1099-INT (INTEREST)
Required Envelope:
77771 or 77772
1099-DIV (DIVIDEND)
Required Envelope:
77771 or 77772
1099 PRE-PRINTED FORMS
7
 DETACH BEFORE MAILING
 MANUFACTURED  ON OCR LASER BOND PAPER USING HEAT RESISTANT  INKS
5132
RECIPIENT'S name, street address, city or town, state or province, country, and ZIP or foreign postal code
$ 
$ 
$ 
$ 
$ 
$ 
$ 
$ 
$ 
$ 
$ 
$ 
$ 
$ 
$ 
$ 
$ 
$ 
Form 1099-DIV 
(Rev. January 2024)
Dividends and 
Distributions 
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0110 
For calendar year
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
Account number (see instructions) 
1a  Total ordinary dividends 
1b  
2a  Total capital gain distr.
2b  Unrecap. Sec. 1250 gain 
2c  Section 1202 gain 
2d  Collectibles (28%) gain 
2e  Section 897 ordinary dividends
2f  Section 897 capital gain 
3    Nondividend distributions 
4    Federal income tax withheld
5    Section 199A dividends
6    Investment expenses 
7    Foreign tax paid 
8    Foreign country or U.S. possession
9    Cash liquidation distributions 10   Noncash liquidation distributions 
11  
requirement
12  Exempt-interest dividends
13  
bond interest dividends
14  State 
15  
16  State tax withheld
Form 1099-DIV (Rev. 1-2024)
www.irs.gov/Form1099DIV
RECIPIENT'S name, street address, city or town, state or province, country, and ZIP or foreign postal code
$ 
$ 
$ 
$ 
$ 
$ 
$ 
$ 
$ 
$ 
$ 
$ 
$ 
$ 
$ 
$ 
$ 
$ 
Form 1099-DIV 
(Rev. January 2024)
Dividends and 
Distributions 
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0110 
For calendar year
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
Account number (see instructions) 
1a  Total ordinary dividends 
1b  
2a  Total capital gain distr.
2b  Unrecap. Sec. 1250 gain 
2c  Section 1202 gain 
2d  Collectibles (28%) gain 
2e  Section 897 ordinary dividends
2f  Section 897 capital gain 
3    Nondividend distributions 
4    Federal income tax withheld
5    Section 199A dividends
6    Investment expenses 
7    Foreign tax paid 
8    Foreign country or U.S. possession
9    Cash liquidation distributions 10   Noncash liquidation distributions 
11  
requirement
12  Exempt-interest dividends
13  
bond interest dividends
14  State 
15  
16  State tax withheld
Form 1099-DIV (Rev. 1-2024)
www.irs.gov/Form1099DIV
$ 
$ 
Copy 2
To be Filed with
Recipient’s State or
Local Income Tax
 Return, or Copy 1
For State Tax
Department
To be Filed with
Recipient’s State or
Local Income Tax
 Return, or Copy 1
For State Tax
Department
Copy 2
 DETACH BEFORE MAILING
 MANUFACTURED  ON OCR LASER BOND PAPER USING HEAT RESISTANT  INKS
5131
 
RECIPIENT'S name, street address, city or town, state or province, country, and ZIP or foreign postal code
$ 
$ 
$ 
$ 
$ 
$ 
$ 
$ 
$ 
$ 
$ 
$ 
$ 
$ 
$ 
$ 
$ 
$ 
Form 1099-DIV
(Rev. January 2024)
Dividends and 
Distributions 
Copy B 
For Recipient 
Department of the Treasury - Internal Revenue Service
This is important tax 
information and is 
being furnished to 
the IRS. If you are 
return, a negligence 
penalty or other 
sanction may be 
imposed on you if 
 this income is taxable 
and the IRS 
determines that it has 
not been reported. 
OMB No. 1545-0110 
For calendar year
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) 
1a  Total ordinary dividends 
1b  
2a  Total capital gain distr.
2b  Unrecap. Sec. 1250 gain 
2c  Section 1202 gain 
2d  Collectibles (28%) gain 
2e  Section 897 ordinary dividends
2f  Section 897 capital gain 
3    Nondividend distributions 
4    Federal income tax withheld 
5    Section 199A dividends
6    Investment expenses 
7    Foreign tax paid 
8    Foreign country or U.S. possession
9    Cash liquidation distributions 10   Noncash liquidation distributions 
11  
requirement
12  Exempt-interest dividends
13  
bond interest dividends
14  State 
15  
16  State tax withheld
Form 1099-DIV (Rev. 1-2024)
(keep for your records) 
www.irs.gov/Form1099DIV
 
RECIPIENT'S name, street address, city or town, state or province, country, and ZIP or foreign postal code
$ 
$ 
$ 
$ 
$ 
$ 
$ 
$ 
$ 
$ 
$ 
$ 
$ 
$ 
$ 
$ 
$ 
$ 
Form 1099-DIV
(Rev. January 2024)
Dividends and 
Distributions 
Copy B 
For Recipient 
Department of the Treasury - Internal Revenue Service
This is important tax 
information and is 
being furnished to 
the IRS. If you are 
return, a negligence 
penalty or other 
sanction may be 
imposed on you if 
 this income is taxable 
and the IRS 
determines that it has 
not been reported. 
OMB No. 1545-0110 
For calendar year
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) 
1a  Total ordinary dividends 
1b  
2a  Total capital gain distr.
2b  Unrecap. Sec. 1250 gain 
2c  Section 1202 gain 
2d  Collectibles (28%) gain 
2e  Section 897 ordinary dividends
2f  Section 897 capital gain 
3    Nondividend distributions 
4    Federal income tax withheld 
5    Section 199A dividends
6    Investment expenses 
7    Foreign tax paid 
8    Foreign country or U.S. possession
9    Cash liquidation distributions 10   Noncash liquidation distributions 
11  
requirement
12  Exempt-interest dividends
13  
bond interest dividends
14  State 
15  
16  State tax withheld
Form 1099-DIV (Rev. 1-2024)
(keep for your records) 
www.irs.gov/Form1099DIV
$ 
$ 
9191
9191
 MANUFACTURED  ON OCR LASER BOND PAPER USING HEAT RESISTANT  INKS
5130
 DETACH BEFORE MAILING
(Rev. January 2024)
41-0852411
Form 1099-DIV 
Dividends and 
Distributions 
Copy A
For 
Internal Revenue 
Service Center 
Department of the Treasury - Internal Revenue Service
File with Form 1096.
OMB No. 1545-0110 
For Privacy Act 
and Paperwork 
Reduction Act 
Notice, see the 
current General 
Instructions for 
Certain 
Information 
Returns. 
For calendar year
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) 
2nd TIN not. 
1a  Total ordinary dividends 
1b  
2a  Total capital gain distr.
2b  Unrecap. Sec. 1250 gain 
2c  Section 1202 gain 
2d  Collectibles (28%) gain 
2e  Section 897 ordinary dividends
2f  Section 897 capital gain 
3    Nondividend distributions 
4    Federal income tax withheld 
5    Section 199A dividends
6    Investment expenses 
7    Foreign tax paid 
8    Foreign country or U.S. possession
9    Cash liquidation distributions 10   Noncash liquidation distributions
11  
requirement
12  Exempt-interest dividends
13  
bond interest dividends
14  State 
15  
16  State tax withheld
$ 
$ 
$ 
$ 
$ 
$ 
$ 
$ 
$ 
$ 
$ 
$ 
$ 
$ 
$ 
$ 
$ 
$ 
Form 1099-DIV (Rev. 1-2024)
www.irs.gov/Form1099DIV
Do  Not  Cut  or  Separate  Forms  on  This  Page    —     Do  Not  Cut  or  Separate  Forms  on  This  Page
VOID 
CORRECTED
Street address (including apt. no.) 
Total capital gain distr.
2e  
 
 
7    
$ 
 
(Rev. January 2024)
41-0852411
Form 1099-DIV 
Dividends and 
Distributions 
Copy A
For 
Internal Revenue 
Service Center 
Department of the Treasury - Internal Revenue Service
File with Form 1096.
OMB No. 1545-0110 
For Privacy Act 
and Paperwork 
Reduction Act 
Notice, see the 
current General 
Instructions for 
Certain 
Information 
Returns. 
For calendar year
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) 
2nd TIN not. 
1a  Total ordinary dividends 
1b  
2a  Total capital gain distr.
2b  Unrecap. Sec. 1250 gain 
2c  Section 1202 gain 
2d  Collectibles (28%) gain 
2e  Section 897 ordinary dividends
2f  Section 897 capital gain 
3    Nondividend distributions 
4    Federal income tax withheld 
5    Section 199A dividends
6    Investment expenses 
7    Foreign tax paid 
8    Foreign country or U.S. possession
9    Cash liquidation distributions 10   Noncash liquidation distributions
11  
requirement
12  Exempt-interest dividends
13  
bond interest dividends
14  State 
15  
16  State tax withheld
$ 
$ 
$ 
$ 
$ 
$ 
$ 
$ 
$ 
$ 
$ 
$ 
$ 
$ 
$ 
$ 
$ 
$ 
Form 1099-DIV (Rev. 1-2024)
www.irs.gov/Form1099DIV
VOID 
CORRECTED
Street address (including apt. no.) 
Total capital gain distr.
2e  
 
 
7    
$ 
 
 DETACH BEFORE MAILING
 MANUFACTURED ON OCR LASER BOND PAPER USING HEAT RESISTANT INKS
5122
$
$
$
$
$
$
$
$
$
$
$
$
$
$
RECIPIENT'S name, street address, city or town, state or province, country, and ZIP or foreign postal code
Form 1099-INT
(Rev. January 2024)
Interest 
Income
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0112
For calendar year
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
requirement
Account number (see instructions)
Payer’s RTN (optional)
1 Interest income
2 Early withdrawal penalty
3 Interest on U.S. Savings Bonds and Treasury obligations
4 Federal income tax withheld 5 Investment expenses
6 Foreign tax paid
7 Foreign country or U.S. territory
8 Tax-exempt interest
9  
interest
10 Market discount
11 Bond premium
12 Bond premium on Treasury obligations 13 Bond premium on tax-exempt bond
14 Tax-exempt and tax credit 
bond CUSIP no.
15 State 16 
17 State tax withheld
Form 1099-INT (Rev. 1-2024)
www.irs.gov/Form1099INT
$
$
$
$
$
$
$
$
$
$
$
$
$
$
RECIPIENT'S name, street address, city or town, state or province, country, and ZIP or foreign postal code
Form 1099-INT
(Rev. January 2024)
Interest 
Income
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0112
For calendar year
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
requirement
Account number (see instructions)
Payer’s RTN (optional)
1 Interest income
2 Early withdrawal penalty
3 Interest on U.S. Savings Bonds and Treasury obligations
4 Federal income tax withheld 5 Investment expenses
6 Foreign tax paid
7 Foreign country or U.S. territory
8 Tax-exempt interest
9  
interest
10 Market discount
11 Bond premium
12 Bond premium on Treasury obligations 13 Bond premium on tax-exempt bond
14 Tax-exempt and tax credit 
bond CUSIP no.
15 State 16 
17 State tax withheld
Form 1099-INT (Rev. 1-2024)
www.irs.gov/Form1099INT
Copy 2
To be Filed with
Recipient’s State or
Local Income Tax
 Return, or Copy 1
For State Tax
Department
To be Filed with
Recipient’s State or
Local Income Tax
 Return, or Copy 1
For State Tax
Department
Copy 2
 DETACH BEFORE MAILING
 MANUFACTURED ON OCR LASER BOND PAPER USING HEAT RESISTANT INKS
5121
RECIPIENT'S name, street address, city or town, state or province, country, and ZIP or foreign postal code
$
$
$
$
$
$
$
$
$
$
$
$
$
$
Form 1099-INT
(Rev. January 2024)
Interest 
Income
Copy B
For Recipient
Department of the Treasury - Internal Revenue Service
This is important tax 
information and is 
being furnished to the 
IRS. If you are 
return, a negligence 
penalty or other 
sanction may be 
 imposed on you if 
this income is 
taxable and the IRS 
determines that it has 
not been reported.
OMB No. 1545-0112
For calendar year
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
requirement
Account number (see instructions)
Payer’s RTN (optional)
1 Interest income
2 Early withdrawal penalty
3 Interest on U.S. Savings Bonds and Treasury obligations
4 Federal income tax withheld 5 Investment expenses
6 Foreign tax paid
7 Foreign country or U.S. territory
8 Tax-exempt interest
9  
interest
10 Market discount
11 Bond premium
12 Bond premium on Treasury obligations 13 Bond premium on tax-exempt bond
14 Tax-exempt and tax credit 
bond CUSIP no.
15 State 16 
17 State tax withheld
Form 1099-INT (Rev. 1-2024)
(keep for your records)
www.irs.gov/Form1099INT
RECIPIENT'S name, street address, city or town, state or province, country, and ZIP or foreign postal code
$
$
$
$
$
$
$
$
$
$
$
$
$
$
Form 1099-INT
(Rev. January 2024)
Interest 
Income
Copy B
For Recipient
Department of the Treasury - Internal Revenue Service
This is important tax 
information and is 
being furnished to the 
IRS. If you are 
return, a negligence 
penalty or other 
sanction may be 
 imposed on you if 
this income is 
taxable and the IRS 
determines that it has 
not been reported.
OMB No. 1545-0112
For calendar year
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
requirement
Account number (see instructions)
Payer’s RTN (optional)
1 Interest income
2 Early withdrawal penalty
3 Interest on U.S. Savings Bonds and Treasury obligations
4 Federal income tax withheld 5 Investment expenses
6 Foreign tax paid
7 Foreign country or U.S. territory
8 Tax-exempt interest
9  
interest
10 Market discount
11 Bond premium
12 Bond premium on Treasury obligations 13 Bond premium on tax-exempt bond
14 Tax-exempt and tax credit 
bond CUSIP no.
15 State 16 
17 State tax withheld
Form 1099-INT (Rev. 1-2024)
(keep for your records)
www.irs.gov/Form1099INT
 DETACH BEFORE MAILING
9292
9292
 MANUFACTURED ON OCR LASER BOND PAPER USING HEAT RESISTANT INKS
5120
41-0852411
$
$
$
$
$
$
$
$
$
$
$
$
$
$
Form 1099-INT
(Rev. January 2024)
Interest 
Income
Copy A
For 
Internal Revenue 
Service Center
Department of the Treasury - Internal Revenue Service
File with Form 1096.
OMB No. 1545-0112
For Privacy Act 
and Paperwork 
Reduction Act 
Notice, see the 
current General 
Instructions for 
Certain 
Information 
Returns.
For calendar year
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
requirement
Account number (see instructions)
2nd TIN not.
Payer’s RTN (optional)
2 Early withdrawal penalty
1 Interest income
3 Interest on U.S. Savings Bonds and Treasury obligations
4 Federal income tax withheld 5 Investment expenses
6 Foreign tax paid
7 Foreign country or U.S. territory
8 Tax-exempt interest
9  
interest
10 Market discount
11 Bond premium
12 Bond premium on Treasury obligations 13 Bond premium on tax-exempt bond
14 Tax-exempt and tax credit 
bond CUSIP no.
15 State 16 
17 State tax withheld
Form 1099-INT (Rev. 1-2024)
www.irs.gov/Form1099INT
Do Not Cut or Separate Forms on This Page  —  Do Not Cut or Separate Forms on This Page
41-0852411
$
$
$
$
$
$
$
$
$
$
$
$
$
$
Form 1099-INT
(Rev. January 2024)
Interest 
Income
Copy A
For 
Internal Revenue 
Service Center
Department of the Treasury - Internal Revenue Service
File with Form 1096.
OMB No. 1545-0112
For Privacy Act 
and Paperwork 
Reduction Act 
Notice, see the 
current General 
Instructions for 
Certain 
Information 
Returns.
For calendar year
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
requirement
Account number (see instructions)
2nd TIN not.
Payer’s RTN (optional)
2 Early withdrawal penalty
1 Interest income
3 Interest on U.S. Savings Bonds and Treasury obligations
4 Federal income tax withheld 5 Investment expenses
6 Foreign tax paid
7 Foreign country or U.S. territory
8 Tax-exempt interest
9  
interest
10 Market discount
11 Bond premium
12 Bond premium on Treasury obligations 13 Bond premium on tax-exempt bond
14 Tax-exempt and tax credit 
bond CUSIP no.
15 State 16 
17 State tax withheld
Form 1099-INT (Rev. 1-2024)
www.irs.gov/Form1099INT
5121
5131
5122
5132
5120
5130
	 Sheets per pack
	
25	
50	
500	
FORM DESCRIPTION
	
512025	
512050	
5120B	
1099-INT Federal Copy A – 1 Sheet Equals 2 Forms
	
512125	
512150	
5121B	
1099-INT Recipient Copy B – 1 Sheet Equals 2 Forms
	
512225	
512250	
5122B	
1099-INT State and/or File Copy – 1 Sheet Equals 2 Forms
	
513025	
513050	
N/A	
1099-DIV Federal Copy A – 1 Sheet Equals 2 Forms
	
513125	
513150	
N/A	
1099-DIV Recipient Copy B – 1 Sheet Equals 2 Forms
	
513225	
513250	
N/A	
1099-DIV State and/or File Copy – 1 Sheet Equals 2 Forms

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