Form Gr-1040 - Grand Rapids Individual Return - 2010 Page 4
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6Taxpayer's name
Taxpayer's SSN
FORM GR-1040, PAGE 4
LINE 9 - EXCLUSIONS AND ADJUSTMENTS TO IRA DISTRIBUTIONS
Schedule R
List all IRA distributions reported as taxable on federal return
Enter T for
Distribution
Payer's federal
Federally taxable
Excludible IRA
taxpayer or S
Payer's name
Code (Form
ID Number
IRA distributions
distributions
for Spouse
1099-R, box 7)
Total Federally taxable IRA distributions (Add lines above for this column.
Amount should equal the amount reported on page 1, line 9, Column A)
Total excludible IRA distributions (Enter here and also on page 1, line 9, Column B)
LINE 10 - EXCLUSIONS AND ADJUSTMENTS TO PENSION DISTRIBUTIONS
List pension distributions reported as taxable on federal return
Kind of pension
distribution
(employer's
Enter T for
Federally taxable
Distribution
Payer's federal
pension plan
Excludible pension
taxpayer or S
Payer's name
pension
Code (Form
ID Number
distribution, 401k
distributions
for Spouse
distributions
1099-R, box 7)
plan distribution,
457 plan
distribution, etc.)
Total Federally taxable pension distributions (Add lines above for this column. Amount
should equal the amount reported on page 1, line 10, Column A)
Total excludible pension distributions (Enter here and also on page 1, line 10, Column B)
Form GR-1040, Page 4
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