Form 1099-Qa - Distributions From Able Accounts - 2016

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VOID
CORRECTED
1A1A
PAYER’S name, street address, city or town, state or province, country, ZIP or
1 Gross distribution
OMB No. 1545-2262
foreign postal code, and telephone no.
Distributions
2016
$
from ABLE
2 Earnings
Accounts
1099-QA
$
Form
Copy A
PAYER’S federal identification no.
RECIPIENT’S social security number
3 Basis
4 Program-to-program
transfer
$
For
Internal Revenue
RECIPIENT’S name
5 Check if ABLE account
6 Check if the recipient is
Service Center
terminated in 2016
not the designated
beneficiary
File with Form 1096.
For Privacy Act
Street address (including apt. no.)
and Paperwork
Reduction Act
Notice, see the
City or town, state or province, country, and ZIP or foreign postal code
2016 General
Instructions for
Account number (see instructions)
Certain Information
Returns.
1099-QA
Form
Cat. No. 67554X
Department of the Treasury - Internal Revenue Service
Do Not Cut or Separate Forms on This Page — Do Not Cut or Separate Forms on This Page

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