or
Profit-Sharing
Plans, IRAs,
Insurance
Contracts, etc.

$
$
14 Name of locality

15 Local distribution

$
$
Department of the Treasury - Internal Revenue Service

Instructions for Recipient
Generally, distributions from pensions, annuities, profit-sharing
and retirement plans (including section 457 state and local
government plans), IRAs, insurance contracts, etc., are reported
to recipients on Form 1099-R.
Qualified plans. If your annuity starting date is after 1997, you
must use the simplified method to figure your taxable amount if
your payer did not show the taxable amount in box 2a. See
the instructions for Form 1040 or 1040A.
IRAs. For distributions from a traditional individual retirement
arrangement (IRA), simplified employee pension (SEP), or savings
incentive match plan for employees (SIMPLE), generally the
payer is not required to compute the taxable amount. Therefore,
the amounts in boxes 1 and 2a will be the same most of the
time. See the Form 1040 or 1040A instructions to determine the
taxable amount. If you are at least age 701⁄2 , you must take
minimum distributions from your IRA (other than a Roth IRA). If
you do not, you may be subject to a 50% excise tax on the
amount that should have been distributed. See Pub. 590 for
more information on IRAs.
Roth IRAs. For distributions from a Roth IRA, generally the
payer is not required to compute the taxable amount. You must
compute any taxable amount on Form 8606. An amount shown
in box 2a may be taxable earnings on an excess contribution.
Loans treated as distributions. If you borrow money from a
qualified plan, section 403(b) plan, or government plan, you may
have to treat the loan as a distribution and include all or part of
the amount borrowed in your income. There are exceptions to
this rule. If your loan is taxable, Code L will be shown in box 7.
See Pub. 575.
Account number. May show an account or other unique
number the payer assigned to distinguish your account.

Box 1. Shows the total amount you received this year. The
amount may have been a direct rollover, a transfer or conversion
to a Roth IRA, a recharacterized IRA contribution; or you may
have received it as periodic payments, as nonperiodic payments,
or as a total distribution. Report the amount on Form 1040 or
1040A on the line for “IRA distributions” or “Pensions and
annuities” (or the line for “Taxable amount”), and on Form 8606,
as applicable. However, if this is a lump-sum distribution, see
Form 4972. If you have not reached minimum retirement age,
report your disability payments on the line for “Wages, salaries,
tips, etc.” on your tax return. Also report on that line permissible
withdrawals from eligible automatic contribution arrangements
and corrective distributions of excess deferrals, excess
contributions, or excess aggregate contributions except if you
are self-employed.
If a life insurance, annuity, or endowment 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 7. You need not report this on your tax return.
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 IRAs and Roth IRAs above. For a direct rollover,
other than from a qualified plan 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 from a
qualified plan (other than from a designated Roth account) to a
Roth IRA, you must include on the “Taxable amount” line of your
tax return the amount shown in this box plus the amount in box
6, if any.
(Continued on the back of Copy C.)

CORRECTED (if checked)
1 Gross distribution

PAYER’S name, street address, city, state, and ZIP code

OMB No. 1545-0119

$

2008

2a Taxable amount

$

Form

2b Taxable amount
not determined
PAYER’S federal identification
number

RECIPIENT’S identification
number

RECIPIENT’S name

Street address (including apt. no.)

1st year of desig. Roth contrib.

Total
distribution

3 Capital gain (included
in box 2a)

4 Federal income tax
withheld

$

$

5 Employee contributions
/Designated Roth
contributions or
insurance premiums

6 Net unrealized
appreciation in
employer’s securities

$

$

7 Distribution
code(s)

City, state, and ZIP code

1099-R

IRA/
SEP/
SIMPLE

9a Your percentage of total
distribution
%
10 State tax withheld

13 Local tax withheld

$
$
Form

1099-R

(keep for your records)

Copy C
For Recipient’s
Records

8 Other

$
%
9b Total employee contributions

This information is
being furnished to
the Internal
Revenue Service.

$
11 State/Payer’s state no. 12 State distribution

$
$
Account number (see instructions)

Distributions From
Pensions, Annuities,
Retirement or
Profit-Sharing
Plans, IRAs,
Insurance
Contracts, etc.

$
$
14 Name of locality

15 Local distribution

$
$
Department of the Treasury - Internal Revenue Service

Instructions for Recipient ( Continued)
If this is a total distribution from a qualified plan (other than an IRA
or section 403(b) plan) and you were born before January 2, 1936 (or
you are the beneficiary of someone born before January 2, 1936),
you may be eligible for the 10-year tax option. See the Form 4972
instructions for more information.
Box 2b. If the first box is checked, the payer was unable to
determine the taxable amount, and box 2a should be blank.
However, if this is a traditional IRA, SEP, or SIMPLE distribution,
then see IRAs earlier. If the second box is checked, the distribution
was a total distribution that closed out your account. If you are an
eligible retired public safety officer who elected to exclude from
income distributions from your eligible plan used to purchase certain
insurance premiums, the amount shown in box 2b has not been
reduced by the exclusion amount. See the instructions for Form
1040 or Form 1040A for more information.
Box 3. If you received a lump-sum distribution from a qualified plan
and were born before January 2, 1936 (or you are the beneficiary of
someone born before January 2, 1936), you may be able to elect to
treat this amount as a capital gain on Form 4972 (not on Schedule D
(Form 1040)). See the Form 4972 instructions. For a charitable gift
annuity, report as a long-term capital gain on Schedule D.
Box 4. Shows federal income tax withheld. Include this amount on
your income tax return as tax withheld, and if box 4 shows an
amount (other than zero), attach Copy B to your return. Generally, if
you will receive payments next year that are not eligible rollover
distributions, you can change your withholding or elect not to have
income tax withheld by giving the payer Form W-4P.
Box 5. Generally, this shows the employee’s investment in the
contract (after-tax contributions), if any, recovered tax free this year;
the portion that is your basis in a designated Roth account; the part
of premiums paid on commercial annuities or insurance contracts
recovered tax free; or the nontaxable part of a charitable gift annuity.
This box does not show any IRA contributions. If the amount shown
is your basis in a designated Roth account, the year you first made
contributions to that account may be entered in the box next to
box 10.

Box 6. If you received a lump-sum distribution from a qualified plan
that includes securities of the employer’s company, the net
unrealized appreciation (NUA) (any increase in value of such
securities while in the trust) is taxed only when you sell the securities
unless you choose to include it in your gross income this year.
However, if the distribution was a qualified rollover contribution to a
Roth IRA, see the instructions for Box 2a. See Pub. 575 and the
Form 4972 instructions. If you did not receive a lump-sum
distribution, the amount shown is the NUA attributable to employee
contributions, which is not taxed until you sell the securities.
Box 7. The following codes identify the distribution you received. For
more information on these distributions, see the instructions for your
tax return. Also, certain distributions may be subject to an additional
10% tax. See the instructions for Forms 5329 and 8606.
1—Early distribution, no known exception (in most cases, under age
59½).
2—Early distribution, exception applies (under age 59½).
3—Disability.
4—Death.
5—Prohibited transaction.
6—Section 1035 exchange (a tax-free exchange of life insurance,
annuity, or endowment contracts).
7—Normal distribution.
8—Excess contributions plus earnings/excess deferrals (and/or
earnings) taxable in 2008.
9—Cost of current life insurance protection.
A—May be eligible for 10-year tax option (see Form 4972).
B—Designated Roth account distribution.
D—Excess contributions plus earnings/excess deferrals taxable in
2006.
(Continued on the back of Copy 2.)

CORRECTED (if checked)
PAYER’S name, street address, city, state, and ZIP code

1 Gross distribution

OMB No. 1545-0119

$

2008

2a Taxable amount

$

Form

2b Taxable amount
not determined
PAYER’S federal identification
number

RECIPIENT’S identification
number

RECIPIENT’S name

Street address (including apt. no.)

1st year of desig. Roth contrib.

Total
distribution

3 Capital gain (included
in box 2a)

4 Federal income tax
withheld

$

$

5 Employee contributions
/Designated Roth
contributions or
insurance premiums

6 Net unrealized
appreciation in
employer’s securities

$

$

7 Distribution
code(s)

City, state, and ZIP code

1099-R

IRA/
SEP/
SIMPLE

9a Your percentage of total
distribution
%
10 State tax withheld

13 Local tax withheld

$
$
Form

1099-R

Copy 2
File this copy
with your state,
city, or local
income tax
return, when
required.

8 Other

$
%
9b Total employee contributions
$
11 State/Payer’s state no. 12 State distribution

$
$
Account number (see instructions)

Distributions From
Pensions, Annuities,
Retirement or
Profit-Sharing
Plans, IRAs,
Insurance
Contracts, etc.

$
$
14 Name of locality

15 Local distribution

$
$
Department of the Treasury - Internal Revenue Service

Instructions for Recipient (Continued)
E—Excess annual additions under section 415 and certain
excess amounts under section 403(b) plans.
F—Charitable gift annuity.
G—Direct rollover of a distribution (other than a designated Roth
account distribution) to a qualified plan, a section 403(b)
plan, a governmental section 457(b) plan, or an IRA.
H—Direct rollover of a designated Roth account distribution to a
Roth IRA.
J—Early distribution from a Roth IRA, no known exception (in
most cases, under age 59½).
L—Loans treated as distributions.
N—Recharacterized IRA contribution made for 2008 and
recharacterized in 2008.
P—Excess contributions plus earnings/excess deferrals taxable
in 2007.
Q—Qualified distribution from a Roth IRA.
R—Recharacterized IRA contribution made for 2007 and
recharacterized in 2008.
S—Early distribution from a SIMPLE IRA in first 2 years, no
known exception (under age 59½).
T—Roth IRA distribution, exception applies.
If the IRA/SEP/SIMPLE box is checked, you have received a
traditional IRA, SEP, or SIMPLE distribution.
Box 8. If you received an annuity contract as part of a
distribution, the value of the contract is shown. It is not taxable
when you receive it and should not be included in boxes 1 and
2a. When you receive periodic payments from the annuity
contract, they are taxable at that time. If the distribution is made
to more than one person, the percentage of the annuity contract
distributed to you is also shown. You will need this information if
you use the 10-year tax option (Form 4972).

Box 9a. If a total distribution was made to more than one
person, the percentage you received is shown.
Box 9b. For a life annuity from a qualified plan or from a section
403(b) plan (with after-tax contributions), an amount may be
shown for the employee’s total investment in the contract. It is
used to compute the taxable part of the distribution. See
Pub. 575.
Boxes 10–15. If state or local income tax was withheld from the
distribution, boxes 12 and 15 may show the part of the
distribution subject to state and/or local tax.
Additional information. You may want to see:
W-4P, Withholding Certificate for Pension or Annuity Payments,
Form 4972, Tax on Lump-Sum Distributions,
Form 5329, Additional Taxes on Qualified Plans (Including IRAs)
and Other Tax-Favored Accounts,
Form 8606, Nondeductible IRAs,
Pub. 560, Retirement Plans for Small Business (SEP, SIMPLE,
and Qualified Plans),
Pub. 571, Tax-Sheltered Annuity Plans (403(b) Plans),
Pub. 575, Pension and Annuity Income,
Pub. 590, Individual Retirement Arrangements (IRAs),
Pub. 721, Tax Guide to U.S. Civil Service Retirement Benefits,
Pub. 939, General Rule for Pensions and Annuities,
Pub. 969, Health Savings Accounts and Other Tax-Favored
Health Plans.

VOID

CORRECTED

PAYER’S name, street address, city, state, and ZIP code

1 Gross distribution

OMB No. 1545-0119

$

2008

2a Taxable amount

$

Form

2b Taxable amount
not determined
PAYER’S federal identification
number

RECIPIENT’S identification
number

RECIPIENT’S name

Street address (including apt. no.)

1st year of desig. Roth contrib.

Total
distribution

3 Capital gain (included
in box 2a)

4 Federal income tax
withheld

$

$

5 Employee contributions
/Designated Roth
contributions or
insurance premiums

6 Net unrealized
appreciation in
employer’s securities

$

$

7 Distribution
code(s)

City, state, and ZIP code

1099-R

IRA/
SEP/
SIMPLE

9a Your percentage of total
distribution
%
10 State tax withheld

13 Local tax withheld

$
$
Form

1099-R

Copy D
For Payer

For Privacy Act
and Paperwork
Reduction Act
Notice, see the
2008 General
Instructions for
Forms 1099,
1098, 5498,
and W-2G.

8 Other

$
%
9b Total employee contributions
$

11 State/Payer’s state no. 12 State distribution

$
$
Account number (see instructions)

Distributions From
Pensions, Annuities,
Retirement or
Profit-Sharing
Plans, IRAs,
Insurance
Contracts, etc.

$
$
14 Name of locality

15 Local distribution

$
$
Department of the Treasury - Internal Revenue Service

Instructions for Payers
We provide general and specific form
instructions as separate products. The
products you should use to complete Form
1099-R are the 2008 General Instructions for
Forms 1099, 1098, 5498, and W-2G and the
2008 Instructions for Forms 1099-R and
5498. A chart in the general instructions gives
a quick guide to which form must be filed to
report a particular payment. To order these
instructions and additional forms, visit the IRS
website at www.irs.gov or call
1-800-TAX-FORM (1-800-829-3676).
Caution: Because paper forms are scanned
during processing, you cannot file with the
IRS Forms 1096, 1098, 1099, or 5498 that
you print from the IRS website.
Due dates. Furnish Copies B, C, and 2 of
this form to the recipient by February 2, 2009.

File Copy A of this form with the IRS by
March 2, 2009. If you file electronically, the
due date is March 31, 2009. To file
electronically, you must have software that
generates a file according to the
specifications in Pub. 1220, Specifications for
Filing Forms 1098, 1099, 5498, and W-2G
Electronically. IRS does not provide a fill-in
form option.
Need help? If you have questions about
reporting on Form 1099-R, call the
information reporting customer service site
toll free at 1-866-455-7438 or 304-263-8700
(not toll free). For TTY/TDD equipment, call
304-267-3367 (not toll free). The hours of
operation are Monday through Friday from
8:30 a.m. to 4:30 p.m., Eastern time.