9 Sheets per pack 25 50 FORM DESCRIPTION N/A 515650 1099-G Federal Copy A – 1 Sheet Equals 3 Forms N/A 515750 1099-G Recipient Copy B – 1 Sheet Equals 3 Forms N/A 515850 1099-G State and/or File Copy – 1 Sheet Equals 3 Forms 532525 532550 1099-K Federal Copy A – 1 Sheet Equals 2 Forms 532625 532650 1099-K Payee Copy B – 1 Sheet Equals 2 Forms 532725 532750 1099-K State and/or File Copy – 1 Sheet Equals 2 Forms 1099-G (CERTAIN GOVERNMENT PAYMENTS) DETACH BEFORE MAILING MANUFACTURED ON OCR LASER BOND PAPER USING HEAT RESISTANT INKS To be Filed with Recipient’s State or Local Income Tax Return, or Copy 1 For State Tax Department Copy 2 To be Filed with Recipient’s State or Local Income Tax Return, or Copy 1 For State Tax Department Copy 2 To be Filed with Recipient’s State or Local Income Tax Return, or Copy 1 For State Tax Department Copy 2 $ $ $ $ $ $ $ $ Form 1099-G (Rev. ) Certain Government Payments OMB No. 1545-0120 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) 1 Unemployment compensation $ 2 State or local income tax refunds, credits, or offsets 3 Box 2 amount is for tax year 4 Federal income tax withheld 5 RTAA payments 6 Taxable grants 7 Agriculture payments 8 Check if box 2 is trade or business income 9 Market gain 10a State 10b 11 State income tax withheld Form 1099-G www.irs.gov/Form1099G Department of the Treasury - Internal Revenue Service $ $ $ $ $ $ $ $ Form 1099-G (Rev. 2024) Certain Government Payments OMB No. 1545-0120 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) 1 Unemployment compensation $ 2 State or local income tax refunds, credits, or offsets 3 Box 2 amount is for tax year 4 Federal income tax withheld 5 RTAA payments 6 Taxable grants 7 Agriculture payments 8 Check if box 2 is trade or business income 9 Market gain 10a State 10b 11 State income tax withheld Form 1099-G (Rev. 3-2024) (Rev. 3-2024) www.irs.gov/Form1099G Department of the Treasury - Internal Revenue Service $ $ $ $ $ $ $ $ Form 1099-G (Rev. ) Certain Government Payments Department of the Treasury - Internal Revenue Service OMB No. 1545-0120 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) 1 Unemployment compensation $ 2 State or local income tax refunds, credits, or offsets 3 Box 2 amount is for tax year 4 Federal income tax withheld 5 RTAA payments 6 Taxable grants 7 Agriculture payments 8 Check if box 2 is trade or business income 9 Market gain 10a State 10b 11 State income tax withheld Form 1099-G (Rev. 3-2024) www.irs.gov/Form1099G 5158 RECIPIENT'S name, street address, city or town, state or province, country, and ZIP or foreign postal code RECIPIENT'S name, street address, city or town, state or province, country, and ZIP or foreign postal code RECIPIENT'S name, street address, city or town, state or province, country, and ZIP or foreign postal code DETACH BEFORE MAILING MANUFACTURED ON OCR LASER BOND PAPER USING HEAT RESISTANT INKS 5157 RECIPIENT'S name, street address, city or town, state or province, country, and ZIP or foreign postal code $ $ $ $ $ $ $ $ $ Form 1099-G Certain Government Payments 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 required 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. 1545-0120 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) 1 Unemployment compensation 2 State or local income tax refunds, credits, or offsets 3 Box 2 amount is for tax year 4 Federal income tax withheld 5 RTAA payments 6 Taxable grants 7 Agriculture payments 8 If checked, box 2 is trade or business income 9 Market gain 10a State 10b 11 State income tax withheld Form 1099-G (keep for your records) www.irs.gov/Form1099G RECIPIENT'S name, street address, city or town, state or province, country, and ZIP or foreign postal code $ $ $ $ $ $ $ $ $ Form 1099-G Certain Government Payments 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 required 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. 1545-0120 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) 1 Unemployment compensation 2 State or local income tax refunds, credits, or offsets 3 Box 2 amount is for tax year 4 Federal income tax withheld 5 RTAA payments 6 Taxable grants 7 Agriculture payments 8 If checked, box 2 is trade or business income 9 Market gain 10a State 10b 11 State income tax withheld Form 1099-G (keep for your records) www.irs.gov/Form1099G RECIPIENT'S name, street address, city or town, state or province, country, and ZIP or foreign postal code $ $ $ $ $ $ $ $ $ Form 1099-G Certain Government Payments 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 required 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. 1545-0120 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) 1 Unemployment compensation 2 State or local income tax refunds, credits, or offsets 3 Box 2 amount is for tax year 4 Federal income tax withheld 5 RTAA payments 6 Taxable grants 7 Agriculture payments 8 If checked, box 2 is trade or business income 9 Market gain 10a State 10b 11 State income tax withheld Form 1099-G (keep for your records) www.irs.gov/Form1099G (Rev. 3-2024) (Rev. March 2024) (Rev. 3-2024) (Rev. March 2024) (Rev. March 2024) (Rev. 3-2024) DETACH BEFORE MAILING MANUFACTURED ON OCR LASER BOND PAPER USING HEAT RESISTANT INKS (Rev. 3-2024) LGA 5156 8686 41-0852411 $ $ $ $ $ $ $ $ Form 1099-G (Rev. March 2024) Certain Government Payments Copy A For Internal Revenue Service Center Department of the Treasury - Internal Revenue Service File with Form 1096. OMB No. 1545-0120 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. 1 Unemployment compensation $ 2 State or local income tax refunds, credits, or offsets 3 Box 2 amount is for tax year 4 Federal income tax withheld 5 RTAA payments 6 Taxable grants 7 Agriculture payments 8 Check if box 2 is trade or business income 9 Market gain 10a State 10b 11 State income tax withheld Form 1099-G (Rev. 3-2024) www.irs.gov/Form1099G Do Not Cut or Separate Forms on This Page — Do Not Cut or Separate Forms on This Page 8686 41-0852411 $ $ $ $ $ $ $ $ Form 1099-G (Rev. March 2024) Certain Government Payments Copy A For Internal Revenue Service Center Department of the Treasury - Internal Revenue Service File with Form 1096. OMB No. 1545-0120 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. 1 Unemployment compensation $ 2 State or local income tax refunds, credits, or offsets 3 Box 2 amount is for tax year 4 Federal income tax withheld 5 RTAA payments 6 Taxable grants 7 Agriculture payments 8 Check if box 2 is trade or business income 9 Market gain 10a State 10b 11 State income tax withheld Form 1099-G www.irs.gov/Form1099G Do Not Cut or Separate Forms on This Page — Do Not Cut or Separate Forms on This Page 8686 41-0852411 $ $ $ $ $ $ $ $ Form 1099-G (Rev. March 2024) Certain Government Payments Copy A For Internal Revenue Service Center Department of the Treasury - Internal Revenue Service File with Form 1096. OMB No. 1545-0120 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. 1 Unemployment compensation $ 2 State or local income tax refunds, credits, or offsets 3 Box 2 amount is for tax year 4 Federal income tax withheld 5 RTAA payments 6 Taxable grants 7 Agriculture payments 8 Check if box 2 is trade or business income 9 Market gain 10a State 10b 11 State income tax withheld Form 1099-G (Rev. 3-2024) www.irs.gov/Form1099G DETACH BEFORE MAILING MANUFACTURED ON OCR LASER BOND PAPER USING HEAT RESISTANT INKS PAYEE'S name, st eet address, city or town, sta e or province, country, and ZIP or foreign postal code Form 1099-K (Rev. March 2024) (Rev. March 2024) Payment Card and Third Party Network Transactions Department of the Treasury - Internal Revenue Service OMB No. 1545-2205 For calendar year VOID FILER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. Check to indicate if FILER is a (an): Payment settlement entity (PSE) Electronic Payment Facilitator (EPF)/Other third party Check to indicate transactions reported are: Payment card Third party network PSE’S name and telephone number Account number (see instructions) FILER’S TIN PAYEE’S TIN 1a Gross amount of payment card/third party network transactions $ 1b Card Not Present transactions $ 2 Merchant category code 3 Number of payment transactions 4 Federal income tax withheld $ 5a January $ 5b February $ 5c March $ 5d April $ 5e May $ 5f June $ 5g July $ 5h August $ 5i September $ 5j October $ 5k November $ 5l December $ 6 State 7 8 State income tax withheld $ $ Form 1099-K (Rev. 3-2024) www.irs.gov/Form1099K CORRECTED (if checked) 5327 PAYEE'S name, st eet address, city or town, sta e or province, country, and ZIP or foreign postal code Form 1099-K Payment Card and Third Party Network Transactions Department of the Treasury - Internal Revenue Service OMB No. 1545-2205 For calendar year VOID FILER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. Check to indicate if FILER is a (an): Payment settlement entity (PSE) Electronic Payment Facilitator (EPF)/Other third party Check to indicate transactions reported are: Payment card Third party network PSE’S name and telephone number Account number (see instructions) FILER’S TIN PAYEE’S TIN 1a Gross amount of payment card/third party network transactions $ 1b Card Not Present transactions $ 2 Merchant category code 3 Number of payment transactions 4 Federal income tax withheld $ 5a January $ 5b February $ 5c March $ 5d April $ 5e May $ 5f June $ 5g July $ 5h August $ 5i September $ 5j October $ 5k November $ 5l December $ 6 State 7 8 State income tax withheld $ $ Form 1099-K (Rev. 3-2024) www.irs.gov/Form1099K CORRECTED (if checked) 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 5326 r rd d a te e ts ,e m a n S'E E Y A P r ess, city or town, sta e or province, country, and ZIP or foreign postal code Form 1099-K (Rev. March 2024) (Rev. March 2024) Payment Card and Third Party Network Transactions Copy B For Payee 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 taxable income results from this transaction and the IRS determines that it has not been reported. OMB No. 1545-2205 For calendar year CORRECTED (if checked) FILER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. Check to indicate if FILER is a (an): Payment settlement entity (PSE) Electronic Payment Facilitator (EPF)/Other third party Check to indicate transactions reported are: Payment card Third party network PSE’S name and telephone number Account number (see instructions) FILER’S TIN PAYEE’S TIN 1a Gross amount of payment card/third party network transactions $ 1b Card Not Present transactions $ 2 Merchant category code 3 Number of payment transactions 4 Federal income tax withheld $ 5a January $ 5b February $ 5c March $ 5d April $ 5e May $ 5f June $ 5g July $ 5h August $ 5i September $ 5j October $ 5k November $ 5l December $ 6 State 7 8 State income tax withheld $ $ Form 1099-K (Rev. 3-2024) (Keep for your records) www.irs.gov/Form1099K PAYEE'S name, st eet address, city or town, sta e or province, country, and ZIP or foreign postal code Form 1099-K Payment Card and Third Party Network Transactions Copy B For Payee 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 taxable income results from this transaction and the IRS determines that it has not been reported. OMB No. 1545-2205 For calendar year CORRECTED (if checked) FILER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. Check to indicate if FILER is a (an): Payment settlement entity (PSE) Electronic Payment Facilitator (EPF)/Other third party Check to indicate transactions reported are: Payment card Third party network PSE’S name and telephone number Account number (see instructions) FILER’S TIN PAYEE’S TIN 1a Gross amount of payment card/third party network transactions $ 1b Card Not Present transactions $ 2 Merchant category code 3 Number of payment transactions 4 Federal income tax withheld $ 5a January $ 5b February $ 5c March $ 5d April $ 5e May $ 5f June $ 5g July $ 5h August $ 5i September $ 5j October $ 5k November $ 5l December $ 6 State 7 8 State income tax withheld $ $ Form 1099-K (Rev. 3-2024) (Keep for your records) www.irs.gov/Form1099K Required Envelope: 77771 or 77772 DETACH BEFORE MAILING 1010 1010 MANUFACTURED ON OCR LASER BOND PAPER USING HEAT RESISTANT INKS 5325 41-0852411 Form 1099-K Payment Card and Third Party Network Transactions Copy A For Internal Revenue Service Center File with Form 1096. Department of the Treasury - Internal Revenue Service OMB No. 1545-2205 For Privacy Act and Paperwork Reduction Act Notice, see the current General Instructions for Certain Information Returns. For calendar year VOID CORRECTED FILER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. Check to indicate if FILER is a (an): Payment settlement entity (PSE) Electronic Payment Facilitator (EPF)/Other third party Check to indicate transactions reported are: Payment card Third party network PAYEE’S name Street address (including apt. no.) City or town, state or province, country, and ZIP or foreign postal code PSE’S name and telephone number Account number (see instructions) 2nd TIN not. FILER’S TIN PAYEE’S TIN 1a Gross amount of payment card/third party network transactions $ 1b Card Not Present transactions $ 2 Merchant category code 3 Number of payment transactions 4 Federal income tax withheld $ 5a January $ 5b February $ 5c March $ 5d April $ 5e May $ 5f June $ 5g July $ 5h August $ 5i September $ 5j October $ 5k November $ 5l December $ 6 State 7 8 State income tax withheld $ $ Form 1099-K www.irs.gov/Form1099K Do Not Cut or Separate Forms on This Page — Do Not Cut or Separate Forms on This Page 41-0852411 Form 1099-K Payment Card and Third Party Network Transactions Copy A For Internal Revenue Service Center File with Form 1096. Department of the Treasury - Internal Revenue Service OMB No. 1545-2205 For Privacy Act and Paperwork Reduction Act Notice, see the current General Instructions for Certain Information Returns. For calendar year VOID CORRECTED FILER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. Check to indicate if FILER is a (an): Payment settlement entity (PSE) Electronic Payment Facilitator (EPF)/Other third party Check to indicate transactions reported are: Payment card Third party network PAYEE’S name Street address (including apt. no.) City or town, state or province, country, and ZIP or foreign postal code PSE’S name and telephone number Account number (see instructions) 2nd TIN not. FILER’S TIN PAYEE’S TIN 1a Gross amount of payment card/third party network transactions $ 1b Card Not Present transactions $ 2 Merchant category code 3 Number of payment transactions 4 Federal income tax withheld $ 5a January $ 5b February $ 5c March $ 5d April $ 5e May $ 5f June $ 5g July $ 5h August $ 5i September $ 5j October $ 5k November $ 5l December $ 6 State 7 8 State income tax withheld $ $ Form 1099-K www.irs.gov/Form1099K (Rev. March 2024) (Rev. March 2024) (Rev. 3-2024) (Rev. 3-2024) 1099-K (MERCHANT CARD AND 3RD PARTY NETWORK PAYMENTS) 1099 PRE-PRINTED FORMS Required Envelope: DW19W or DW19WS 5156 5157 5158 5325 5326 5327 Individual Laser Packs
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