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

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VOID

9898

CORRECTED

PAYER’S name, street address, city or town, state or province,
country, ZIP or foreign postal code, and telephone no.

1 Gross distribution

OMB No. 1545-0119

2a Taxable amount

2025

$

Form

$

2b Taxable amount
not determined

1099-R

Total
distribution

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

Copy A

TREASURY/IRS
AND OMB USE
ONLY DRAFT
February 18, 2025
DO NOT FILE
PAYER’S TIN

3 Capital gain (included in 4 Federal income tax
box 2a)
withheld

RECIPIENT’S TIN

$

$

5 Employee contributions/ 6 Net unrealized
Designated Roth
appreciation in
contributions or
employer’s securities
insurance premiums

RECIPIENT’S name

$

$

7 Distribution
code(s)

Street address (including apt. no.)

For
Internal Revenue
Service Center

For filing information,
Privacy Act, and
Paperwork Reduction
Act Notice, see the

General
Instructions
for Certain
Information
Returns.

IRA/
8 Other
SEP/
SIMPLE

$
%
City or town, state or province, country, and ZIP or foreign postal code 9a Your percentage of total 9b Total employee contributions
distribution
%$
www.irs.gov/Form1099
10 Amount allocable to IRR
11 1st year of desig. 12 FATCA filing 14 State tax withheld
15 State/Payer’s state no. 16 State distribution
Roth contrib.
within 5 years
requirement $
$

$

$

Account number (see instructions)

Form 1099-R

Cat. No. 14436Q

13 Date of
payment

$

17 Local tax withheld

$
$

19 Local distribution

$
$

www.irs.gov/Form1099R

Do Not Cut or Separate Forms on This Page

18 Name of locality

—

Department of the Treasury - Internal Revenue Service

Do Not Cut or Separate Forms on This Page

VOID

CORRECTED

PAYER’S name, street address, city or town, state or province,
country, ZIP or foreign postal code, and telephone no.

1 Gross distribution

OMB No. 1545-0119

2a Taxable amount

2025

$

Form

$

2b Taxable amount
not determined

1099-R

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

Total
distribution

Copy 1

TREASURY/IRS
AND OMB USE
ONLY DRAFT
February 18, 2025
DO NOT FILE
PAYER’S TIN

3 Capital gain (included in 4 Federal income tax
box 2a)
withheld

RECIPIENT’S TIN

$

$

For
State, City,
or Local
Tax Department

5 Employee contributions/ 6 Net unrealized
Designated Roth
appreciation in
contributions or
employer’s securities
insurance premiums

RECIPIENT’S name

$

7 Distribution
code(s)

Street address (including apt. no.)

$

IRA/
8 Other
SEP/
SIMPLE

$
%
City or town, state or province, country, and ZIP or foreign postal code 9a Your percentage of total 9b Total employee contributions
distribution
%$

10 Amount allocable to IRR
within 5 years

11 1st year of desig. 12 FATCA filing 14 State tax withheld
requirement $
Roth contrib.

$

Account number (see instructions)

Form 1099-R

15 State/Payer’s state no. 16 State distribution

$
$

$

13 Date of
payment

www.irs.gov/Form1099R

17 Local tax withheld

$
$

18 Name of locality

19 Local distribution

$
$

Department of the Treasury - Internal Revenue Service

CORRECTED (if checked)
PAYER’S name, street address, city or town, state or province,
country, ZIP or foreign postal code, and telephone no.

1 Gross distribution

OMB No. 1545-0119

2a Taxable amount

2025

$

Form

$

2b Taxable amount
not determined

1099-R

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

Total
distribution

Copy B

TREASURY/IRS
AND OMB USE
ONLY DRAFT
February 18, 2025
DO NOT FILE
PAYER’S TIN

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.

3 Capital gain (included in 4 Federal income tax
box 2a)
withheld

RECIPIENT’S TIN

$

$

5 Employee contributions/ 6 Net unrealized
Designated Roth
appreciation in
contributions or
employer’s securities
insurance premiums

RECIPIENT’S name

$

7 Distribution
code(s)

Street address (including apt. no.)

$

IRA/
8 Other
SEP/
SIMPLE

This information is
being furnished to
the IRS.

$

%
City or town, state or province, country, and ZIP or foreign postal code 9a Your percentage of total 9b Total employee contributions
distribution
%$

10 Amount allocable to IRR
within 5 years

11 1st year of desig. 12 FATCA filing 14 State tax withheld
requirement $
Roth contrib.

$

Account number (see instructions)

Form 1099-R

15 State/Payer’s state no. 16 State distribution

$
$

$

13 Date of
payment

www.irs.gov/Form1099R

17 Local tax withheld

$
$

18 Name of locality

19 Local distribution

$
$

Department of the Treasury - Internal Revenue Service

Instructions for Recipient

Generally, distributions from retirement plans (IRAs, qualified plans,
section 403(b) plans, and governmental section 457(b) plans),
insurance contracts, etc., are reported to recipients on Form 1099-R.
Qualified plans and section 403(b) plans. If your annuity starting
date is after 1997, you must use the simplified method to figure your
taxable amount if your payer didn’t show the taxable amount in box
2a. See the instructions for your tax return.
Traditional IRAs or traditional SIMPLE IRAs. For distributions from
a traditional individual retirement arrangement (IRA) or a traditional
SIMPLE IRA, generally the payer isn’t required to compute the taxable
amount. See the instructions for your tax return to determine the
taxable amount. If you’re at least age 73, you must take minimum
distributions from your IRA (other than a Roth IRA or Roth SIMPLE
IRA). If you don’t, you’re subject to an excise tax on the amount that
should’ve been distributed. See Pub. 590-A and Pub. 590-B for more
information on IRAs.
Roth IRAs or Roth SIMPLE IRAs. For distributions from a Roth IRA
or Roth SIMPLE IRA, generally the payer isn’t 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 governmental section 457(b) 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.
Recipient’s taxpayer identification number (TIN). For your
protection, this form may show only the last four digits of your TIN
(SSN, ITIN, ATIN, or EIN). However, the payer has reported your
complete TIN to the IRS.
Account number. May show an account, policy, or other unique
number the payer assigned to distinguish your account.
Box 1. Shows the total amount distributed this year. The amount may
have been a direct rollover, a transfer or conversion to a Roth IRA or
Roth SIMPLE IRA, a recharacterized IRA contribution; or you may
have received it as periodic payments, nonperiodic payments, or a
total distribution. Report the amount on Form 1040, 1040-SR, or

1040-NR 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 haven’t 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 the distribution is of designated Roth
contributions or your after-tax contributions or if you’re self-employed.
If a life insurance, annuity, qualified long-term care, 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. If a charge or payment was made against the cash value of an
annuity contract or the cash surrender value of a life insurance
contract for the purchase of qualified long-term care insurance, an
amount will be shown in this box and code W will be shown in box 7.
You need not report these amounts on your tax return. If code C is
shown in box 7, the amount shown in box 1 is a receipt of reportable
death benefits that is taxable in part.
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 Traditional IRAs or
Traditional SIMPLE IRAs and Roth IRAs or Roth SIMPLE IRAs, earlier.
For a direct rollover, other than from a qualified plan, section 403(b)
plan, or governmental section 457(b) plan to a designated Roth
account in the same plan or 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 (other than a distribution from a
designated Roth account) from a qualified plan, section 403(b) plan, or
governmental section 457(b) plan to a designated Roth account in the
same plan or 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)

TREASURY/IRS
AND OMB USE
ONLY DRAFT
February 18, 2025
DO NOT FILE

CORRECTED (if checked)
PAYER’S name, street address, city or town, state or province,
country, ZIP or foreign postal code, and telephone no.

1 Gross distribution

OMB No. 1545-0119

2a Taxable amount

2025

$

Form

$

2b Taxable amount
not determined

1099-R

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

Total
distribution

Copy C

TREASURY/IRS
AND OMB USE
ONLY DRAFT
February 18, 2025
DO NOT FILE
PAYER’S TIN

For Recipient’s
Records

3 Capital gain (included in 4 Federal income tax
box 2a)
withheld

RECIPIENT’S TIN

$

$

5 Employee contributions/ 6 Net unrealized
Designated Roth
appreciation in
contributions or
employer’s securities
insurance premiums

RECIPIENT’S name

$

7 Distribution
code(s)

Street address (including apt. no.)

$

IRA/
8 Other
SEP/
SIMPLE

This information is
being furnished to
the IRS.

$

%
City or town, state or province, country, and ZIP or foreign postal code 9a Your percentage of total 9b Total employee contributions
distribution
%$

10 Amount allocable to IRR
within 5 years

11 1st year of desig. 12 FATCA filing 14 State tax withheld
requirement $
Roth contrib.

$

$
$

$

Account number (see instructions)

Form 1099-R

15 State/Payer’s state no. 16 State distribution

(keep for your records)

13 Date of
payment

17 Local tax withheld

$
$

www.irs.gov/Form1099R

18 Name of locality

19 Local distribution

$
$

Department of the Treasury - Internal Revenue Service

Instructions for Recipient (continued)

If this is a total distribution from a qualified plan and you were born
before January 2, 1936 (or you’re 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.
If you’re an eligible retired public safety officer who elected to
exclude from income distributions from your eligible plan used to pay
certain insurance premiums, the amount shown in box 2a hasn’t been
reduced by the exclusion amount. See the instructions for your tax
return 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, except for a
traditional IRA or traditional SIMPLE IRA. It’s your responsibility to
determine the taxable amount. If the second box is checked, the
distribution was a total distribution that closed out your account.
Box 3. If you received a lump-sum distribution from a qualified plan
and were born before January 2, 1936 (or you’re 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 as explained in the
Instructions for Form 8949.
Box 4. Shows federal income tax withheld. Include this amount on
your income tax return as tax withheld. Generally, if you receive
payments that aren’t eligible rollover distributions, you can change
your withholding or elect not to have income tax withheld by giving
the payer Form W-4P or Form W-4R, as applicable.
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’s your basis in a designated Roth account; the part of
premiums paid on commercial annuities or insurance contracts
recovered tax free; the nontaxable part of a charitable gift annuity; or
the investment in a life insurance contract reportable under section
6050Y. This box doesn’t 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 box 11.

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. See Pub. 575 and
Form 4972. If you roll over the distribution to a designated Roth
account in the same plan or to a Roth IRA or Roth SIMPLE IRA, see
the instructions for box 2a. For a direct rollover to a designated Roth
account in the same plan or to a Roth IRA or Roth SIMPLE IRA, the
NUA is included in box 2a. If you didn’t receive a lump-sum
distribution, the amount shown is the NUA attributable to employee
contributions, which isn’t 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 Form 5329.
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, qualified long-term care insurance, or endowment
contracts).
7—Normal distribution.
8—Excess contributions plus earnings/excess deferrals (and/or
earnings) taxable in 2025.
9—Cost of current life insurance protection.
A—May be eligible for 10-year tax option (see Form 4972).
B—Designated Roth account distribution.
Note: If code B is in box 7 and an amount is reported in box 10,
see the Instructions for Form 5329.
C—Reportable death benefits under section 6050Y.
D—Annuity payments from nonqualified annuities that may be subject
to tax under section 1411.
(Continued on the back of Copy 2)

TREASURY/IRS
AND OMB USE
ONLY DRAFT
February 18, 2025
DO NOT FILE

CORRECTED (if checked)
PAYER’S name, street address, city or town, state or province,
country, ZIP or foreign postal code, and telephone no.

1 Gross distribution

OMB No. 1545-0119

2a Taxable amount

2025

$

Form

$

2b Taxable amount
not determined

1099-R

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

Total
distribution

Copy 2

TREASURY/IRS
AND OMB USE
ONLY DRAFT
February 18, 2025
DO NOT FILE
PAYER’S TIN

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

3 Capital gain (included in 4 Federal income tax
box 2a)
withheld

RECIPIENT’S TIN

$

$

5 Employee contributions/ 6 Net unrealized
Designated Roth
appreciation in
contributions or
employer’s securities
insurance premiums

RECIPIENT’S name

$

7 Distribution
code(s)

Street address (including apt. no.)

$

IRA/
8 Other
SEP/
SIMPLE

$
%
City or town, state or province, country, and ZIP or foreign postal code 9a Your percentage of total 9b Total employee contributions
distribution
%$

10 Amount allocable to IRR
within 5 years

11 1st year of desig. 12 FATCA filing 14 State tax withheld
requirement $
Roth contrib.

$

Account number (see instructions)

Form 1099-R

15 State/Payer’s state no. 16 State distribution

$
$

$

13 Date of
payment

www.irs.gov/Form1099R

17 Local tax withheld

$
$

18 Name of locality

19 Local distribution

$
$

Department of the Treasury - Internal Revenue Service

Instructions for Recipient (continued)

E—Distributions under Employee Plans Compliance Resolution
System (EPCRS).
F—Charitable gift annuity.
G—Direct rollover of a 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 or Roth SIMPLE IRA.
J—Early distribution from a Roth IRA or Roth SIMPLE IRA, no known
exception (in most cases, under age 59½).
K—Distribution of traditional IRA assets not having a readily available
FMV.
L—Loans treated as distributions.
M—Qualified plan loan offset.
N—Recharacterized IRA contribution made for 2025 and
recharacterized in 2025.
P—Excess contributions plus earnings/excess deferrals (and/or
earnings) taxable in 2024 or a previous year.
Q—Qualified distribution from a Roth IRA or Roth SIMPLE IRA.
R—Recharacterized IRA contribution made for 2024 and
recharacterized in 2025 or a previous year.
S—Early distribution from a SIMPLE IRA in first 2 years, no known
exception (under age 59½).
T—Roth IRA or Roth SIMPLE IRA distribution, exception applies.
U—Dividend distribution from ESOP under section 404(k).
Note: This distribution isn’t eligible for rollover.
W—Charges or payments for purchasing qualified long-term care
insurance contracts under combined arrangements.
Y—Qualified charitable distribution (QCD) claimed by taxpayer under
section 408(d)(8).
If the IRA/SEP/SIMPLE box is checked, you’ve 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 isn’t taxable when you receive it and
shouldn’t be included in boxes 1 and 2a. When you receive periodic
payments from the annuity contract, they’re 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’ll need this
information if you use the 10-year tax option (Form 4972). If you
previously received an annuity contract as part of a distribution and
periodic payments from that annuity contract are included in box 1,
the value of the contract as of the end of the year is shown. This
information may be provided to your plan administrator to determine
any required distribution from that plan. If charges were made for
qualified long-term care insurance contracts under combined
arrangements, the amount of the reduction in the investment (but not
below zero) in the annuity or life insurance contract is reported here.
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.
Box 10. If an amount is reported in this box, see the Instructions for
Form 5329 and Pub. 575.
Box 11. The first year you made a contribution to the designated Roth
account reported on this form is shown in this box.
Box 12. If checked, the payer is reporting on this Form 1099 to satisfy
its Internal Revenue Code chapter 4 account reporting requirement
under FATCA. You may also have a filing requirement. See the
Instructions for Form 8938.
Box 13. Shows the date of payment for reportable death benefits
under section 6050Y.
Boxes 14–19. If state or local income tax was withheld from the
distribution, boxes 16 and 19 may show the part of the distribution
subject to state and/or local tax.

TREASURY/IRS
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ONLY DRAFT
February 18, 2025
DO NOT FILE
Additional information. You may want to see:
Form W-4P, Form 4972, Form 5329, Form 8606,
Pub. 525, Pub. 560, Pub. 571, Pub. 575, Pub. 590-A,
Pub. 590-B, Pub. 721, Pub. 939, and Pub. 969.