Understanding Your 1099-R Tax Document

20 20 Re tireme nt Be nefit Re cipien ts

Important Tax Information

Understanding Your 1099-R Tax Document

This sheet includes important information about your 1099-R Tax Document. Distributions from pensions, annuities and retirement plans are reported to recipients on Form 1099-R. This is not intended to be tax advice.

CORRECTED (IF CHECKED)

TO INDIVIDUAL

PAYER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code

MINNESOTA STATE RETIREMENT SYSTEM 60 EMPIRE DRIVE SUITE 300 ST PAUL MN 55103-3000 1-800-657-5757

1 1 Gross distribution

$

11,240.85

2a Taxable amount

$

11,2420a.85

OMB No. 1545-0119

22020

Form 1099-R

2b Taxable amount not determined

Total distribution

X

PRINTED ON

12/03/2020

PPeeDDnnississitiotrorininbbssuu,,ttiAiAoonnnnnnssuuFFiittrriiooeemsms,, RetiremReenttiroermPernotfiot-r Profit-SShhaarriinngg PPllaannss,,IIRRAAs,, IInnssuurraanncceeCCoonnttrraaccttss,,eettcc..

PAYER'S federal identification number

41-6111469

RECIPIENT'S name (first, middle, last) and address

IVAN ALVARADO 2600 BRYANT AVE S #103 MINNEAPOLIS MN 55408

RECIPIENT'S identification number

XXX-XX-4907RI

3 Capital gain (included in box 2a)

$

5 Employee contributions / Designated Roth contributions or insurance premiums

$

5

7 Distribution code(s) IRA/SEP/SIMPLE

17

4 Federal income tax withheld

$

2,2484.17

6 Net unrealized appreciation in employer's securities

$

8 Other

CCooppyy 22 FFileilethstitsahtcieso, pccyitoywp, ioythr wlyoocituahrl inycoomuer tsatxarteet,urrcenqi,tuwyi,rheeodnr.

local income

$

%

tax return,

Account Number (see instructions)

1041190487-01A0N1

9a Your percentage of total distribution

9b Total

% employee contributions

$ 9b

when required.

10 Amount Allocable to

11 1st year of desig. Roth 12 FATCA filing requirement 13 Date of payment 14 State tax withheld

IRR within 5 years

contributions

$

14

15 State/Payer's state no.

MN 7535919 15

16 State distribution

$

11,24106.85

Form 1099-R

form1099r

Department of the Treasury - Internal Revenue Service

Explanation & Important Tax Information CoOfR1R0EC9T9E-DR(IF CHECKED) TO INDIVIDUAL

PRINTED ON

12/03/2020

PAYER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code

1 Gross distribution

OMB No. 1545-0119

Box 1.

2020 GroMssINDNiEsStOriTbAutSioTAnT. EThRiEsTIiRsEtMhEeNtToStaYlSToEfMgross benefit

may60apEpMlPy.IRSEeeDRthIVeEinstructions for Form 1040 or Form SUITE 300 ST PAUL MN 55103-3000

paym$ ents for t1h1e,24y0e.a85r. If you are

10402aATafxaobrle more amount information.

$

11,240.85

Form

collecting

1099-R

a

disabPilietDynisbsiteorninbesuf,ittiA,ondninsffueFirtreioenmst,

Retirement or ProfitSharing Plans, IRAs,

tax

rules

Box 2a.

Tax1a-8b0le0-6A5m7-5o7u5n7t.

This

is

generally

the

taxable

amount

of

benefit payments 2b Taxable amount not

determined

for the year. Total distribution

BoXx

2a

has

bIenesnurraenduceceCdobnytrtahcetasn,entuca. l

exclusion

of

Box 4.

prPeAYvEiRo'Sufsedleyraltiadexnteificdaticononnumtbreirbutions. Note: If you are an eligible RECIPIENT'S identification number retired3 Cpapuitabl glaiicn (isncaludfeedtiyn booxf2fai)cer, premiums d4e1d-6u1c1t1e4d69from your annuity bXeXnXef-iXtsX.-4T9h0a7t amount w$ill be reported to you

tihnea4$aFsemdeeropaluainnrcaotmteientalxBewtoitthexh2er2l.,d2aS48ed.e1o7ethseniontsRsterhpuoocrwttiothhniessainCfloctohormpFinyeosoBrunmran1c0e40

or Form 1040A for more information. RECIPIENT'S name (first, middle, last) and address IVAN ALVARADO

5 Employee contributions / Designated Roth 6 Net unrealized appreciation in employer's

contributions or insurance premiums

securities

your federal tax return. If this form shows

2600 BRYANT AVE S

Fceadn#Me1cIrN0ha3NalEnIAngPecOoLyImoSuMerNTfu5a5tux40rW8e withithhheoldld.inTghiosr

is

the

amount

of

$

$

federal taxes you have had withheld 7 Distribution code(s) IRA/SEP/SIMPLE

8 Other

from

your

federal income tax

MSwthRiitshShceoblpdeyinntoebyofoxitu4rp,raeatttuyarcmnh. ents.

You

elect not to have income tax1withheld. To do that:$1) complete a Tax Wit%hholding Election form available

on our website, 2) log into your MSRS account online, or 3) ca9lal the MSRS Your percentage of Service Cente9brT.otal

Account Number (see instructions)

1041190487-0101

total distribution

% employee contributions

$

This information is being furnished to the

Internal Revenue Service.

Box 5. Employee Contributions. This is the amount of employee after-tax contributions recovered this year. 10 Amount Allocable to IRR within 5 years

11 1st year of desig. Roth 12 FATCA filing requirement 13 Date of payment 14 State tax withheld contributions

15 State/Payer's state no.

$

MN 7535919

16 State distribution

$

11,240.85

Box 7. DiFsortmr1i0b9u9-tRion Codes. Identifies the type of diswtwrwib.irsu.gtoivo/fonrm1r0e99cr eived. For more information, see the federal income Department tax return instructions. of the Treasury - Internal Revenue Service Distribution codes 2= Early distribution, exception applies (under age 59 1/2), 3= Disability, 7= Normal distribution

CORRECTED (IF CHECKED)

TO INDIVIDUAL

PRINTED ON

12/03/2020

2020 Recipient's Id Number (RI). This is your Social Security number. PAYER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code MINNESOTA STATE RETIREMENT SYSTEM 60 EMPIRE DRIVE

The

fir1sGtrosfsivdiestridbuitigonits ( i.e. xxx-xx)

$

11,240.85

2a Taxable amount

haOvMeBbNoe. e15n45-m011a9 sked

or

truncDatiesdtrifborutdiaotnaspFrirvoamcy

Pensions, Annuities,

purposes.

Account

NuSmUbITeEr 3(0A0N). ST PAUL MN

The first 10-digits

55103-3000

represent

your

MSRS

accou$nt

ID

numbe11r.,2T4h0e.85remainiFnogrmdi1g0it9s9-aRre

for

MSRSRuesteireomnlye.nt or Profit-

Sharing Plans, IRAs,

Box 9b.

1-800-657-5757

Total Employee

Contributions.

Shows

remaining

balance

2b Taxable amount not

ofdpeterremivneidously taxed

Total distribution

contributions

to

X

Insurance Contracts,etc.

be recovered by annual exclusions in

future

years.

PAYER'S federal identification number

RECIPIENT'S identification number

3 Capital gain (included in box 2a)

4 Federal income tax withheld

Copy C

Box 14.

41-6111469

State Tax Withheld. If Minnesota RECIPIENT'S name (first, middle, last) and address

state

XXX-XX-4907

income tax was

withheld from your benefit payments, this box shows the amount submitted to the $

$

2,248.17

5 Employee contributions / Designated Roth 6 Net unrealized appreciation in employer's

For Recipient's Records

Minnesota

DepIVaArNtmAeLnVAt RoAf DROevenue to cover your Minnesota tax liability. Include the contributions amount on your or insurance premiums Minsencueritsiesota income tax return as tax withheld. See the

inst2#r61u00c03tiBoRnYsAfNoTr ABVoExS4 if

MINNEAPOLIS MN 55408

you

wish

to

change

your

future

Minnesota$ withholding tax amount.

7 Distribution code(s) IRA/SEP/SIMPLE

$

8 Other

1

$

Box 15. State/Payer's State Number. Shows MSRS' Minnesota tax identification number.

9a Your percentage of

9b Total

Account Number (see instructions)

1041190487-0101

total distribution

% employee contributions

$

Box 16. State Distribution. Total state, taxable income. 10 Amount Allocable to

11 1st year of desig. Roth 12 FATCA filing requirement 13 Date of payment 14 State tax withheld

15 State/Payer's state no.

IRR within 5 years

contributions

$

MN 7535919

%

This information is being furnished to the

Internal Revenue Service.

16 State distribution

$

11,240.85

Form 1099-R

form1099r

Department of the Treasury - Internal Revenue Service

Understanding Your 1099-R Tax Document

Additional Important Tax Information

You may want to go to the IRS' website at to review the information below:

w Publication 575, Pension and Annuity Income w Publication 939, General Rule for Pensions and Annuities

If you need more information about the tax document. Please visit the IRS' website for their instruction sheet at

Questions?

Contact the MSRS Service Center: 1.800.657.5757 or 651.296.2761

Go online: msrs.state.mn.us

Email us: info@msrs.us

Locations

St. Paul - Main Office

60 Empire Drive, Suite 300 St. Paul, MN 55103 Monday ? Friday 8 a.m. - 4:30 p.m.

Additional Offices

Addresses and hours of operation available online.

? Duluth ? St. Cloud

? Mankato ? Detroit Lakes

Our Mission

We empower Minnesota public employees to build a strong foundation for retirement.

UnderstandingYour1099-RTaxInformation/MSRS/12.2020

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