Form AR1000TD Fillable Lump Sum Distribution Averaging

(all forms fillable on Windows, Mac, Android tablets, and iPad using Adobe Reader XI)$ 18 999 00 $ 19 000 00 $ 19 999 00 $ 4 199 00 $ 4 200 00 $ 4 999 00 $ 42 00 $ 585 00 % OF THE (: 1) Unchecked (: 1) Unchecked (: 1) Unchecked (: 2) Unchecked (: 2) Unchecked (: 2) Unchecked (501) 682 1100 (c)a participant in the plan for at least 5 years before the year of the distribution? 4 (However (TD 1) (TD 15) (TD 16) (TD 17) (TD 18) (TD 19) (TD 2) (TD 20) (TD 21) (TD 22) (TD 23) (TD 24) (TD 25) (TD 26) (TD 27) (TD 28) (TD 29) (TD 30) (TD 31) (TD 32) 1 040 00 1 100 00 1 160 00 1 220 00 1 280 00 1 340 00 1 400 00 1 460 00 1 496 00 1 Income from Form 1099 R Box 2a: (Enter on this line instead of on AR1000F/AR1000NR) 1 1 Wasthisadistributionofaplanparticipant sentirebalancefromallofanemployer squalifiedplansofonekind(pension profit sharing or stock bonus)? If No do not use this form 1 10 000 00 10 999 00 10 Tax on the amount on Line 9: (Use tax rate schedule on reverse side) 10 10) A lump sum credit or payment from the Federal Civil Service Retirement 11 000 00 11 999 00 11 Multiply Line 10 by ten (10) If Line 2 is zero skip Lines 12 through 17 and enter on Line 18: 11 11) A distribution from a tax sheltered annuity 112 00 12 000 00 12 399 00 12 400 00 12 999 00 12 Divide Line 2 by Line 3: (Carry to four places to the right of the decimal) 12 13 000 00 13 999 00 13 Multiply Line 7 by Line 12: 13 13) A distribution from a privately purchased commercial annuity 137 00 14 000 00 14 999 00 14 Subtract Line 13 from Line 2: 14 14) A distribution from a Section 457 deferred compensation plan of a state 145 00 15 000 00 15 999 00 15 Multiply Line 14 by 10% ( 10): 15 16 000 00 16 999 00 16 Tax on amount on Line 15: (Use tax rate schedule on reverse side) 16 169 00 17 000 00 17 999 00 17 Multiply Line 16 by ten (10): 17 18 000 00 18 999 00 18 Subtract Line 17 from Line 11: (Enter this amount on Line 29 of Form AR1000F/AR1000NR) 18 19 999 00 2 Current actuarial value of annuity from Form 1099 R Box 8: (If none enter 0 ) 2 2 Did you roll over any part of the distribution? If Yes do not use this form 2 2 Enter that amount on Line 1 of AR1000TD in Part ll 20 000 00 20 699 00 20 700 00 20 999 00 204 00 21 000 00 21 999 00 22 000 00 22 999 00 23 000 00 23 999 00 239 00 24 000 00 24 999 00 25 000 00 25 999 00 26 000 00 26 999 00 27 000 00 27 999 00 274 00 28 000 00 28 999 00 288 00 29 000 00 29 999 00 3 Complete as instructed on the form 3 Total taxable amount: (Add Lines 1 and 2 If total is $70 000 or more skip Lines 4 through 7 and enter amount on Line 8) 3 3 Was this distribution paid to you as a beneficiary of a plan participant who was born before January 2 1936? 3 30 000 00 30 999 00 31 000 00 31 999 00 315 00 32 000 00 32 999 00 33 000 00 33 999 00 34 000 00 34 599 00 34 600 00 360 00 4 999 00 4 Multiply Line 3 by 50% ( 50); but do not enter more than $10 000: 4 4 Were you (a) a plan participant who received this distribution (b) born before January 2 1936 and 4) The current actuarial value of an annuity contract included in a lump sum 405 00 450 00 495 00 5 000 00 5 999 00 5 Subtract $20 000 from Line 3 and enter the difference 540 00 5a Did you use Form AR1000TD for a previous distribution from your own plan? If Yes do not use this form 5A 5b Ifyouarereceivingthisdistributionasabeneficiaryofaplanparticipantwhodied wastheAR1000TDusedforaprevious distribution received for that plan participant? If Yes do not use this form 5B 6 000 00 6 999 00 6 Multiply Line 5 by 20% ( 20): 6 6) A distribution from an IRA 62 00 630 00 662 00 680 00 7 000 00 7 999 00 7 Minimum distribution allowance: (Subtract Line 6 from Line 4) 7 7) A distribution of the redemption proceeds of bonds rolled over tax free 740 00 8 000 00 8 299 00 8 300 00 8 999 00 8 Subtract Line 7 from Line 3: 8 8) if applicable 800 00 860 00 87 00 9 000 00 9 999 00 9 Multiply Line 8 by 10% ( 10): 9 9) A corrective distribution of excess deferrals excess contributions excess 920 00 980 00 A distribution of your deductible voluntary employee contributions and any a) Was made by the employee in a tax year beginning after 1981 After you have completed Part l of this form and determined that you qualify aggregate contributions or excess annual additions and over another AR1000F/AR1000NR With this method the lump sum is taxed as if you AR1000TD AR1000TD AR1000TD (R 05/28/13) AR1000TD 2013 AR1000TD Instr (R 10/10/13) ARKANSAS INDIVIDUAL INCOME TAX Attach to AR1000F/AR1000NR See Instructions on Reverse Side averaging b) Was not designated by the employee as nondeductible and because before benefits BUT NOT c) Was not mandatory complete Complete Part I above to see if you qualify for 10 year averaging before completing Part II complete Part II to determine the amount of tax to include on Line 29 of Form contact contribution is a contribution that: determine different distribution distribution distribution distribution distribution distribution distributions Distributions that do not qualify: during election Combine the tax on Line 29 of Form AR1000F/AR1000NR employee employer estate If you do not use the ten year averaging method report the lumpsum exceeds EXCESS OVER: figure figure filed filing first follows: for any year after 1982 and before 1989 and used Form AR1000TD for formula General government If result is zero or less enter 0 : 5 If you answered No to both questions 3 and 4 do not use this form If you make an election this year you cannot make an election another year with If you received another lump sum distribution or an annuity contract distribution IF YOUR NET If your NET TAXABLE INCOME is less than $4 200 your tax is one percent (1%) of your net taxable income [Example: If your net taxable income Income INCOME IS: income part of the distribution under the 10 year tax option method ) Individual Instructions is $2 700 your tax is one percent (1%) of that amount ($27) ] joint lump sum LUMP SUM DISTRIBUTION AVERAGING lumpsum method method MORE THAN: Multiply your percentage of the total distribution by the total amount Name Social Security Number net earnings on these contributions A deductible voluntary employee not use AR1000TD if the distribution was passed through an NOYES of distribution shown in Boxes 1 2a 3 and 8 of the Form 1099 R of your distribution The amounts to use in completing AR1000TD are the Office on Line 16 of Form AR1000F/AR1000NR on Line 18 of Part ll on the lump sum distributions for the previous years from the amount of tax on the total amount or local government or a tax exempt organization ordinary original or amended return You have three (3) years from the due date of Other Information owner PART I Complete this part to see if you qualify to use the AR1000TD PART II 10 YEAR AVERAGING participant participant in the plan unless it was made because the employee died penalty plan that allows such contributions provided purchase qualified qualified qualified qualified qualifies questions received recipients respect to another lump sum distribution retirement return return rolled shared spouse spouse s subject surviving spouse previously received an eligible rollover distribution from System (or the Federal Employees Retirement System) TAX IS: tax on AR1000TD for the combined distributions Subtract the tax you paid TAX RATE SCHEDULE TAXABLE taxable annuity (Box 2a) and the current actuarial value of the annuity (Box The Form 1099 R provided to you by the payer reports the different parts the same plan (or another plan of the employer required to be combined those together tribution trusts U S Retirement Plan Bonds distributed as a lump sum under value were to receive it in equal amounts over the next ten years You should with that plan for the lump sum distribution rules) and the previous dis years