Your Email address				Taxpayer's Social Security No
Recipient's Name				Recipient's Social Security No if different
Payer's Name				Payer's Identification Number
1  Gross distribution				2a  Taxable amount
2b  Taxable amount not determined				Total Distribution
3  Capital gain included in box 2a				4  Federal income tax withheld
5  Employee contributions or      insurance premiums				6  Net unrealized appreciation in emp sec
7  Distribution code			IRA SEP Simple	8  Other amount      %
9a  Your percentage of total distribution %				9b  Total employee contributions
1st year of desig. Roth contrib.
10  State tax withheld			11  State No		12  State distribution
13  Local tax withheld			14  Local Name		15  Local distribution

NOTE: If you have other 1099-R's:
      Press "Send to Jack Burson, CPA" to submit this 1099-R, then press "Clear Form",
      enter your next 1099-R (if any)information and press "Send to Jack Burson, CPA" again
      ...repeat for additional 1099-R's.