Schedule H Individual - Income From Annuities Or Pensions - 2005

Schedule H Individual

INCOME FROM ANNUITIES

Rev. 05.05

2005

OR PENSIONS

Taxable year beginning on ______________________, ________ and ending on _____________________, ________

Social Security Number

Taxpayer's name

Recipient of pension (Fill in one):

1 Taxpayer

2 Spouse

35

Pension granted by (Fill in one):

1 ELA

2 Federal

3 Private Business Employer

Place where the service was performed:

Puerto Rico

United States

Others __________________

Date in which you began receiving the pension: Day______ Month_______ Year______

Part I

Determination of Cost to be Recovered (See instructions)

1.

Cost of annuity (amount paid). If it is zero, go to Part II and enter zero on line 10 ......................................................................

00

(01)

2.

Pension received in previous years:

Year:

_________

__________ __________

__________

__________

Amount: _________

__________ __________

__________

__________ ...................................................

00

(02)

3.

Less:

(a) Taxable pension received in previous years:

Year:

__________

__________ __________

__________

__________

Amount: __________

__________ __________ __________

__________

(03)

00

(b) Tax exempt pension received in previous years:

Year:

__________

__________ __________

__________

__________

Amount:

__________

__________ __________ __________

__________

00

(04)

00

4.

Total (Add lines 3(a) and 3(b)) ...................................................................................................................................................

(05)

00

5.

Cost of pension tax exempt recovered in previous years (Subtract line 4 from line 2) .................................................................

(06)

00

6.

Cost of pension to be recovered (Subtract line 5 from line 1) ........................................................................................................

(07)

Part II

Taxable Income (See instructions)

7.

Total amount received in the year ...............................................................................................................................................

00

(08)

8.

Tax exempt amount ....................................................................................................................................................................

00

(09)

9.

Pension income less the exempt amount (Subtract line 8 from line 7. If it is less than zero, go to line 13) .....................................

00

(10)

10.

Cost of pension to be recovered (Same as line 6) ......................................................................................................................

00

(11)

11.

Pension income in excess of the cost to be recovered (Subtract line 10 from line 9) ....................................................................

00

(12)

12.

Taxable pension income (Enter here the amount of line 11 or 3% of line 1, whichever is larger

(but not larger than the amount of line 9). Enter this amount in Part 2, line 2K of the Long Form) ...................................................

00

(13)

13.

Tax withheld on annuity or pension for the taxable year (Enter this amount in Part 4, line 31B

of the Long Form) ....................................................................................................................................................................

00

(14)

Conservation Period: Ten (10) years