Department of the Treasury
Internal Revenue Service
Publication 2188  (Nov. 1997)
Cat. No. 24733I

Tax Item.  Request for IRS to Figure Taxable Part of Annuity

This item is available on Internet or by fax only.

Purpose of      If you are a retiree, or the survivor of an employee or retiree, and you cannot
Request         determine how much of the annuity you receive is taxable, you can ask the
                Internal Revenue Service to figure the amount for you.

User Fee and    User Fee.  By making this request, you are asking for a ruling.  The law
Mailing         requires IRS to charge a user fee for a ruling.  A change in the amount was
Address for     under discussion as this Tax Item was approved, so you should call IRS to ask
the Request     what the current fee is.  Ask for the amount of a "computation of exclusion for
                annuitant under Section 72."  Please send the payment with your request for the
                ruling.

                You can deduct the user fee as a miscellaneous itemized deduction on
                Schedule A (Form 1040), Itemized Deductions, subject to the 2% floor on
                most miscellaneous itemized deductions.

                No Fee Required for Some Requests.  There is no fee if you are requesting
                only the following, which are not considered "rulings":
                The value of the refund feature of the pension or annuity.
                The amount of the death benefit exclusion.

                Mailing Address.  Mail your request to:
                       Internal Revenue Service 
                       Attention: CP:E:EP
                       P.O. Box 14073 
                       Ben Franklin Station
                       Washington, D.C.  20044

When to    Make IRS processes requests in the order we receive them, but requests sent between
the Request     February 1 and April 15 may be delayed.  If you do not receive your ruling by
                the due date for your return, file Form 4868, Application for Automatic
                Extension of Time to File U.S. Individual Income Tax Return.  

What to Send    To make the request, please send the following information.  If you do not send
                it, processing your request will be delayed.  Please send photocopies only, not
                originals, because we keep the information for our records.
                A letter explaining the question or questions you want resolved, or the
                information you need from the ruling.

                                                  Page 1 of 4

             Copies of any documents that show distributions, guaranteed amount,
             annuity rates, and annuity options available to you.
             A copy of any Forms 1099-R, Distributions From Pensions, Annuities,
             Retirement or Profit-Sharing Plans, IRAs, Insurance Contracts, etc., that
             you received since your annuity began.
             A power of attorney if someone other than you, an attorney, a certified
             public accountant, or an enrolled agent is signing this request.  You may use
             Form 2848, Power of Attorney and Declaration of Representative, for the
             purpose.
             A completed Tax Information Sheet.  A blank one is on the next two pages. 
             The retiree or survivor annuitant must sign and date the Disclosure and
             Perjury Statement, on the last page.  A representative cannot sign it.

             Also remember to send your user fee.

For More     For more information, or if you decide to figure the taxable part of your annuity
Information  yourself, start with the instructions for Form 1040, lines 16a and 16b; or Form
             1040A, or lines 11a and 11b.  For detailed information see:
             Publication 575, Pension and Annuity Income.
             Publication 939, General Rule for Pensions and Annuities.

Ordering     To order free IRS forms and publications, call 1-800-TAX-FORM (1-(800)-
Forms and    829-3676).  If you have access to TDD equipment, you can call 1-(800)-829-
Publications 4059.  See your tax package for the hours of operation.  You can also write to
             the IRS Forms Distribution Center nearest you.  Check your income tax
             package for the address.

             If you have access to a personal computer and a modem, you can download
             forms and publications from our Website.  Your income tax package has more
             details.

                                     Page 2 of 4

               Tax Information Sheet -- Computation of Exclusion for Annuitant Under Section 72

Retired Annuitants:   Complete and send in sections 1, 2, and 4 with your request.
Survivors of Deceased Employees or Retirees:   Complete and send in sections 1, 3, and 4 with your
       request.
Section 1.  General Information for All Requests 
      A.  Name of retiree, deceased employee, or deceased retiree                                                                           
      B.  Name of taxpayer, if different from name above                                                                                        
      C.  Address                                                                                                                                                        
      D.  Daytime phone number     (           )                                                                                                            
      E.  Organization providing annuity or pension                                                                                                
      F.  Annuity starting date       >month                                                            day                 year                      
      G.  Total taxed contributions   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .   >    $                           
      H.  Taxed contributions after June 1986 * . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .      >    $                           
          *    Employees in many retirement systems stopped paying taxes on contributions before July 1, 1986. 
               Does this statement apply to this annuity contract?    Yes       No    
          If no, and if you cannot furnish the amount for item H, please indicate that you are electing, under
          section 1.72-9 of the Federal Income Tax Regulations, to treat the entire cost of the contract as a post-
          June 1986 cost.  (Making this election tells IRS what annuity tables to use to figure the taxable part of
          your annuity.)                                                                                                                                               
                                                                                                                                                                   
      I.  Was the employee (or retiree) a nonresident alien at any time during his or her employment on which
            the annuity is figured?    No        Yes        If yes, please explain:                                                           
                                                                                                                                                                                 
      J.   Is the annuity for life or for a specified period?  Please explain:                                                                
                                                                                                                                                                                 
      K.  Is there a feature which guarantees that a certain minimum amount will be paid under the contract, 
            even if the annuitant(s) should die before that amount has been paid?      No        Yes        If yes,
            how much is guaranteed?  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  > $                      
      L.  Is the annuity a disability retirement annuity?    No        Yes        If yes, when would you** have been
            eligible for retirement if you had not been disabled?     >          month                               day         year           
      M.  Did you** elect to receive a modified annuity in order to receive a lump sum payment or other
             benefit?         No         Yes        If yes, please indicate:
          (I)   Date you** made election       > month                                                day                 year                   
          (ii)  Date of payment(s)      >  month                                       day           year                   
                   Type of payment(s)                                                           > Amount  . . . . . . . . . .    >$                      
          (iii) Annuity rate before election    . . . . . . . . . . . . . . . . . . . . .                                 >
          (iv) Annuity rate after election   . . . . . . . . . . . . . . . . . . . . . . .                                 >
          (v)  Amount, deposit or redeposit of contributions you** were deemed to have made    >                                  $                     
      N.  Have you filed your return for the year for which your are making this request?     No       Yes  
      O.  Have you requested an extension of time to file your return?        No          Yes        If yes, what
            is the extension date?        >month                                                  day                 year                   

      **  If you are a survivor of a deceased employee or retiree, please answer questions L and M based on
             what the deceased person did in relation to the annuity contract.

      Are you:
          The retired annuitant?    If yes, go to Section 2.
          A survivor of a deceased employee or retiree?  If yes, skip to Section 3. 

                                                         Page 3 of 4

Section 2.  For Retired Annuitant 
A.  Your date of birth        >month                                                  day                 year                   
B.  Your social security number   ___ ___ ___ - ___ ___ - ___ ___ ___ ___
C.  Your sex    Female         Male  
D.  Your gross monthly annuity   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .        >$                           
E.  Do you plan to have a survivor annuitant?    No         Yes        If yes, please indicate that person's:
    (I)  Name                                                 Date of birth    >  month                            day         year           
    (ii)  Potential monthly annuity   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .         >$                           

Skip to Section 4.

Section 3.  For Survivors of Deceased Employees or Retirees 
A.  Please provide the following information about each person who receives payments under the annuity
            contract.  

                       Widow or widower                                 Child                                 Other

Name

Social security
number                               -         -                      -         -                                 -         -

Sex                      Female       Male                Female       Male                           Female       Male  

Date of birth                        /        /                       /        /                                  /        /

Monthly annuity
rate

Other amounts
payable                $                                $                                           $

B.  At the time of death, the decedent was (check one):
        Retired on disability.
        Retired on non-disability.
        Still employed.

Go to Section 4.

Section 4.  Disclosure and Perjury Statement.  Required for ALL Requests.  Please sign and date:
I advise that no deletions need be made under Internal Revenue Code section 6110(c), except my name,
address, telephone number, and social security number, in regard to the ruling request made on my behalf.

Further, under the penalties of perjury, I declare that I have examined this request, including
accompanying documents, and to the best of my knowledge and belief, the facts presented to support the
requested ruling are true, correct, and complete.

________________________________________                                ______________________
              Signature of Taxpayer                                                                            Date

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