Anne Banks is a single, 60-year old retired teacher who does not itemize. Her only income is reported to her on the Fonn 1099-R provided by her retirement plan and the Form 1099-DIV provided by her broker. These forms are found in Figures 1:3-5 and 1:3-6. Complete page 2 of her Form 1040.

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PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and phone no. Teachers Retirement Assn 500 Andrew Blvd. Atlanta, GA 30301 PAYER'S TIN 13-1234567 RECIPIENT'S name Anne Banks RECIPIENT'S TIN 123-45-6789 Street address (including apt. no.) 306 W. Olive St. 10 Amount allocable to IRR within 5 years $ 0.00 CORRECTED (if checked) 1 Gross distribution 11 1st year of desig. Roth contrib Account number (see instructions) C0053312 Form 1099-R (keep for your records) $32,000.00 2a Taxable amount $ 32,000.00 2b Taxable amount not determined City or town, state or province, country, and ZIP or foreign postal code 9a East Springs, FL 32701 Date of payment Total distribution 3 Capital gain (included 4 Federal income tax in box 2a) withheld FATCA filing 12 requirement $ 5 Employee contributions/ 6 Designated Roth contributions or insurance premiums OMB No. 1545-0119 IRA/ SEP/ SIMPLE 2019 15 Local tax withheld www.irs.gov/Form1099R Form 1099-R 7 Distribution code(s) 7 % Your percentage of total 9b Total employee contributions distribution State tax withheld %$ 2,500.00 Net unrealized appreciation in employer's securities 8 Other Distributions From Pensions, Annuities, Retirement or Profit-Sharing Plans, IRAS, Insurance Contracts, etc. 13 State/Payer's state no. 16 Name of locality Copy C For Recipient's Records This information is being furnished to the IRS. 14 State distribution $ 17 Local distribution Department of the Treasury - Internal Revenue Service CORRECTED (if checked) PAYER'S name, street address, city or town, state or province, country, ZIP 1a Total ordinary dividends or foreign postal code, and telephone no. TD Investment Fund P.O. Box 2 Omaha, NE 68102 PAYER'S TIN 47-0533312 RECIPIENT'S name Anne Banks Street address (including apt. no.) 306 W. Olive St. City or town, state or province, country, and ZIP or foreign postal code East Springs, FL 32701 Account number (see instructions) C0057777 RECIPIENT'S TIN 123-45-6789 Form 1099-DIV (keep for your records) $ 1,000.00 1b Qualified dividends $ 900.00 2a Total capital gain distr. $ 2c Section 1202 gain $ S3550S $ $ 7 Foreign tax paid OMB No. 1545-0110 $ FATCA filling 11 Exempt-interest dividends requirement 3 Nondividend distributions 4 Federal income tax withheld $ 5 Section 199A dividends 6 Investment expenses $ & Foreign country or U.S. possession 2019 Form 1099-DIV 2b Unrecap. Sec. 1250 gain $ 2d Collectibles (28%) gain 59 www.irs.gov/Form1099DIV This is important tax information and is being furnished to the IRS. If you are required to file a return, a negligence penalty or other sanction may be imposed on you if $ Cash liquidation distributions 10 Noncash iquidation distributions this income is taxable $ 12 Specified private activity bond interest dividends the IRS determines that it has not been reported. Dividends and Distributions $ 5,000.00 $ 13 State 14 State identification no. 15 State tax withheld $ $ Copy B For Recipient Department of the Treasury - Internal Revenue Service