The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.
Before you begin:
If you are the beneciary of a deceased employee or former employee who died before August 21, 1996, include
any death benet exclusion that you are entitled to (up to $5,000) in the amount entered on line 2 below.
More than one pension or annuity. If you had more than one partially taxable pension or annuity, gure the taxable part of each separately. Enter
the total of the taxable parts on Form 1040, line 4b. Enter the total pension or annuity payments received in 2018 on Form 1040, line 4a.
1.
1.
2.
2.
Note. If 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.
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 beneciary, enter the appropriate
number from Table 2 below
3.
4. Divide line 2 by the number on line 3
4.
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, skip lines 6 and 7 and enter this amount on line 8.
Otherwise, go to line 6
5.
6. Enter the amount, if any, recovered tax free in years after 1986. If you completed this
worksheet last year, enter the amount from line 10 of last year’s worksheet
6.
7. Subtract line 6 from line 2
7.
8. Enter the smaller of line 5 or line 7
8.
9. Taxable amount. Subtract line 8 from line 1. Enter the result, but not less than zero. Also, enter this amount on Form
1040, line 4b. If your Form 1099-R shows a larger amount, use the amount on this line instead of the amount from
Form 1099-R. If you are a retired public safety ofcer, see Insurance Premiums for Retired Public Safety Ofcers
before entering an amount on line 4b
9.
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 2018. You will need this
number if you need to ll out this worksheet next year
10.
Table 1 for Line 3 Above
AND your annuity starting date was—
IF the age at annuity starting
date was . . .
before November 19, 1996,
enter on line 3 . . .
after November 18, 1996,
enter on line 3 . . .
360
310
260
210
160
300
260
240
170
120
55 or under
56–60
61–65
66–70
71 or older
Table 2 for Line 3 Above
IF the combined ages at annuity
starting date were . . .
THEN enter on line 3 . . .
410
360
310
260
210
110 or under
111–120
121–130
131–140
141 or older
11.
11.
Balance of cost to be recovered. Subtract line 10 from line 2. If zero, you won’t have to complete this
worksheet next year. The payments you receive next year will generally be fully taxable
Enter the total pension or annuity payments from Form 1099-R, box 1. Also, enter this amount on Form 1040,
line 4a
Enter your cost in the plan at the annuity starting date . . . . . . . . . . . . .
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Need more information or forms? Visit IRS.gov.
