Instructions For Form 1040-A - U.s. Individual Income Tax Return - 2016 Page 29

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2017 Form 1040A—Lines 12a Through 13
Simplified Method Worksheet—Lines 12a and 12b
Keep for Your Records
Before you begin:
If you are the beneficiary of a deceased employee or former employee who died before August 21, 1996, include any death
benefit exclusion that you are entitled to (up to $5,000) in the amount entered on line 2 below.
More than one pension or annuity. If you had more than one partially taxable pension or annuity, figure the taxable part of each
separately. Enter the total of the taxable parts on Form 1040A, line 12b. Enter the total pension or annuity payments received in 2017
on Form 1040A, line 12a.
1. Enter the total pension or annuity payments from Form 1099-R, box 1. Also, enter this amount on Form 1040A,
line 12a . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1.
2. Enter your cost in the plan at the annuity starting date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.
Note. If 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 (even if the amount of your pension or annuity has changed).
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 the number on 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, skip lines 6 and 7 and enter this amount on line 8. Otherwise, go
to line 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.
6. Enter the amount, if any, recovered tax free in years after 1986. If you completed this worksheet last
year, enter the amount from line 10 of last year's worksheet . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.
7. Subtract line 6 from line 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.
8. Enter the smaller of line 5 or line 7
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8.
9. Taxable amount. Subtract line 8 from line 1. Enter the result, but not less than zero. Also, enter this amount on Form 1040A,
line 12b. If your Form 1099-R shows a larger amount, use the amount on this line instead of the amount from Form 1099-R. If
you are a retired public safety officer, see
Insurance premiums for retired public safety officers
before entering an amount
on line 12b . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9.
10. Was your annuity starting date before 1987?
STOP
Do not complete the rest of this worksheet.
Yes.
Add lines 6 and 8. This is the amount you have recovered tax free through 2017. You will need this number if
No.
you need to fill out this worksheet next year.
10.
11. Balance of cost to be recovered. Subtract line 10 from line 2. If zero, you won't have to complete this worksheet next year.
The payments you receive next year will generally be fully taxable.
11.
Table 1 for Line 3 Above
AND your annuity starting date was—
IF the age at annuity starting date
before November 19,
after November 18, 1996,
was . . .
1996,
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 older
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 older
210
leave program, reduce the amount you report on line 13 by
Line 13
those contributions.
Unemployment Compensation and Alaska
If you received an overpayment of unemployment compen-
Permanent Fund Dividends
sation in 2017 and you repaid any of it in 2017, subtract the
amount you repaid from the total amount you received. Enter
Unemployment compensation. You should receive a Form
the result on line 13. Also, enter “Repaid” and the amount you
1099-G showing in box 1 the total unemployment compensa-
repaid in the space to the left of line 13. If, in 2017, you repaid
tion paid to you in 2017. Report this amount on line 13. How-
unemployment compensation that you included in gross in-
ever, if you made contributions to a governmental unemploy-
come in an earlier year, you can deduct the amount repaid. But
ment compensation program or to a governmental paid family
you must use Form 1040 to do so. See Pub. 525 for details.
-29-
Need more information or forms? Visit IRS.gov.

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