b"PRE-PRINTED 1099 FORMS PRE-PRINTED 1099 FORMSContinuous 1099 Forms Continuous 1099 Forms1099-R9898 VOID CORRECTED OMB No. 1545-0119 Distributions FromCOPY A9191 VOIDCORRECTED OMB No. 1545-01101099-DIV7171 VOID CORRECTED OMB No. 1545-0116 1099-NECPAYERS name, street address, city or town, state or province,1Gross distribution Pensions, Annuities, DETACH BEFORE MAILING7152-4 / TC-D4 4PT MFOR MANUFACTURED ON OCR LASER BOND PAPER USING HEAT RESISTANT INKSPAYERS name, street address, city or town, state or province, country, ZIP$1aTotal ordinary dividendsForm1099-DIVDividends andCOPY A PAYERS name, street address, city or town, state or province, country, ZIPForm1099-NEC NonemployeeCOPY A country, ZIP or foreign postal code, and telephone no. $ Retirement or or foreign postal code, and telephone no.1b (Rev. January 2022) Distributionsor foreign postal code, and telephone no. (Rev. 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Service Center City or town, state or province, country, and ZIP or foreign postal code $7Foreign tax paid8Foreign country or U.S. possession Notice, see theAccount number (see instructions) 2nd TIN not.$ 5 State tax withheld 6 State/Payers state no. $ CORRECTED (if checked) OMB No. 1545-0116 NonemployeeCOPY B $ $ File with Form 1096. DETACH BEFORE MAILING MANUFACTURED ON OCR LASER BOND PAPER USING HEAT RESISTANT INKS7 State incomecurrent GeneralPAYERS name, street address, city or town, state or province, country, ZIP Instructions foror foreign postal code, and telephone no. Form1099-NEC$9Cash liquidation distributions $10 Noncash liquidation distributions CertainForm1099-NEC(Rev. 1-2022) 41-0852411 $ $ (Rev. 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January 2022) Compensation Account number (see instructions) payment17 19Local distribution$$www.irs.gov/Form1099NEC Department of the Treasury - Internal Revenue Service$3Nondividend distributions 4Federal income tax withheldFor Privacy ActDo Not Cut or Separate Forms on This PageDo Not Cut or Separate Forms on This Page For calendar year $ $Street address (including apt. no.)$7Foreign tax paid$8Foreign country or U.S. possession and Paperwork7171 VOID CORRECTED PAYERS TIN RECIPIENTS TIN $ 1 Nonemployee compensation Copy B Form 1099-R 41-0852411 www.irs.gov/Form1099R Department of the Treasury - Internal Revenue Service5Section 199A dividends 6Investment expensesReduction Act$ $7152-4 / TC-D4 4PT MFOR $Notice, see theFor Recipientcurrent GeneralPAYERS name, street address, city or town, state or province, country, ZIPRECIPIENT'S name, street addres OMB No. 1545-0116 2 Payer made direct sales totaling $5,000 or more ofThis is important tax City or town, state or province, country, and ZIP or foreign postal code $9Cash liquidation distributions10 Noncash liquidation distributions Instructions for Certainor foreign postal code, and telephone no. , city or town, state or province, country, and ZIP or foreign postal code 3 consumer products to recipient for resale information and is being1096 DoNotCutorSeparateFormsonThisPage DoNotCutorSeparateFormsonThisPageForm1099-NEC Nonemployeefurnished to the IRS. If you are InformationDo Not Staple 6969 negligence penalty or other $$Returns.(Rev. 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January 2022) Information Street address (including apt. no.) Paperwork Reduction Actcountry, ZIP or foreign postal code, and telephone no. Pensions, Annuities,For calendar yearStreet address (including room or suite number)$ 3 Other income 20 Copy A City or town, state or province, country, and ZIP or foreign postal code $ 4 Federal income tax withheld General Instructions forcurrentRetirement or Notice, see the PAYERS TIN RECIPIENTS TIN $ 5 Fishing boat proceeds $ 4 Federal income tax withheld ForAccount number (see instructions) 2nd TIN not.$ 5 State tax withheld 6 State/Payers state no. $ Certain InformationReturns. Form1099-NEC Nonemployee$ 2023 Prot-Sharing Plans, CORRECTED (if checked)PAYERS name, street address, city or town, state or province, country, ZIP City or town, state or province, country, and ZIP or foreign postal codeOMB No. 1545-01166 Medical and health careInternal Revenueor foreign postal code, and telephone no. 7 State income 2aTaxable amountpayments Service Center $ Name of person to contact Telephone number For Ofcial Use Only IRAs, Insurance $RECIPIENTS name $ 7 Payer made direct sales$ 8 of dividends or interest File with Form 1096. Form1099-NEC(Rev. 1-2022)NECLMA41-0852411NEC5110 www.irs.gov/Form1099NEC Department of the Treasury - Internal Revenue Service (Rev. January 2022) Compensation Form 1099-R Contracts, etc.Substitute payments in lieuFor Privacy ActEmail address Fax numberFor calendar year $Street address (including apt. no.) totaling $5,000 or more of$ attorney and Paperwork1099-MISCPAYERS TIN 1 RECIPIENTS TIN 2 Social security number $ 4 Federal income tax withheld5 Total amount reported with this Form 1096 2bTaxable amountTotalCopy A consumer products to1 Nonemployee compensation3 Total number of forms Copy Brecipient for resale Reduction Act City or town, state or province, country, and ZIP or foreign postal code $ 9 Crop insurance proceeds 10 Gross proceeds paid to anNotice, see theOMB No. 1545-0115 MiscellaneousRECIPIENT'S name, street addres, city or town, state or province, country, and ZIP or foreign postal code $ 2 Payer made direct sales totaling $5,000 or more of79 85 For Recipient$ 1099-DIV1099-G1099-INT1099-K PAYERS TIN RECIPIENTS TIN not determined 4 distribution For or foreign postal code, and telephone no. current GeneralForm1099-MISC COPY B 6W-2G 1097-BTC10981098-C 3 consumer products to recipient for resale 1099-B This is important tax91 86 92 10 3Capital gain (included inFederal income tax Internal Revenue CORRECTED (if checked)PAYERS name, street address, city or town, state or province, country, ZIP1 Rents information and is being 11 Fish purchased for resale $ Instructions forCertain (Rev. January 2022) Information 32 50 81 78 1098-E1098-F 1098-Q1098-T1099-A 1099-C1099-CAPwithheld12 Section 409A deferrals 84 03 74 83 80 furnished to the IRS. If you are Information$ 2 Royalties negligence penalty or otherbox 2a)73M FORM FOR$ $ Returns. For calendar year4 Federal income tax withheld sanction may be imposed onService Center 13 requirement 14 Excess golden parachute15compensation $ 20 1099-LS 1099-LTC1099-MISC 1099-NEC 1099-OID1099-PATR 1099-Q1099-QA 1099-R1099-S you if this income is taxable3922 54985498-ESA5498-QA Account number (see instructions) 2nd TIN not. payments 17 State/Payers state no.RECIPIENTS TIN 18 State income 3 Other income 4 Federal income tax withheld Copy B Account number (see instructions) 16 93 95 71 $ 5 State tax withheld 31 6 State/Payers state no. 75 1099-SA 1099-SB 3921 26 28 72 2A $ $ File with Form 1096.and the IRS determines that it 96 97 1A 98 94 has not been reported.$ PAYERS TIN $ $ $ 5 Fishing boat proceeds $ 6 Medical and health careFor Recipient 5498-SA$ $ 7 State income 25 RECIPIENTS name 5Employee contributions/6Net unrealized 4316 State tax withheld$ payments $ $Form1099-MISC(Rev. 1-2022)41-0852411 $ RECIPIENT'S name, stret adres $ $ e totaling $5,000 or more of$ 8 Substitute payments in lieuThis is important taxForm1099-NEC(Rev. 1-2022)NECLMB(keep for your records)NEC5111www.irs.gov/Form1099NEC Department of the Treasury - Internal Revenue Service Designated Rothappreciation inFor Privacy Act www.irs.gov/Form1099MISC Department of the Treasury - Internal Revenue Service 27Do Not Cut or Separate Forms on This PageDo Not Cut or Separate Forms on This Pag 7 Payer made direct salesof dividends or interest contributions oremployers securities and Paperwork , city or town, state or province, country, and ZIP or foreign postal code consumer products to$ information and isReturn this entire page to the Internal Revenue Service. Photocopies are not acceptable.$ insurance premiums $ Reduction Act 9595 VOID CORRECTED OMB No. 1545-0115 $ recipient for resale 10 Gross proceeds paid to anbeing furnished toSend this form, with the copies of the form checked in box 6, to the IRS in a at mailer (not folded). Street address (including apt. no.) 7DistributionIRA/ 8Other Notice, see the 9 Crop insurance proceeds attorney 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.PAYERS name, street address, city or town, state or province, country, ZIP1 Rents Form1099-MISC Miscellaneous$ return, a negligenceSignature Title Date code(s) SEP/2023 General or foreign postal code, and telephone no. $ 2 Royalties (Rev. January 2022) 11 Fish purchased for resale 12 Section 409A deferrals penalty or otherSIMPLE Instructions for sanction may be imposed on you if For calendar yearInformation $ this income isInstructions number), and TIN in the spaces provided on the form. The name, address,$ % Certain $ taxable and the IRS $ 3 Other income 420 13 requirement 14 Excess golden parachute15 compensation has not beenFuture developments. For the latest information about developmentsupper left area of Form 1097, 1098, 1099, 3921, 3922, 5498, or W-2G. City or town, state or province, country, and ZIP or foreign postal code 9aYour percentage of total9bTotal employee contributions Information determines that it PAYERS TIN RECIPIENTS TIN $ 5 Fishing boat proceeds $ Federal income tax withheld payments $ reported. related to Form 1096, such as legislation enacted after it was published, goWhen to le. File Form 1096 as follows. distribution % $ Returns.Copy A$ For17 State/Payers state no. 18 State income to www.irs.gov/Form1096.16 State tax withheldAccount number (see instructions)6 Medical and health care payments Internal Revenue$ Reminder. The only acceptable method of electronically through the FIRE February 28, 2024. 10Amount allocable to IRR111st year of desig. 12 14State tax withheld 15State/Payers state no. 16State distribution$ returns listed on this form in box 6 with the IRS isService Center$ $ System. See Pub. 1220. RECIPIENTS name $ Form1099-MISC(Rev. 1-2022) (keep for your records)File with Form 1096. Department of the Treasury - Internal Revenue Service Purpose of form. Use this form to transmit paper Forms 1097, 1098, anyWhere To File within 5 years Roth contrib. requirement $ $Payer made direct sales$ of dividends or interest www.irs.gov/Form1099MISC 1099, 3921, 3922, 5498, and W-2G to the IRS. 7 totaling $5,000 or more of8 Substitute payments in lieuFor Privacy ActCaution: consumer products to$ and Paperwork electronically but fail to do so, and you do not have an$ $ $ 7154-3 3 PT/ TCM3Street address (including apt. no.) recipient for resale 10 Gross proceeds paid to anReduction Act approved waiver, you may be subject to a penalty. The Taxpayer First ActIf your principal business, ofce orUse the followingAccount number (see instructions) 13Date of17Local tax withheld 18Name of locality 19Local distributionCity or town, state or province, country, and ZIP or foreign postal code 9 Crop insurance proceeds attorney Notice, see the of 2019, enacted July 1, 2019, authorized the Department of the Treasuryagency, or legal residence in theaddress payment$ $current Generaland the IRS to issue regulations that reduce the 250-return requirement forcase of an individual, is located in$ $ Instructions forCertain 2022 tax returns. If those regulations are issued and effective for 2023 tax www.irs.gov/ Alabama, Arizona, Arkansas, Delaware, 11 Fish purchased for resale 12 Section 409A deferrals InformationForm1099 explaining the change. Until regulations are issued, however,Florida, Georgia, Kentucky, Maine,Internal Revenue Service13 requirement $ payments $ compensation Returns. information, see part F in the 2023 General Instructions for CertainMassachusetts, Mississippi, NewP.O. Box 149213Form LRA 41-0852411 5140 $ $14 Excess golden parachute15Information Returns. Hampshire, New Jersey, New Mexico,Austin, TX 78714-9213 1099-R www.irs.gov/Form1099R Department of the Treasury - Internal Revenue ServiceNew York, North Carolina, Ohio, Texas, Vermont, Virginia$ $ returns. Alaska, Colorado, Hawaii, Idaho, Account number (see instructions) 2nd TIN not.16 State tax withheld 17 State/Payers state no. 18 State income Who must le.Illinois, Indiana, Iowa, Kansas,Internal Revenue Service Center $ $ Michigan, Minnesota, Missouri,P.O. Box 219256 $ $ Caution:Montana, Nebraska, Nevada, North Kansas City, MO 64121-9256Form1099-MISC(Rev. 1-2022)41-0852411 www.irs.gov/Form1099MISC Department of the Treasury - Internal Revenue Service 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,your paying agent or service bureau. Utah, Washington, Wisconsin, Wyoming 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.5 Transmittal 1096 forms are included with each Red Federal Copy A form order MFG SKUMFG IDFORM DESCRIPTIONMFG SKUMFG ID TC-R4715944-Part 1099-R 1 WD Carbonless Dated Copy A, B, C, DFORM DESCRIPTION TC-S4716044-Part 1099-S 1 WD Carbonless Copy A, State, B, C1096109622-Part 1096 Carbonless Annual Summary & Transmittal Of U.S. Information Returns TC18-3716833-Part 1098 1 WD Carbonless Copy A, B, CTC-D4715244-Part 1099-DIV 1 Wd Carbonless Copy A, B, C *TC-I4715044-Part 1099-INT 1 Wd Carbonless Copy A, B, CTC-M3715433-Part 1099-MISC 1 Wd Carbonless Copy A, B, C * BASIC 1099 INFORMATION FOR CONTINUOUS FORMS 1099-MISC: ELECTRONIC FILINGNECTC-M3NEC715433-Part 1099-NEC 1 Wd Carbonless Copy A, B, C *TC-M4715444-Part 1099-MISC 1 Wd Carbonless Copy A, State, B, C * The Federal Government requires that all 1099s not filed electronically be submittedCopy A has been deleted from these forms for those who file electronically.in 11 segments. Forms 1099-MISC, 1099-DIV, 1099-R, 1099-B, 1099-INT, must be NECTC-M4NEC715444-Part 1099-NEC 1 Wd Carbonless Copy A, State, B, C * two-to-a page while all others arethree forms PER page. If filing 250 or more you must TC-M5715455-Part 1099-MISC 1 Wd Carbonless Copy A, State, B, 2, C * submit them electronically. 1099-DIV: OPTICALLY SCANNABLE REPORTINGNECTC-M5NEC715455-Part 1099-NEC 1 Wd Carbonless Copy A, State, B, 2, C * 1099-MISC: OPTICALLY SCANNABLE REPORTING These forms include Copy A printed in red dropout ink for OCR scanning.These forms include Copy A printed in red dropout ink for OCR scanning.18 19"