Cost in the plan at the annuity starting date (RRB line 3)
0
2
Check age of primary annuitant at annuity starting
date
55
or under
56-60
61-65
66-70
71
or older
Check if the annuity starting date is after 11/18/1996.
Check if the annuity starting date is after 12/31/1997
and this is a joint and survivor annuity. Use table
below. Check combinded age of annuitants at annuity
starting date
110
or under
111-120
121-130
131-140
141
or more
3
Exclusion per month
0
4
Number of months for which payments were received
this year
0
5
If the annuity started after 1986, enter the amount recovered tax
free in prior years