18 1099-R LASER PACKAGED SET (3) Transmittal 1096 forms are included with each set MANUFACTURE D ON OCR LASER BOND PAPER USING HEAT RESISTANT INKS 41-0852411 DETACH BEFORE MAILING 5100 Do Not Staple 6969 Form 1096 Department of the Treasury Internal Revenue Service Annual Summary and Transmittal of U.S. Information Returns OMB No. 1545-0108 2026 FILER’S name Street address Room or suite no. City or town State or province Country ZIP or foreign postal code Name of person to contact Telephone number Email address Fax number For Official Use Only 1 Employer identification number 2 Social security number 3 Total number of forms 4 Federal income tax withheld $ 5 Total amount reported with this Form 1096 $ 6 Enter an “X” in only one box below to indicate the type of form being filed. W-2G 32 1097-BTC 50 1098 81 1098-C 78 1098-E 84 1098-F 03 1098-Q 74 1098-T 83 1098-VLI 1B 1099-A 80 1099-B 79 1099-C 85 1099-CAP 73 1099-DA 7A 1099-DIV 91 1099-G 86 1099-INT 92 1099-K 10 1099-LPS 2B 1099-LS 16 1099-LTC 93 1099-MISC 95 1099-NEC 71 1099-OID 96 1099-PATR 97 1099-Q 31 1099-QA 1A 1099-R 98 1099-S 75 1099-SA 94 1099-SB 43 3921 25 3922 26 5498 28 5498-ESA 72 5498-QA 2A 5498-SA 27 5498-TA 3B 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 flat mailer (not folded). 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. Signature Title Date Instructions Future developments. For the latest information about developments related to Form 1096, such as legislation enacted after it was published, go to www.irs.gov/Form1096. Purpose of form. Use this form to transmit paper Forms 1097, 1098, 1099, 3921, 3922, 5498, and W-2G to the IRS. Who must file. Any person or entity who files any form checked in box 6 above must file Form 1096 to transmit those forms to the IRS. Caution: Your name and taxpayer identification number (TIN) (employer identification number (EIN) or social security number (SSN)) must match the 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 of your paying agent or service bureau. Enter the filer’s name, address (including room, suite, or other unit number), and TIN in the spaces provided on the form. The name, address, and TIN of the filer on this form must be the same as those you enter in the upper left area of Form 1097, 1098, 1099, 3921, 3922, 5498, or W-2G. When to file. If any date shown falls on a Saturday, Sunday, or legal holiday in the District of Columbia or where the return is to be filed, the due date is the next business day. File Form 1096 in the calendar year following the year for which the information is being reported, as follows. • With Forms 1097, 1098, 1099, 3921, 3922, or W-2G, file by February 28.* • With Forms 1099-NEC, file by January 31. • With Form 1099-LPS, file by February 1. • With Forms 5498, file by May 31. Where To File Send all information returns filed on paper with Form 1096 to the following. If your principal business, office or agency, or legal residence in the case of an individual, is located in: Use the following address: Alabama, Arizona, Arkansas, Delaware, Florida, Georgia, Kentucky, Maine, Massachusetts, Mississippi, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Texas, Vermont, Virginia Internal Revenue Service P.O. Box 149213 Austin, TX 78714-9213 Alaska, Colorado, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Montana, Nebraska, Nevada, North Dakota, Oklahoma, Oregon, South Carolina, South Dakota, Tennessee, Utah, Washington, Wisconsin, Wyoming Internal Revenue Service Center P.O. Box 219256 Kansas City, MO 64121-9256 California, Connecticut, District of Columbia, Louisiana, Maryland, Pennsylvania, Rhode Island, West Virginia Internal Revenue Service Center 1973 North Rulon White Blvd. Ogden, UT 84201 If your legal residence or principal place of business is outside the United States, file with the Internal Revenue Service, P.O. Box 149213, Austin, TX 78714-9213. For more information and the Privacy Act and Paperwork Reduction Act Notice, see Pub. 1099. Form 1096 (2026) Created 12/15/25 * Leap years do not impact the due date. See Announcement 91-179, 1991-49 I.R.B. 78, for more information. DETACH BEFORE MAILING MANUFACTURED ON OCR LASER BOND PAPER USING HEAT RESISTANT INKS 5142 RECIPIENT’S name, street address, city or town, state or province, country and ZIP or foreign postal code Form 1099-R Distributions From Pensions, Annuities, Retirement or Profit-Sharing Plans, IRAs, Insurance Contracts, etc. Department of the Treasury - Internal Revenue Service This information is being furnished to the IRS. OMB No. 1545-0119 CORRECTED (if checked) PAYER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. PAYER’S TIN RECIPIENT’S TIN Account number (see instructions) 1 Gross distribution $ 2a Taxable amount $ 2b Taxable amount not determined Total distribution 3 Capital gain (included in box 2a) $ 4 Federal income tax withheld $ 5 Employee contributions/ Designated Roth contributions or insurance premiums $ 6 Net unrealized appreciation in employer’s securities $ 7 Distribution code(s) IRA/ SEP/ SIMPLE 8 Other $ 9a Your percentage of total distribution 9b Total employee contributions $ 10 Amount allocable to IRR within 5 years $ requirement 13 Date of payment 14 State tax withheld $ $ 15 State/Payer’s state no. 16 State distribution $ $ 17 Local tax withheld $ $ 18 Name of locality 19 Local distribution $ $ Form 1099-R (keep for your records) www.irs.gov/Form1099R RECIPIENT’S name, street address, city or town, state or province, country and ZIP or foreign postal code Form 1099-R Distributions From Pensions, Annuities, Retirement or Profit-Sharing Plans, IRAs, Insurance Contracts, etc. Department of the Treasury - Internal Revenue Service This information is being furnished to the IRS. OMB No. 1545-0119 CORRECTED (if checked) PAYER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. PAYER’S TIN RECIPIENT’S TIN Account number (see instructions) 1 Gross distribution $ 2a Taxable amount $ 2b Taxable amount not determined Total distribution 3 Capital gain (included in box 2a) $ 4 Federal income tax withheld $ 5 Employee contributions/ Designated Roth contributions or insurance premiums $ 6 Net unrealized appreciation in employer’s securities $ 7 Distribution code(s) IRA/ SEP/ SIMPLE 8 Other $ 9a Your percentage of total distribution 9b Total employee contributions $ 10 Amount allocable to IRR within 5 years $ 11 1st year of desig. Roth contrib. 12 11 1st year of desig. Roth contrib. 12 requirement 13 Date of payment 14 State tax withheld $ $ 15 State/Payer’s state no. 16 State distribution $ $ 17 Local tax withheld $ $ 18 Name of locality 19 Local distribution $ $ Form 1099-R (keep for your records) www.irs.gov/Form1099R % % % % LRC Copy C For Recipient's Copy C For Recipient's Records Records 2025 2025 DETACH BEFORE MAILING MANUFACTURED ON OCR LASER BOND PAPER USING HEAT RESISTANT INKS RECIPIENT’S name, street address, city or town, state or province, country and ZIP or foreign postal code LRB 5141 Form 1099-R Distributions From Pensions, Annuities, Retirement or Profit-Sharing Plans, IRAs, Insurance Contracts, etc. Copy B Report this income on your federal tax return. If this form shows federal income tax withheld in box 4, attach this copy to your return. Department of the Treasury - Internal Revenue Service This information is being furnished to the IRS. OMB No. 1545-0119 CORRECTED (if checked) PAYER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. PAYER’S TIN RECIPIENT’S TIN Account number (see instructions) 1 Gross distribution $ 2a Taxable amount $ 2b Taxable amount not determined Total distribution 3 Capital gain (included in box 2a) $ 4 Federal income tax withheld $ 5 Employee contributions/ Designated Roth contributions or insurance premiums $ 6 Net unrealized appreciation in employer’s securities $ 7 Distribution code(s) IRA/ SEP/ SIMPLE 8 Other $ 9a Your percentage of total distribution 9b Total employee contributions $ 10 Amount allocable to IRR within 5 years $ 11 1st year of desig. Roth contrib. 12 requirement 13 Date of payment 14 State tax withheld $ $ 15 State/Payer’s state no. 16 State distribution $ $ 17 Local tax withheld $ $ 18 Name of locality 19 Local distribution $ $ Form 1099-R www.irs.gov/Form1099R RECIPIENT’S name, street address, city or town, state or province, country and ZIP or foreign postal code Form 1099-R Distributions From Pensions, Annuities, Retirement or Profit-Sharing Plans, IRAs, Insurance Contracts, etc. Copy B Report this income on your federal tax return. If this form shows federal income tax withheld in box 4, attach this copy to your return. Department of the Treasury - Internal Revenue Service This information is being furnished to the IRS. OMB No. 1545-0119 CORRECTED (if checked) PAYER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. PAYER’S TIN RECIPIENT’S TIN Account number (see instructions) 1 Gross distribution $ 2a Taxable amount $ 2b Taxable amount not determined Total distribution 3 Capital gain (included in box 2a) $ 4 Federal income tax withheld $ 5 Employee contributions/ Designated Roth contributions or insurance premiums $ 6 Net unrealized appreciation in employer’s securities $ 7 Distribution code(s) IRA/ SEP/ SIMPLE 8 Other $ 9a Your percentage of total distribution 9b Total employee contributions $ 10 Amount allocable to IRR within 5 years $ 11 1st year of desig. Roth contrib. 12 requirement 13 Date of payment 14 State tax withheld $ $ 15 State/Payer’s state no. 16 State distribution $ $ 17 Local tax withheld $ $ 18 Name of locality 19 Local distribution $ $ Form 1099-R www.irs.gov/Form1099R % % % % 2025 2025 DETACH BEFORE MAILING 9898 9898 MANUFACTURED ON OCR LASER BOND PAPER USING HEAT RESISTANT INKS 5140 41-0852411 Form 1099-R 2025 Distributions From Pensions, Annuities, Retirement or Profit-Sharing Plans, IRAs, Insurance Contracts, etc. Department of the Treasury - Internal Revenue Service Copy A For Internal Revenue Service Center OMB No. 1545-0119 VOID CORRECTED PAYER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. PAYER’S TIN RECIPIENT’S TIN RECIPIENT’S name Street address (including apt. no.) City or town, state or province, country, and ZIP or foreign postal code Account number (see instructions) 1 Gross distribution 2a $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ Taxable amount 2b Taxable amount not determined Total distribution 3 Capital gain (included in box 2a) 4 Federal income tax withheld 5 Employee contributions/ Designated Roth contributions or insurance premiums 6 Net unrealized appreciation in employer’s securities 7 Distribution code(s) IRA/ SEP/ SIMPLE 8 Other 9a Your percentage of total distribution % 9b Total employee contributions 10 Amount allocable to IRR within 5 years 11 1st year of desig. Roth contrib. 12 requirement 13 Date of payment 14 State tax withheld 15 State/Payer’s state no. 16 State distribution 17 Local tax withheld 18 Name of locality 19 Local distribution Form 1099-R www.irs.gov/Form1099R Do Not Cut or Separate Forms on This Page — Do Not Cut or Separate Forms on This Page 41-0852411 Form 1099-R 2025 Distributions From Pensions, Annuities, Retirement or Profit-Sharing Plans, IRAs, Insurance Contracts, etc. Department of the Treasury - Internal Revenue Service Copy A For Internal Revenue Service Center OMB No. 1545-0119 VOID CORRECTED PAYER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. PAYER’S TIN RECIPIENT’S TIN RECIPIENT’S name Street address (including apt. no.) City or town, state or province, country, and ZIP or foreign postal code Account number (see instructions) 1 Gross distribution 2a $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ Taxable amount 2b Taxable amount not determined Total distribution 3 Capital gain (included in box 2a) 4 Federal income tax withheld 5 Employee contributions/ Designated Roth contributions or insurance premiums 6 Net unrealized appreciation in employer’s securities 7 Distribution code(s) IRA/ SEP/ SIMPLE 8 Other 9a Your percentage of total distribution % 9b Total employee contributions 10 Amount allocable to IRR within 5 years 11 1st year of desig. Roth contrib. 12 requirement 13 Date of payment 14 State tax withheld 15 State/Payer’s state no. 16 State distribution 17 Local tax withheld 18 Name of locality 19 Local distribution Form 1099-R www.irs.gov/Form1099R $ $ % Privacy Act, and Paperwork Reduction Act Notice, see the General Instructions for Certain Information Returns. www.irs.gov/Form1099 Privacy Act, and Paperwork Reduction Act Notice, see the General Instructions for Certain Information Returns. www.irs.gov/Form1099 % 1099 PRE-PRINTED FORMS 5142 5141 5140 5100 1099-R Packaged Sets 77771 or 77772 1099-R LASER PACKAGED SET FOR 100 RECIPIENTS 95944E 4-Part Set includes: (50 Sheets EACH) 1099-R Copy A, B, C + Gum Seal ENV (100) Catalog images may not reflect official IRS revisions at the time of publication. Final products will be in compliance with official IRS revisions.
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