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Form 1099-Q - Payments From Qualified Education Programs (Under Sections 529 And 530) - 2017 Page 2

VOID

CORRECTED

3131

PAYER’S/TRUSTEE'S name, street address, city or town, state or province, country,

1 Gross distribution

OMB No. 1545-1760

Payments From

ZIP or foreign postal code, and telephone no.

Qualified

2017

Education

Programs

2 Earnings

(Under Sections

529 and 530)

1099-Q

Form

Copy A

PAYER’S/TRUSTEE'S federal identification no. RECIPIENT’S taxpayer identification no.

3 Basis

4 Trustee-to-trustee

transfer

For

Internal Revenue

RECIPIENT’S name

5 Check one:

6 Check if the recipient is

Service Center

not the designated

• Qualified tuition program—

beneficiary

File with Form 1096.

Private

State

For Privacy Act

Street address (including apt. no.)

• Coverdell ESA

and Paperwork

Reduction Act

Notice, see the

City or town, state or province, country, and ZIP or foreign postal code

2017 General

Instructions for

Account number (see instructions)

Certain Information

Returns.

1099-Q

Form

Cat. No. 32223J

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

Form 1099-Q - Payments From Qualified Education Programs (Under Sections 529 And 530) - 2017 Page 2

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