| 1. |
Enter the total pension or annuity payments received this year. Also, add this amount to the total for Form 1040, line 16a;
Form 1040A, line 12a; or Form 1040NR, line 17a
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1. |
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| 2. |
Enter your cost in the plan (contract) at the annuity starting date plus any death benefit exclusion.* See Cost (Investment in the Contract) earlier
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2. |
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Note: If your annuity starting date was before this year and you completed this worksheet last year, skip line 3 and enter the
amount from line 4 of last year's worksheet on line 4 below (even if the amount of your pension or annuity has changed). Otherwise,
go to line 3.
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| 3. |
Enter the appropriate number from Table 1 below. But if your annuity starting date was after 1997 and the payments are for
your life and that of your beneficiary, enter the appropriate number from Table 2 below.
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3. |
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| 4. |
Divide line 2 by line 3 |
4. |
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| 5. |
Multiply line 4 by the number of months for which this year's payments were made. If your annuity starting date was before
1987, enter this amount on line 8 below and skip lines 6, 7, 10, and 11. Otherwise, go to line 6
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5. |
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| 6. |
Enter any amounts previously recovered tax free in years after 1986. This is the amount shown on line 10 of your worksheet
for last year
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6. |
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| 7. |
Subtract line 6 from line 2 |
7. |
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| 8.
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Enter the smaller of line 5 or line 7 |
8. |
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| 9. |
Taxable amount for year. Subtract line 8 from line 1. Enter the result, but not less than zero. Also, add this amount to the total for Form 1040,
line 16b; Form 1040A, line 12b; or Form 1040NR, line 17b.
Note: If your Form 1099-R shows a larger taxable amount, use the amount figured on this line instead. If you are a retired public
safety officer, see Insurance Premiums for Retired Public Safety Officers earlier before entering an amount on your tax return
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9. |
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| 10. |
Was your annuity starting date before 1987?
□ Yes. STOP. Do not complete the rest of this worksheet.
□ No. Add lines 6 and 8. This is the amount you have recovered tax free through 2008. You will need this number if you need
to fill out this worksheet next year
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10. |
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| 11. |
Balance of cost to be recovered. Subtract line 10 from line 2. If zero, you will not have to complete this worksheet next year. The payments you receive next
year will generally be fully taxable
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11. |
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| * A death benefit exclusion (up to $5,000) applied to certain benefits received by employees who died before August 21, 1996. |
| Table 1 for Line 3 Above |
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IF the age at
annuity starting date was
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AND your annuity starting date was— |
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BEFORE November 19, 1996,
enter on line 3
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AFTER November 18, 1996,
enter on line 3
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55 or under |
300 |
360 |
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56-60 |
260 |
310 |
| |
61-65 |
240 |
260 |
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66-70 |
170 |
210 |
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71 or over |
120 |
160 |
| Table 2 for Line 3 Above |
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IF the combined ages at annuity starting date were |
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THEN enter on line 3 |
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110 or under |
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410 |
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111-120 |
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360 |
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121-130 |
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310 |
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131-140 |
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260 |
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141 or over |
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210 |
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