California Schedule G-1 - Tax On Lump-Sum Distributions - 2012

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TAXABLE YEAR
CALIFORNIA SCHEDULE
G-1
Tax on Lump-Sum Distributions
2012
Attach to Form 540, Long Form 540NR, or Form 541. Use this Form only for lump-sum distributions from qualified plans.
Name(s) as shown on return
SSN, ITIN, or FEIN
Part I
Complete this part to see if you can use Schedule G-1.
Yes
No
1 Was this a distribution of a plan participant’s entire balance from all of an employer’s qualified plans
of one kind (pension, profit-sharing, or stock bonus)? If “No,” do not use this form . . . . . . . . . . . . . . . . . . . . . 1
   
2 Did you roll over any part of the distribution? If “Yes,” do not use this form . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
   
   
3 Was this distribution paid to you as a beneficiary of a plan participant who was born before January 2, 1936? 3
4 Were you (a) a plan participant who received this distribution (b) born before January 2, 1936, and (c) a
participant in the plan for at least 5 years before the year of distribution? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
   
If you answered “No” to both questions 3 and 4, do not use this form .
5 Did you use Schedule G-1 in a prior year for any distribution received after 1986 for the same plan
participant, including yourself, for whom the 2012 distribution was made? If “Yes,” do not use
this form . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
   
Part II
Complete this part to choose the 5.5% capital gain election. See instructions.
6 Capital gain from federal Form 1099-R, box 3 . If you are taking the death benefit exclusion,
see instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6
00
7 Multiply line 6 by 5 .5% ( .055) and enter here . If you elect to use Part III, go to line 8 . Otherwise,
enter the amount from line 7 on Form 540, line 34; Long Form 540NR, line 41; or Form 541, line 21b . . . .
7
00
Part III
Complete this part to choose the 10-year averaging method. See instructions.
8 Ordinary income from federal Form 1099-R, box 2a minus box 3 . If you did not complete
Part II, enter the amount from federal Form 1099-R, box 2a . See instructions . . . . . . . . . . . . . . . . . . . .
8
00
9 Death benefit exclusion for a beneficiary of a plan participant who died before August 21, 1996 .
See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
00
10 Total taxable amount . Subtract line 9 from line 8 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
00
11 Current actuarial value of annuity, if applicable, from federal Form 1099-R, box 8 . . . . . . . . . . . . . . . . . . . 11
00
12 Adjusted total taxable amount . Add line 10 and line 11 . If this amount is $70,000 or more, skip line 13
through line 16, and enter this amount on line 17 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
00
13 Multiply line 12 by 50% ( .50), but do not enter more than $10,000 . . . . . . . . .13
00
14 Subtract $20,000 from line 12 and enter the difference .
If the result is zero or less, enter -0- . . . . . . . . . . . . .14
00
15 Multiply line 14 by 20% ( .20) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15
00
16 Minimum distribution allowance . Subtract line 15 from line 13 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
00
17 Subtract line 16 from line 12 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
00
18 Multiply line 17 by 10% ( .10) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
00
19 Tax on amount on line 18 . Use the Tax Rate Schedule on page 2 of the instructions . . . . . . . . . . . . . . . . . 19
00
20 Multiply line 19 by ten (10) . If line 11 is blank, skip line 21 through line 26 and enter this amount
on line 27 . Otherwise, continue to line 21 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
00
21 Divide line 11 by line 12 (rounded to at least three places) . See instructions . . . . . . . . . . . . . . . . . . . . . . . 21 ___ . ___ ___ ___ ___
22 Multiply line 16 by the decimal amount on line 21 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
00
23 Subtract line 22 from line 11 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
00
24 Multiply line 23 by 10% ( .10) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
00
25 Tax on amount on line 24 . Use the Tax Rate Schedule on page 2 of the instructions . . . . . . . . . . . . . . . . . 25
00
26 Multiply line 25 by ten (10) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
00
27 Subtract line 26 from line 20 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
00
28 Tax on lump-sum distribution . Add Part II, line 7 and Part III, line 27 . Enter here and on Form 540,
line 34; Long Form 540NR, line 41; or Form 541, line 21b . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
28
00
Schedule G-1 2012
7821123

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