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Department of the Treasury

Internal Revenue Service

Publication 2188 (Nov. 1997)

Cat. No. 24733I

Tax Item. Request for IRS to Figure Taxable Part of Annuity

This item is available on Internet or by fax only.

Purpose of

Request

If you are a retiree, or the survivor of an employee or retiree, and you cannot

determine how much of the annuity you receive is taxable, you can ask the

Internal Revenue Service to figure the amount for you.

User Fee and

Mailing 

Address for 

the Request

User Fee. By making this request, you are asking for a ruling. The law

requires IRS to charge a user fee for a ruling. A change in the amount was

under discussion as this Tax Item was approved, so you should call IRS to ask

what the current fee is. Ask for the amount of a "computation of exclusion for

annuitant under Section 72." Please send the payment with your request for the

ruling.

You can deduct the user fee as a miscellaneous itemized deduction on

Schedule A (Form 1040), Itemized Deductions, subject to the 2% floor on

most miscellaneous itemized deductions.

No Fee Required for Some Requests. There is no fee if you are requesting

only the following, which are not considered "rulings":

! The value of the refund feature of the pension or annuity.

! The amount of the death benefit exclusion.

Mailing Address. Mail your request to:

Internal Revenue Service 

Attention: CP:E:EP

P.O. Box 14073 

Ben Franklin Station

Washington, D.C. 20044

When to Make

the Request

IRS processes requests in the order we receive them, but requests sent between

February 1 and April 15 may be delayed. If you do not receive your ruling by

the due date for your return, file Form 4868, Application for Automatic

Extension of Time to File U.S. Individual Income Tax Return. 

What to Send To make the request, please send the following information. If you do not send

it, processing your request will be delayed. Please send photocopies only, not

originals, because we keep the information for our records.

! A letter explaining the question or questions you want resolved, or the

information you need from the ruling.
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! Copies of any documents that show distributions, guaranteed amount,

annuity rates, and annuity options available to you.

! A copy of any Forms 1099-R, Distributions From Pensions, Annuities,

Retirement or Profit-Sharing Plans, IRAs, Insurance Contracts, etc., that

you received since your annuity began.

! A power of attorney if someone other than you, an attorney, a certified

public accountant, or an enrolled agent is signing this request. You may use

Form 2848, Power of Attorney and Declaration of Representative, for the

purpose.

! A completed Tax Information Sheet. A blank one is on the next two pages. 

The retiree or survivor annuitant must sign and date the Disclosure and

Perjury Statement, on the last page. A representative cannot sign it.

Also remember to send your user fee.

For More

Information

For more information, or if you decide to figure the taxable part of your annuity

yourself, start with the instructions for Form 1040, lines 16a and 16b; or Form

1040A, or lines 11a and 11b. For detailed information see:

! Publication 575, Pension and Annuity Income.

! Publication 939, General Rule for Pensions and Annuities.

Ordering 

Forms and

Publications

To order free IRS forms and publications, call 1-800-TAX-FORM (1-(800)-

829-3676). If you have access to TDD equipment, you can call 1-(800)-829-

4059. See your tax package for the hours of operation. You can also write to

the IRS Forms Distribution Center nearest you. Check your income tax

package for the address.

If you have access to a personal computer and a modem, you can download

forms and publications from our Website. Your income tax package has more

details.
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Tax Information Sheet -- Computation of Exclusion for Annuitant Under Section 72

Retired Annuitants: Complete and send in sections 1, 2, and 4 with your request.

Survivors of Deceased Employees or Retirees: Complete and send in sections 1, 3, and 4 with your

 request.

Section 1. General Information for All Requests

A. Name of retiree, deceased employee, or deceased retiree 

B. Name of taxpayer, if different from name above 

C. Address 

D. Daytime phone number ( ) 

E. Organization providing annuity or pension 

F. Annuity starting date > month day year 

G. Total taxed contributions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . > $ 

H. Taxed contributions after June 1986 * . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . > $ 

* Employees in many retirement systems stopped paying taxes on contributions before July 1, 1986. 

Does this statement apply to this annuity contract? Yes No 

If no, and if you cannot furnish the amount for item H, please indicate that you are electing, under

section 1.72-9 of the Federal Income Tax Regulations, to treat the entire cost of the contract as a postJune 1986 cost. (Making this election tells IRS what annuity tables to use to figure the taxable part of

your annuity.) 

 

I. Was the employee (or retiree) a nonresident alien at any time during his or her employment on which

 the annuity is figured? No Yes If yes, please explain: 

 

J. Is the annuity for life or for a specified period? Please explain: 

 

K. Is there a feature which guarantees that a certain minimum amount will be paid under the contract, 

 even if the annuitant(s) should die before that amount has been paid? No Yes If yes,

 how much is guaranteed? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . > $ 

L. Is the annuity a disability retirement annuity? No Yes If yes, when would you** have been

 eligible for retirement if you had not been disabled? > month day year 

M. Did you** elect to receive a modified annuity in order to receive a lump sum payment or other

 benefit? No Yes If yes, please indicate:

(I) Date you** made election > month day year 

(ii) Date of payment(s) > month day year 

 Type of payment(s) > Amount . . . . . . . . . . > $ 

(iii) Annuity rate before election . . . . . . . . . . . . . . . . . . . . . > 

(iv) Annuity rate after election . . . . . . . . . . . . . . . . . . . . . . . > 

(v) Amount, deposit or redeposit of contributions you** were deemed to have made > $ 

N. Have you filed your return for the year for which your are making this request? No Yes 

O. Have you requested an extension of time to file your return? No Yes If yes, what

 is the extension date? > month day year 

** If you are a survivor of a deceased employee or retiree, please answer questions L and M based on

 what the deceased person did in relation to the annuity contract.

! Are you:

 ! The retired annuitant? If yes, go to Section 2.

 ! A survivor of a deceased employee or retiree? If yes, skip to Section 3.
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Section 2. For Retired Annuitant

A. Your date of birth > month day year 

B. Your social security number ___ ___ ___ - ___ ___ - ___ ___ ___ ___

C. Your sex Female Male 

D. Your gross monthly annuity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . > $ 

E. Do you plan to have a survivor annuitant? No Yes If yes, please indicate that person's:

(I) Name Date of birth > month day year 

(ii) Potential monthly annuity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . > $ 

! Skip to Section 4.

Section 3. For Survivors of Deceased Employees or Retirees

A. Please provide the following information about each person who receives payments under the annuity

 contract. 

Widow or widower Child Other

Name

Social security

number - - - - - -

Sex Female Male Female Male Female Male 

Date of birth / / / / / /

Monthly annuity

rate

Other amounts

payable $ $ $

B. At the time of death, the decedent was (check one):

 Retired on disability.

 Retired on non-disability.

 Still employed.

! Go to Section 4.

Section 4. Disclosure and Perjury Statement. Required for ALL Requests. Please sign and date:

I advise that no deletions need be made under Internal Revenue Code section 6110(c), except my name,

address, telephone number, and social security number, in regard to the ruling request made on my behalf.

Further, under the penalties of perjury, I declare that I have examined this request, including

accompanying documents, and to the best of my knowledge and belief, the facts presented to support the

requested ruling are true, correct, and complete.

________________________________________ ______________________

 Signature of Taxpayer Date