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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