Publication 575 - Pension And Annuity Income - 2004 Page 34

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Worksheet A. Simplified Method (Keep for Your Records)
1. Enter the total pension or annuity payments received this year. Also, add this amount to the
total for Form 1040, line 16a, or Form 1040A, line 12a . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1.
2. Enter your cost in the plan (contract) at the annuity starting date plus any death benefit
exclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2.
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. 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 beneficiary, enter the
appropriate number from Table 2 below. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3.
4. Divide line 2 by 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, enter this amount on line 8 below and skip lines 6, 7,
10, and 11. Otherwise go to line 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5.
6. Enter any amounts previously recovered tax free in years after 1986 . . . . . . . . . . . . . . . . .
6.
7. Subtract line 6 from line 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7.
8. Enter the smaller of line 5 or line 7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8.
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, or Form 1040A, line 12b.
Note: If your Form 1099-R shows a larger taxable amount, use the amount on this line
instead . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9.
10. Add lines 6 and 8 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
10.
11. Balance of cost to be recovered. Subtract line 10 from line 2 . . . . . . . . . . . . . . . . . . . . . .
11.
Table 1 for Line 3 Above
AND your annuity starting date was —
IF the age at
before November 19, 1996,
after November 18, 1996,
annuity starting date was
enter on line 3 . . . . . . . . . . .
enter on line 3 . . . . . . . . . . . . . .
55 or under
300
360
56 –60
260
310
61 –65
240
260
66 –70
170
210
71 or over
120
160
Table 2 for Line 3 Above
IF the combined ages at
annuity starting date were
THEN enter on line 3 . . . . .
110 or under
410
111 –120
360
121 –130
310
131 –140
260
141 or over
210
Page 34

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