Form 1099-R - Record 3 - 2016 Page 2
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2IT-1099-R (2017) (back)
1099-R Record 3
Corrected (1099-R
)
Recipient’s identification
number for this 1099-R ..................
Box 11 1st year of desig. Roth contrib.
Box A Payer’s name and full address
State
Box 12 State tax withheld (for NY State)
N Y
.
00
Box 14 State distribution
Box B Payer’s federal identification number
.
Box 3 Capital gain
00
(included in box 2a)
NY State
.
00
Box 15 Local tax withheld (NYC or Yonkers)
.
Box 1 Gross distribution
Box 7 Distribution code(s)
00
Locality a
.
.
00
00
Locality b
Box 2a Taxable amount
Box 9a Percentage of distribution
Box 16 Locality name
.
00
Locality a
Box 9b Employee contributions
Locality b
.
00
Box 17 Local distribution
Box 2b Taxable amount not determined
.
Box 10 Amount allocable to IRR within 5 years
00
Locality a
.
.
00
00
Total distribution . ......................
Locality b
Box C Account number
Do not detach.
Instructions
General instructions
Recipient’s identification number for this Form 1099-R –
Enter your SSN (or your spouse’s SSN) or the EIN of the estate
Who must file this form – You must complete Form IT-1099-R,
or trust, as applicable.
if you file a New York State income tax return and you received
1099-R statements that show New York State, New York City, or
In Box A and Box B, enter the payer’s name and address and
Yonkers withholding.
the payer’s federal identification number as they appear on the
corresponding federal Form 1099-R.
Specific instructions
Mark an X in the Total distribution box of the 1099-R Record if
Enter the name(s) and entire 9-digit social security number
the corresponding box on federal Form 1099-R is marked.
(SSN) or employer identification number (EIN) as entered on
your income tax return. If you are married filing a joint return,
Corrected (1099-R) – If the 1099-R Record is for a federal
enter both names and the SSN listed first on the return.
corrected Form 1099-R, mark an X in the Corrected (1099-R)
box.
Entering whole dollar amounts – When entering amounts,
enter whole dollar amounts only (zeros have been preprinted).
Transfer the tax withheld amounts to your income tax return.
Use the following rounding rules when entering your amounts;
Include the total NYS tax withheld amounts, the total NYC tax
drop amounts below 50 cents and increase amounts from 50 to
withheld amounts, and the total Yonkers tax withheld amounts
99 cents to the next dollar. For example, $1.39 becomes $1 and
from all your Form(s) IT-1099-R as follows:
$2.50 becomes $3.
• NYS tax withheld – Include on Form IT-201, line 72;
Form IT-203, line 62; or Form IT-205, line 34.
Complete one 1099-R Record section for each federal
Form 1099-R you (and if filing jointly, your spouse), or an estate
• NYC tax withheld – Include on Form IT-201, line 73;
or trust received that shows New York State, New York City,
Form IT-203, line 63; or Form IT-205, line 35.
or Yonkers withholding. Enter only the information requested
• Yonkers tax withheld – Include on Form IT-201, line 74;
on Form IT-1099-R. Complete additional Form(s) IT-1099-R if
Form IT-203, line 64; or Form IT-205, line 36.
necessary.
Do not detach or separate the 1099-R Records.
How to complete each 1099-R Record
File Form IT-1099-R as an entire page. Submit this
form (IT-1099-R) with your New York State income tax
Each box in the 1099-R Record section corresponds to a
return: Form IT-201, IT-203, or IT-205. Submit additional
numbered box on federal Form 1099-R. Enter the amount,
Form(s) IT-1099-R if applicable.
code, or description provided on federal Form 1099-R in the
corresponding numbered boxes on Form IT-1099-R.
Do not submit your federal 1099-R forms; keep them for your
records.
099002173094
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