Form 1099-R Distributions From Pensions, Annuities, Retirement or Profit-Sharing Plans, IRAs, Insurance Contracts, etc. 2018

Form 1099-R Distributions From Pensions, Annuities, Retirement or Profit-Sharing Plans, IRAs, Insurance Contracts, etc. 2018

Summary: This is an example of Form 1099-R (2018) with information completed per the text. The line items are completed as follows:

"PAYER'S name, street address, city, state, and ZIP code" field contains:
Crabtree Corporation Employees' Pension Plan
1111 Main Street
Anytown, Texas 75000
"PAYER'S federal identification number" field contains 10-0000000
"RECIPIENT'S identification number" field contains 002-00-XXXX
"RECIPIENT'S name" field contains Robert C. Smith
"RECIPIENT'S identification number" field contains 002-00-XXXX
"Street address (including apartment number)" field contains 911 Mill Way
"City, state, and ZIP code" field contains Anytown, Texas 75000
"1. Gross distribution" field contains $175000.00
"2a. Taxable amount" field contains $150000.00
"2b. Total distribution" checkbox checked
"3. Capital gain (included in box 2a)" field contains $10000.00
"4. Federal income tax withheld" field contains $30000.00
"5. Employee contributions/Designated Roth contributions or insurance premiums" field contains $25000.00
"7. Distribution code(s)" field contains 7A