b'MISCELLANEOUS FORMS TO MAKE YOUR ORDER PROCESS1042-S, W-2G & I-9 EASIER & FASTER .1042-S LASER 1042-SAPEX L42A23TFP 532023Form1042-S Foreign Persons U.S. Source Income Subject to Withholding 2023 Form1042-S forForeign Persons U.S. Source Income Subject to WithholdingForeign Persons U.S. Source Income Subject to WithholdingForeign Persons U.S. Source Income Subject to Withholding 2023 OMB No. 1545-0096 Used to report all income and/or tax withh eld for non-resident aliens and foreignPlease provide your account # (prefixed with an A or T) on your purchase ordersDepartment of the TreasuryForm1042-S Foreign Persons U.S. Source Income Subject to Withholding 2023 Form1042-S AMENDED 2023 Form1042-S Go to2023 OMB No. 1545-0096 AMENDED AMENDMENT NO. Copy E OMB No. 1545-0096 OMB No. 1545-0096 OMB No. 1545-0096Department of the TreasuryGo to www.irs.gov/Form1042S for instructions and the latest information. AMENDMENT NO. Copy B Go to www.irs.gov/Form1042S for instructions and the latest information. AMENDMENT NO. Copy Dfor RecipientInternal Revenue Service Go to www.irs.gov/Form1042S for instructions and the latest information. AMENDMENT NO. Copy AGo to www.irs.gov/Form1042S for instructions and the latest information. AMENDMENT NO. Copy Cfor Recipient www.irs.gov/Form1042S for instructions and the latest information. for Withholding Agent1 Income 2Gross income3aTax rate . 4aUNIQUE FORM IDENTIFIER . AMENDED 13i.Recipients UNIQUE FORM IDENTIFIER13j AMENDED 13i. 4as UNIQUE FORM IDENTIFIER13jLOB code13i.Recipients UNIQUE FORM IDENTIFIER13j AMENDED 13i. 4as UNIQUE FORM IDENTIFIER .13jLOB codeGIIN13iRecipients 13f Ch. 4 status code13jLOB codecorporations with United States income. (However, resident aliens are treated the same Internal Revenue Service Department of the TreasuryDepartment of the TreasuryDepartment of the Treasury Internal Revenue Service for RecipientInternal Revenue Service Internal Revenue Service Internal Revenue Servicecode 3 Chapter indicator.Enter 3 or 41 Income code 2Gross income 3 Chapter indicator.Enter 3 or 413f1 Ch. 3 status codeIncome code 2Gross income 3 Chapter indicator.Enter 3 or 413f1 Ch. 3 status codeIncome code 2Gross income 3 Chapter indicator.Enter 3 or 413f1 Ch. 3 status codeIncome code 2Gross income 3Exemption code 13f Ch. 4 status code13eRecipients U.S. TIN, if any 13g Ch. 3 status code13eRecipients U.S. TIN, if any 13eRecipients U.S. TIN, if any 13eRecipients U.S. TIN, if any 13eRecipients U.S. TIN, if any13g Ch. 3 status code3a Chapter indicator.Enter 3 or 44b Tax rate 3bs Tax rate 4b Exemption code Recipients3b Tax rate 13g Ch. 4 status code.Tax rate 4b Exemption code LOB codeGIIN4b Tax rate5Withholding allowance 5Withholding allowanceGIIN13g Ch. 4 status code. LOB codeGIINnumber, if any 5Withholding allowanceGIIN13g Ch. 4 status code. number, if any3b Exemption code Exemption code 13hRecipient 3a Exemption code 4a Tax rate 13h 3a Exemption code Recipient Exemption code 13hRecipients3b3a Exemption code 4a Tax rate 13hRecipients3b Tax rate Recipient Exemption code 13hRecipients number, if any6Net income 6Net income number, if any . . 5Withholding allowance . . 4b Tax rate . . . . number, if any . . 5Withholding allowance . . . . . . . . 13kRecipients account number as U.S. citizens; thus a regular W-2 Formmay be used for reporting. If in doubt whether 7aFederal tax withheld . . . . . . . . . . . . . . 7aFederal tax withheld13kRecipients account number . . . . . . . . . . . . . . . 6Net income . . 13lRecipients date of birth (YYYYMMDD). . . . . . . . . . . 6Net income . . 13lRecipients date of birth (YYYYMMDD). . . . . . . . . . . . 6Net income . . . 13lRecipients date of birth (YYYYMMDD). . . . . . . . . . . . . . 13lRecipients date of birth (YYYYMMDD) employee qualifies as a resident or non-resident, check with local IRS offices.) Example: A123456 or T1234 7aFederal tax withheld13kRecipients account number 7aFederal tax withheld13kRecipients account number 7aFederal tax withheld13kRecipients account number escrow procedures were applied (see instructions)7b .Check if federal tax withheld was not deposited with the IRS because 7b .Check if federal tax withheld was not deposited with the IRS because escrow procedures were applied (see instructions) escrow procedures were applied (see instructions) escrow procedures were applied (see instructions)7b escrow procedures were applied (see instructions) 7bCheck if federal tax withheld was not deposited with the IRS because 13lRecipients date of birth (YYYYMMDD). 7b .Check if federal tax withheld was not deposited with the IRS becauseCheck if federal tax withheld was not deposited with the IRS because7cCheck if withholding occurred in subsequent year with respect to a7cCheck if withholding occurred in subsequent year with respect to a7c .Check if withholding occurred in subsequent year with respect to a Check if withholding occurred in subsequent year with respect to a partnership interest partnership interest partnership interest7c . partnership interest7cCheck if withholding occurred in subsequent year with respect to as.Name (if applicable)8Tax withheld by other agents 14aPrimary Withholding Agents.Name (if applicable)8Tax withheld by other agents 14aPrimary Withholding Agents Name (if applicable)partnership interests.Name (if applicable) 14aPrimary Withholding Agents Name (if applicable)8Tax withheld by other agents8Tax withheld by other agents 14aPrimary Withholding Agent 9 Ch. 3 status code 14bPrimary Withholding Agents EIN 9 Ch. 3 status code 14bPrimary Withholding Agents EIN 8Tax withheld by other agents 14aPrimary Withholding Agent 15Check if pro-rata basis reporting15Check if pro-rata basis reportingOnly available in Laser format. 9Overwithheld tax repaid to recipient pursuant to adjustment procedures (see instructions) 99Overwithheld tax repaid to recipient pursuant to adjustment procedures (see instructions) Overwithheld tax repaid to recipient pursuant to adjustment procedures (see instructions)Overwithheld tax repaid to recipient pursuant to adjustment procedures (see instructions)Overwithheld tax repaid to recipient pursuant to adjustment procedures (see instructions)()() 15Check if pro-rata basis reporting15Check if pro-rata basis reporting14bPrimary Withholding Agents EIN10Total withholding credit (combine boxes 7a, 8, and 9) 14bPrimary Withholding Agents EIN 15Check if pro-rata basis reporting() 14bPrimary Withholding Agents EIN10Total withholding credit (combine boxes 7a, 8, and 9) () ()10Total withholding credit (combine boxes 7a, 8, and 9) 10Total withholding credit (combine boxes 7a, 8, and 9) 10Total withholding credit (combine boxes 7a, 8, and 9)15a15b15aCh. 4 status code 15b15aCh. 4 status code 15b Ch. 3 status code15aCh. 4 status code 15b Ch. 3 status code15aCh. 4 status code 15b Ch. 3 status code15c Ch. 4 status code15c 15c 15c 15c11Tax paid by withholding agent (amounts not withheld) (see instructions)11Tax paid by withholding agent (amounts not withheld) (see instructions)15ds EIN 12bCh. 3 status code 11Tax paid by withholding agent (amounts not withheld) (see instructions)11Tax paid by withholding agent (amounts not withheld) (see instructions)11Tax paid by withholding agent (amounts not withheld) (see instructions) 15d Required Envelope: APEX: SW42TFP: 2121115dCh. 4 status codeCh. 4 status code 12c 12aWithholding agent15d12c 12aWithholding agent15d 12aWithholding agents EIN 12bCh. 3 status code12c 12aWithholding agent15e12c 12aWithholding agent15es EIN 12bCh. 3 status codeCh. 4 status code 15e s EIN 12bCh. 3 status codeCh. 4 status code 15e s EIN 12bCh. 3 status code12cCh. 4 status code 15e12dWithholding agents name 12dWithholding agent15fCountry codes name12g 15g 12dWithholding agent15fCountry codes name12g 15g 12dWithholding agent15fCountry codes name12g 15g 12dWithholding agent15fCountry codes name12g 15g 15fCountry code 15g Order by year:2023 = 23 2024 = 24 If you are unsure of your account #, please call or email:12eWithholding agent 12eWithholding agent15hAddress (number and street) 12eWithholding agent15hAddress (number and street) 12eWithholding agent15hAddress (number and street) 12eWithholding agent15hAddress (number and street) 15hAddress (number and street)12fCountry code 12g 12fCountry code15iCity or town, state or province, country, ZIP or foreign postal code 12fCountry code15iCity or town, state or province, country, ZIP or foreign postal code 15iCity or town, state or province, country, ZIP or foreign postal code12fCountry code15iCity or town, state or province, country, ZIP or foreign postal code 12fCountry code15iCity or town, state or province, country, ZIP or foreign postal code12hAddress (number and street) 12hAddress (number and street)16aPayers name12hAddress (number and street) 12hAddress (number and street) 12hAddress (number and street) 16d16bPayer16as TINPayer 16cPayer s name16d16bPayers TIN To IRS/SSA and to Recipient Paper Filing due date: March 1516bPayer16as TINPayer s name16bPayer16as TINPayer s name16bPayer16as TINPayer s name 12iCity or town, state or province, country, ZIP or foreign postal code12iCity or town, state or province, country, ZIP or foreign postal code16cPayers GIIN 16d 12iCity or town, state or province, country, ZIP or foreign postal code 16e Ch. 4 status code 16d 12iCity or town, state or province, country, ZIP or foreign postal code 16e Ch. 4 status code Ch. 3 status code16e Ch. 4 status code 800-482-9367info@complyright.com16cPayers GIIN Ch. 3 status code16cPayers GIIN Ch. 3 status code16cPayers GIINCh. 3 status code16e Ch. 4 status code 16d 12iCity or town, state or province, country, ZIP or foreign postal code 16e Ch. 4 status code Ch. 3 status code s GIIN13aRecipients name 13bRecipients country code13a,c,dRecipients name, address, city, state and ZIP codeRecipients country code17c17aName of state 17b13bPayers state tax no.17c17aName of state 17b13bPayers state tax no.17c17aName of state 17b13bPayers state tax no.17c17aName of state 17bPayers state tax no.17cName of state17aState income tax withheld 17b13bPayers state tax no. State income tax withheldRecipients country codeRecipients name, address, city, state and ZIP codeRecipients country codeRecipients name, address, city, state and ZIP codeRecipients country code State income tax withheld13a,c,dRecipients name, address, city, state and ZIP code 13a,c,d State income tax withheld 13a,c,d State income tax withheld13cAddres (number and street)13dCity or town, state or province, country, ZIP or foreign postal code L42A 5320 Form1042-S(2023) 5321 Form1042-S(2023) For Privacy Act and Paperwork Reduction Act Notice, see instructions. 1042-S(2023) 5324 Form1042-S(2023) 1042-S FOREIGN PERSONS U.S. SOURCE INCOME SUBJECT TOWITHHOLDINGFor Privacy Act and Paperwork Reduction Act Notice, see instructions.(keep for your records) L42B L42C 5322 Form1042-S(2023) 5323 FormL42EL42DAPEXTFP LASER FORMS 202420232024 Below is a listing of departments where each item is applicable2023L42A23L42A24532023532024Laser 1042-S Copy A L42B23L42B24532123532124Laser 1042-S Copy B L42C23L42C24532223532224Laser 1042-S Copy C L42D23L42D24532323532324Laser 1042-S Copy D CUSTOMER ACCOUNTSW-2G LASER W-2G CONTINUOUSDATELESSL42E23L42E24532423532424Laser 1042-S Copy E ORDERSAPEX LW2GATFP 5230 TFP 71936 SERVICE RECEIVABLEW-2G3232 VOIDCORRECTED OMB No. 1545-0238 3232 VOIDCORRECTED 2Date won OMB No. 1545-0238 __PAYERS name, street address, city or town, province or state, country, 1Reportable winnings 2Date won PAYERS name, street address, city or town, province or state, country, 1Reportable winnings DETACH BEFORE MAILING MANUFACTURED ON OCR LASER BOND PAPER USING HEAT RESISTANT INKS7183-6/ W-2G 6PT M FOR and ZIP or foreign postal code $ 3Type of wager $ 4Federal income tax withheld Form W-2G and ZIP or foreign postal code $ 3Type of wager $ 4Federal income tax withheld Form W-2G Form W-2G is used to report gambling winnings and any Federal income tax withheldInstantaneous/Most Efficient: Website:complyrightdealer.com Email: credit@complyright.comCertainCertain GamblingGambling 5Transaction 7 6Race Winnings 5Transaction 7 6Race Winnings on those winnings. The requirements for reporting and withholding depend on the (Rev. January 2021) (Rev. January 2021)PAYERS telephone number $ 9Winnings from identical wagers8Cashier For calendar year PAYERS telephone number $ 9Winnings from identical wagers8Cashier For calendar year Website:complyrightdealer.com20 2010Window For Privacy Act10Window For Privacy Acttype of gambling, the amount of the gambling winnings, and generally the ratio of WINNERS name 11 12 and PaperworkWINNERS name 11 12 and PaperworkEmail: info@complyright.com Call:800-482-9367Reduction ActReduction Actthe winnings to the wager. The types of gambling are grouped as follows: 1. Horse Notice, see theNotice, see the current Generalcurrent General Instructions forInstructions for Street address (including apt. no.) 13$ 14State winnings Certain Information Returns. Street address (including apt. no.) 13$ 14State winnings Certain Information Returns. Racing, Dog Racing, Jai Alai, and Other Wagering Transactions, 2. Sweepstakes,(Request to speak with customer service.)City or town, province or state, country, and ZIP or foreign postal code 15State income tax withheld16Local winnings File with Form 1096 City or town, province or state, country, and ZIP or foreign postal code 15State income tax withheld16Local winnings File with Form 1096 Email: orders@complyright.com (For Inquiries only - Do not send Purchase $ 17Local income tax withheld $ 18Name of locality Copy A$ 17Local income tax withheld $ 18Name of locality Copy AWagering Pools, and Lotteries, 3. Bingo, Keno, and Slot Machines.Due to recent IRS For Internal RevenueFor Internal RevenueOrders to this email)$ Service Center $ Service Center (For orders only)Under penalties of perjury, I declare that, to the best of my knowledge and belief, the name, address, and taxpayertled to any part of these payments. Icorrectly identify me as the recipient of this payment and any payments from identical wagers, and that no other person is enti Itled to any part of these payments. Ichanges we only offer Dateless forms, available in both laser and continuous formats. correctly identify me as the recipient of this payment and any payments from identical wagers, and that no other person is enti number that have furnishedUnder penalties of perjury, declare that, to the best of my knowledge and belief, the name, address, and taxpayernumber that have furnishedRemember, the following servicesSignature 41-0852411 www.irs.gov/FormW2G Date Signature 41-0852411 www.irs.gov/FormW2G Date Required Envelope: DWW2GFormW-2G(Rev. 1-2021) Department of the Treasury - Internal Revenue Service FormW-2G(Rev. 1-2021) Department of the Treasury - Internal Revenue ServiceDo Not Cut or Separate Forms on This PageDo Not Cut or Separate Forms on This Page Do Not Cut or Separate Forms on This PageDo Not Cut or Separate Forms on This Page Call: 800-482-93673232 VOIDCORRECTED OMB No. 1545-0238 3232 VOIDCORRECTED 2Date won OMB No. 1545-0238 Fax: 800-526-1040 are available:PAYERS name, street address, city or town, province or state, country, $ 1Reportable winnings 2Date won Form W-2G PAYERS name, street address, city or town, province or state, country, $ 1Reportable winnings Form W-2G W-2G CERTAIN GAMBLING WINNINGSand ZIP or foreign postal code and ZIP or foreign postal codePAYERS telephone number $ 7 5Transaction $ 6Race 20 CertainPAYERS telephone number $ 3Type of wager 7 $ 4Federal income tax withheld 20 CertainAPEXTFPn 3Type of wager 4Federal income tax withheld Gambling5Transaction 6Race Gamblingn Questions regarding our product,Winnings from identical wagers8Cashier WinningsWinnings from identical wagers8Cashier Winnings Print invoices on our website.(Rev. January 2021) (Rev. January 2021)For calendar year For calendar yearWINNERS name 910Window For Privacy ActWINNERS name 910Window For Privacy Act LASER FORMS orders, pricing or inventoryIf you need first time setup infoStreet address (including apt. no.) 11 12 and PaperworkStreet address (including apt. no.) 11 12 and PaperworkWEBSITE ORDERS:Reduction ActReduction Act 13 $ 14State winnings Notice, see the13 $ 14State winnings Notice, see the5230can be obtained through ouryou can contact customer service.current Generalcurrent General Instructions forInstructions forLW2GALaser W2-G Copy ACertain Information Returns. Certain Information Returns. 7183-6/ W-2G 6PT M FOR City or town, province or state, country, and ZIP or foreign postal code $ 15State income tax withheld $ 16Local winnings File with Form 1096 City or town, province or state, country, and ZIP or foreign postal code $ 15State income tax withheld $ 16Local winnings File with Form 1096 LW2GB5231Laser W2-G Copy B New updated site customer service department. Under penalties of perjury, I declare that, to the best of my knowledge$ 17Local income tax withheld and18Name of locality number that I haveCopy AUnder penalties of perjury, I declare that, to the best of my knowledge$ 17Local income tax withheld and18Name of locality number that I haveCopy ALW2GC5232Laser W2-G Copy 2 and/or C n and belief, the name, address,taxpayerFor Internal Revenuecorrectly identify me as the recipient of this payment and any payments from identical wagers, and that no other person is enti For Internal Revenuecomplyrightdealer.comOur reps are standing by to You can request copies of your Service Center Service Centerfurnishedand belief, the name, address,taxpayerfurnished correctly identify me as the recipient of this payment and any payments from identical wagers, and that no other person is entitled to any part of these payments. tled to any part of these payments.Signature 5230 LW2GA 41-0852411 www.irs.gov/FormW2G Date Signature 41-0852411 www.irs.gov/FormW2G Date LW2GD5233Laser W2-G Copy D requires your email to be setassist you! invoices or credit memos from our FormW-2G(Rev. 1-2021) Department of the Treasury - Internal Revenue Service FormW-2G(Rev. 1-2021) Department of the Treasury - Internal Revenue Serviceup. If this is your first timecustomer service department.I-9 CONTINUOUS FORMS logging in, please contact 71936W2-G 6-Part 1-Widen Questions on payments, resale N/ACustomer Service atAPEX I-9TFP 10251 Continuous Dateless certificates or accounting Employment Eligibility VerificationUSCIS info@complyright.comDepartment of Homeland Security Form I-9can be answered by ourU.S. Citizenship and Immigration Servicesy OMB No. 1615-0047for access.Expires 10/31/2022uSriTnAgR cTo HmEpRleEti:o Rne oafd t hiniss tfrourcmti.o Enms pcaloryeefursl a rbee lfioarbel ec foomr pelrertoirnsginth iths ef ocromm. Tplheeti oinns otrfu tchtiiso nfosr mm.u st be available, either in paper or electronicaly,customer service department.d It is illegal to discriminate against work-authorized individuals. Employers CANNOT specify which document(s) an l because theMISCELLANEOUS FORMSANTI-DISCRIMINATION NOTICE: employee may present to establish employment authorization and identity. The refusal to hire or continue to employ an individuadocumentation presented has a future expiration date may also constitute illegal discrimination. Section 1. Employee Information and Attestation (Employees must complete and sign Section 1 of Form I-9 no laterOrders will be in our system than the first day of employment, but not before accepting a job offer.)Last Name (Family Name) First Name (Given Name) City or Town Middle Initial Other Last Names Used (if any) APEXTFP nAddress (Street Number and Name) Apt. Number State ZIP Code Credit ratingPlease emailDate of Birth (mm/dd/yyyy)U.S. Social Security NumberEmployee\'s E-mail Address Employee\'s Telephone Number within minutes, and you getI am aware that federal law provides for imprisonment and/or fines for false statements or use of false documents in- - DESCRIPTION your request to:connection with the completion of this form. a confirmation email forI attest, under penalty of perjury, that I am (check one of the following boxes): I-910251I-91 Page Equals 1 Form (20 SHEETS PER FORM/50 PER PACK)1. A citizen of the United States credit@complyright.com2. A noncitizen national of the United States (See instructions) your records.3. A lawful permanent resident (Alien Registration Number/USCIS Number):4. An alien authorized to workuntil (expiration date, if applicable, mm/dd/yyyy):Some aliens may write "N/A" in the expiration date field.(See instructions)Aliens authorized to work must provide only one of the following document numbers to complete Form I-9: QR Code - Section 1 An Alien Registration Number/USCIS Number OR Form I-94 Admission Number OR Foreign Passport Number. Do Not Write In This Space1. Alien Registration Number/USCIS Number: I-9 EMPLOYMENT ELIGIBILITY VERIFICATIONOR2. Form I-94 Admission Number:OR The Department of Homeland Security: Requires employers to use this form to document that 3. Foreign Passport Number:Country of Issuance:Signature of Employee Today\'s Date (mm/dd/yyyy) each new employee (both citizens and noncitizens) hired after November 6, 1986, is authorized Preparer and/or Translator Certification (check one): to work in the United States. This form must be completed no later than the time of hire, which I did not use a preparer or translator.A preparer(s) and/or translator(s) assisted the employee in completing Section 1. is the actual beginning of employment. Both employer and employee are required to fill inNEED A QUICK ANSWER?(Fields below must be completed and signed when preparers and/or translators assist an employee in completing Section 1.)I attest, under penalty of perjury, that I have assisted in the completion of Section 1 of this form and that to the best of my knowledge the information is true and correct.Signature of Preparer or Translator Today\'s Date (mm/dd/yyyy)Last Name (Family Name) First Name (Given Name) State ZIP Code information to complete an I-9 form.Address (Street Number and Name) City or Town You can use our website to check status on your orders!F Form I-910/21/2019 Employer Completes Next Page Page 1 of 3 If you need first-time setup info, you can contact customer service.orm I-9 10/21/201960 61'