Retirement and Gambling Income
(Form 1099)

2009 Tax Year 

Note:  This form does not calculate your taxes, information is submitted to the Tax Preparer.

Complete all applicable details below and click on the "Submit" button at the bottom of the form.
 
Form 1099-R represents distributions from Pensions, Annuities, Retirement or Profit-Sharing Plans, IRAs, Insurance Contracts, etc.  If you have more than three 1099Rs or more than three 1099Gs for submission, complete this form and Submit. Then return to this form and repeat as necessary to submit all your 1099s.
Taxpayer Name: E-Mail:

Form 1099 - No. 1
RECIPIENT'S Name
Payer's Name
Payer's Address
Payer's City, State and Zip
Payer's Federal Identification No.
1. Gross distribution
 		  
2a. Taxable amount
 		  
2b. Taxable amount
not determined 		Total distribution
3. Capital gain included in box 2a
 		4. Federal income tax withheld
5. Employee contributions
or insurance premiums
 		6. Net unrealized appreciation
in employer's securities
7. Distribution code
 		IRA/
SEP/
SIMPLE
8. Other
%
9a. Your percentage of
total distribution
 % 		9b. Total employee contributions
10. State tax withheld
 		11. State
12. State distribution
 		13. Local tax withheld
14. Name of locality
 		15. Local distribution
Enter any additional comments for your tax preparer in the space below:
Form 1099 - No. 2
RECIPIENT'S Name
Payer's Name
Payer's Address
Payer's City, State and Zip
Payer's Federal Identification No.
1. Gross distribution
 		  
2a. Taxable amount
 		  
2b. Taxable amount
not determined 		Total distribution
3. Capital gain included in box 2a
 		4. Federal income tax withheld
5. Employee contributions
or insurance premiums
 		6. Net unrealized appreciation
in employer's securities
7. Distribution code
 		IRA/
SEP/
SIMPLE
8. Other
%
9a. Your percentage of
total distribution
 % 		9b. Total employee contributions
10. State tax withheld
 		11. State
12. State distribution
 		13. Local tax withheld
14. Name of locality
 		15. Local distribution
Enter any additional comments for your tax preparer in the space below:
Form 1099 - No. 3
RECIPIENT'S Name
Payer's Name
Payer's Address
Payer's City, State and Zip
Payer's Federal Identification No.
1. Gross distribution
 		  
2a. Taxable amount
 		  
2b. Taxable amount
not determined 		Total distribution
3. Capital gain included in box 2a
 		4. Federal income tax withheld
5. Employee contributions
or insurance premiums
 		6. Net unrealized appreciation
in employer's securities
7. Distribution code
 		IRA/
SEP/
SIMPLE
8. Other
%
9a. Your percentage of
total distribution
 % 		9b. Total employee contributions
10. State tax withheld
 		11. State
12. State distribution
 		13. Local tax withheld
14. Name of locality
 		15. Local distribution
Enter any additional comments for your tax preparer in the space below:
Form W-2G - No. 1 (Gambling)
WINNER'S Name
Payer's Name
Payer's Address
Payer's City, State and Zip
Payer's Federal I.D. No
1. Gross winnings
 2. Federal income tax withheld
3. Type of wager
 4. Date won
5. Transaction
 6. Race
7. Winnings from identical wagers
 8. Cashier
9. Window's Taxpayer identification no.
 10. Window
11. First I.D.
 12. Second I.D.
13. State
 14. State income tax withheld
Enter any additional comments for your tax preparer in the space below:s

Form W-2G - No. 2 (Gambling)
WINNER'S Name
Payer's Name
Payer's Address
Payer's City, State and Zip
Payer's Federal I.D. No
1. Gross winnings
 2. Federal income tax withheld
3. Type of wager
 4. Date won
5. Transaction
 6. Race
7. Winnings from identical wagers
 8. Cashier
9. Window's Taxpayer identification no.
 10. Window
11. First I.D.
 12. Second I.D.
13. State
 14. State income tax withheld
Enter any additional comments for your tax preparer in the space below:s

Form W-2G - No. 3 (Gambling)
WINNER'S Name
Payer's Name
Payer's Address
Payer's City, State and Zip
Payer's Federal I.D. No
1. Gross winnings
 2. Federal income tax withheld
3. Type of wager
 4. Date won
5. Transaction
 6. Race
7. Winnings from identical wagers
 8. Cashier
9. Window's Taxpayer identification no.
 10. Window
11. First I.D.
 12. Second I.D.
13. State
 14. State income tax withheld
Enter any additional comments for your tax preparer in the space below:s


Note:  You will view a Confirmation Preview to double check your entries before final submission.  Click the "Submit" button at the top of the Confirmation Preview to submit information.

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