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1099-R
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1099 INT
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1099-R
Step
1
of
2
50%
Email Information
Insert the e-mail address to which you want to receive your 1099-R form
Email
*
General Information
Tax Year
2023
2022
2021
Payer's Information
PAYER'S name, street address, city or town, state or province, country, ZIP
Payer's TIN
Recipient’s Information
Recipient’s Name
Recipient’s TIN
Recipient’s Address
Street Address(including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Distributions From Pensions, Annuities, Retirement or Profit-Sharing Plans, IRAs, Insurance Contracts, etc.
Account Number
FATCA Filing Requirement
FATCA Filing Requirement
1. Gross Distribution
2a. Taxable Amount
untitled
2b. Taxable amount not determined
untited
2b. Total distribution
3. Capital Gain
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)
1—Early distribution, no known exception
2—Early distribution, exception applies.
3—Disability.
4—Death.
5—Prohibited transaction.
6—Section 1035 exchange.
7—Normal distribution
8—Excess contributions plus earnings/excess deferrals (and/or earnings) taxable in 2023
9—Cost of current life insurance protection.
A—May be eligible for 10-year tax option.
B—Designated Roth account distribution.
C—Reportable death benefits under section 6050Y.
D—Annuity payments from nonqualified annuities and distributions from life insurance contracts that may be subject to tax under section 1411
E—Distributions under Employee Plans Compliance Resolution System (EPCRS).
F—Charitable gift annuity.
G—Direct rollover and direct payment.
H—Direct rollover of a designated Roth account distribution to a Roth IRA.
J—Early distribution from a Roth IRA.
K—Distribution of traditional IRA assets not having a readily available FMV.
L—Loans treated as deemed distributions under section 72(p).
M—Qualified plan loan offset.
N—Recharacterized IRA contribution made for 2022.
P—Excess contributions plus earnings/excess deferrals taxable in 2021.
Q—Qualified distribution from a Roth IRA.
R—Recharacterized IRA contribution made for 2021.
S—Early distribution from a SIMPLE IRA in the first 2 years, no known exception.
T—Roth IRA distribution, exception applies
U—Dividends distributed from an ESOP under section 404(k).
W—Charges or payments for purchasing qualified long-term care insurance contracts under combined arrangements.
Untitled
Check this box in the IRA/SEP/SIMPLE checkbox if the distribution is from a traditional IRA, SEP IRA, or SIMPLE IRA. Do not check the box for a distribution from a Roth IRA or for an IRA recharacterization
8. Enter the current actuarial value of an annuity contract that is part of a lump-sum distribution.
8. Enter the percentage (%) of the total annuity contract
9a. Your Percentage of Total Distribution
9b. Total Employee Contributions
10. Amount Allocable to IRR Within 5 Years
11. 1st Year of Designated Roth Contribution
13. Date of Payment
MM slash DD slash YYYY
14. State income tax withheld (Line 1)
15. State/Payer’s state no. (Line 1)
16. State distribution (Line 1)
Do you wish to enter another state income tax withheld?
YES
NO
14. State income tax withheld (Line 2)
15. State/Payer’s state no. (Line 2)
16. State distribution (Line 2)
17. Local tax withheld (Line 1)
18. Name of locality (Line 1)
19. Local distribution (Line 1)
Do you wish to enter another local tax withheld for your locality?
YES
NO
17. Local tax withheld (Line 2)
18. Name of locality (Line 2)
19. Local distribution (Line 1)
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1099-R
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Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number
Expiration Date
Security Code
Cardholder Name
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