PDF document
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                                       Attention: 

Copy A of this form is provided for informational purposes only. Copy A appears in red, 
similar to the official IRS form. The official printed version of Copy A of this IRS form is 
scannable, but the online version of it, printed from this website, is not. Do not print and file 
copy A downloaded from this website; a penalty may be imposed for filing with the IRS 
information return forms that can’t be scanned. See part O in the current General 
Instructions for Certain Information Returns, available at IRS.gov/Form1099, for more 
information about penalties.

Please note that Copy B and other copies of this form, which appear in black, may be 
downloaded and printed and used to satisfy the requirement to provide the information to 
the recipient.

If you have 10 or more information returns to file, you may be required to file e-file. Go to 
IRS.gov/InfoReturn for e-file options. 

If you have fewer than 10 information returns to file, we strongly encourage you to e-file. If 
you want to file them on paper, you can place an order for the official IRS information 
returns, which include a scannable Copy A for filing with the IRS and all other applicable 
copies of the form, at IRS.gov/EmployerForms. We’ll mail you the forms you request and 
their instructions, as well as any publications you may order. 

See Publications 1141,1167  , and 1179 for more information about printing these forms.



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            9898                    VOID               CORRECTED
PAYER’S name, street address, city or town, state or province,           1  Gross distribution        OMB No. 1545-0119        Distributions From 
country, ZIP or foreign postal code, and telephone no.                                                                         Pensions, Annuities, 
                                                                                                                                           Retirement or 
                                                                         $
                                                                                                                               Profit-Sharing Plans, 
                                                                         2a  Taxable amount
                                                                                                        2024                            IRAs, Insurance 
                                                                                                                                        Contracts, etc.
                                                                         $                            Form  1099-R
                                                                         2b  Taxable amount               Total                                 Copy A 
                                                                             not determined               distribution
                                                                                                                                                For 
PAYER’S TIN                 RECIPIENT’S TIN                              3  Capital gain (included in 4  Federal income tax            Internal Revenue 
                                                                             box 2a)                      withheld
                                                                                                                                        Service Center 
                                                                                                                                                              
                                                                         $                            $                            File with Form 1096.
RECIPIENT’S name                                                         5  Employee contributions/  6  Net unrealized 
                                                                            Designated Roth              appreciation in                   For Privacy Act 
                                                                            contributions or             employer’s securities             and Paperwork 
                                                                            insurance premiums                                             Reduction Act 
                                                                         $                            $                                    Notice, see the 
Street address (including apt. no.)                                      7  Distribution     IRA/     8  Other                              2024 General 
                                                                            code(s)          SEP/                                       Instructions for 
                                                                                             SIMPLE
                                                                                                      $                        %                Certain 
                                                                                                                                            Information 
City or town, state or province, country, and ZIP or foreign postal code 9a  Your percentage of total 9b  Total employee contributions          Returns.
                                                                             distribution          % $
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
     within 5 years                 Roth contrib.      requirement       $                                                             $
$                                                                        $                                                             $
Account number (see instructions)                  13  Date of           17  Local tax withheld       18  Name of locality             19  Local distribution
                                                       payment           $                                                             $
                                                                         $                                                             $
Form 1099-R                 Cat. No. 14436Q            www.irs.gov/Form1099R                            Department of the Treasury - Internal Revenue Service
Do  Not  Cut  or  Separate  Forms  on  This  Page    —     Do  Not  Cut  or  Separate  Forms  on  This  Page



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                                    VOID               CORRECTED
PAYER’S name, street address, city or town, state or province,           1  Gross distribution        OMB No. 1545-0119               Distributions From 
country, ZIP or foreign postal code, and telephone no.                                                                        Pensions, Annuities,
                                                                                                                                          Retirement or 
                                                                         $
                                                                                                                              Profit-Sharing Plans, 
                                                                         2a  Taxable amount
                                                                                                        2024                           IRAs, Insurance 
                                                                                                                                       Contracts, etc.
                                                                         $                             Form  1099-R
                                                                         2b  Taxable amount               Total                           Copy 1 
                                                                             not determined               distribution
                                                                                                                                                  For 
PAYER’S TIN                 RECIPIENT’S TIN                              3  Capital gain (included in 4  Federal income tax               State, City, 
                                                                            box 2a)                      withheld
                                                                                                                                          or Local 
                                                                                                                                      Tax Department 
                                                                         $                            $
RECIPIENT’S name                                                         5  Employee contributions/  6  Net unrealized 
                                                                            Designated Roth              appreciation in 
                                                                            contributions or             employer’s securities
                                                                            insurance premiums
                                                                         $                            $
Street address (including apt. no.)                                      7  Distribution     IRA/     8  Other
                                                                            code(s)          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 11  1st year of desig. 12  FATCA filing      14  State tax withheld       15  State/Payer’s state no.     16  State distribution
     within 5 years                 Roth contrib.      requirement       $                                                            $
$                                                                        $                                                            $
Account number (see instructions)                  13  Date of           17  Local tax withheld       18  Name of locality            19  Local distribution
                                                       payment           $                                                            $
                                                                         $                                                            $
Form 1099-R                         www.irs.gov/Form1099R                                               Department of the Treasury - Internal Revenue Service



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                                                       CORRECTED (if checked)
PAYER’S name, street address, city or town, state or province,           1  Gross distribution        OMB No. 1545-0119        Distributions From 
country, ZIP or foreign postal code, and telephone no.                                                                         Pensions, Annuities,
                                                                                                                                           Retirement or 
                                                                         $
                                                                                                                               Profit-Sharing Plans, 
                                                                         2a  Taxable amount
                                                                                                        2024                            IRAs, Insurance 
                                                                                                                                        Contracts, etc.
                                                                         $                            Form  1099-R
                                                                         2b  Taxable amount               Total                            Copy B 
                                                                             not determined               distribution
                                                                                                                                           Report this 
PAYER’S TIN                 RECIPIENT’S TIN                              3  Capital gain (included in 4  Federal income tax             income on your 
                                                                            box 2a)                      withheld
                                                                                                                                           federal tax 
                                                                                                                                           return. If this 
                                                                         $                            $                                    form shows 
RECIPIENT’S name                                                         5  Employee contributions/  6  Net unrealized                  federal income 
                                                                            Designated Roth              appreciation in                tax withheld in 
                                                                            contributions or             employer’s securities             box 4, attach 
                                                                            insurance premiums
                                                                         $                            $                                    this copy to 
                                                                                             IRA/     8  Other                             your return. 
Street address (including apt. no.)                                      7  Distribution 
                                                                            code(s)          SEP/
                                                                                             SIMPLE
                                                                                                                                        This information is 
                                                                                                      $                        %        being furnished to 
City or town, state or province, country, and ZIP or foreign postal code 9a  Your percentage of total 9b  Total employee contributions         the IRS.
                                                                             distribution          % $
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
     within 5 years                 Roth contrib.      requirement       $                                                             $
$                                                                        $                                                             $
Account number (see instructions)                  13  Date of           17  Local tax withheld       18  Name of locality             19  Local distribution
                                                       payment           $                                                             $
                                                                         $                                                             $
Form 1099-R                         www.irs.gov/Form1099R                                               Department of the Treasury - Internal Revenue Service



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Instructions for Recipient                                              as periodic payments, nonperiodic payments, or a total distribution. 
Generally, distributions from retirement plans (IRAs, qualified plans,  Report the amount on Form 1040, 1040-SR, or 1040-NR on the line 
section 403(b) plans, and governmental section 457(b) plans),           for “IRA distributions” or “Pensions and annuities” (or the line for 
insurance contracts, etc., are reported to recipients on Form 1099-R.   “Taxable amount”) and on Form 8606, as applicable. However, if this 
Qualified plans and section 403(b) plans.If your annuity starting       is a lump-sum distribution, see Form 4972. If you haven’t reached 
date is after 1997, you must use the simplified method to figure your   minimum retirement age, report your disability payments on the line 
taxable amount if your payer didn’t show the taxable amount in box      for “Wages, salaries, tips, etc.” on your tax return. Also report on that 
2a. See the instructions for your tax return.                           line permissible withdrawals from eligible automatic contribution 
IRAs. For distributions from a traditional individual retirement        arrangements and corrective distributions of excess deferrals, excess 
arrangement (IRA), simplified employee pension (SEP), or savings        contributions, or excess aggregate contributions except if the 
incentive match plan for employees (SIMPLE), generally the payer isn’t  distribution is of designated Roth contributions or your after-tax 
required to compute the taxable amount. See the instructions for your   contributions or if you’re self-employed.
tax return to determine the taxable amount. If you’re at least age 73,     If a life insurance, annuity, qualified long-term care, or endowment 
you must take minimum distributions from your IRA (other than a Roth    contract was transferred tax free to another trustee or contract issuer, 
IRA). If you don’t, you’re subject to an excise tax on the amount that  an amount will be shown in this box and code 6 will be shown in box 
should’ve been distributed. See Pub. 590-A and Pub. 590-B for more      7. If a charge or payment was made against the cash value of an 
information on IRAs.                                                    annuity contract or the cash surrender value of a life insurance 
Roth IRAs. For distributions from a Roth IRA, generally the payer isn’t contract for the purchase of qualified long-term care insurance, an 
required to compute the taxable amount. You must compute any            amount will be shown in this box and code W will be shown in box 7. 
taxable amount on Form 8606. An amount shown in box 2a may be           You need not report these amounts on your tax return. If code C is 
taxable earnings on an excess contribution.                             shown in box 7, the amount shown in box 1 is a receipt of reportable 
Loans treated as distributions. If you borrow money from a qualified    death benefits that is taxable in part.
plan, section 403(b) plan, or governmental section 457(b) plan, you     Box 2a. This part of the distribution is generally taxable. If there is no 
may have to treat the loan as a distribution and include all or part of entry in this box, the payer may not have all the facts needed to figure 
the amount borrowed in your income. There are exceptions to this        the taxable amount. In that case, the first box in box 2b should be 
rule. If your loan is taxable, code L will be shown in box 7. See Pub.  checked. You may want to get one of the free publications from the 
575.                                                                    IRS to help you figure the taxable amount. See Additional information 
Recipient’s taxpayer identification number (TIN). For your              on the back of Copy 2. For an IRA distribution, seeIRAs and Roth 
protection, this form may show only the last four digits of your TIN    IRAs, earlier. For a direct rollover, other than from a qualified plan, 
(SSN, ITIN, ATIN, or EIN). However, the payer has reported your         section 403(b) plan, or governmental section 457(b) plan to a 
complete TIN to the IRS.                                                designated Roth account in the same plan or to a Roth IRA, zero 
Account number. May show an account, policy, or other unique            should be shown and you must enter zero (-0-) on the “Taxable 
number the payer assigned to distinguish your account.                  amount” line of your tax return. If you roll over a distribution (other 
Box 1. Shows the total amount distributed this year. The amount may     than a distribution from a designated Roth account) from a qualified 
have been a direct rollover, a transfer or conversion to a Roth IRA, a  plan, section 403(b) plan, or governmental section 457(b) plan to a 
recharacterized IRA contribution; or you may have received it           designated Roth account in the same plan or to a Roth IRA, you must 
                                                                                                             (Continued on the back of Copy C)



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                                                       CORRECTED (if checked)
PAYER’S name, street address, city or town, state or province,           1  Gross distribution        OMB No. 1545-0119       Distributions From 
country, ZIP or foreign postal code, and telephone no.                                                                        Pensions, Annuities,
                                                                                                                                           Retirement or 
                                                                         $
                                                                                                                              Profit-Sharing Plans, 
                                                                         2a  Taxable amount
                                                                                                        2024                            IRAs, Insurance 
                                                                                                                                        Contracts, etc.
                                                                         $                             Form  1099-R
                                                                         2b  Taxable amount               Total                            Copy C 
                                                                             not determined               distribution
                                                                                                                                        For Recipient’s 
PAYER’S TIN                 RECIPIENT’S TIN                              3  Capital gain (included in 4  Federal income tax 
                                                                            box 2a)                      withheld                          Records 

                                                                         $                            $
RECIPIENT’S name                                                         5  Employee contributions/  6  Net unrealized 
                                                                            Designated Roth              appreciation in 
                                                                            contributions or             employer’s securities
                                                                            insurance premiums
                                                                         $                            $
Street address (including apt. no.)                                      7  Distribution     IRA/     8  Other
                                                                            code(s)          SEP/                                       This information is 
                                                                                             SIMPLE
                                                                                                      $                       %         being furnished to 
City or town, state or province, country, and ZIP or foreign postal code 9a  Your percentage of total 9b  Total employee contributions     the IRS.
                                                                             distribution          % $
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
     within 5 years                 Roth contrib.      requirement       $                                                             $
$                                                                        $                                                             $
Account number (see instructions)                  13  Date of           17  Local tax withheld       18  Name of locality             19  Local distribution
                                                       payment           $                                                             $
                                                                         $                                                             $
Form 1099-R         (keep for your records)            www.irs.gov/Form1099R                            Department of the Treasury - Internal Revenue Service



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Instructions for Recipient  (continued)                                   Box 6. If you received a lump-sum distribution from a qualified plan 
include on the “Taxable amount” line of your tax return the amount        that includes securities of the employer’s company, the net unrealized 
shown in this box plus the amount in box 6, if any.                       appreciation (NUA) (any increase in value of such securities while in 
If this is a total distribution from a qualified plan and you were born   the trust) is taxed only when you sell the securities unless you choose 
before January 2, 1936 (or you’re the beneficiary of someone born         to include it in your gross income this year. See Pub. 575 and       
before January 2, 1936), you may be eligible for the 10-year tax          Form 4972. If you roll over the distribution to a designated Roth 
option. See the Form 4972 instructions for more information.              account in the same plan or to a Roth IRA, see the instructions for box 
If you’re an eligible retired public safety officer who elected to        2a. For a direct rollover to a designated Roth account in the same plan 
exclude from income distributions from your eligible plan used to pay     or to a Roth IRA, the NUA is included in box 2a. If you didn’t receive a 
certain insurance premiums, the amount shown in box 2a hasn’t been        lump-sum distribution, the amount shown is the NUA attributable to 
reduced by the exclusion amount. See the instructions for your tax        employee contributions, which isn’t taxed until you sell the securities.
return for more information.                                              Box 7.The following codes identify the distribution you received. For 
Box 2b. If the first box is checked, the payer was unable to determine    more information on these distributions, see the instructions for your 
the taxable amount and box 2a should be blank, except for an IRA.         tax return. Also, certain distributions may be subject to an additional 
It’s your responsibility to determine the taxable amount. If the second   10% tax. See the Instructions for Form 5329.
box is checked, the distribution was a total distribution that closed out 1—Early distribution, no known exception (in most cases, under age 
your account.                                                                59½).
Box 3. If you received a lump-sum distribution from a qualified plan      2—Early distribution, exception applies (under age 59½).
and were born before January 2, 1936 (or you’re the beneficiary of        3—Disability.
someone born before January 2, 1936), you may be able to elect to         4—Death.
treat this amount as a capital gain on Form 4972 (not on Schedule D       5—Prohibited transaction.
(Form 1040)). See the Form 4972 instructions. For a charitable gift       6—Section 1035 exchange (a tax-free exchange of life insurance, 
annuity, report as a long-term capital gain as explained in the              annuity, qualified long-term care insurance, or endowment 
Instructions for Form 8949.                                                  contracts).
Box 4. Shows federal income tax withheld. Include this amount on          7—Normal distribution.
your income tax return as tax withheld. Generally, if you receive         8—Excess contributions plus earnings/excess deferrals (and/or 
payments that aren’t eligible rollover distributions, you can change         earnings) taxable in 2024.
your withholding or elect not to have income tax withheld by giving       9—Cost of current life insurance protection.
the payer Form W-4P or Form W-4R, as applicable.                          A—May be eligible for 10-year tax option (see Form 4972).
Box 5. Generally, this shows the employee’s investment in the             B—Designated Roth account distribution.
contract (after-tax contributions), if any, recovered tax free this year; Note: If code B is in box 7 and an amount is reported in box 10,  
the portion that’s your basis in a designated Roth account; the part of   see the Instructions for Form 5329.
premiums paid on commercial annuities or insurance contracts              C—Reportable death benefits under section 6050Y.
recovered tax free; the nontaxable part of a charitable gift annuity; or  D—Annuity payments from nonqualified annuities that may be subject 
the investment in a life insurance contract reportable under section          to tax under section 1411.
6050Y. This box doesn’t show any IRA contributions. If the amount         E—Distributions under Employee Plans Compliance Resolution 
shown is your basis in a designated Roth account, the year you first          System (EPCRS). 
made contributions to that account may be entered in box 11.                                                  (Continued on the back of Copy 2)



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                                                       CORRECTED (if checked)
PAYER’S name, street address, city or town, state or province,           1  Gross distribution        OMB No. 1545-0119               Distributions From 
country, ZIP or foreign postal code, and telephone no.                                                                        Pensions, Annuities,
                                                                                                                                          Retirement or 
                                                                         $
                                                                                                                              Profit-Sharing Plans, 
                                                                         2a  Taxable amount
                                                                                                        2024                           IRAs, Insurance 
                                                                                                                                       Contracts, etc.
                                                                         $                             Form  1099-R
                                                                         2b  Taxable amount               Total                             Copy 2 
                                                                             not determined               distribution
                                                                                                                                          File this copy 
PAYER’S TIN                 RECIPIENT’S TIN                              3  Capital gain (included in 4  Federal income tax            with your state, 
                                                                            box 2a)                      withheld
                                                                                                                                          city, or local 
                                                                                                                                          income tax 
                                                                         $                            $                                   return, when 
RECIPIENT’S name                                                         5  Employee contributions/  6  Net unrealized                      required. 
                                                                            Designated Roth              appreciation in 
                                                                            contributions or             employer’s securities
                                                                            insurance premiums
                                                                         $                            $
Street address (including apt. no.)                                      7  Distribution     IRA/     8  Other
                                                                            code(s)          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 11  1st year of desig. 12  FATCA filing      14  State tax withheld       15  State/Payer’s state no.     16  State distribution
     within 5 years                 Roth contrib.      requirement       $                                                            $
$                                                                        $                                                            $
Account number (see instructions)                  13  Date of           17  Local tax withheld       18  Name of locality            19  Local distribution
                                                       payment           $                                                            $
                                                                         $                                                            $
Form 1099-R                         www.irs.gov/Form1099R                                               Department of the Treasury - Internal Revenue Service



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Instructions for Recipient  (continued)                                   were made for qualified long-term care insurance contracts under 
F—Charitable gift annuity.                                                combined arrangements, the amount of the reduction in the 
G—Direct rollover of a distribution to a qualified plan, a section 403(b) investment (but not below zero) in the annuity or life insurance 
  plan, a governmental section 457(b) plan, or an IRA.                    contract is reported here. 
H—Direct rollover of a designated Roth account distribution to a Roth     Box 9a. If a total distribution was made to more than one person, the 
  IRA.                                                                    percentage you received is shown.
J—Early distribution from a Roth IRA, no known exception (in most         Box 9b. For a life annuity from a qualified plan or from a section 
  cases, under age 59½).                                                  403(b) plan (with after-tax contributions), an amount may be shown for 
K—Distribution of traditional IRA assets not having a readily available   the employee’s total investment in the contract. It is used to compute 
  FMV.                                                                    the taxable part of the distribution. See Pub. 575.
L—Loans treated as distributions.                                         Box 10. If an amount is reported in this box, see the Instructions for 
M—Qualified plan loan offset.                                             Form 5329 and Pub. 575.
N—Recharacterized IRA contribution made for 2024 and                      Box 11. The first year you made a contribution to the designated Roth 
  recharacterized in 2024.                                                account reported on this form is shown in this box.
P—Excess contributions plus earnings/excess deferrals (and/or             Box 12. If checked, the payer is reporting on this Form 1099 to satisfy 
  earnings) taxable in 2023.                                              its Internal Revenue Code chapter 4 account reporting requirement 
Q—Qualified distribution from a Roth IRA.                                 under FATCA. You may also have a filing requirement. See the 
R—Recharacterized IRA contribution made for 2023 and                      Instructions for Form 8938.
  recharacterized in 2024.                                                Box 13. Shows the date of payment for reportable death benefits 
S—Early distribution from a SIMPLE IRA in first 2 years, no known         under section 6050Y.
  exception (under age 59½).                                              Boxes 14–19. If state or local income tax was withheld from the 
T—Roth IRA distribution, exception applies.                               distribution, boxes 16 and 19 may show the part of the distribution 
U—Dividend distribution from ESOP under section 404(k).                   subject to state and/or local tax.
Note: This distribution isn’t eligible for rollover.                      Additional information. You may want to see:  
W—Charges or payments for purchasing qualified long-term care             Form W-4P, Form 4972, Form 5329, Form 8606
  insurance contracts under combined arrangements.                        Pub. 525, Taxable and Nontaxable Income
If the IRA/SEP/SIMPLE box is checked, you’ve received a traditional       Pub. 560, Retirement Plans for Small Business
IRA, SEP, or SIMPLE distribution.
Box 8. If you received an annuity contract as part of a distribution, the Pub. 571, Tax-Sheltered Annuity Plans
value of the contract is shown. It isn’t taxable when you receive it and  Pub. 575, Pension and Annuity Income
shouldn’t be included in boxes 1 and 2a. When you receive periodic        Pub. 590-A, Contributions to IRAs
payments from the annuity contract, they’re taxable at that time. If the  Pub. 590-B, Distributions from IRAs
distribution is made to more than one person, the percentage of the       Pub. 721, U.S. Civil Service Retirement Benefits
annuity contract distributed to you is also shown. You’ll need this       Pub. 939, General Rule for Pensions and Annuities
information if you use the 10-year tax option (Form 4972). If charges     Pub. 969, HSAs and Other Tax-Favored Health Plans






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