Question 12 of 50 The Form 1099 REvonne received is shown in the image below. The form shows code in box, indicating that the south due to down What amount it any will Evaneed to donated? CORRECTED ( chocked PAYERS rare, street access, city or low, state or province 1 Grosso OMBRISESTI country ZIP or foreign postal code and phone no Distributions From Pensions, Annuities, STATE BANK AND TRUST $ 2,000.00 Retirement or 105 JEFFERSON STREET 2020 Profit Sharing Plans, 2a Tawaamount IRAS, Insurance YOUR CITY, YS XXXXX $ 2,000.00 Contracts, oto for 1099-R (XXX) 555-1234 2b Tale amount TOWN Copy B noterined stribution X PAYER'S TN RECIPIENTS TIN 3 Capital gain included 4 Federal income tax Report this in box 20 with income on your federal tax XX-XXXXXXX XXX-XX-XXXX return. If this $ 200.00 form shows RECIPIENT'S name Emokyo contributions Noured federal income Designated appreciation in tax withheld in EVONNE WILLIAMS contine or employer's box 4, attach insurance prema $ this copy to your return Strot address cluding al.no 7 Don Cher SOR code SE 1116 WEST 49TH TERRACE 4 XS This information is being fushed to City or own stor province, couvy, and Por foreign postal code Ga Your percentage of our couple the RS YOUR CITY, YS XXXXX dobution ws 10 Autoca FR 11 years 12 FATCA 14 Stawi 15 State Payer's state no 10 e distribution within 5 years Rshort $ IS Account numbers trucos 13 Date of 17 Local 18 Name of 19 Lo distribution IS BB1234562 1. www.am Department of the Sovice Thu Pom 100 ved is hown in the image. The tum how come into indicating that the debt is our ch. Wall, iary windows say? CORRECTED Mhacker PAYER'Same, streets, city ortow, ale or ROVINOR courty ZIP or foreign pood, and phone 1 bon Distributions From Pensions, Annuities STATE BANK AND TRUST $ 2,000.00 Retirement or 105 JEFFERSON STREET 2a Tastament 2020 Profit Sharing Plans IRAs, Insurance YOUR CITY, YS XXXXX $ 2,000.00 Pun 1099-R Contracts to (XXX) 555-1234 ? To mount Total not determined Copy B distribution X PAYER'S TIN RECIPIENT'S TIN 3 Capital Onded 14 Fede AK Report this into income on your wild XX-XXXXXXX federal tax XXX-XX-XXXX return. If this Is $ 200.00 form shows RECIPIENT'Same 5 Employee contro Naturalized federal income Designed Roth appreciation in tax withheld in EVONNE WILLIAMS contribution oployer's secure insurance box 4, attach this copy to your retum Shadores including ant.no 7 Distrito WO SER code SE 1116 WEST 49TH TERRACE 4 This information is X IS beinglanished to City or town, state or province, country, and ZIP for postcode On Your percentage of our core the IRS YOUR CITY, YS XXXXX dibution 10 A 10 FOR 11 1st year oldes 12 FATCA 14 Sut tax with 15 Seat Payer's no 16 Sate distribution within 5 years Rothco rent 17 Local 18 Name of locally 19 Local distribution Account numbers instruction 881234562 13 Date of payment Depost their own For 1099-R $0 5100 $200