F1099R RCPS
F1099R RCPS
F1099R RCPS
Page 1 of 2
12/ 08/ 2004
1 Gross distribution
$ 12610.68
2004
2a Taxable amount
$ 12610.68
2b
Total Distribution
7 Distribution code
7
%
11 State/Payer's state number
Distribution From
Pensions, Annuities,
Retirement or
Profit -Sharing Plans,
IRAs, Insurance
Contracts, etc.
Copy 2
File this copy with your
state, city, or local
income tax return
when required
$ 0.00
RETIRED
01012004- 12312004
Form 1099-R
1 Gross distribution
$ 12610.68
2004
2a Taxable amount
$ 12610.68
2b
Total Distribution
7 Distribution code
7
%
11 State/Payer's state number
$ 0.00
RETIRED
Copy B
Report this income on
your Federal tax return.
This information is
being furnished to the
Internal Revenue
Service.
01012004- 12312004
Form 1099-R
Distribution From
Pensions, Annuities,
Retirement or
Profit -Sharing Plans,
IRAs, Insurance
Contracts, etc.
1 Gross distribution
$ 12610.68
2a Taxable amount
$ 12610.68
2004
Distribution From
Pensions, Annuities,
Retirement or
Profit -Sharing Plans,
https://mypay.dfas.mil/F1099R_RCPS.ASPX?AccessString=RCPS&globalid=DNET010720050330090819W0074914&gcCurPysy=R...
3/30/2005
2b
Total Distribution
7 Distribution code
7
%
11 State/Payer's state number
IRAs, Insurance
Contracts, etc.
Copy C
For Receipient's Records
This information is
being furnished to the
Internal Revenue
Service.
$ 0.00
RETIRED
01012004- 12312004
Form 1099-R
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