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January 2022) Miscellaneous2 Royalties (Rev. January 2022) Miscellaneous2 Royalties (Rev. January 2022) MiscellaneousU.S. Information Returns (Rev. January 2022) (Rev. 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Payer made direct sales$ Substitute payments in lieu RECIPIENT'S name, stret ad Payer made direct sales$ Substitute payments in lieu RECIPIENT'S name, stret ad Payer made direct sales$ Substitute payments in lieu Name of person to contact 2 Social security number Fax number 4 Federal income tax withheld5 Total amount reported with this Form 1096 Payer made direct sales$ Substitute payments in lieuinformation and istotaling $5,000 or more of$ Substitute payments in lieuand PaperworkTFP 77772For Privacy Act City or town, state or province, country, and ZIP or foreign postal code $ consumer products to$ 10 Gross proceeds paid to anand Paperwork$ consumer products to$ 10 Gross proceeds paid to aninformation and is$ consumer products to$ 10 Gross proceeds paid to anand Paperwork3 Total number of forms $ $ TFP 77771 consumer products to10 Gross proceeds paid to anbeing furnished toconsumer products to10 Gross proceeds paid to anReduction Act recipient for resale Reduction Actrecipient for resale being furnished torecipient for resale Email addressReduction Act 9 Crop insurance proceeds attorney Notice, see the 9 Crop insurance proceeds attorney the IRS. 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If you arerecipient for resalecurrent General return, a negligencecurrent General 9 Crop insurance proceeds attorney return, a negligence9 Crop insurance proceeds attorney1 Instructions forpenalty or other $ 11 Fish purchased for resale $ 12 Section 409A deferrals Certain $ 11 Fish purchased for resale $ 12 Section 409A deferrals sanction may be$ 11 Fish purchased for resale $ 12 Section 409A deferrals Instructions forCertain 50 10981098-C1098-E1098-F1098-Q1098-T1099-A1099-B1099-C1099-CAP1099-DIV1099-G1099-INT1099-K $ $ penalty or other$ $ Notice, see the13 requirement 14 Excess golden parachute 15 compensation Information 13 requirement 14 Excess golden parachute 15 compensation imposed on you if13 requirement 14 Excess golden parachute 15compensation 6W-2G 1097-BTC 81 78 84 03 74 83 80 79 85 73 3921 91 86 92 10 11 Fish purchased for resale 12 Section 409A deferrals sanction may be11 Fish purchased for resale 12 Section 409A deferrals current General Returns. this income isInformationpayments payments taxable and the IRSpayments Returns. 93 95 1099-NEC 1099-OID1099-PATR 1099-Q1099-QA 1099-R1099-S1099-SA 1099-SB25 392254985498-ESA5498-QA13 requirement $ payments $ imposed on you if13 requirement $ payments $ Instructions forCertain32determines that itInformationhas not been1099-LS 1099-LTC1099-MISC71 96 97 31 1A 98 75 94 43 26 28 72 2A 14 Excess golden parachute15 compensation this income is14 Excess golden parachute15 compensation Returns.$ $ $ $ reported. $ $ 16 taxable and the IRS Account number (see instructions) 2nd TIN not.16 State tax withheld 17 State/Payers state no. 18 Account number (see instructions) 16 State tax withheld 17 State/Payers state no. 18 Account number (see instructions) 2nd TIN not.16 State tax withheld 17 State/Payers state no. 18 State income determines that it State income State income has not been Form(Rev. 1-2022)41-0852411 $ $ 1099-MISC(Rev. 1-2022) (keep for your records) $ www.irs.gov/Form1099MISC $ 1099-MISC(Rev. 1-2022) $ $ 5498-SAAccount number (see instructions) $ $ reported. Account number (see instructions) 2nd TIN not. $ $ 18 State income$ $ $ $ $ $ 27 16 State tax withheld 17 State/Payers state no. 18 State income 16 State tax withheld 17 State/Payers state no.1099-MISCwww.irs.gov/Form1099MISC Department of the Treasury - Internal Revenue ServiceFormDepartment of the Treasury - Internal Revenue ServiceFormwww.irs.gov/Form1099MISC Department of the Treasury - Internal Revenue ServiceDo Not Cut or Separate Forms on This PageDo Not Cut or Separate Forms on This Page $ $ $ $Return this entire page to the Internal Revenue Service. Photocopies are not acceptable.$ $ $ $Send this form, with the copies of the form checked in box 6, to the IRS in a at mailer (not folded). Form1099-MISC(Rev. 1-2022) (keep for your records) www.irs.gov/Form1099MISC Department of the Treasury - Internal Revenue Service Form1099-MISC(Rev. 1-2022) www.irs.gov/Form1099MISC Department of the Treasury - Internal Revenue Service9595 VOID CORRECTED OMB No. 1545-0115 CORRECTED (if checked) OMB No. 1545-0115 VOID CORRECTED OMB No. 1545-0115 Under penalties of perjury, I declare that I have examined this return and accompanying documents and, to the best of my knowledge and belief, they are true, correct, and complete.PAYERS name, street address, city or town, state or province, country, ZIP 1 Rents PAYERS name, street address, city or town, state or province, country, ZIP1 Rents PAYERS name, street address, city or town, state or province, country, ZIP1 Rentsor foreign postal code, and telephone no. (Rev. 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Use this form to transmit paper Forms 1097, 1098, orCopy1099, 3921, 3922, 5498, and W-2G to the IRS. Caution: any RECIPIENTS name $ 7 Payer made direct sales$ 8 of dividends or interest File with Form 1096. res, city or town, state or province, country, and ZIP or foreign postal code $ 7 Payer made direct sales$ 8 of dividends or interest RECIPIENT'S name, stret adres, city or town, state or province, country, and ZIP or foreign postal code $ 7 Payer made direct sales$ 8 of dividends or interest approved waiver, you may be subject to a penalty. 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Box 219256recipient for resale 10 Gross proceeds paid to anbeing furnished torecipient for resale 10 Gross proceeds paid to anReduction Act Returns.Who must le. payments payments determines that itpayments Caution:Montana, Nebraska, Nevada, North Kansas City, MO 64121-9256 9 Crop insurance proceeds attorney the IRS. If you are9 Crop insurance proceeds attorney current Generalhas not beenthe name and TIN used on your 94X series tax return(s) or you may beMichigan, Minnesota, Missouri, Account number (see instructions) 2nd TIN not. $ 16 State tax withheld $ 17 State/Payers state no. $ 18 Account number (see instructions) $ 16 State tax withheld $ 17 State/Payers state no. $ reported. 2nd TIN not. $ 16 State tax withheld $ 17 State/Payers state no. $ subject to information return penalties. 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Carolina, South Dakota, Tennessee,$ $ $ $ State income $ $ For more information and the Privacy Act and Paperwork Reduction Act Notice,L1096 41-0852411 5100 Form1096(2023) 11 Fish purchased for resale 12 Section 409A deferrals sanction may be11 Fish purchased for resale 12 Section 409A deferrals Instructions forCertain (Rev. 1-2022)LMA 41-0852411 5110 $ Department of the Treasury - Internal Revenue ServiceForm1099-MISC(Rev. 1-2022)LMB(keep for your records)5111 $ www.irs.gov/Form1099MISC Department of the Treasury - Internal Revenue ServiceForm1099-MISC(Rev. 1-2022) LMC/LM2 $ 5112 Department of the Treasury - Internal Revenue Service imposed on you ifInformationForm1099-MISCwww.irs.gov/Form1099MISC www.irs.gov/Form1099MISC see the 2023 General Instructions for Certain Information Returns. this income isReturns. $ $ taxable and the IRS$ $determines that it 13 requirement 14 Excess golden parachute15 compensation has not been13 requirement 14 Excess golden parachute15compensationpayments reported. payments$ $ $ $Account number (see instructions) 16 State tax withheld 17 State/Payers state no. 18 State income Account number (see instructions) 2nd TIN not.16 State tax withheld 17 State/Payers state no. 18 State income$ $ $ $$ $ $ $Form1099-MISC(Rev. 1-2022)LMB(keep for your records)5111www.irs.gov/Form1099MISC Department of the Treasury - Internal Revenue Service Form1099-MISC(Rev. 1-2022) LMC/LM2 www.irs.gov/Form1099MISC 5112 Department of the Treasury - Internal Revenue ServiceTFP 1099-MISC LASER PACKAGED SET TFP 1099-MISC BLANK LASER PACKAGED SET TFP 1099-INT LASER PACKAGED SETTFP 5110 TFP 5144 TFP 5100FOR 50 EMPLOYEES 9595 VOID CORRECTED OMB No. 1545-0115 MiscellaneousDo Not Staple 6969 Annual Summary and Transmittal of OMB No. 1545-0108 TFP 5120 TFP 5121 TFP 5122 TFP 5100PAYERS name, street address, city or town, state or province, country, ZIP 1 Rents Form 1099-MISC Information Form1096 U.S. Information Returns 2023 DETACH BEFORE MAILINGDETACH BEFORE MAILING MANUFACTURED ON OCR LASER BOND PAPER USING HEAT RESISTANT INKSDETACH BEFORE MAILINGDETACH BEFORE MAILINGDETACH BEFORE MAILINGor foreign postal code, and telephone no.6102E3-Part PRE-PACKAGED CONVENIENCE SET includes: PAYERS TIN RECIPIENTS TIN $ $ $ 52 Royalties $ (Rev. January 2022) Copy A Department of the Treasury9292 VOID CORRECTED OMB No. 1545-0112 or foreign postal code, and telephone no. CORRECTED (if checked) OMB No. 1545-0112 or foreign postal code, and telephone no. VOID CORRECTED OMB No. 1545-0112 9595 VOID CORRECTED OMB No. 1545-0115For calendar yearInternal Revenue ServiceFILERS name3 Fishing boat proceeds 4 Federal income tax withheld Internal RevenueStreet address (including room or suite number) PAYERS name, street address, city or town, state or province, country, ZIP Payers RTN (optional) PAYERS name, street address, city or town, state or province, country, ZIP Payers RTN (optional) PAYERS name, street address, city or town, state or province, country, ZIP Payers RTN (optional) PAYERS name, street address, city or town, state or province, country, ZIP1 RentsOther income MANUFACTURED ON OCR LASER BOND PAPER USING HEAT RESISTANT INKSMANUFACTURED ON OCR LASER BOND PAPER USING HEAT RESISTANT INKSMANUFACTURED ON OCR LASER BOND PAPER USING HEAT RESISTANT INKSpayments Service CenterFor 5110 (50), 5111 (50), 5112 (100), 5100 - 1096 (3), 77772 Envelopes (50) RECIPIENTS name $ 7 totaling $5,000 or more of$ 6 Medical and health careFile with Form 1096. City or town, state or province, country, and ZIP or foreign postal codeTelephone number For Ofcial Use Only or foreign postal code, and telephone no. 1 Interest income Form1099-INT Interest1 Interest income Form1099-INT Interest1 Interest income Form1099-INT or foreign postal code, and telephone no. $ 2 Royalties Form1099-MISC Miscellaneous Interest Payer made direct sales8 of dividends or interest For Privacy ActName of person to contact (Rev. January 2022) Income (Rev. January 2022) Income (Rev. January 2022) Income (Rev. 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RECIPIENTS name Substitute payments in lieu 6103E4-Part PRE-PACKAGED CONVENIENCE SET includes: 1099-MISCVOID www.irs.gov/Form1099MISC OMB No. 1545-0115 27 Street address (including apt. no.) $ 6 Foreign tax paid 7 Foreign country or U.S. possession For Privacy Act$ 6 Foreign tax paid 7 Foreign country or U.S. possession information and is$ 6 Foreign tax paid 7 Foreign country or U.S. possession For Privacy Actconsumer products to$ attorney and Paperwork Do Not Cut or Separate Forms on This PageDo Not Cut or Separate Forms on This Page being furnished to therecipient for resale9595 CORRECTED Form 1099-MISC MiscellaneousReturn this entire page to the Internal Revenue Service. Photocopies are not acceptable.Date City or town, state or province, country, and ZIP or foreign postal code $ 8 Tax-exempt interest $ 9 interest Reduction Act$ 8 Tax-exempt interest $ 9 interest IRS. 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For the latest information about developmentsupper left area of Form 1097, 1098, 1099, 3921, 3922, 5498, or W-2G. requirement $ 12 Bond premium on Treasury obligations $ 13 Bond premium on tax-exempt bond Instructions for requirement $ 12 Bond premium on Treasury obligations $ 13 Bond premium on tax-exempt bond this income isrequirement $ 12 Bond premium on Treasury obligations $ 13 Bond premium on tax-exempt bond Instructions forCertain13 requirement $ payments $ Returns.Service CenterForrelated to Form 1096, such as legislation enacted after it was published, goWhen to le. File Form 1096 as follows. Returns.taxable and the IRSInformation14 Excess golden parachute15 compensationto www.irs.gov/Form1096.through the FIREFebruary 28, 2024. Certaindetermines that it hasReturns.PAYERS TIN RECIPIENTS TIN 3 Fishing boat proceeds 6 Medical and health careInternal RevenueReminder. The only acceptable method of electronicallyInformation not been reported.returns listed on this form in box 6 with the IRS isFOR 25 EMPLOYEES RECIPIENTS name $ 7 totaling $5,000 or more of$ payments File with Form 1096. System. See Pub. 1220.Where To File Use the followingAccount number (see instructions) 2nd TIN not. $ 14 Tax-exempt and tax credit$ 15 State16Account number (see instructions) $ 14 Tax-exempt and tax credit$ 15 State16Account number (see instructions) 2nd TIN not. $ 14 Tax-exempt and tax credit$ 15 State16Account number (see instructions) 2nd TIN not. $ $ 18 State incomePurpose of form. Use this form to transmit paper Forms 1097, 1098, any 1099, 3921, 3922, 5498, and W-2G to the IRS. Caution: Substitute payments in lieu electronically but fail to do so, and you do not have an Payer made direct sales8 of dividends or interest For Privacy Actapproved waiver, you may be subject to a penalty. The Taxpayer First ActIf your principal business, ofce orbond CUSIP no. 17 State tax withheld bond CUSIP no. 17 State tax withheld bond CUSIP no. 17 State tax withheld 16 State tax withheld 17 State/Payers state no.recipient for resale attorney and Paperworkof 2019, enacted July 1, 2019, authorized the Department of the Treasury www.irs.gov/ agency, or legal residence in theInternal Revenue Service $ $ $ $ $6103254-Part PRE-PACKAGED CONVENIENCE SET includes: Street address (including apt. no.) $ consumer products to$ $ 10 Gross proceeds paid to anReduction Act 2022 tax returns. If those regulations are issued and effective for 2023 taxcase of an individual, is located in address Form1099-INT(Rev. 1-2022) 41-0852411 www.irs.gov/Form1099INT $ 1099-INT(Rev. 1-2022) (keep for your records) www.irs.gov/Form1099INT $ 1099-INT(Rev. 1-2022) www.irs.gov/Form1099INT $ o1099-MISC(Rev. 1-2022) rra 41-0852411 rms on This Pag $ Do Not Cut or Separate Forms$ on This Pageand the IRS to issue regulations that reduce the 250-return requirement for City or town, state or province, country, and ZIP or foreign postal code $ 11 Fish purchased for resale $ 12 Section 409A deferrals Notice, see the information, see Returns. part F in the 2023 General Instructions for CertainFlorida, Georgia, Kentucky, Maine,Austin, TX 78714-9213 Do Not Cut or Separate Forms on This PageDo Not Cut or Separate Forms on This Page FormNotCuto Sepa teFo e9 Crop insurance proceeds current General Form1099 explaining the change. Until regulations are issued, however,Alabama, Arizona, Arkansas, Delaware,P.O. Box 149213Department of the Treasury - Internal Revenue ServiceFormDepartment of the Treasury - Internal Revenue ServiceFormDepartment of the Treasury - Internal Revenue Service www.irs.gov/Form1099MISC Department of the Treasury - Internal Revenue ServiceMassachusetts, Mississippi, New Instructions for Information Hampshire, New Jersey, New Mexico, Certain Vermont, VirginiaInformation returns. New York, North Carolina, Ohio, Texas,D5110 (25), 5111 (25), 5112 (50), 5100 (3)Account number (see instructions) LMA41-0852411 13 requirement $ $ $ 14 Excess golden parachute$ 15 compensation $ $ Returns. Who must le.Illinois, Indiana, Iowa, Kansas,Internal Revenue Service Center9292 VOID CORRECTED OMB No. 1545-0112 or foreign postal code, and telephone no. CORRECTED (if checked) OMB No. 1545-0112 or foreign postal code, and telephone no. VOID CORRECTED OMB No. 1545-0112 9595 VOID CORRECTED OMB No. 1545-0115Alaska, Colorado, Hawaii, Idaho, Michigan, Minnesota, Missouri,P.O. Box 219256 payments Caution:Montana, Nebraska, Nevada, North Kansas City, MO 64121-9256the name and TIN used on your 94X series tax return(s) or you may beCarolina, South Dakota, Tennessee,2nd TIN not.16 State tax withheld 17 State/Payers state no. 18 State income subject to information return penalties. Do not use the name and/or TIN ofDakota, Oklahoma, Oregon, South your paying agent or service bureau. Utah, Washington, Wisconsin, Wyoming 6103E254-Part PRE-PACKAGED CONVENIENCE SET includes: Form 1099-MISC (Rev. 1-2022) 5110 www.irs.gov/Form1099MISC Department of the Treasury - Internal Revenue Service 5144M For more information and the Privacy Act and Paperwork Reduction Act Notice,L1096 41-0852411 5100 Form 1096 (2023) PAYERS name, street address, city or town, state or province, country, ZIP Payers RTN (optional) Form1099-INT PAYERS name, street address, city or town, state or province, country, ZIP Payers RTN (optional) Form1099-INT PAYERS name, street address, city or town, state or province, country, ZIP Payers RTN (optional) Form1099-INT PAYERS name, street address, city or town, state or province, country, ZIP$ 1 Rents Form1099-MISC Miscellaneous see the 2023 General Instructions for Certain Information Returns. or foreign postal code, and telephone no. or foreign postal code, and telephone no.InterestInterestInterest 1 Interest income (Rev. January 2022) Income 1 Interest income (Rev. January 2022) Income 1 Interest income (Rev. January 2022) Income 2 Royalties (Rev. January 2022) Information5110 (25), 5111 (25), 5112 (50), 5100 - 1096 (3), 77772 Envelopes (25) $ 2 Early withdrawal penalty For calendar year Copy A $ 2 Early withdrawal penalty For calendar year Copy B $ 2 Early withdrawal penalty For calendar year Copy C $ 3 Other income $ For calendar yearCopy A204 Federal income tax withheldTFP 1099-NEC LASER PACKAGED SET Internal Revenue ForFor Recipient For Payer $ payments For 6105255-Part PRE-PACKAGED CONVENIENCE SET includes: PAYERS TIN RECIPIENTS TIN$ 3 Interest on U.S. Savings Bonds and Treasury obligations PAYERS TIN RECIPIENTS TIN $ 3 Interest on U.S. Savings Bonds and Treasury obligations PAYERS TIN RECIPIENTS TIN $ 3 Interest on U.S. Savings Bonds and Treasury obligations PAYERS TIN State RECIPIENTS TIN $ 5 Fishing boat proceeds $ 6 Medical and health careInternal Revenue Service CenterService Center Copyand/or1TFP NEC5110 TFP NEC5111 TFP NEC5112 TFP 5100 RECIPIENTS name $ 4 Federal income tax withheld $ 5 Investment expenses RECIPIENT'Sname,stretadres,cityortown,stateorprovince,country,andZIPorforeignpostalcode $ 4 Federal income tax withheld $ 5 Investment expenses RECIPIENT'Sname,stretadres,cityortown,stateorprovince,country,andZIPorforeignpostalcode $ 4 Federal income tax withheld $ 5 Investment expenses orCopy2 7totaling $5,000 or more of$ 8 of dividends or interest File with Form 1096.5110 (25), 5111 (25), 5112 (75), 5100 - 1096 (3) OMB No. 1545-0116 OMB No. 1545-0116 Do Not Staple 6969 Annual Summary and Transmittal of OMB No. 1545-0108 Street address (including apt. no.) $ 6 Foreign tax paid 7 Foreign country or U.S. possession File with Form 1096. $ 6 Foreign tax paid 7 Foreign country or U.S. possession This is important tax$ 6 Foreign tax paid 7 Foreign country or U.S. possession RECIPIENTS name $ Payer made direct sales$ Substitute payments in lieuFor Privacy Act $ For Privacy Act$ information and is$ For Privacy Actconsumer products to10 Gross proceeds paid to anand Paperwork being furnished to therecipient for resale Reduction Act 7171 VOID CORRECTED CORRECTED (if checked) VOID CORRECTED OMB No. 1545-0116 8 Tax-exempt interest 9 interest and Paperwork8 Tax-exempt interest 9 interest IRS. If you are8 Tax-exempt interest 9 interest and Paperwork9 Crop insurance proceeds attorney current GeneralPAYERS name, street address, city or town, state or province, country, ZIP$ 3 1 Nonemployee compensation Form 20 or foreign postal code, and telephone no. res RECIPIENTS TIN $ 3 1 Nonemployee compensation PAYERS name, street address, city or town, state or province, country, ZIPtad,or or or $ 3 2Nonemployee compensation FormForm20 1096 Compensation U.S. Information Returns 2023 City or town, state or province, country, and ZIP or foreign postal code $ 10 Market discount $ 11 Bond premium Reduction Actrequirement $ 10 Market discount $ 11 Bond premium return, a negligencerequirement $ 10 Market discount $ 11 Bond premium Street address (including apt. no.) 13 requirement 11 Fish purchased for resale 12 Section 409A deferrals Notice, see theReduction Act or foreign postal code, and telephone no. PAYERS name, street address, city or town, state or province, country, ZIP__DETACH BEFORE MAILING Formor foreign postal code, and telephone no.DETACH BEFORE MAILING Department of the TreasuryNonemployee DETACH BEFORE MAILING Notice, see the penalty or otherNotice, see the Instructions forCertainMANUFACTURED ON OCR LASER BOND PAPER USING HEAT RESISTANT INKSMANUFACTURED ON OCR LASER BOND PAPER USING HEAT RESISTANT INKSMANUFACTURED ON OCR LASER BOND PAPER USING HEAT RESISTANT INKSMANUFACTURED ON OCR LASER BOND PAPER USING HEAT RESISTANT INKS 1099-NEC1099-NEC1099-NEC sanction may becurrent GeneralTFP 1099-NEC LASER PACKAGED LASER SET PAYERS TINS name RECIPIENTS TIN (Rev. January 2022) t ad Nonemployee(Rev. January 2022) stre rescity NonemployeeS TIN ZIPforeignpostalcode (Rev. January 2022) Copy C requirement $ 12Bond premium on Treasury obligations $ 13 Bond premium on tax-exempt bond current General $ 12Bond premium on Treasury obligations $ 13 Bond premium on tax-exempt bondimposed on you if$ 12Bond premium on Treasury obligations $ 13 Bond premium on tax-exempt bond City or town, state or province, country, and ZIP or foreign postal code $ payments $ InformationFor calendar year Compensation For calendar year Compensation For calendar year this income isInstructions forCertain Returns. Internal Revenue ServiceRECIPIENT PAYERS TIN Copy A 20 name, town,state RECIPIENT and FILERS name For Payer Instructions for Certain taxable and the IRSInformation14 Excess golden parachute15 compensation2 Payer made direct sales totaling $5,000 or more ofFor Internal RevenuePAYERS TIN Copy B country, Street address (including room or suite number) Information determines that it hasReturns.RECIPIENT'S name, stre File with Form 1096. 2 Payer made direct sales totaling $5,000 or more ofFor Recipient 1 Payer made direct sales totaling $5,000 or more ofCopy 1 or Copy 2 Returns. not been reported.Service Center RECIPIENT'S This is important tax consumer products to recipient for resale , city or town, state or province, country, and ZIP or foreign postal code consumer products to recipient for resale information and is beingconsumer products to recipient for resale and/or Stateprovince,Street address (including apt. no.) 41-0852411 2nd TIN not.$ 54 Federal income tax withheld s state no. $ $ General Instructions for $ $ $ 4 Federal income tax withheld Forms state no. $ $ furnished to the IRS. If you are2nd TIN not. $ $ $ 4 Federal income tax withheld Name of person to contact 61$ $ 78 For Privacy Act and03 1098-Q1098-T1099-A1099-B $ 1099-C1099-CAPFor Ofcial Use Only $ 1099-K Account number (see instructions) LIA41-0852411 2nd TIN not. $ 14 Tax-exempt and tax credit$ 15 State16Account number (see instructions) LIB (keep for your records) 5121 $ 14 Tax-exempt and tax credit$ 15 State16Account number (see instructions) LIC 2nd TIN not. $ 14 Tax-exempt and tax credit$ 15 State16$ Account number (see instructions) LMA 41-0852411 2nd TIN not. $ $ 18 State incomeFOR 50 EMPLOYEES City or town, state or province, country, and ZIP or foreign postal code $ $ State tax withheld 6 State/Payer Form 1099-NECPaperwork Reduction Act current 5 State tax withheld 1099-NECsanction may be imposed on5 State tax withheld City or town, state or province, country, and ZIP or foreign postal codeTelephone numberFax number3 Total number of forms4 Federal income tax withheld5 Total amount reported with this Form 1096 Form1099-INT(Rev. 1-2022) 5120 bond CUSIP no. $ 17 State tax withheld bond CUSIP no. $ 17 State tax withheld 5122 bond CUSIP no. $ 17 State tax withheld (Rev. 1-2022) 5110 16 State tax withheld 17 State/Payers state no. $For Privacy Act and negligence penalty or otherPaperwork Reduction Notice, see theyou if this income is taxableInstructions for CertainAct Notice, see the Certain Information and the IRS determines that itcurrent General7 State income Returns. 6 State/PayerAccount number (see instructions) has not been reported. 6 State/PayerEmail addresss state no. 7 Information Returns. $ $ $ $Account number (see instructions) Account number (see instructions) 7 State income State income $2 Social security number 1099-INT(Rev. 1-2022) www.irs.gov/Form1099INT Department of the Treasury - Internal Revenue ServiceForm1099-INT(Rev. 1-2022) www.irs.gov/Form1099INT Department of the Treasury - Internal Revenue Service www.irs.gov/Form1099MISC Department of the Treasury - Internal Revenue ServiceForm 1099-NEC (Rev. 1-2022) www.irs.gov/Form1099NEC Department of the Treasury - Internal Revenue Service (Rev. 1-2022) Form1099-MISC Do Not Cut or Separate Forms on This PageDo Not Cut or Separate Forms on This Page www.irs.gov/Form1099NEC Department of the Treasury - Internal Revenue Service www.irs.gov/Form1099NEC Department of the Treasury - Internal Revenue Service 74 83 80 79 85 73 1099-DIV1099-G1099-INT 10 www.irs.gov/Form1099INT Department of the Treasury - Internal Revenue ServiceForm (Rev. 1-2022) (keep for your records)NEC61023-Part PRE-PACKAGED CONVENIENCE SET includes: 7171 VOID CORRECTED Form PAYERS name, street address, city or town, state or province, country, ZIPVOID CORRECTED Form W-2G 1097-BTC1098 1098-C1098-E1098-F1099-Q1099-QA 1099-R1099-S1099-SA 1099-SB 3921 26 91 86 92 5498-QA 32 50 81 84PAYERS name, street address, city or town, state or province, country, ZIPOMB No. 1545-0116 CORRECTED (if checked) OMB No. 1545-0116 OMB No. 1545-0116 1099-MISC1099-NEC 1099-OID1099-PATR 31 1A 98 75 94 43 25 392254985498-ESA 2Aor foreign postal code, and telephone no.1099-NEC PAYERS name, street address, city or town, state or province, country, ZIP1099-LS 1099-LTC 95 71 96 97 28 72or foreign postal code, and telephone no. Formor foreign postal code, and telephone no.1099-NECNEC5110 (50), NEC5111 (50), NEC5112 (50), 5100 - 1096 (3) PAYERS TINS name RECIPIENTS TIN $ 1 Nonemployee compensation (Rev. January 2022) t adres Nonemployee$ 1 Nonemployee compensation (Rev. January 2022) stretadres,city Nonemployeeor or S TIN ZIPorforeignpostalcode $ Nonemployee compensation (Rev. January 2022) Nonemployee(3) 1096 Transmittal forms are included with each set 1099-NEC 16 93For calendar year Compensation For calendar year Compensation For calendar year CompensationRECIPIENT 20 PAYERS TIN For Internal Revenue20 name, town,state RECIPIENT and 5498-SACopy CRECIPIENTS TIN 2720Copy A PAYERS TIN Copy B For Payer2 Payer made direct sales totaling $5,000 or more of3 File with Form 1096. 2 Payer made direct sales totaling $5,000 or more of3 For Recipient country, 1 Payer made direct sales totaling $5,000 or more of3 Copy 1 or Copy 2RECIPIENT'S name, stre , city or town, state or province, country, and ZIP or foreign postal code RECIPIENT'S This is important taxReturn this entire page to the Internal Revenue Service. Photocopies are not acceptable. Service Center province, 2 consumer products to recipient for resale and/or StateNEC6102E3-Part PRE-PACKAGED CONVENIENCE SET includes: NEC5110 (50), Street address (including apt. no.) 41-0852411 2nd TIN not.$ $ $ consumer products to recipient for resale 1099-NEC$ $ Paperwork Reduction Act$ $ $ consumer products to recipient for resale $ $ information and is being2nd TIN not. $ $ $ 4 Federal income tax withheld Send this form, with the copies of the form checked in box 6, to the IRS in a at mailer (not folded). $ $For Privacy Act andfurnished to the IRS. If you areUnder penalties of perjury, I declare that I have examined this return and accompanying documents and, to the best of my knowledge and belief, they are true, correct, and complete.sanction may be imposed onFor Privacy Act andNotice, see thenegligence penalty or otherPaperwork Reduction City or town, state or province, country, and ZIP or foreign postal code 4 Federal income tax withheld General Instructions forcurrent4 Federal income tax withheld s state no. and the IRS determines that it5 State tax withheld Signature Instructions for Certain Title DateAct Notice, see the5 State tax withheld Certain InformationReturns. 5 State tax withheld you if this income is taxable6 State/Payers state no. current General number), and TIN in the spaces provided on the form. The name, address, 6 State/Payers state no.Account number (see instructions) 6 State/PayerAccount number (see instructions) Instructions 7 Information Returns.7 State income has not been reported. Future developments. State income7 State incomeNEC5111 (50), NEC5112 (50), 5100 - 1096 (3), DW19WS Envelopes (50) Account number (see instructions) www.irs.gov/Form1099NEC Department of the Treasury - Internal Revenue Service www.irs.gov/Form1099NEC Department of the Treasury - Internal Revenue Service www.irs.gov/Form1099NEC related to Form 1096, such as legislation enacted after it was published, go anyupper left area of Form 1097, 1098, 1099, 3921, 3922, 5498, or W-2G.Form 1099-NEC (Rev. 1-2022) Form(Rev. 1-2022) (keep for your records) to www.irs.gov/Form1096 For the latest information about developmentsFebruary 28, 2024.Do Not Cut or Separate Forms on This PageDo Not Cut or Separate Forms on This PageCORRECTED (if checked) Form 1099-NEC (Rev. 1-2022) VOID CORRECTED Department of the Treasury - Internal Revenue Service. When to le. File Form 1096 as follows. TFP 1099-MISC LASER PACKAGED SET FOR ELECTRONIC FILING TFP 1099-INT LASER PACKAGED SETPAYER 7171 VOID CORRECTED OMB No. 1545-0116 S name, street address, city or town, state or province, country, ZIPReminder. The only acceptable method of electronically through the FIRE1098, Where To Filereturns listed on this form in box 6 with the IRS isSystem. See Pub. 1220. Purpose of form. Use this form to transmit paper Forms 1097,1099, 3921, 3922, 5498, and W-2G to the IRS. NEC61034-Part PRE-PACKAGED CONVENIENCE SET includes: or foreign postal code, and telephone no. RECIPIENTS TIN $ 2Nonemployee compensation Form 20 or foreign postal code, and telephone no. res RECIPIENTS TIN $ 1 Nonemployee compensation OMB No. 1545-0116 stretadres,city Compensation or or S TIN ZIPorforeignpostalcode $ Nonemployee compensation OMB No. 1545-0116 Compensation If your principal business, ofce orUse the followingS name, street address, city or town, state or province, country, ZIPPAYERS name, street address, city or town, state or province, country, ZIPPAYER Caution: electronically but fail to do so, and you do not have an1099-NEC NonemployeeFormor foreign postal code, and telephone no. Form 1099-NEC Nonemployeecase of an individual, is located in address 1099-NEC Nonemployeeapproved waiver, you may be subject to a penalty. The Taxpayer First Actagency, or legal residence in the (Rev. January 2022) Compensation (Rev. January 2022) of 2019, enacted July 1, 2019, authorized the Department of the Treasury www.irs.gov/ Alabama, Arizona, Arkansas, Delaware,Internal Revenue Serviceand the IRS to issue regulations that reduce the 250-return requirement for For calendar year For calendar year (Rev. January 2022) Florida, Georgia, Kentucky, Maine,P.O. Box 149213 2022 tax returns. If those regulations are issued and effective for 2023 tax RECIPIENTS TINS name RECIPIENT'S name, stre For Internal Revenue2 Payer made direct sales totaling $5,000 or more ofFor Recipient country, For calendar year For Payer New York, North Carolina, Ohio, Texas,FOR 50 EMPLOYEES FOR 50 EMPLOYEESForm1099 explaining the change. Until regulations are issued, however,Massachusetts, Mississippi, New NEC5110 (50), NEC5111 (50), NEC5112 (100),5100 - 1096 (3) PAYER (Rev. 1-2022)NECLMA41-0852411NEC5110 $ 1 Payer made direct sales totaling $5,000 or more of3 t ad $ General Copy A NEC5111 $ $ 4 Federal income tax withheld 3 20name, $ $ town,state RECIPIENT and 2nd TIN not.$ $ $ 3 45 Federal income tax withheld 20 $ $ Copy C Hampshire, New Jersey, New Mexico,Austin, TX 78714-9213(2023)PAYERS TIN PAYERS TIN Copy B information, see Returns. part F in the 2023 General Instructions for CertainVermont, Virginiaconsumer products to recipient for resale File with Form 1096. consumer products to recipient for resale information and is being1 Payer made direct sales totaling $5,000 or more ofCopy 1 or Copy 2 Illinois, Indiana, Iowa, Kansas,Internal Revenue Service Center Information, city or town, state or province, country, and ZIP or foreign postal code RECIPIENT'S This is important tax2 consumer products to recipient for resaleWho must le. returns. and/or State Alaska, Colorado, Hawaii, Idaho, Service Center province,Street address (including apt. no.) 4 Federal income tax withheld Paperwork Reduction Actfurnished to the IRS. If you areCaution:For Privacy Act andMichigan, Minnesota, Missouri,P.O. Box 219256 City or town, state or province, country, and ZIP or foreign postal code $ $ 5 State tax withheld $ For Privacy Act and current$ 5 State tax withheld 6 State/Payers state no. negligence penalty or otherState tax withheld the name and TIN used on your 94X series tax return(s) or you may beMontana, Nebraska, Nevada, North Kansas City, MO 64121-9256 6112E3 part PRE-PACKAGED CONVENIENCE SET includes: 61043-Part PRE-PACKAGED CONVENIENCE SET includes:Notice, see thesanction may be imposed onPaperwork ReductionDakota, Oklahoma, Oregon, South Act Notice, see the NEC6103E4-Part PRE-PACKAGED CONVENIENCE SET includes: NEC5110 (50), Account number (see instructions) 2nd TIN not. Form 1099-NECCertain Information www.irs.gov/Form1099NEC Form 1099-NECyou if this income is taxableNEC5112www.irs.gov/Form1099NEC subject to information return penalties. Do not use the name and/or TIN ofCarolina, South Dakota, Tennessee, 5100 Form 1096 Instructions for and the IRS determines that itInstructions for Certain Utah, Washington, Wisconsin, Wyoming 7 State income Returns. 7 State income your paying agent or service bureau. current General L1096 41-08524116 State/Payers state no.Account number (see instructions) Account number (see instructions) 6 State/Payers state no. 7 Information Returns.has not been reported. State incomeFor more information and the Privacy Act and Paperwork Reduction Act Notice, see the 2023 General Instructions for Certain Information Returns.NEC5111 (50), NEC5112 (100), 5100 - 1096 (3), DW19WS Envelopes (50) Form 1099-NECwww.irs.gov/Form1099NEC Department of the Treasury - Internal Revenue Service 1099-NEC(Rev. 1-2022)NECLMCDepartment of the Treasury - Internal Revenue Service 5144 (150), 77772 (50) Envelopes 5120 (50), 5121 (50), 5122 (100), 5100- 1096 (3)(Rev. 1-2022)NECLMB(keep for your records) Department of the Treasury - Internal Revenue Service611361064-Part PRE-PACKAGED CONVENIENCE SET includes:NEC61055-Part PRE-PACKAGED CONVENIENCE SET includes: (3) 1096 Transmittal forms are included with each set 3-Part PRE-PACKAGED CONVENIENCE SET includes:NEC5110 (50), NEC5111 (50),NEC5112 (150), 5100 - 1096 (3) 5111 (50), 5112 (100) 5120 (50), 5121 (50), 5122 (100), 5100 - 1096 (3)6113E3-Part PRE-PACKAGED CONVENIENCE SET includes: FOR 25 EMPLOYEESFOR 25 EMPLOYEESNEC6103254-Part PRE-PACKAGED CONVENIENCE SET includes: 5111 (50), 5112 (100), 77772 (50) Envelopes 6106254-Part PRE-PACKAGED CONVENIENCE SET includes:NEC5110 (25), NEC5111 (25), NEC5112 (50), 5100 - 1096 (3) TFP 1099-NEC BLANK LASER PACKAGED SET FOR 25 EMPLOYEES 5120 (25), 5121 (25), 5122 (50), 5100 - 1096 (3)NEC6103E25 4-Part PRE-PACKAGED CONVENIENCE SET includes: FOR 50 EMPLOYEES 6113E253-Part PRE-PACKAGED CONVENIENCE SET includes: NEC5110 (25), NEC5111 (50), NEC5112 (50), 5100 - 1096 (3),NEC61745-Part PRE-PACKAGED CONVENIENCE SET includes: 5111 (25), 5112 (50), 77772 (25) EnvelopesDW19WS Envelopes (25) NEC5110 (50), NEC5144 (200), NEC5100 - 1096 (3) TFP 1099-NEC LASER PACKAGED SET FOR ELECTRONIC FILINGTFP 1099-MISC BLANK LASER PACKAGED SET FOR 50 EMPLOYEESFOR 50 EMPLOYEES NEC61133-Part PRE-PACKAGED CONVENIENCE SET includes:61745-Part PRE-PACKAGED CONVENIENCE SET includes: NEC5111 (50), NEC5112 (100)5110 (50), 5144 (200), 5100 - 1096 (3) NEC6113E3-Part PRE-PACKAGED CONVENIENCE SET includes: NEC5111 (50), NEC5112 (100), DW19WS (50) EnvelopesFOR 25 EMPLOYEES46 NEC6113E253-Part PRE-PACKAGED CONVENIENCE SET includes:47NEC5111 (25), NEC5112 (50), DW19WS (25) Envelopes"