3131 VOID CORRECTED

PAYER’S name, street address, city, state, ZIP code, and telephone number Qualified

Tuition

Program

Payments

(Under

Section 529)

PAYER’S Federal identification no. RECIPIENT’S social security number 3

RECIPIENT’S name

2

Street address (including apt. no.)

City, state, and ZIP code

Account number (optional)

Form 1099-Q Cat. No. 32223J Department of the Treasury - Internal Revenue Service

Form 1099-Q

OMB No. 1545-1760

Do Not Cut or Separate Forms on This Page — Do Not Cut or Separate Forms on This Page

Basis

Earnings

1 Gross distribution

$

$

$

Copy A

For

Internal Revenue

Service Center

File with Form 1096.

For Privacy Act

and Paperwork

Reduction Act

Notice, see the

2002 General

Instructions for

Forms 1099, 1098,

5498, and W-2G.

2002

5 Check one:

Private State

Check if the recipient is

not the designated

beneficiary

6

4 Trustee-to-trustee

rollover
CORRECTED (if checked)

PAYER’S name, street address, city, state, ZIP code, and telephone number Qualified

Tuition

Program

Payments

(Under

Section 529)

PAYER’S Federal identification no. RECIPIENT’S social security number 3

RECIPIENT’S name

2

Street address (including apt. no.)

City, state, and ZIP code

Account number (optional)

Form 1099-Q Department of the Treasury - Internal Revenue Service

Form 1099-Q

OMB No. 1545-1760

Basis

Earnings

1 Gross distribution

$

$

$

2002

5

Private State

Copy B

(keep for your records)

This is important tax

information and is

being furnished to the

Internal Revenue

Service. If you are

required to file a

return, a negligence

penalty or other

sanction may be

imposed on you if this

income is taxable and

the IRS determines

that it has not been

reported.

For Recipient 6 If this box is checked, the

recipient is not the

designated

beneficiary

4 Trustee-to-trustee

rollover
Instructions for Recipient

Box 1. Shows the gross distribution (including in-kind

distributions) paid to you this year from a qualified

tuition program (Section 529 program). This amount is

the total of the amounts shown in box 2 and box 3. See

Pub. 970, Tax Benefits for Higher Education, for more

information.

Box 2. Shows the earnings part of the gross distribution

shown in box 1. This may be taxable to you. See your

tax return instructions for information about how to

report this income.

Box 4. This box is checked if the amount in box 1 was

transferred by you from one Section 529 program to

another Section 529 program in a trustee-to-trustee

transfer. The amount in box 2 is taxable to you, if there

has been more than one transfer within any 12-month

period with respect to the same beneficiary, or if there

has been a change in designated beneficiary and the

new designated beneficiary is not a family member of

the prior designated beneficiary.

Box 5. Shows whether the gross distribution was from

a private prepaid program or a state program.

Box 6. This box is checked if the recipient is not the

designated beneficiary under section 529.

Box 3. Shows your basis in the gross distribution

reported in box 1.
For Payer

For Privacy Act

and Paperwork

Reduction Act

Notice, see the

2002 General

Instructions for

Forms 1099,

1098, 5498, and

W-2G.

Copy C

VOID CORRECTED

PAYER’S name, street address, city, state, ZIP code, and telephone number Qualified

Tuition

Program

Payments

(Under

Section 529)

PAYER’S Federal identification no. RECIPIENT’S social security number 3

RECIPIENT’S name

2

Street address (including apt. no.)

City, state, and ZIP code

Account number (optional)

Form 1099-Q Department of the Treasury - Internal Revenue Service

Form 1099-Q

OMB No. 1545-1760

Basis

Earnings

1 Gross distribution

$

$

$

2002

5 Check one:

Private State

6 Check if the recipient is

not the designated

beneficiary

4 Trustee-to-trustee

rollover
Instructions for Payers

We now provide general and specific form

instructions as separate products. The products you

should use for 2002 are the General Instructions for

Forms 1099, 1098, 5498, and W-2G and the

separate specific instructions for each information

return you file. Specific information needed to

complete this form is given in the 2002 Instructions

for Form 1099-Q. A chart in the general instructions

gives a quick guide to which form must be filed to

report a particular payment. To order these

instructions and additional forms, call

1-800-TAX-FORM (1-800-829-3676).

Due dates. Furnish Copy B of this form to the

recipient by January 31, 2003.

File Copy A of this form with the IRS by

February 28, 2003. If you file electronically, the due

date is March 31, 2003.

Caution: Because the IRS processes paper forms by

machine (optical character recognition equipment),

you cannot file with the IRS Forms 1096, 1098, 1099,

or 5498 that you print from the IRS Web Site.