26 27 1099 forms 1099 forms 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 2 21 22 23 24 25 26 27 28 29 30 FORM 7184-4 / TC-C4 4PT FORM 7184-4 / TC-C4 4PT FORM 7184-4 / TC-C4 4PT 8585 8585 8585 41-0852411 Form 1099-C 2018 Cancellation of Debt Copy A For Internal Revenue Service Center Department of the Treasury - Internal Revenue Service File with Form 1096. OMB No. 1545-1424 For Privacy Act and Paperwork Reduction Act Notice, see the 2016 General Instructions for Certain Information Returns. VOID CORRECTED CREDITOR'S name, street address, city, state, ZIP code, and telephone no. CREDITOR'S federal identification number DEBTOR'S identification number DEBTOR'S name Street address (including apt. no.) City, state, and ZIP code Account number (see instructions) 1 Date of identifiable event 2 Amount of debt discharged $ 3 Interest if included in box 2 $ 4 Debt description 5 Check here if the debtor was personally liable for repayment of the debt . . . . . . . 6 Identifiable event code 7 Fair market value of property $ Form 1099-C Do Not Cut or Separate Forms on This Page — Do Not Cut or Separate Forms on This Page 41-0852411 Form 1099-C 2018 Cancellation of Debt Copy A For Internal Revenue Service Center Department of the Treasury - Internal Revenue Service File with Form 1096. OMB No. 1545-1424 For Privacy Act and Paperwork Reduction Act Notice, see the 2016 General Instructions for Certain Information Returns. VOID CORRECTED CREDITOR'S name, street address, city, state, ZIP code, and telephone no. CREDITOR'S federal identification number DEBTOR'S identification number DEBTOR'S name Street address (including apt. no.) City, state, and ZIP code Account number (see instructions) 1 Date of identifiable event 2 Amount of debt discharged $ 3 Interest if included in box 2 $ 4 Debt description 5 Check here if the debtor was personally liable for repayment of the debt . . . . . . . 6 Identifiable event code 7 Fair market value of property $ Form 1099-C Do Not Cut or Separate Forms on This Page — Do Not Cut or Separate Forms on This Page 41-0852411 Form 1099-C 2018 Cancellation of Debt Copy A For Internal Revenue Service Center Department of the Treasury - Internal Revenue Service File with Form 1096. OMB No. 1545-1424 For Privacy Act and Paperwork Reduction Act Notice, see the 2016 General Instructions for Certain Information Returns. VOID CORRECTED CREDITOR'S name, street address, city, state, ZIP code, and telephone no. CREDITOR'S federal identification number DEBTOR'S identification number DEBTOR'S name Street address (including apt. no.) City, state, and ZIP code Account number (see instructions) 1 Date of identifiable event 2 Amount of debt discharged $ 3 Interest if included in box 2 $ 4 Debt description 5 Check here if the debtor was personally liable for repayment of the debt . . . . . . . 6 Identifiable event code 7 Fair market value of property $ Form 1099-C 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 3 4 5 6 7 8 9 10 11 12 13 14 15 2 __ __ __ __ __ 41-1628061 CORRECTED 0 2 1 0 - 5 4 5 1 . o N B M O . o n e n o h p e l e t d n a , e d o c P I Z , e t a t s , y t i c , s s e r d d a t e e r t s , e m a n S ’ R E Y A P Unemployment compensation 1 $ State or local income tax refunds, credits, or offsets 2 $ PAYER’S federal identification number RECIPIENT’S identification number Federal income tax withheld 4 Box 2 amount is for tax year 3 $ Taxable grants 6 RECIPIENT’S name $ 8 Check if box 2 is trade or business income Agriculture payments 7 Street address (including apt. no.) $ City, state, and ZIP code Account number (see instructions) Department of the Treasury - Internal Revenue Service Form 1099-G VOID Do Not Cut or Separate Forms on This Page — Do Not Cut or Separate Forms on This Page Form 1099-G Certain Government Payments 5 Copy A For Internal Revenue Service Center File with Form 1096. For Privacy Act and Paperwork Reduction Act Notice, see the 2016 General Instructions for Forms 1099, 1098, 3921, 3922, 5498, and W-2G. ATAA payments $ 15 Market gain 9 $ CORRECTED 0 2 1 0 - 5 4 5 1 . o N B M O . o n e n o h p e l e t d n a , e d o c P I Z , e t a t s , y t i c , s s e r d d a t e e r t s , e m a n S ’ R E Y A P Unemployment compensation 1 $ State or local income tax refunds, credits, or offsets 2 $ PAYER’S federal identification number RECIPIENT’S identification number Federal income tax withheld 4 Box 2 amount is for tax year 3 $ Taxable grants 6 RECIPIENT’S name $ 8 Check if box 2 is trade or business income Agriculture payments 7 Street address (including apt. no.) $ City, state, and ZIP code VOID Form 1099-G Certain Government Payments 5 Copy A For Internal Revenue Service Center File with Form 1096. For Privacy Act and Paperwork Reduction Act Notice, see the 2016 General Instructions for Forms 1099, ATAA payments $ 15 Market gain 9 $ 8686 8686 18 18 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 2 21 22 23 24 25 26 27 28 29 30 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 2 21 22 23 24 25 26 27 28 29 30 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 2 21 22 23 24 25 26 27 28 29 30 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 2 21 22 23 24 25 26 27 28 29 30 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 2 21 22 23 24 25 26 27 28 29 30 __ __ __ __ LIA 5120 DETACH BEFORE MAILING __ 41-0852411 Department of the Treasury - Internal Revenue Service Form 1099-INT www.irs.gov/form1099int Do Not Cut or Separate Forms on This Page — Do Not Cut or Separate Forms on This Page Form 1099-INT 2018 Interest Income Copy A For Internal Revenue Service Center File with Form 1096. OMB No. 1545-0112 For Privacy Act and Paperwork Reduction Act Notice, see the 2016 General Instructions for Certain Information Returns. VOID CORRECTED PAYER’S name, street address, city or town, province or state, country, ZIP or foreign postal code, and telephone no. PAYER’S federal identification number RECIPIENT’S identification number RECIPIENT’S name Street address (including apt. no.) City or town, province or state, country, and ZIP or foreign postal code Account number (see instructions) 2nd TIN not. Payer's RTN (optional) 1 Interest income $ 2 Early withdrawal penalty $ 3 Interest on U.S. Savings Bonds and Treas. obligations $ 4 Federal income tax withheld $ 5 Investment expenses $ 6 Foreign tax paid $ 7 Foreign country or U.S. possession 8 Tax-exempt interest $ 9 Specified private activity bond interest $ 10 Tax-exempt bond CUSIP no. 11 State 12 State identification no. 13 State tax withheld $ $ 41-0852411 Department of the Treasury - Internal Revenue Service Form 1099-INT www.irs.gov/form1099int Form 1099-INT 2018 Interest Income Copy A For Internal Revenue Service Center File with Form 1096. OMB No. 1545-0112 For Privacy Act and Paperwork Reduction Act Notice, see the 2016 General Instructions for Certain Information Returns. VOID CORRECTED PAYER’S name, street address, city or town, province or state, country, ZIP or foreign postal code, and telephone no. PAYER’S federal identification number RECIPIENT’S identification number RECIPIENT’S name Street address (including apt. no.) City or town, province or state, country, and ZIP or foreign postal code Account number (see instructions) 2nd TIN not. Payer's RTN (optional) 1 Interest income $ 2 Early withdrawal penalty $ 3 Interest on U.S. Savings Bonds and Treas. obligations $ 4 Federal income tax withheld $ 5 Investment expenses $ 6 Foreign tax paid $ 7 Foreign country or U.S. possession 8 Tax-exempt interest $ 9 Specified private activity bond interest $ 10 Tax-exempt bond CUSIP no. 11 State 12 State identification no. 13 State tax withheld $ $ __ __ MANUFACTURED IN U.S.A. ON OCR LASER BOND PAPER USING HEAT RESISTANT INKS 9292 9292 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 2 21 22 23 24 25 26 27 28 29 30 __ __ __ __ MANUFACTURED IN U.S.A. ON OCR LASER BOND PAPER USING HEAT RESISTANT INKS DETACH BEFORE MAILING LIB 5121 __ Department of the Treasury - Internal Revenue Service Form 1099-INT (keep for your records) www.irs.gov/form1099int Form 1099-INT 2018 Interest Income Copy B For Recipient This is important tax information and is being furnished to the Internal Revenue Service. If you are required to file a return, a negligence penalty or other sanction may be imposed on you if this income is taxable and the IRS determines that it has not been reported. OMB No. 1545-0112 CORRECTED (if checked) PAYER’S name, street address, city or town, province or state, country, ZIP or foreign postal code, and telephone no. PAYER’S federal identification number RECIPIENT’S identification number Account number (see instructions) Payer's RTN (optional) 1 Interest income $ 2 Early withdrawal penalty $ 3 Interest on U.S. Savings Bonds and Treas. obligations $ 4 Federal income tax withheld $ 5 Investment expenses $ 6 Foreign tax paid $ 7 Foreign country or U.S. possession 8 Tax-exempt interest $ 9 Specified private activity bond interest $ 10 Tax-exempt bond CUSIP no. 11 State 12 State identification no. 13 State tax withheld $ $ Department of the Treasury - Internal Revenue Service Form 1099-INT (keep for your records) www.irs.gov/form1099int Form 1099-INT 2018 Interest Income Copy B For Recipient This is important tax information and is being furnished to the Internal Revenue Service. If you are required to file a return, a negligence penalty or other sanction may be imposed on you if this income is taxable and the IRS determines that it has not been reported. OMB No. 1545-0112 CORRECTED (if checked) PAYER’S name, street address, city or town, province or state, country, ZIP or foreign postal code, and telephone no. PAYER’S federal identification number RECIPIENT’S identification number Account number (see instructions) Payer's RTN (optional) 1 Interest income $ 2 Early withdrawal penalty $ 3 Interest on U.S. Savings Bonds and Treas. obligations $ 4 Federal income tax withheld $ 5 Investment expenses $ 6 Foreign tax paid $ 7 Foreign country or U.S. possession 8 Tax-exempt interest $ 9 Specified private activity bond interest $ 10 Tax-exempt bond CUSIP no. 11 State 12 State identification no. 13 State tax withheld $ $ RECIPIENT'S name, street address, city or town, province or state, country, and ZIP or foreign postal code RECIPIENT'S name, street address, city or town, province or state, country, and ZIP or foreign postal code __ 8403000444 1A 591 8403000444 OMB No. 1545-0112 Form 1099-INT 1B 454 18 1A 591 1B 454 VOID CORRECTED Department of the Treasury - Internal Revenue Service Form 1099-INT www.irs.gov/form1099int Do Not Cut or Separate Forms on This Page — Do Not Cut or Separate Forms on This Page 9292 Interest Income 4 PT 1099 INT MAILER PTM-I4 2130-4 8714871 REMOVE THIS PLY BEFORE MAILING. 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 4 PT 1099 INT MAILER PTM-I4 2130-4 8714871 REMOVE THIS PLY BEFORE MAILING. 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 Payer’s RTN (optional) PAYER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. Interest on U.S. Savings Bonds and Treas. obligations 3 PAYER’S federal identification number RECIPIENT’S identification number Copy A $ For Internal Revenue Service Center Federal income tax withheld Investment expenses 5 4 RECIPIENT’S name File with Form 1096. $ $ Foreign tax paid 6 Street address (including apt. no.) $ 9 Tax-exempt interest 8 City or town, state or province, country, and ZIP or foreign postal code 2nd TIN not. Account number (see instructions) 7 For Privacy Act and Paperwork Reduction Act Notice, see the 2016 General Instructions for Certain Information Returns. 1 Interest income 2 $ Early withdrawal penalty Specified private activity bond interest $ Foreign country or U.S. possession 12 Tax-exempt bond CUSIP no. 13 State 14 State identification no. 15 State tax withheld $ $ $ $ 36-1004130 $ $ Market discount 1 1 0 1 Bond premium 8403000444 OMB No. 1545-0112 Form 1099-INT 18 VOID CORRECTED Department of the Treasury - Internal Revenue Service Form 1099-INT www.irs.gov/form1099int 9292 Interest Income Payer’s RTN (optional) PAYER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. Interest on U.S. Savings Bonds and Treas. obligations 3 PAYER’S federal identification number RECIPIENT’S identification number Copy A $ For Internal Revenue Service Center Federal income tax withheld Investment expenses 5 4 RECIPIENT’S name File with Form 1096. $ $ Foreign tax paid 6 Street address (including apt. no.) $ 9 Tax-exempt interest 8 City or town, state or province, country, and ZIP or foreign postal code 2nd TIN not. Account number (see instructions) 7 For Privacy Act and Paperwork Reduction Act Notice, see the 2016 General Instructions for Certain Information Returns. 1 Interest income 2 $ Early withdrawal penalty Specified private activity bond interest $ Foreign country or U.S. possession 12 Tax-exempt bond CUSIP no. 13 State 14 State identification no. 15 State tax withheld $ $ $ $ 36-1004130 $ $ Market discount 1 1 0 1 Bond premium 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 2 21 22 23 24 25 26 27 28 29 30 CORRECTED VOID OMB No. 1545-0877 LENDER’S name, street address, city, state, ZIP code, and telephone no. Acquisition or Abandonment of Secured Property Balance of principal outstanding 2 1 Date of lender’s acquisition or knowledge of abandonment BORROWER’S identification number LENDER’S federal identification number $ Fair market value of property 4 3 BORROWER’S name $ 5 Was borrower personally liable for repayment of the debt? Street address (including apt. no.) No Yes City, state, and ZIP code Description of property 6 Account number (see instructions) Form 1099-A Department of the Treasury - Internal Revenue Service Copy A For Privacy Act and Paperwork Reduction Act Notice, see the 2016 General Instructions for Forms 1099, 1098, 5498, and W-2G. File with Form 1096. For Internal Revenue Service Center Form 1099-A 18 41-1628061 8080 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 2 21 22 23 24 25 26 27 28 29 30 M R O F FORM 7157-4 4PT 7157-4 4PT 7979 7979 41-0852411 Form 1099-B 2018 Proceeds From Broker and Barter Exchange Transactions Copy A For Internal Revenue Service Center Department of the Treasury - Internal Revenue Service File with Form 1096. For Privacy Act and Paperwork Reduction Act Notice, see the 2016 General Instructions for Certain Information Returns. OMB No. 1545-0715 VOID CORRECTED PAYER'S name, street address, city, state, ZIP code, and telephone no. RECIPIENT'S name Street address (including apt. no.) City, state, and ZIP code Account number (see instructions) 2nd TIN not. CUSIP number 1a Date of sale or exchange 1b Date of acquisition 1c Type of gain or loss Short-term Long-term 1d Stock or other symbol 1e Quantity sold 2a Stocks, bonds, etc. $ Reported to IRS } Gross proceeds Gross proceeds less commissions and option premiums 2b Check if loss not allowed based on amount in box 2a 3 Cost or other basis $ 4 Federal income tax withheld $ 5 Wash sale loss disallowed $ 6 Check if: a Noncovered security b Basis reported to IRS 7 Bartering $ 8 Description 9 2015 on closed contracts $ 10 open contracts—12/31/2014 $ 11 open contracts—12/31/2015 $ 12 contracts $ 13 State 14 15 State tax withheld $ Form 1099-B Do Not Cut or Separate Forms on This Page — Do Not Cut or Separate Forms on This Page 41-0852411 Form 1099-B 2018 Proceeds From Broker and Barter Exchange Transactions Copy A For Internal Revenue Service Center Department of the Treasury - Internal Revenue Service File with Form 1096. For Privacy Act and Paperwork Reduction Act Notice, see the 2016 General Instructions for Certain Information Returns. OMB No. 1545-0715 VOID CORRECTED PAYER'S name, street address, city, state, ZIP code, and telephone no. RECIPIENT'S name Street address (including apt. no.) City, state, and ZIP code Account number (see instructions) 2nd TIN not. CUSIP number 1a Date of sale or exchange 1b Date of acquisition 1c Type of gain or loss Short-term Long-term 1d Stock or other symbol 1e Quantity sold 2a Stocks, bonds, etc. $ Reported to IRS } Gross proceeds Gross proceeds less commissions and option premiums 2b Check if loss not allowed based on amount in box 2a 3 Cost or other basis $ 4 Federal income tax withheld $ 5 Wash sale loss disallowed $ 6 Check if: a Noncovered security b Basis reported to IRS 7 Bartering $ 8 Description 9 2015 on closed contracts $ 10 open contracts—12/31/2014 $ 11 open contracts—12/31/2015 $ 12 contracts $ 13 State 14 15 State tax withheld $ Form 1099-B 8403000378 1A 455 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 REMOVE THIS PLY BEFORE MAILING. 1A 455 2 PT 1099 INT MAILER PTM-I2 2131-2 8214P VOID CORRECTED Copy C For Payer or State Copy 2nd TIN not. For Privacy Act and Paperwork Reduction Act Notice, see the 2016 General Instructions for Certain Information Returns. Payer’s RTN (optional) PAYER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. PAYER’S federal identification number RECIPIENT’S identification number RECIPIENT’S name, Street address (including apt. no.), City or town, state or province, country, and ZIP or foreign postal code Account number (see instructions) Department of the Treasury - Internal Revenue Service Form 1099-INT Interest on U.S. Savings Bonds and Treas. obligations 3 $ Federal income tax withheld Investment expenses 5 4 $ $ Foreign tax paid 6 $ 9 Tax-exempt interest 8 7 1 Interest income $ 2 $ Early withdrawal penalty Specified private activity bond interest Foreign country or U.S. possession $ 12 Tax-exempt bond CUSIP no. 13 State 14 State identification no. 15 State tax withheld $ www.irs.gov/form1099int $ $ 10 Market discount 11 Bond premium $ $ OMB No. 1545-0112 Form 1099-INT 18 Interest Income 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 2 21 22 23 24 25 26 27 28 29 30 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 2 21 22 23 24 25 26 27 28 29 30 form 1099 C “CanCellaTIon of DeBT” File Form 1099-C, Cancellation of Debt, for each debtor for which you cancelled (or discharged) a debt (or indebtedness) owed to you of $600 or more and you are a financial institution, a credit union or a federal government agency. You must file even though debtor may not be subject to tax on the cancelled debt. That is, you are not required to determine whether the debtor qualifies for exclusion under section 108. or example, debts discharged in bankruptcy are reportable. TC-C4 conTinuouS form numberS Carbonless FOrM TC-C4 4-Part form 1099 InT “InTeresT” For reporting Interest Income from savings and loan associations, bank deposits, bonds, debentures, notes, loans, etc. conTinuouS form numberS FOrM T-I1 1-Part Carbonless FOrM TC-I3 3-Part FOrM TC-I4 4-Part maiLer form numberS FOrM PTM-I4 4-Part Peel-aPart Electronic Filing FOrM PTM-I2 2-Part Peel-aPart SeLf maiLerS conTinuouS eLecTronic fiLing DaTeD T-I1 TC-I3, TC-I4 PTM-I4 PTM-I2 form 1099 a “aCQuIsITIon” File Form 1099A, Information Return for Acquisition or Abandonment of Secured Property, for each borrower if you lend money in connection with your trade or business and, in full or partial satisfaction of the debt, you acquire an interest in property that is security for the debt, or you have reason to know that the property has been abandoned. You need not be in the business of lending money to be subject to this reporting requirement. form 1099 B “BroKer” Sales or redemptions of securities, futures transactions, commodities, and barter exchange transactions. conTinuouS form numberS Carbonless: FOrM TC-A4 4-PArT conTinuouS form numberS Carbonless: FOrM TC-B4 4-PArT TC-B4 TC-A4 1099 ParTS SeQuence guiDe Size: 9" x 3-2/3" overall (except 1099int, 1099oid, 5498, 1098c, 1099b, 1099diV, 1099 misc and 1099r which are 9" x 5½" overall) 8" x 3-2/3" detached (except 1099int, 1099oid, 5498, 1098c 1099b, 1099diV, 1099 misc and 1099r which are 8" x 5½") 5498, 1098 & 1099 FOrMS 1099r FOrMS copy a - for internal revenue service copy a - for internal revenue service state copy - for Payer to file with state agency copy 1 - for Payer to file with state agency copy b - for recipient copy b - for recipient to file with federal tax returns copy c - for Payer’s record copy c - for recipient’s records copy 2 - for recipient to file with state agency copy 2 - for recipient to file with state agency copy d - for Payer’s records All 3-Part All 4-Part All 5-Part TC-r4 TC-Mr4 Electronic Filing TC-r6 Part 1 copy a Part 1 copy a Part 1 copy a Part 1 copy a Part 1 copy 1 or copy d Part 1 copy a Part 2 copy b Part 2 state copy Part 2 copy 1 Part 2 copy b Part 2 copy b Part 2 copy 1 Part 3 copy c Part 3 copy b Part 3 copy b Part 3 copy c Part 3 copy c Part 3 copy b Part 4 copy c Part 4 copy 2 Part 4 copy d Part 4 copy 2 Part 4 copy c Part 5 copy c Part 5 copy 2 Part 6 copy d MAILErS 3-Part Peel Apart 4-Part Peel Apart 5-Part MISC Part 1 copy a Part 1 copy a Part 1 copy a Part 2 copy c Part 2 state copy Part 2 state copy 1 Part 3 face of env. Part 3 copy c Part 3 copy c Part 4 copy b, back of env. Part 4 face of env. Part 4 face of env. Part 5 copy b Part 5 copy b back of env. Part 6 state copy 2, back of env. 1099 ELECTrONIC FILING MAILEr PArTS SEQUENCE GUIDE all the 1099’s shown for electronic filing (no copy a). the black reverse area in the upper right can be used for computer generated Postal Permit. Construction 2-Part Peel-Apart Construction 2-Part Insert Construction TM-M3M,POD-M3M Construction TM-Mr4 Part 1 state or copy c Part 1 state or copy c Part 1 state or copy c Part 1 copy 1 or d Part 2 face of env. Part 2 face of env. Part 2 face of env. Part 2 face of env. Part 3 copy b, back of env. Part 3 copy b Part 3 copy b Part 3 copy b Part 4 back of env. Part 4 copy 2, back of env. Part 4 copy c Part 5 copy 2, back of env. AFTEr HANDLING GUIDE: decollate Part 1, remove pattern carbon tissue. burst remaining copies every 3-2/3" (for 1099int, 1099oid, 5498, 1099b, 1099diV, 1099 misc and 1099r - every 5½"). burst mailer envelope every 3-2/3" (for 1099int, 1099oid, 5498, 1099b, 1099diV, 1099 misc and 1099r - every 5½"). remove line hole stubs. available Self Seal Self DW19S SW19 DW19 Use Envelope DW19 or SW19 form 1099 G “GovernmenT” Statements for unemployment compensation, state and local income tax refunds, agricultural payments. 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 2 21 22 23 24 25 26 27 28 29 30 __ __ __ __ __ Unrecap. Sec. 1250 gain CORRECTED VOID OMB No. 1545-0110 Total ordinary dividends 1a PAYER’S name, street address, city, state, ZIP code, and telephone no. 1b Qualified dividends Total capital gain distr. 2a RECIPIENT’S identification number PAYER’S federal identification number Collectibles (28%) gain n i a g 2 0 2 1 n o i t c e S e m a n S ’ T N E I P I C E R 2d 2c 3 Street address (including apt. no.) 5 Investment expenses City, state, and ZIP code Noncash liquidation distributions 9 Cash liquidation distributions 8 Account number (see instructions) 2b Nondividend distributions Form 1099-DIV Dividends and Distributions 2nd TIN not. Department of the Treasury - Internal Revenue Service Form 1099-DIV Copy A File with Form 1096. For Privacy Act and Paperwork Reduction Act Notice, see the 2016 General Instructions for Forms 1099, 1098, 3921, 3922, 5498, and W-2G. For Internal Revenue Service Center Do Not Cut or Separate Forms on This Page — Do Not Cut or Separate Forms on This Page 7 6 Foreign tax paid Foreign country or U.S. possession 4 Federal income tax withheld 18 Unrecap. Sec. 1250 gain CORRECTED VOID OMB No. 1545-0110 Total ordinary dividends 1a PAYER’S name, street address, city, state, ZIP code, and telephone no. 1b Qualified dividends Total capital gain distr. 2a RECIPIENT’S identification number PAYER’S federal identification number Collectibles (28%) gain n i a g 2 0 2 1 n o i t c e S e m a n S ’ T N E I P I C E R 2d 2c 3 Street address (including apt. no.) 5 Investment expenses City, state, and ZIP code Noncash liquidation distributions 9 Cash liquidation distributions 8 Account number (see instructions) 2b Nondividend distributions Form 1099-DIV Dividends and Distributions 2nd TIN not. Department of the Treasury - Internal Revenue Service Form 1099-DIV Copy A File with Form 1096. For Privacy Act and Paperwork Reduction Act Notice, see the 2016 General Instructions for Forms 1099, 1098, 3921, 3922, 5498, and W-2G. For Internal Revenue Service Center 7 6 Foreign tax paid Foreign country or U.S. possession 4 Federal income tax withheld 18 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ 41-1628061 41-1628061 9191 9191 form 1099 DIv “DIvIDenD” Distributions, such as dividends, capital gains distributions, or nontaxable distributions, that were paid on stock and liquidation distributions. TC-D3, TC-D4 TC-G4 conTinuouS form numberS Carbonless FOrM TC-D3 3-Part FOrM TC-D4 4-Part conTinuouS form numberS Carbonless FOrM TC-G4 4-Part available Self Seal Self DWMrS available Self Seal Self DW19S SWMR DWMR Use Envelope DWMr or SWMr SW19 DW19 Use Envelope DW19 or SW19 available Self Seal Self DWMrS SWMR DWMR Use Envelope DWMr or SWMr available Self Seal Self DW19S available Self Seal Self DWMrS SW19 DW19 Use Envelope DW19 or SW19 SWMR DWMR Use Envelope DWMr or SWMr 5 1096 Transmittal Forms Included with each Red Federal Copy A Form Simplify your customers’ filing process. Add software to your order!