2016                                      FORM329                                                                          Page 1

                               Delaware Special Tax Computation for Lump Sum 
                               Distribution from Qualified Retirement Plan

LumpSumDistributions
Thisformapplies, inthecaseofsomeonewhoisnotself-employed,only whenthe distributionwasmade:
-Duetothe participant'sdeath;
-Dueto theparticipant'sseparationfromemployment;or
-Aftertheparticipanthadattainedage591/2
In thecaseofaself-employedperson,thisformappliesonlywhenthedistributionwasmade:
-Duetothe participant'sdeath;
-After the participanthadattainedage 591/2
-Theparticipantwas previouslydisabled.
THIS FORMDOESNOTAPPLYWHENYOUR DISTRIBUTIONWAS:
-Rolled over;
-Anearlydistributionincludinganearlydistributionreceivedformedical,educationorhousingexclusions;or
-Subjectto the earlywithdrawal penaltyon Line58ofyourFederalForm1040.
LASTNAME(S) AS SHOWNONRETURN   YOURFIRSTNAME                   YOURSOCIALSECURITYNUMBER

SPOUSE'SLASTNAME(IFAPPLICABLE) SPOUSE'SFIRSTNAME(IFAPPLICABLE) SPOUSE'SSOCIALSECURITYNUMBER(IFAPPLICABLE)

1. EntercapitalgainportionofdistributionfromBox3 ofForm1099R...............................                                         1.
2. Enterordinaryincomeportion ofdistributionfromBox 2aofForm1099R......................                                             2.
3. AddLines 1and2............................................................................................................       3.
4. Death benefit exclusion allowed onFederalForm 4972..................................................                             4.
5. SubtractLine4fromLine 3..............................................................................................            5.
6. Current actuarialvalue ofannuity (ifapplicable,see Federalinstructions).....................                                     6.
7. Totaltaxableamountofdistribution. AddLines5and6.................................................                                 7.
8. Enter10%ofLine7(MultiplyLine7by .10)....................................................................                         8.
9. Computethetax on Line8(useTax RateScheduleorTableforForm200)..................                                                   9.
10. Multiplythe amounton Line 9 byten...............................................................................                10.
11. Enter10%ofLine6(MultiplyLine6by .10)....................................................................                        11.
12. Computethetax on Line11(useTaxRateScheduleorTableforForm 200)................                                                   12.
13. Multiplythe amounton Line 12 byten.............................................................................                 13.
14. SubtractLine13fromLine10..........................................................................................              14.
15. DivideLine2byLine3andenterresultasadecimal(roundedtoatleasttwoplaces)..                                                         15.

16. Taxonordinaryincomeportion ofdistribution(MultiplyLine 14 bydecimalonLine15
   andenteronForm 200-01, Line 7,orForm400, Line9)................................................                                  16.

             ATTACHFORM329ANDFORM 4972TO FORM 200 OR FORM 400

                                                               *DF30316019999*
   (Rev. 09/2016)                                                         DF30316019999