1099r
Page 1 of 2
12/ 08/ 2004
CORRECTED (if checked)
PAYER'S name, street address, city, state, and ZIP code
Defense Finance and Accounting Service
US Military Retirement Pay
PO Box 7130
London, KY 40742 -7130
PAYER'S Federal identification number
34-0727612
1 Gross distribution
$ 12610.68
OMB No. 1545-0119
2004
2a Taxable amount
$ 12610.68
RECIPIENT'S identification number
555572330
RECIPIENT'S name, address, and ZIP code
HERBERT SOTELO ABILLE
186 MOSS STREET
2b
Taxable amount not determined
4 Federal Income tax withheld
$ 150.72
9 Your percentage of total distribution
10 State income tax withheld
$ 0.00
CHULA VISTA CA 91911
Total Distribution
7 Distribution code
7
%
11 State/Payer's state number
Distribution From
Pensions, Annuities,
Retirement or
Profit -Sharing Plans,
IRAs, Insurance
Contracts, etc.
Copy 2
File this copy with your
state, city, or local
income tax return
when required
$ 0.00
RETIRED
01012004- 12312004
Form 1099-R
Department of the Treasury - Internal Revenue Service
12/ 08/ 2004
CORRECTED (if checked)
PAYER'S name, street address, city, state, and ZIP code
Defense Finance and Accounting Service
US Military Retirement Pay
PO Box 7130
London, KY 40742 -7130
PAYER'S Federal identification number
34-0727612
1 Gross distribution
$ 12610.68
CHULA VISTA CA 91911
2004
2a Taxable amount
$ 12610.68
RECIPIENT'S identification number
555572330
RECIPIENT'S name, address, and ZIP code
HERBERT SOTELO ABILLE
186 MOSS STREET
OMB No. 1545-0119
2b
Taxable amount not determined
4 Federal Income tax withheld
$ 150.72
9 Your percentage of total distribution
10 State income tax withheld
$ 0.00
Total Distribution
7 Distribution code
7
%
11 State/Payer's state number
$ 0.00
RETIRED
Copy B
Report this income on
your Federal tax return.
This information is
being furnished to the
Internal Revenue
Service.
01012004- 12312004
Form 1099-R
Department of the Treasury - Internal Revenue Service
12/ 08/ 2004
CORRECTED (if checked)
PAYER'S name, street address, city, state, and ZIP code
Defense Finance and Accounting Service
US Military Retirement Pay
PO Box 7130
London, KY 40742 -7130
Distribution From
Pensions, Annuities,
Retirement or
Profit -Sharing Plans,
IRAs, Insurance
Contracts, etc.
1 Gross distribution
$ 12610.68
2a Taxable amount
$ 12610.68
OMB No. 1545-0119
2004
Distribution From
Pensions, Annuities,
Retirement or
Profit -Sharing Plans,
https://mypay.dfas.mil/F1099R_RCPS.ASPX?AccessString=RCPS&globalid=DNET010720050330090819W0074914&gcCurPysy=R...
3/30/2005
PAYER'S Federal identification number
34-0727612
RECIPIENT'S name, address, and ZIP code
HERBERT SOTELO ABILLE
186 MOSS STREET
CHULA VISTA CA 91911
RECIPIENT'S identification number
555572330
2b
Taxable amount not determined
4 Federal Income tax withheld
$ 150.72
9 Your percentage of total distribution
10 State income tax withheld
$ 0.00
Total Distribution
7 Distribution code
7
%
11 State/Payer's state number
IRAs, Insurance
Contracts, etc.
Copy C
For Receipient's Records
This information is
being furnished to the
Internal Revenue
Service.
$ 0.00
RETIRED
01012004- 12312004
Form 1099-R
Department of the Treasury - Internal Revenue Service
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