Understanding Your 1099-R Tax Document .us

2019 Retirement Benefit Recipients

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

PRINTED ON

11/30/2018

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

$

600.46

2a 2a Taxable amount

$

600.46

OMB No. 1545-0119

22001189

Form 1099-R

2b Taxable amount not determined

Total distribution

X

Distributions From PeDnPisseitnorsinbiosun,tsiAo, nAnnnsunFuitriitoeiemss,, RetiremeRnettoirremPeronftiot-r ProSfiht-aSrhinarginPglPanlasn,s,IRIRAAss,, InsIunrsaunracneceCCoonntrtraaccttss,,eettcc..

PAYER'S federal identification number

41-6111469

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

OLLIE JACKSON 16041 FLAGSTAFF AVE W ROSEMOUNT MN 55068-1241

RI RECIPIENT'S identification number updated 8.26.19 XXX-XX-1842

AN Account Number (see instructions)

2891059830-0109

3 Capital gain (included in box 2a)

$

4 4 Federal income tax withheld

$

120.09

5 Employee contributions / Designated Roth contributions or insurance premiums

5 $

6 Net unrealized appreciation in employer's securities

$

CCooppyy 2C File thisFocropRyewciipthieynotu'sr

state, cityR, oercloorcdasl

income tax return, when

This informreaqtuioirnedis.

7 Distribution code(s) IRA/SEP/SIMPLE

17

8 Other

$

being furnished

%

to the Internal

9a Your percentage of total distribution

9b Total

9b % employee contributions

$

Revenue Service.

10 Amount Allocable to IRR within 5 years

11 1st year of desig. Roth contributions

FATCA filing requirement

12 12 State tax withheld $

13 13 State/Payer's state no. MN 7535919

14 14 State distribution

$

600.46

Form 1099-R

form1099r

Department of the Treasury - Internal Revenue Service

Explanation & Important Tax Information of 1099-R CORRECTED (IF CHECKED)

TO INDIVIDUAL

PRINTED ON

11/30/2018

2018 BBPooAxxYM6SSE120RUTIN.'aSIEPT.nNMaAEmEmGTUPe3Sar,aILso0ROxtyr0seMaETeasbtNApaDlDdepdSRir5lesyTAIs5V.tsAmr1,SEciT0biteoyE3ueuo-rt3Rnttioo0hwtE0.ennT,0T.siItnRhTatseihEstoriMrsuipsrEcoivtsNgiinoceTtennh, sSceeoYufrnotaStrorylT,ltFayEanodltMrhZomIPefogtr1afro0orxe4siagsn0bpblooesertanalFcemoodfierotmupna1yt0mo4fe120$$nabGATtersoasnxfsaofebodrliefsrimtartitmbhuopoteuiroanentyyeimnafero.nr66Imft00sya00otf..i44ouo66rnat.rheecyoelleaFOcrMo.tBriBnmNogox.11a05249da5-9i0sh1-a1Ra9bsilbiteyebnerneedfuitc,ePdSRdiehfeDbfnaeytiisrsrrteiheitnnoremtginbatesnaPun,nxtluaiAtroaunonnllsreens,sxPucIFRirlutroiAsoefiiomsstn-,, of

1-800-p6r5e7v-i5o7us5l7y taxed contributions. Note: If you are an eligible retire2ddbetTepramuxainbbelledicamsouanftenotyt officer, the amount Total distribution in BoxX2a does noInt sshuorwanhceealtChoinnsturraacntcse,etc.

PAYER'S

premiums deducted from

federal identification number

or F4o1r-6m1111044609A for more

your annuity benefits. That

RECIPIENT'S identification number

informationX.XX-XX-1842

amount3wCailplitabl egairne(ipncolurdteed din

$

btoox

2yao) u

in

a

se4pFeadrearatleincleomtteetra.x

$

wSiteheheltdhe

instructions

for

Form 1040

Copy

120.09

Report this income

B

on

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

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

your federal tax return.

BoxO4L.LIE FJAeCdKeSraOlNIncome Tax Withheld. This is the amount of federal taxes you contributions or insurance have premiumshad wsietchurhitieesld from your MSRS benefitIpf tahyismfoernmtssh. oYwous

16041 FcLaAnGcShTaAnFgFeAyVoEuWr future withholding or elect not to have incom$e tax withheld by completing$Substitute ROSEMCOoUnNtaTcMt MN S55R0S68b-1y2: 411) completing the Tax Withholding form, 2)7 log into your Distribution code(s) aIRcAc/SoEuP/nSItM,PoLEr 3) p8hOothnere.

W-4P,

Tax

WithholwdiitnhgheEfelldedceinrtiaboloninxFc4oo,rmamtet.atcahx

this copy to your return.

1

$

%

Box 5. Employee Contributions.

Account Number (see instructions)

This is the amount of employee

2891059830-0109

after-tax contributions 9a Your percentage of total distribution

recovered this year. 9b Total

% employee contributions

$

This information is being furnished to the

Internal Revenue Service.

Box 7. Distribution Codes. 10 Amount Allocable to IRR within 5 years

11 1st year of contributions

Tdehsige.sReothcodesFAiTdCeAnfitlinifgyretqhuireemteynpt e

of

distribu1t2ioStnaterteaxcweitihvheeldd.

For

more

inform13 aSttaitoe/nPayoenr's

these state no.

distributions,14sSetaete

distribution

the federal income tax return instructions. Distribution codes$ 2= Early distribution, exception apMpNlies 7(u5n3d5e9r19age 59 1/$2), 3= Disabil6it0y0, .46

7= Form 1099-R Normal distribution

form1099r

Department of the Treasury - Internal Revenue Service

AN. The first 10-digits represent your MSRS account ID number. The remaining digits are for MSRS use only.

CORRECTED (IF CHECKED)

TO INDIVIDUAL

PRINTED ON

11/30/2018

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

2018 RI

Number. This is your

MINNESOTA STATE 60 EMPIRE DRIVE

Social Security number.

RETIREMENT SYSTEM

The

first

five

digits

(

i.e$. xxx-xx) have

2a Taxable amount

be6e0n0.m46asked

or

truncated

for

data

privacy pDuirsptorsibesu.tions From

Pensions, Annuities,

BoxS9UbIT. ET3o0ta0l Employee Contributions.

ST PAUL MN 55103-3000

Shows

remaining

balance

of $previously

taxed6c0o0n.4tr6ibutions

Ftoorbme

1re0c9o9v-eRred

by

annualSRehexactilrruiesnmigonePsnliatnnofusrt,PuIrRreoAyfiesta-,rs.

1-800-657-5757

Box 12. State Tax

Withheld.

If

Minnesota

state

income

tax

was

2b Taxable amount

withhedledtefrmroinmed your

not

benefit

Total distribution

payments, this box

X

shows

the

Insurance Contracts,etc.

amount submitted to the Minnesota

PAYER'S fedeDrael idpeantrifticmatieonnntumobfeRr evenue to cRoEvCeIPrIEyNoT'uSridMentiifnicnateionsonutmabetrax liability. Incl3uCdaepittahl geaina(mincoluudendtinobnox y2ao)ur Minne4sFoetdaerianl icnocommeetatxawxithrehetludrn as tax withheld. See thCeopy C

inst4r1u-c6ti1o1n1s4f6o9r Box 4 if you wish to chXaXngXe-XyXou-1r8fu4t2ure Minnesot$a withholding tax amount. $

120.09

For Recipient's Records

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

5 Employee contributions / Designated Roth

OLLIE JACKSON

contributions or insurance premiums

Box161034.1 SFLtAaGteS/TPAaFyFeArV'sESWtate Number. Shows MSRS' Minnesota tax i$dentification number.

ROSEMOUNT MN 55068-1241

7 Distribution code(s) IRA/SEP/SIMPLE

6 Net unrealized appreciation in employer's securities

$

8 Other

Box 14. State Distribution. Total state, taxable income.

Account Number (see instructions)

2891059830-0109

1

9a Your percentage of total distribution

$

9b Total

% employee contributions

$

%

This information is being furnished to the

Internal Revenue Service.

10 Amount Allocable to IRR within 5 years

11 1st year of desig. Roth contributions

FATCA filing requirement

12 State tax withheld

$

13 State/Payer's state no.

MN 7535919

14 State distribution

$

600.46

20010013_1099RFo.irnmd1d0919-R

form1099r

Department of the Treasury - Internal Revenue Service 1/8/20 8:48 AM

UnderstannddiinnggYYoouurr2200119911009999-R-RTaTxaxDDocoucmumenetnt

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

Make an appointment to speak with a retirement representative at one of our offices.

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.

20010013_1099R.indd 2

1/8/20 8:48 AM

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