California Schedule G-1 - Tax On Lump-Sum Distributions - 2011

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TAXABLE YEAR
CALIFORNIA SCHEDULE
G-1
Tax on Lump-Sum Distributions
2011
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 2011 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  2011
7821113

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