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1
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RECIPIENT'S NAME & ADDRESS |
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Your
registration
and mailing
address.
You are
the recipient
as owner
of the
account(s)
listed
on this
form. |
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2
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FUND CODE & ACCOUNT NUMBER |
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The fund code of the fund and the account
number from which the distributions were made. |
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3
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RECIPIENT'S IDENTIFICATION NUMBER |
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The number under which
the distribution amounts have been reported to the IRS. For
individuals, this is your Social Security Number. |
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4
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(Box 1). GROSS DISTRIBUTION |
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Box 1 reports the
total amount of any distribution taken from your retirement
account during 2009. |
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5
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(Box 2a). TAXABLE AMOUNT |
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Box 2a reports the taxable portion
of your IRA account distributions.
This information should be entered on Form 1040:
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If you did not roll over the full amount of your distribution into another
qualified plan, enter the amount on Line 15b.
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If you rolled over the full amount of your
distribution into another qualified plan, enter the amount
on Line 15a and enter zero on Line 15b.
If you have previously made one or more
nondeductible contributions to your traditional IRA account(s), please refer to
the
Frequently Asked Questions section for further information. |
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6
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(Box 2b). TAXABLE AMOUNT
NOT DETERMINED |
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If this box is checked,
the taxable amount of your distribution has not been determined. |
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7
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(Box 2b). TOTAL DISTRIBUTION |
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If this box is checked,
the full balance of the retirement account was distributed to
you during 2009. |
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8
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(Box 4). FEDERAL INCOME
TAX WITHHELD |
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Box 4 reports the amount of federal
income tax that was withheld from any distribution. This amount
is considered a prepayment of your federal personal income tax.
Should be entered on Form 1040, Page 2, Line 61. |
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9
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(Box 7). DISTRIBUTION
CODE |
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The distribution code indicates the
type of distribution you received. A list of the distribution
codes and their corresponding meanings can be found on the reverse
side of your Form 1099-R. |
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10
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IRA/SEP/SIMPLE |
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If
this box
is checked,
the distribution
was taken
from an
IRA, SEP
IRA or
SIMPLE
IRA account. |
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11
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(Box 10). STATE TAX
WITHHELD |
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Box 10 reports the
amount of state tax withheld from any distribution. This amount
is considered a prepayment of your state personal income tax. |
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12
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(Box 11). STATE/PAYER'S
STATE NO. |
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Box 11 indicates the state to which the withholding was paid and the payer's federal identification number. |
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13
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(Box 12). STATE DISTRIBUTION |
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Box 12 reports the
amount of the distribution taken from your account during 2009. |
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