b'1099 PRE-PRINTED FORMS 1099 PRE-PRINTED & BLANK FORMSApex 1099-DIV & 1099-R Packaged Sets Pressure Seal 1099|1098|5498 FormsAPEX 1099-DIV LASER PACKAGED SET 1A This proof is submitted for your review and approval. It is supplied for content, layout, and version review and does not reflect paper or ink match. Please review your proof carefully. 851018906 S2020 APEX PS353 1A S20358210140232 APEX PS80650PAYERS name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. Rents AAPEX LDA APEX LDB APEX LDC APEX L1096 CORRECTED (if checked) $ 2 1 OMB No. 1545-0115 MisInformationA PAYERS TIN RECIPIENTS TIN $ $ 3 5 Royalties Form$ 4 6 1099-MISC celaneous TFP 5113(Rev. January year2022)For calendar 1099-MISC20 Other income Federal income tax withheld Copy 29191 VOIDCORRECTED CORRECTED (if checked) VOIDCORRECTED Do Not Staple 6969 Fishing boat proceeds Medical and health care payments To be filed with L4PSBCPAYERS name, street address, city or town, state or province, country, ZIP 1aTotal ordinary dividendsOMB No. 1545-0110PAYERS name, street address, city or town, state or province, country, ZIP 1aTotal ordinary dividendsOMB No. 1545-0110PAYERS name, street address, city or town, state or province, country, ZIP 1aTotal ordinary dividendsOMB No. 1545-0110Form1096 Annual Summary and Transmittal of OMB No. 1545-0108 RECIPIENTS name, street address (including apt. no.), city or town, state or province, country, and ZIP or foreign postal code $ 7 totaling $5,000$ 8Substitutein lieu of recipients return,incomestate INKSDETACH BEFORE MAILINGINKSUSING HEATDETACH BEFORE MAILINGINKSUSING HEATDETACH BEFORE MAILING PRINTED IN USA DETACH BEFORE MAILINGUSING HEATMANUFACTUREDMANUFACTUREDMANUFACTUREDMANUFACTURED ON OCR LASER BOND PAPER USING HEAT RESISTANT INKS MW353 or foreign postal code, and telephone no.or foreign postal code, and telephone no.or foreign postal code, and telephone no.when tax required.$1b Form1099-DIVDividends and$1b Form1099-DIV Dividends and$1b Form1099-DIVDividends andU.S. Information Returns 2023 9 Payer made direct products or moresalesto 10 $ dividends or payments interest y RESISTANTRESISTANTRESISTANTDepartment of the Treasury (Rev. 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Photocopies are not acceptable.www.irs.gov/Form1099MISC $ Department of the Treasury - Internal Revenue Service $Send this form, with the copies of the form checked in box 6, to the IRS in a at mailer (not folded). 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January 2022) Distributions1b (Rev. January 2022) Instructions number), and TIN in the spaces provided on the form. The name, address,First-Class MailDistributions Future developments. For the latest information about developments For calendar year $For calendar year $2aTotal capital gain distr. For calendar year related to Form 1096, such as legislation enacted after it was published, go. upper left area of Form 1097, 1098, 1099, 3921, 3922, 5498, or W-2G. ImportantReturn$to www.irs.gov/Form1096 When to le. File Form 1096 as follows. Document Tax Enclosed$2aTotal capital gain distr. $2bUnrecap. Sec. 1250 gainCopy AFor$2aTotal capital gain distr. $2bUnrecap. Sec. 1250 gainCopy B$$2bUnrecap. Sec. 1250 gainreturns listed on this form in box 6 with the IRS is February 28, 2024.Copy CPAYERS TIN RECIPIENTS TIN $2cSection 1202 gain$2dCollectibles (28%) gainPAYERS TINRECIPIENTS TIN $2cSection 1202 gain$2dCollectibles (28%) gainFor RecipientRECIPIENTS TIN $2cSection 1202 gain$2dCollectibles (28%) gainReminder. The only acceptable method of electronically through the FIRE1A 851018920 S2020 APEX PSBMISCInternal RevenuePAYERS TINFor PayerSystem. See Pub. 1220. and/or State Service CenterPurpose of form. Use this form to transmit paper Forms 1097, 1098, Copy 1 or Copy 21099, 3921, 3922, 5498, and W-2G to the IRS. $2eSection 897 ordinary dividends $2fSection 897 capital gainFile with Form 1096. $2eSection 897 ordinary dividends $2fSection 897 capital gain$2eSection 897 ordinary dividends $2fSection 897 capital gainCaution: electronically but fail to do so, and you do not have an anyWhere To FileRECIPIENTS name$3Nondividend distributions$4Federal income tax withheld RECIPIENT\'S name, stret adres, city or town, state or province, country, and ZIP or foreign postal code $3Nondividend distributions$4Federal income tax withheld RECIPIENT\'S name, stret adres, city or town, state or province, country, and ZIP or foreign postal code $3Nondividend distributions$4Federal income tax withheldapproved waiver, you may be subject to a penalty. 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If those regulations are issued and effective for 2023 tax www.irs.gov/ Alabama, Arizona, Arkansas, Delaware, Reduction Act 7Foreign tax paid8Foreign country or U.S. possession Notice, see the7Foreign tax paid8Foreign country or U.S. possession return, a negligence7Foreign tax paid8Foreign country or U.S. possession Form1099 explaining the change. Until regulations are issued, however,Florida, Georgia, Kentucky, Maine,Internal Revenue ServiceNotice, see the current Generalpenalty or otherinformation, see Massachusetts, Mississippi, NewP.O. Box 149213 current GeneralHampshire, New Jersey, New Mexico, imposed on you ifInformation Returns. part F in the 2023 General Instructions for CertainVermont, VirginiaLMISCPSBCity or town, state or province, country, and ZIP or foreign postal code $9Cash liquidation distributions10 Noncash liquidation distributions Instructions for Certain$9Cash liquidation distributions10 Noncash liquidation distributionssanction may be$9Cash liquidation distributions10 Noncash liquidation distributionsInstructions for CertainNew York, North Carolina, Ohio, Texas,Austin, TX 78714-92138510018906Information this income is taxablereturns. Alaska, Colorado, Hawaii, Idaho, determines that it has$$InformationIllinois, Indiana, Iowa, Kansas,Internal Revenue Service Center and the IRS $$Returns.$$not been reported.12Exempt-interest dividends13bond interest dividends Who must le.Michigan, Minnesota, Missouri,P.O. Box 219256 Returns. 11requirement 12Exempt-interest dividends13bond interest dividends 11requirement 12Exempt-interest dividends13bond interest dividends 11requirement Caution:Montana, Nebraska, Nevada, North Kansas City, MO 64121-9256 FACE; PERFS AS MARKED; SCREENS 20% & 50%PRINTED IN USAthe name and TIN used on your 94X series tax return(s) or you may be $$$$$$subject to information return penalties. Do not use the name and/or TIN ofDakota, Oklahoma, Oregon, South Account number (see instructions)2nd TIN not.14State 15 16State tax withheld Account number (see instructions)14State 15 16State tax withheld Account number (see instructions)2nd TIN not.14State 15 16State tax withheld Utah, Washington, Wisconsin, WyomingN14EZyour paying agent or service bureau. Carolina, South Dakota, Tennessee,$$$ $$$For more information and the Privacy Act and Paperwork Reduction Act Notice,L1096 41-0852411 5100 Form1096(2023)see the 2023 General Instructions for Certain Information Returns.Form1099-DIV(Rev. 1-2022) LDA 41-0852411 5130 www.irs.gov/Form1099DIV Department of the Treasury - Internal Revenue ServiceForm1099-DIV(Rev. 1-2022)LDB (keep for your records)5131 www.irs.gov/Form1099DIV Department of the Treasury - Internal Revenue ServiceForm1099-DIV(Rev. 1-2022) LDC 5132 www.irs.gov/Form1099DIV Department of the Treasury - Internal Revenue ServiceAPEX 1099-R LASER PACKAGED SET O OG GAPEX LRA APEX LRB APEX LRCLR2 APEX LRD1 APEX L1096Do Not Staple 6969 O O 1A S2032B 07 APEX PB814MB9898 VOID CORRECTED CORRECTED (if checked) CORRECTED (if checked) VOID CORRECTED G G 861012PAYERS name, street address, city or town, state or province,1Gross distribution OMB No. 1545-0119PAYERS name, street address, city or town, state or province,1Gross distribution OMB No. 1545-0119PAYERS name, street address, city or town, state or province,1Gross distribution OMB No. 1545-0119 Distributions From1Gross distribution OMB No. 1545-0119 Form1096 Annual Summary and Transmittal of OMB No. 1545-0108 DETACH BEFORE MAILINGDETACH BEFORE MAILINGDETACH BEFORE MAILINGDETACH BEFORE MAILINGDETACH BEFORE MAILING 8510021331 / 18035116 2018 - 0221Distributions FromDistributions FromPAYERS name, street address, city or town, state or province,Distributions FromMANUFACTURED 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 INKSMANUFACTURED ON OCR LASER BOND PAPER USING HEAT RESISTANT INKS SEE REVERSE SIDE FOR OPENING INSTRUCTIONScountry, ZIP or foreign postal code, and telephone no. 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Pensions, Annuities,$ 2aTaxable amount Retirement or$ 2aTaxable amount Retirement or$ 2aTaxable amount Retirement or$ 2aTaxable amount Department of the TreasuryU.S. Information Returns 2023Retirement or 2023 Prot-Sharing Plans,2023 Prot-Sharing Plans,2023 Prot-Sharing Plans,2023 Internal Revenue ServiceProt-Sharing Plans, IRAs, Insurance IRAs, InsuranceIRAs, InsuranceIRAs, InsuranceContracts, etc.$ Form 1099-R Contracts, etc. $ Form 1099-R Contracts, etc. $ Form 1099-R Contracts, etc. $ Form 1099-R FILERS name2bTaxable amountTotalCopy A2bTaxable amountTotalCopyB2bTaxable amountTotalCopyB2bTaxable amountTotalCopy D PAYERS TIN RECIPIENTS TIN not determined 4 distribution PAYERS TINRECIPIENTS TIN not determined 4 distribution PAYERS TINReport thisRECIPIENTS TIN not determined 4 distribution PAYERS TINReport thisRECIPIENTS TIN not determined 4 distribution Street address (including room or suite number) First-Class Mail3Capital gain (included inFederal income tax Internal Revenue For3Capital gain (included inFederal income tax income on your3Capital gain (included inFederal income tax income on your3box 2a) Federal income tax For PayerImportantRECIPIENTS name $ box 2a) $ withheld Service Center$ box 2a) $ withheld RECIPIENTS name, stret ad federal tax$ 5 box 2a) $ withheld RECIPIENTS name, stret ad federal tax$ 5 Capital gain (included in$ withheld Tax a r d/or Telephone number For Ofcial Use Only 1A Document Tax Enclosed Return S2020 TFP 5229return. If thisreturn. If thisState,nCity,lFile with Form 1096. form showsform showsLocatDepoartmenCity or town, state or province, country, and ZIP or foreign postal code5Employee contributions/ 6appreciation in RECIPIENTS name, stret adres, city or town, state or province, country and ZIP or foreign postal code 5Employee contributions/ 6appreciation in federal incomeEmployee contributions/ 6appreciation in federal incomeEmployee contributions/ 6appreciation in Name of person to contactres, city or town, state or province, country and ZIP or foreign postal codeDesignated RothNet unrealized For Privacy ActDesignated RothNet unrealized res, city or town, state or province, country and ZIP or foreign postal code Designated RothNet unrealized tax withheld incontributions orNet unrealized For Privacy ActFax numberDesignated Roth contributions oremployers securities and Paperworkinsurance premiums employers securities tax withheld ininsurance premiums employers securities box 4, attachinsurance premiums employers securities and Paperwork insurance premiums SEP/ Reduction Actcontributions orSEP/ box 4, attach$ contributions orSEP/ this copy to$ code(s) SEP/ $ Email address Reduction Act2 Social security number 3 Total number of forms $ 4 Federal income tax withheld $ 5 Total amount reported with this Form 1096Street address (including apt. no.) $ 7DistributionIRA/ $ 8Other Notice, see the$ 7DistributionIRA/ $ 8Other this copy to7DistributionIRA/ $ 8Other your return.7DistributionIRA/ 8Other 1Notice, see the2023 Generalyour return. 2023 GeneralN11Zcode(s) SIMPLE $ % Instructions for Certaincode(s) SIMPLE $ % This information iscode(s) SIMPLE $ % This information isSIMPLE $ 6 % Instructions forCertainCity or town, state or province, country, and ZIP or foreign postal code9aYour percentage of total 9bTotal employee contributions Information9aYour percentage of total 9bTotal employee contributions 9aYour percentage of total 9bTotal employee contributions 9aYour percentage of total 9bTotal employee contributions 50 Information1098-C1098-E1098-F 1098-Q1098-T1099-A1099-B1099-C1099-CAP1099-DIV1099-G1099-INT1099-Kdistribution %$ Returns. distribution %$ being furnished to the IRS. distribution %$ being furnished to the IRS. distribution %$ W-2G 1097-BTCReturns. 78 84 03 74 83 80 79 85 73 91 86 92 1032 10988116State distribution 16State distribution 16State distribution OPENINGSEE REVERSE INSTRUCTIONSSIDE FOR10Amount allocable to IRR111st year of desig. 12 requirement$ 14State tax withheld 15State/Payers state no.10Amount allocable to IRR111st year of desig. 12 requirement$ 14State tax withheld 15State/Payers state no.10Amount allocable to IRR111st year of desig. 12 requirement$ 14State tax withheld 15State/Payers state no.10Amount allocable to IRR111st year of desig. 12 requirement$ 14State tax withheld 15State/Payers state no. $ 16State distribution1099-NEC 1099-OID1099-PATR 1099-Q1099-QA 1099-R1099-S1099-SA 1099-SB 39213922 54985498-ESA5498-QA 8510018050 / 18056347 - 0221 SEE REVERSE INSTRUCTIONSSIDE FOR OPENING within 5 years Roth contrib. within 5 years Roth contrib. within 5 years Roth contrib. within 5 years Roth contrib. 1099-LS 1099-LTC1099-MISC 71 96 97 31 1A 98 75 94 43 25 26 28 72 2A$ $ $$ $ $ $ $ $ $ $ $ $ $ 16 $ 93 95Account number (see instructions) 13Date of17Local tax withheld 18Name of localityAccount number (see instructions) 13Date of17Local tax withheld 18Name of localityAccount number (see instructions) 13Date of17Local tax withheld 18Name of localityAccount number (see instructions) 13Date of17Local tax withheld 18Name of locality 19Local distribution19Local distribution 19Local distribution 19Local distributionpayment$ $ payment$ $ payment$ $ payment$ $$ $ $ $ $ $ $ 5498-SA 27 $Form 1099-R 41-0852411 www.irs.gov/Form1099R Department of the Treasury - Internal Revenue Service www.irs.gov/Form1099R Department of the Treasury - Internal Revenue Service www.irs.gov/Form1099R Department of the Treasury - Internal Revenue Service www.irs.gov/Form1099R Department of the Treasury - Internal Revenue ServiceForm 1099-R Form 1099-R Form 1099-RDoNotCutorSeparateFormsonThisPage DoNotCutorSeparateFormsonThisPageReturn this entire page to the Internal Revenue Service. 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The Taxpayer First ActIf your principal business, ofce orUse the followingO Oemployers securities For Privacy Act contributions orDesignated Rothtax withheld incontributions ortax withheld inDesignated Rothof 2019, enacted July 1, 2019, authorized the Department of the Treasuryagency, or legal residence in the $ insurance premiums $ employers securities and Paperwork$ insurance premiums $ employers securities box 4, attach$ insurance premiums $ employers securities box 4, attach$ insurance premiums $ 2022 tax returns. If those regulations are issued and effective for 2023 tax www.irs.gov/ Alabama, Arizona, Arkansas, Delaware, and Paperwork Reduction Actthis copy tothis copy toReduction Act IRA/ 8Other Notice, see the7DistributionIRA/ 8Other your return.7DistributionIRA/ 8Other your return.7DistributionIRA/ 8Other Notice, see theFlorida, Georgia, Kentucky, Maine,Internal Revenue ServiceForm1099 explaining the change. 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Alaska, Colorado, Hawaii, Idaho, distribution %$ Returns. distribution %$ distribution %$ distribution %$ returns. Illinois, Indiana, Iowa, Kansas,Internal Revenue Service Center Who must le. 10Amount allocable to IRR111st year of desig. 12 requirement$ 14State tax withheld 15State/Payers state no.10Amount allocable to IRR111st year of desig. 12 requirement$ 14State tax withheld 15State/Payers state no.10Amount allocable to IRR111st year of desig. 12 requirement$ 14State tax withheld 15 10Amount allocable to IRR111st year of desig. 12 requirement$ 14State tax withheld 15State/Payers state no. $ 16State distribution Michigan, Minnesota, Missouri,P.O. Box 219256 16State distribution 16State distribution State/Payers state no.16State distribution Caution:Montana, Nebraska, Nevada, North Kansas City, MO 64121-9256within 5 years Roth contrib. within 5 years Roth contrib. within 5 years Roth contrib. within 5 years Roth contrib. the name and TIN used on your 94X series tax return(s) or you may beDakota, Oklahoma, Oregon, South $ $ $ subject to information return penalties. Do not use the name and/or TIN ofCarolina, South Dakota, Tennessee,$ $ $ $ $ $ $ $ $ $ $ $ Utah, Washington, Wisconsin, Wyoming Account number (see instructions) 13Date of17Local tax withheld 18Name of localityAccount number (see instructions) 13Date of17Local tax withheld 18Name of localityAccount number (see instructions) 13Date of17Local tax withheld 18Name of localityAccount number (see instructions) 13Date of17Local tax withheld 18Name of locality your paying agent or service bureau.19Local distribution 19Local distribution 19Local distribution 19Local distributionpayment$ $ payment$ $ payment$ $ payment$ $Form 1099-R LRA 41-0852411 5140 $ Form $ LRB 5141 www.irs.gov/Form1099R $ Form $ LRB 5141 www.irs.gov/Form1099R $ Form $ LRD1 5143 www.irs.gov/Form1099R $ For more information and the Privacy Act and Paperwork Reduction Act Notice,L1096 41-0852411 5100 Form1096(2023) ZFold ZFold$(3) Transmittal 1096 forms are included with each set SEE REVERSE INSTRUCTIONSSIDE FOR OPENINGSEE REVERSE INSTRUCTIONS SIDE FOR OPENING Important Tax Document Enclosed SEE REVERSE INSTRUCTIONS SIDE FOR1099-R 1099-R 1099-R Department of the Treasury - Internal Revenue Service OPENINGSEE REVERSE INSTRUCTIONSSIDE FOR OPENINGwww.irs.gov/Form1099R Department of the Treasury - Internal Revenue Service Department of the Treasury - Internal Revenue Service Department of the Treasury - Internal Revenue Service see the 2023 General Instructions for Certain Information Returns.First-Class MailAPEX 1099-DIV LASER PACKAGED SETAPEX 1099-R LASER PACKAGED SET STANDARD SETS (50 Sheets for 100 Recipients) STANDARD SETS w/ Envelopes (50 Sheets for 100 Recipients) APEX - Sheets per packTFP - Forms per pack959333-Part SET includes: (50 Sheets EACH) 1099-DIV Copy A, B, C 95944E4-Part SET includes: (50 Sheets EACH) 1099-R Copy A, B, C, D,500s500sFORM DESCRIPTION959344-Part SET includes: (50 Sheets EACH) 1099-DIV Copy A, B, C, C + DWMR (100) PS353511311" Printed 1099-MISC Copy B, 2Z-Fold Simplex1 Page Equals 1 Form*VALUE SETS w/ Self-Seal Envelopes (10 Sheets for 20 Recipients) 95946E6-Part set includes: (50 Sheets EACH) 1099-R Copy A, B, C, D, 1, 2,NECPS353NEC511311" Printed 1099-NEC 2-Up Horizontal Copy B, 2Z-Fold Simplex1 Page Equals 1 Form* 95910ES4-Part SET includes: (10 Sheets EACH) 1099-DIV Copy A, B, C, C,+ DWMR (100) N/A511911" Blank 1099 3-Up HorizontalZ-Fold1 Page Equals 1 Form+ DWMRS (20) PSBMISC550111" Blank 1099-MISC Copy B, 2 w/ BackerZ-Fold1 Page Equals 1 FormNECPSBMISCNEC550111" Blank 1099-NEC w/ Backer InstructionsZ-Fold 1 Page Equals 1 FormPSN11Z522911" Blank 1099 2-UpZ-Fold Simplex1 Page Equals 1 FormPSN14EZN/A14" Blank 1099 Multi-Purpose 2-Up w/ Screened BackEccentric Z-Fold1 Page Equals 1 FormPSB80650N/A14" Blank Universal1 Page Equals 1 FormPSB99ZN/A11" Blank 1099 3-Up w/ Screened Back1 Page Equals 1 Form50 51'