Schedule H Individual - Income From Annuities Or Pensions - 2010
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Schedule H Individual
2010
Rev. 12.10
INCOME FROM ANNUITIES 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
2
Federal
3
Private Business Employer
ELA
Place where the service was performed:
1
Puerto Rico
2
United States
Others ____________________
3
Date on which you started to receive 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 ...............................................
.
0
0
(01)
,
2.
Pension received in previous years:
Year:
_______
_______
_______
_______
_______
Amount:
_______
_______
_______
_______
_______
...............................................
.
0
0
,
(02)
3.
Less:
(a) Taxable pension received in previous years:
Year:
_______
_______
_______
_______
_______
.
Amount:
_______
_______
_______
_______
_______
,
0
0
(03)
(b) Tax exempt pension received in previous years:
Year:
_______
_______ _______
_______
_______
.
Amount:
_______
_______ _______ _______
_______
(04)
,
0
0
4.
.
Total (Add lines 3(a) and 3(b)) ...........................................................................................................................
(05)
0
0
,
5.
Cost of pension tax exempt recovered in previous years (Subtract line 4 from line 2) ........................................
.
(06)
0
0
,
.
6.
Cost of pension to be recovered (Subtract line 5 from line 1) ..............................................................................
,
0
0
(07)
Part II:
Taxable Income (See instructions)
7.
Total amount received in the year ......................................................................................................................
.
.
(08)
0
0
,
,
8.
Tax exempt amount ............................................................................................................................
.
(09)
0
0
,
9.
Pension income less the exempt amount (Subtract line 8 from line 7. If it is less than zero, go to line 13)
.
.
(10)
,
0
0
10.
Cost of pension to be recovered (Same as line 6)
............................................................................................
.
(11)
,
0
0
11.
Pension income in excess of the cost to be recovered (Subtract line 10 from line 9) ...........................................
.
(12)
0
0
,
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 3 of the Short Form
or line 3 of Schedule CO Individual, as applicable) ............................................................................................
.
(13)
0
0
,
13.
Tax withheld on annuity or pension for the taxable year (Enter this amount in Part 4,
.
line 16B of the Short Form) ................................................................................................................................
,
0
0
(14)
Retention Period: Ten (10) years
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