Taxpayer's name and annuity/pension type
for tax year |
Check if a public safety officer pension
?
Check if this is or was a disability pension ? | |||||
Enter dates as MM/DD/YYYY | Age at annuity start | |||||
Annuity start date | ||||||
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Earliest retirement age | Yr, Mo. | |||||
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(N/A for annuity before 1998) ? | |||||
Combined age for survivor annuity | Not used | |||||
Months received this year () |
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Gross distribution ( Check if RRB1099-R) |
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Total annuity contributions | ||||||
Annual cost of insurance to exclude |
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Exclusion months in 1st year | ||||||
Total months to be excluded | ||||||
Monthly exclusion | ||||||
First year exclusion | ||||||
Exclusion for remaining years | ||||||
Final year exclusion |
or use the worksheet:
or use the worksheet:
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1099-R Nontaxable Income | ||||||||
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Schedule A - Medical Deductions |
Medical and dental insurance - |
Schedule A - Other Deductions |
Unrecovered Investment in Pension - $ |
Years of service | Retirement age | |
---|---|---|
Civil Service Retirement System (CSRS) | ||
5 | 62 | |
20 | 60 | |
201 | 50 | |
30 | 55 | |
Federal Employees Retirement System (FERS) | ||
5 | 62 | |
10 | 55 | |
201 | 50 | |
251 | Any | |
Railroad Retirement Board (RRB) | ||
5 after 1995 | 62 | |
10 | 62 | |
30 | 60 |