3131 VOID CORRECTED

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

PAYER’S/TRUSTEE’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 (see instructions)

Form 1099-Q Cat. No. 32223J Department of the Treasury - In

Form 1099-Q

OMB No. 1545-1760

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

Basis

Earnings

1 Gross distribution

$

$

$

F

Check if the recipient is

not the designated

beneficiary

6

4 Trustee-to-trustee

transfer

5

Private State

● Coverdell ESA

Check one:

● Qualified tuition program—

or

2009
CORRECTED (if checked)

RECIPIENT’S social security number 3

RECIPIENT’S name

2

Street address (including apt. no.)

City, state, and ZIP code

Account number (see instructions)

Form 1099-Q Department of the Treasury - In

Form 1099-Q

OMB No. 1545-1760

Basis

Earnings

1 Gross distribution

$

$

$

5

(keep for your records)

6 If this box is checked,

the recipient is not

the designated

beneficiary

4 Trustee-to-trustee

transfer

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

PAYER’S/TRUSTEE’S federal identification no.

Private State

● Coverdell ESA

Check one:

● Qualified tuition program—

or

If an FMV amount is shown below, see Pub. 970, Tax

Benefits for Education, for how to figure earnings.

2009
Instructions for Recipient

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

to you this year from a qualified tuition program (QTP), under section 529,

or a Coverdell ESA (CESA), under section 530. This amount is the total

of the amounts shown in box 2 and box 3. See Pub. 970 for more

information.

Box 2. Shows the earnings part of the gross distribution shown in box 1.

Generally, amounts distributed are included in income unless they are

used to pay for qualified education expenses, transferred between

trustees, or rolled over to another qualified education program within 60

days. Report taxable amounts as “Other Income” on Form 1040.

Box 4. This box is checked if a trustee-to-trustee transf

one QTP to another QTP, from one CESA to another 

CESA to a QTP. However, in certain transfers from a C

be blank.

Box 5. Shows whether the gross distribution was from 

state) or from a CESA.

Box 3. Shows your basis in the gross distribution repo

Under a CESA, the amount in box 2 is included in in

been a change in the designated beneficiary and th

beneficiary is not a family member or is over ag

beneficiaries with special needs).

Also, an additional 10% tax may apply to part or 

included in income from the CESA or QTP. See Form 

return instructions for more information.

If a final (total) distribution is made from your acco

not recovered your contributions, you may have a ded

itemize, claim any loss on the “Other expenses” line of 

1040), Itemized Deductions.

Under a QTP, the amount in box 2 is included in income if there has

been (a) more than one transfer or rollover within any 12-month period

with respect to the same beneficiary, or (b) a change in the designated

beneficiary and the new designated beneficiary is not a family member.

Caution: For CESA distributions (other than earnings on excess

contributions) made during 2009, the payer/trustee is not required to report

amounts in boxes 2 and 3. Instead, the payer/trustee may report the fair

market value of the CESA as of December 31, 2009, in the blank box below

boxes 5 and 6. To figure your earnings and basis, use the Coverdell

ESA—Taxable Distributions and Basis worksheet in Pub. 970.

Distribution codes. For 2009, the payer/trustee may, 

to, report (in the box below boxes 5 and 6) one of the 

identify the distribution you received: 1—Distributions (i

2—Excess contributions plus earnings taxable in 2

contributions plus earnings taxable in 2008; 4—Disabi

6—Prohibited transaction. Note: Nontaxable distribu

and QTPs, including rollovers, are not required to be 

income tax return. See Pub. 970 for more information.

What’s New? If any of the distribution relates to your economic stimulus

payment, see the instructions for Form 1040 or 1040A.

Account number. May show an account or other unique number the

payer has assigned to distinguish your account.
VOID CORRECTED

RECIPIENT’S social security number 3

RECIPIENT’S name

2

Street address (including apt. no.)

City, state, and ZIP code

Account number (see instructions)

Form 1099-Q Department of the Treasury - In

Form 1099-Q

OMB No. 1545-1760

Basis

Earnings

1 Gross distribution

$

$

$

6 Check if the recipient is

not the designated

beneficiary

4 Trustee-to-trustee

transfer

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

PAYER’S/TRUSTEE’S federal identification no.

5

Private State

● Coverdell ESA

Check one:

● Qualified tuition program—

or

2009
Instructions for Payers/Trustees

General and specific form instructions are provided

as separate products. The products you should use

to complete Form 1099-Q are the 2009 General

Instructions for Forms 1099, 1098, 3921, 3922, 5498,

and W-2G and the 2009 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, visit the IRS website at www.irs.gov

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

Due dates. Furnish Copy B of this form to the

recipient by February 1, 2010.

File Copy A of this form with the IRS b

March 1, 2010. If you file electronically, t

March 31, 2010. To file electronically, yo

software that generates a file according 

specifications in Pub. 1220, Specification

Forms 1098, 1099, 3921, 3922, 5498, an

Electronically. IRS does not provide a fill

Printed on recycled paper

Caution: Because paper forms are scanned during

processing, you cannot file with the IRS Forms 1096,

1098, 1099, 3921, 3922, or 5498 that you download

from the IRS website.

Need help? If you have questions about 

Form 1099-Q, call the information report

service site toll free at 1-866-455-7438 o

304-263-8700 (not toll free). For TTY/TDD 

call 304-267-3367 (not toll free).