b"1099 PRE-PRINTED FORMSTFP 1099-DIV & 1099-R Packaged SetsTFP 1099-DIV LASER PACKAGED SETTFP 5130 TFP 5131 TFP 5132 TFP 5100VOIDCORRECTED CORRECTED (if checked) VOIDCORRECTED Do Not StaplePAYERS name, street address, city or town, state or province, country, ZIP 1aTotal ordinary dividendsOMB No. 1545-0110PAYERS name, street address, city or town, state or province, country, ZIP 1aTotal ordinary dividendsOMB No. 1545-0110PAYERS name, street address, city or town, state or province, country, ZIP 1aTotal ordinary dividendsOMB No. 1545-0110Form1096 Annual Summary and Transmittal of OMB No. 1545-0108or foreign postal code, and telephone no.$1b Form1099-DIVDividends andor foreign postal code, and telephone no.$1b Form1099-DIV Dividends andor foreign postal code, and telephone no.$1b Form1099-DIVDividends and INKSRESISTANTUSING HEATBOND PAPERON OCR LASERMANUFACTURED Department of the TreasuryU.S. Information Returns 2024 DETACH BEFORE MAILING(Rev. January 2024) Distributions(Rev. January 2024) Distributions(Rev. January 2022) DistributionsInternal Revenue ServiceFor calendar year For calendar year For calendar year FILERS name$$$ $2aTotal capital gain distr. $2bUnrecap. Sec. 1250 gainCopy A $2aTotal capital gain distr. $2bUnrecap. Sec. 1250 gainCopy B$2aTotal capital gain distr. $2bUnrecap. Sec. 1250 gainCopy C Street address (including room or suite number)PAYERS TIN RECIPIENTS TIN 2cSection 1202 gain2dCollectibles (28%) gainForPAYERS TINRECIPIENTS TIN 2cSection 1202 gain2dCollectibles (28%) gainFor RecipientPAYERS TINRECIPIENTS TIN 2cSection 1202 gain2dCollectibles (28%) gainFor PayerInternal Revenueand/or State $$Service Center$$$$ Copy 1 or Copy 22eSection 897 ordinary dividends2fSection 897 capital gainFile with Form 1096. $2eSection 897 ordinary dividends $2fSection 897 capital gain$2eSection 897 ordinary dividends $2fSection 897 capital gainCity or town, state or province, country, and ZIP or foreign postal code$$ For Ofcial Use OnlyRECIPIENTS name$3Nondividend distributions$4Federal income tax withheldand PaperworkRECIPIENT'S name, stret adres, city or town, state or province, country, and ZIP or foreign postal code $3Nondividend distributions$4Federal income tax withheldThis is important taxRECIPIENT'S name, stret adres, city or town, state or province, country, and ZIP or foreign postal code $3Nondividend distributions$4Federal income tax withheld For Privacy ActName of person to contact Telephone numberFor Privacy Actinformation and is5Section 199A dividends 6Investment expensesand PaperworkEmail address Fax numberbeing furnished to Street address (including apt. no.)$5Section 199A dividends $6Investment expensesReduction Act$5Section 199A dividends $6Investment expensesthe IRS. If you are$$Reduction Act 7Foreign tax paid8Foreign country or U.S. possession Notice, see the7Foreign tax paid8Foreign country or U.S. possession return, a negligence7Foreign tax paid8Foreign country or U.S. possession Notice, see the12 Social security number 3 Total number of forms 4 Federal income tax withheld5 Total amount reported with this Form 1096current Generalpenalty or othercurrent General$ $City or town, state or province, country, and ZIP or foreign postal code $Instructions for$imposed on you if$Instructions for6 sanction may be 9Cash liquidation distributions10 Noncash liquidation distributions Certain9Cash liquidation distributions10 Noncash liquidation distributions this income is taxable9Cash liquidation distributions10 Noncash liquidation distributionsCertainW-2G 1097-BTC10981098-C1098-E1098-F1098-Q1098-T1099-A1099-B1099-C1099-CAP1099-DIV1099-G1099-INT1099-KInformationdetermines that it has$$Information32 50 81 78 84 03 74 83 80 79 85 73 91 86 92 10and the IRS $$Returns.requirement $$bond interest dividends not been reported.12Exempt-interest dividends13 bond interest dividends Returns. 11 requirement 12Exempt-interest dividends13 bond interest dividends 11 12Exempt-interest dividends13 11requirement$$$$$$1099-LS 1099-LTC1099-MISC 1099-NEC 1099-OID1099-PATR 1099-Q1099-QA 1099-R1099-S1099-SA 1099-SB 3921392254985498-ESA5498-QA Account number (see instructions)2nd TIN not.14State 15 16State tax withheld Account number (see instructions)14State 15 16State tax withheld Account number (see instructions)2nd TIN not.14State 15 16State tax withheld 16 93 95 71 96 97 31 1A 98 75 94 43 25 26 28 72 2A$$$ $$$5498-SA Form1099-DIV(Rev. 1-2024) Department of the Treasury - Internal Revenue Service Form1099-DIV(Rev. 1-2024) (keep for your records)Department of the Treasury - Internal Revenue Service Form1099-DIV(Rev. 1-2022) www.irs.gov/Form1099DIV Department of the Treasury - Internal Revenue Service 27Return this entire page to the Internal Revenue Service. Photocopies are not acceptable. Send this form, with the copies of the form checked in box 6, to the IRS in a at mailer (not folded).VOIDCORRECTED CORRECTED (if checked) VOIDCORRECTED Under penalties of perjury, I declare that I have examined this return and accompanying documents and, to the best of my knowledge and belief, they are true, correct, and complete.PAYERS name, street address, city or town, state or province, country, ZIP 1aTotal ordinary dividendsOMB No. 1545-0110PAYERS name, street address, city or town, state or province, country, ZIP 1aTotal ordinary dividendsOMB No. 1545-0110PAYERS name, street address, city or town, state or province, country, ZIP 1aTotal ordinary dividendsOMB No. 1545-0110 or foreign postal code, and telephone no.$Form1099-DIVDividends andor foreign postal code, and telephone no.$Form1099-DIV Dividends andor foreign postal code, and telephone no.$Form1099-DIVDividends andSignature TitleDate1b (Rev. January 2024) Distributions1b (Rev. January 2024) Distributions1b (Rev. January 2022) DistributionsInstructions When to le. If any date shown falls on a Saturday, Sunday, or legal For calendar year For calendar year For calendar year Future developments. For the latest information about developmentsthe due date is the next business day. File Form 1096 in the calendar $$$related to Form 1096, such as legislation enacted after it was published, goyear following the year for which the information is being reported, as Total capital gain distr. Copy C to www.irs.gov/Form1096. follows.$2aTotal capital gain distr. $2bUnrecap. Sec. 1250 gainCopy AForPAYERS TINRECIPIENTS TIN $2aTotal capital gain distr. $2bUnrecap. Sec. 1250 gainCopy BPAYERS TINRECIPIENTS TIN $2aTotal capital gain distr. $2bUnrecap. Sec. 1250 gainFor Payer Reminder. returns. Go to www.irs.gov/inforeturn PAYERS TIN RECIPIENTS TIN 2cSection 1202 gain2dCollectibles (28%) gainInternal Revenue2cSection 1202 gain2dCollectibles (28%) gainFor Recipient2cSection 1202 gain2dCollectibles (28%) gainand/or Statethe 2024 General Instructions for Certain Information Returns.$$Service Center$$$$ Copy 1 or Copy 2 Purpose of form. Use this form to transmit paper Forms 1097, 1098,*Leap years do not impact the due date. See Announcement 91-179,2eSection 897 ordinary dividends2fSection 897 capital gainFile with Form 1096. $2eSection 897 ordinary dividends $2fSection 897 capital gain$2eSection 897 ordinary dividends $2fSection 897 capital gain1099, 3921, 3922, 5498, and W-2G to the IRS.1991-49 I.R.B. 78, for more information.$$Caution: Where To Filenumber of returns.RECIPIENTS name$3Nondividend distributions$4Federal income tax withheldand PaperworkRECIPIENT'S name, stret adres, city or town, state or province, country, and ZIP or foreign postal code $3Nondividend distributions$4Federal income tax withheldThis is important taxRECIPIENT'S name, stret adres, city or town, state or province, country, and ZIP or foreign postal code $3Nondividend distributions$4Federal income tax withheld For Privacy ActWho must le.If your principal business, ofce orUse the followingFor Privacy Actinformation and is6Investment expensesand PaperworkCaution:agency, or legal residence in theaddress:being furnished to Street address (including apt. no.)$5Section 199A dividends $6Investment expensesReduction Act$5Section 199A dividends $6Investment expensesthe IRS. If you are$5Section 199A dividends $Reduction Actthe name and TIN used on your 94X series tax return(s) or you may becase of an individual, is located in:7Foreign tax paid8Foreign country or U.S. possession Notice, see the7Foreign tax paid8Foreign country or U.S. possession return, a negligence7Foreign tax paid8Foreign country or U.S. possession Notice, see thesubject to information return penalties. Do not use the name and/or TIN ofAlabama, Arizona, Arkansas, Delaware,Internal Revenue ServiceCity or town, state or province, country, and ZIP or foreign postal code $current General$penalty or other$current Generalyour paying agent or service bureau. Florida, Georgia, Kentucky, Maine,P.O. Box 149213 Instructions forsanction may beInstructions fornumber), and TIN in the spaces provided on the form. The name, address,Massachusetts, Mississippi, NewAustin, TX 78714-92139Cash liquidation distributions10 Noncash liquidation distributions Certain9Cash liquidation distributions10 Noncash liquidation distributionsimposed on you if9Cash liquidation distributions10 Noncash liquidation distributionsCertainHampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Texas, Information this income is taxableInformationupper left area of Form 1097, 1098, 1099, 3921, 3922, 5498, or W-2G. Vermont, Virginiaand the IRS $$Returns.$$determines that it has$$Returns.Alaska, Colorado, Hawaii, Idaho, not been reported.Illinois, Indiana, Iowa, Kansas, 11requirement 12Exempt-interest dividends13bond interest dividends 11requirement 12Exempt-interest dividends13 bond interest dividends 11requirement 12Exempt-interest dividends13 bond interest dividends Montana, Nebraska, Nevada, NorthInternal Revenue Service Center Michigan, Minnesota, Missouri,P.O. Box 219256 $$$$$$Dakota, Oklahoma, Oregon, South Kansas City, MO 64121-9256Utah, Washington, Wisconsin, Wyoming Account number (see instructions)2nd TIN not.14State 15 16State tax withheld Account number (see instructions)14State 15 16State tax withheld Account number (see instructions)2nd TIN not.14State 15 16State tax withheld Carolina, South Dakota, Tennessee,$$$ $$$For more information and the Privacy Act and Paperwork Reduction Act Notice,Form1096(2024)Form1099-DIV(Rev. 1-2024) Department of the Treasury - Internal Revenue Service Form1099-DIV(Rev. 1-2024) (keep for your records)Department of the Treasury - Internal Revenue Service Form1099-DIV(Rev. 1-2022) LDC 5132 www.irs.gov/Form1099DIV Department of the Treasury - Internal Revenue Service see the 2024 General Instructions for Certain Information Returns.TFP 1099-R LASER PACKAGED SETTFP 5140 TFP 5141 TFP 5142 TFP 51009898 VOID CORRECTED CORRECTED (if checked) CORRECTED (if checked) Do Not Staple OMB No. 1545-0108PAYERS name, street address, city or town, state or province,1Gross distribution OMB No. 1545-0119 PAYERS name, street address, city or town, state or province,1Gross distribution OMB No. 1545-0119 Distributions From1Gross distribution OMB No. 1545-0119 Form1096 Annual Summary and Transmittal of DETACH BEFORE MAILINGDETACH BEFORE MAILINGDETACH BEFORE MAILINGDistributions FromPAYERS name, street address, city or town, state or province,Distributions FromMANUFACTURED ON OCR LASER BOND PAPER USING HEAT RESISTANT INKSMANUFACTURED ON OCR LASER BOND PAPER USING HEAT RESISTANT INKSMANUFACTURED ON OCR LASER BOND PAPER USING HEAT RESISTANT INKScountry, ZIP or foreign postal code, and telephone no. Pensions, Annuities, Pensions, Annuities, Pensions, Annuities,country, ZIP or foreign postal code, and telephone no. country, ZIP or foreign postal code, and telephone no.$ 2aTaxable amount 2024 Retirement or$ 2aTaxable amount 2024 Retirement or$ 2aTaxable amount 2024 Department of the TreasuryU.S. Information Returns 2024Prot-Sharing Plans,Prot-Sharing Plans,Retirement or Prot-Sharing Plans, IRAs, InsuranceIRAs, InsuranceInternal Revenue ServiceIRAs, Insurance FILERS name$ Taxable amountForm 1099-R Contracts, etc. $ Taxable amountForm 1099-R Contracts, etc. $ 2bTaxable amountForm 1099-R Contracts, etc.2bnot determined TotalCopy A2bnot determined TotalCopyBnot determined TotalCopy C PAYERS TIN RECIPIENTS TIN 3Capital gain (included in 4 distribution PAYERS TIN ForRECIPIENTS TIN 3Capital gain (included in 4 distribution PAYERS TIN Report thisRECIPIENTS TIN 3Capital gain (included in 4 distribution Street address (including room or suite number)For Recipient's box 2a) Federal income tax Internal Revenuebox 2a) Federal income tax income on yourbox 2a) Federal income tax Recordswithheld Service Centerwithheld federal taxwithheld City or town, state or province, country, and ZIP or foreign postal codereturn. If this $ $ File with Form 1096. $ $ form shows$ $ Name of person to contact Telephone number For Ofcial Use OnlyDesignated RothNet unrealized For Privacy ActDesignated RothNet unrealized federal incomeDesignated RothNet unrealizedRECIPIENTS name 5Employee contributions/ 6appreciation in RECIPIENTS name, stret adres, city or town, state or province, country and ZIP or foreign postal code 5Employee contributions/ 6appreciation in RECIPIENTS name, stret adres, city or town, state or province, country and ZIP or foreign postal code 5Employee contributions/ 6appreciation incontributions oremployers securities and Paperworkcontributions oremployers securities tax withheld incontributions oremployers securities Email address Fax numberinsurance premiums Reduction Actinsurance premiums box 4, attachinsurance premiumsStreet address (including apt. no.) $ 7DistributionSEP/ $ 8Other Notice, see the $ 7DistributionSEP/ $ 8Other this copy to$ 7DistributionIRA/ $ 8Other 1This information is2 Social security number 3 Total number of forms $ 4 Federal income tax withheld $ 5 Total amount reported with this Form 1096IRA/ 2024 GeneralIRA/ your return. City or town, state or province, country, and ZIP or foreign postal code code(s) SIMPLE 9bTotal employee contributions Instructions forcode(s) SIMPLE 9bTotal employee contributions This information iscode(s) SEP/ $ 6% 1097-BTC10981098-C1098-E1098-F1098-Q1098-T1099-A1099-B1099-C1099-CAP1099-DIV1099-G1099-INT1099-K9aYour percentage of total$ % Certain12 requirement$ 9aYour percentage of total$ 10 % $ being furnished to111st year of desig. 12 requirement$ 9a distribution SIMPLE $ 9bTotal employee contributions 32 $ being furnished to the IRS. 78 84 03 74 83 80 79 85 73 3921 91 86 92 10%$ Information%$ Your percentage of totalW-2G50 81distribution Returns. distribution the IRS. %10Amount allocable to IRR111st year of desig. 12 14State tax withheld 15State/Payers state no.10Amount allocable to IRR111st year of desig.14State tax withheld 15State/Payers state no.16State distribution 14State tax withheld 15State/Payers state no.16State distribution16State distribution Amount allocable to IRR within 5 years Roth contrib. requirement$ within 5 years Roth contrib. within 5 years Roth contrib. 1099-LS 1099-LTC1099-MISC 1099-NEC 1099-OID1099-PATR 1099-Q1099-QA 1099-R1099-S1099-SA 1099-SB25 392254985498-ESA5498-QA $$ $ $ $ $ $ $ $ 16 $ 93 95 71 96 97 31 1A 98 75 94 43 26 28 72 2AAccount number (see instructions) 13Date of17Local tax withheld 18Name of locality Account number (see instructions) 13Date of17Local tax withheld 18Name of locality 19Local distribution 13Date of17Local tax withheld 18Name of locality 19Local distribution19Local distribution payment$ Account number (see instructions) payment$ $payment$ $ $$ $ $ $ $ 5498-SA 27 $Form 1099-R 41-0852411 www.irs.gov/Form1099R Department of the Treasury - Internal Revenue Service www.irs.gov/Form1099R Department of the Treasury - Internal Revenue Service www.irs.gov/Form1099R Department of the Treasury - Internal Revenue ServiceForm 1099-R Form 1099-R (keep for your records)DoNotCutorSeparateFormsonThisPage DoNotCutorSeparateFormsonThisPageReturn 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 at mailer (not folded).9898 VOID CORRECTED CORRECTED (if checked) CORRECTED (if checked) 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.Distributions FromDistributions From PAYERS name, street address, city or town, state or province,1Gross distribution OMB No. 1545-0119 PAYERS name, street address, city or town, state or province,1Gross distribution OMB No. 1545-0119PAYERS name, street address, city or town, state or province,1Gross distribution OMB No. 1545-0119 Distributions From country, ZIP or foreign postal code, and telephone no. country, ZIP or foreign postal code, and telephone no. country, ZIP or foreign postal code, and telephone no. Pensions, Annuities, TitleDatePensions, Annuities, Pensions, Annuities, SignatureRetirement or Retirement orRetirement or $ 2aTaxable amount 2024 Prot-Sharing Plans,$ 2aTaxable amount 2024 Prot-Sharing Plans,$ 2aTaxable amount 2024 Prot-Sharing Plans,When to le. If any date shown falls on a Saturday, Sunday, or legal IRAs, InsuranceIRAs, Insurance$ Form 1099-R Instructions the due date is the next business day. File Form 1096 in the calendar IRAs, Insurance Contracts, etc.Future developments. For the latest information about developments $ Form 1099-R Contracts, etc. $ Form 1099-R Contracts, etc. related to Form 1096, such as legislation enacted after it was published, goyear following the year for which the information is being reported, as to www.irs.gov/Form1096. follows.2bTaxable amountTotalCopy A2bTaxable amountTotalCopyB2bTaxable amountTotalReminder.Copy Cnot determined distribution not determined distribution Report thisRECIPIENTS TIN not determined 4 distribution For Recipient'sreturns. Go to www.irs.gov/inforeturn box 2a) withheld Internal Revenue Forbox 2a) withheld income on yourbox 2a) withheld Records *Leap years do not impact the due date. See Announcement 91-179,PAYERS TIN RECIPIENTS TIN 3Capital gain (included in 4Federal income taxPAYERS TIN RECIPIENTS TIN 3Capital gain (included in 4Federal income tax PAYERS TIN 3Capital gain (included inFederal income taxthe 2024 General Instructions for Certain Information Returns.Service Centerfederal taxPurpose of form. Use this form to transmit paper Forms 1097, 1098,1991-49 I.R.B. 78, for more information.Designated Rothemployers securitiesFor Privacy Actcontributions orappreciation inRECIPIENTS name, stre return. If this$ 5Employee contributions/$ 6appreciation in 1099, 3921, 3922, 5498, and W-2G to the IRS.Where To File Use the followingCaution:RECIPIENTS name $ 5Employee contributions/$ 6Net unrealizedFile with Form 1096. $ 5Employee contributions/$ 6Net unrealizedform showsDesignated RothNet unrealized number of returns. If your principal business, ofce or t adres, city or town, state or province, country and ZIP or foreign postal codeinsurance premiums appreciation in RECIPIENTS name, stret adres, city or town, state or province, country and ZIP or foreign postal code Designated Rothemployers securities federal income$ insurance premiums $ employers securities agency, or legal residence in theaddress:Who must le. contributions orand Paperworkinsurance premiums tax withheld incontributions orCaution:case of an individual, is located in:Reduction Actbox 4, attach $ IRA/ $ 8Other Notice, see the $ 7DistributionIRA/ $ 8Other this copy to7DistributionIRA/ 8Other the name and TIN used on your 94X series tax return(s) or you may beAlabama, Arizona, Arkansas, Delaware,Internal Revenue Serviceyour return. Street address (including apt. no.) 7DistributionSEP/ 2024 Generalcode(s) SIMPLE This information iscode(s) SEP/ $ subject to information return penalties. Do not use the name and/or TIN ofFlorida, Georgia, Kentucky, Maine,Austin, TX 78714-9213code(s) SIMPLE Instructions forSEP/ SIMPLE your paying agent or service bureau. Hampshire, New Jersey, New Mexico,P.O. Box 149213 This information isMassachusetts, Mississippi, New City or town, state or province, country, and ZIP or foreign postal code9aYour percentage of total$ % Certain9aYour percentage of total$ % being furnished to the IRS. 9aYour percentage of total$ 9b % being furnished to the IRS. New York, North Carolina, Ohio, Texas, 9bTotal employee contributions Information9bTotal employee contributions distribution % Total employee contributions Vermont, Virginianumber), and TIN in the spaces provided on the form. The name, address, within 5 years Roth contrib. requirement$ distribution %$ within 5 years Returns. Roth contrib. requirement$ distribution %$ $ Amount allocable to IRR111st year of desig. 12 requirement$ 14State tax withheld upper left area of Form 1097, 1098, 1099, 3921, 3922, 5498, or W-2G. Alaska, Colorado, Hawaii, Idaho,Internal Revenue Service Center 10Amount allocable to IRR111st year of desig. 12 14State tax withheld 15State/Payers state no.10Amount allocable to IRR111st year of desig. 12 14State tax withheld 15State/Payers state no.10 $ 16State distribution Roth contrib. $ 15State/Payers state no. $ 16State distribution Illinois, Indiana, Iowa, Kansas, Kansas City, MO 64121-925616State distribution within 5 years Michigan, Minnesota, Missouri,P.O. Box 219256 $ $ Montana, Nebraska, Nevada, North $ $ $ $ $ $ 13Date of17Local tax withheld 18Name of locality 19Local distribution Dakota, Oklahoma, Oregon, South Account number (see instructions) 13Date of17Local tax withheld 18Name of locality Account number (see instructions) 13Date of17Local tax withheld 18Name of locality Account number (see instructions) payment$ $ Utah, Washington, Wisconsin, Wyoming 19Local distribution 19Local distribution Carolina, South Dakota, Tennessee,payment$ $ payment$ Form $ (keep for your records) LRC $ 5142 $ Form1096(2024)Form 1099-R LRA 41-0852411 5140 $ Form $ 1099-R LRB 5141 www.irs.gov/Form1099R $ 1099-R www.irs.gov/Form1099R Department of the Treasury - Internal Revenue Service$ For more information and the Privacy Act and Paperwork Reduction Act Notice, www.irs.gov/Form1099R Department of the Treasury - Internal Revenue Service Department of the Treasury - Internal Revenue Service see the 2024 General Instructions for Certain Information Returns.Required Envelope:(3) 1096 Transmittal forms are included with each set TFP: 77771 or 77772TFP 1099-DIV LASER PACKAGED SET* TFP 1099-R LASER PACKAGED SET FOR 50 EMPLOYEES FOR 50 EMPLOYEES61074-Part PRE-PACKAGED CONVENIENCE SET includes: 56466-Part PRE-PACKAGED CONVENIENCE SET includes:5130 (50), 5131 (50), 5132 (100), 5100 - 1096 (3) 5140 (50), 5141 (50), 5142 (100), 5143 (100), 5100 - 1096 (3)FOR 25 EMPLOYEES FOR 25 EMPLOYEES6107254-Part PRE-PACKAGED CONVENIENCE SET includes: 5644254-Part PRE-PACKAGED CONVENIENCE SET includes:5130 (25), 5131 (25), 5132 (50), 5100 - 1096 (3) 5140 (25), 5141 (25), 5142 (25), 5143 (25), 5100 - 1096 (3)5646256-Part PRE-PACKAGED CONVENIENCE SET includes:5140 (25), 5141 (25), 5142 (50), 5143 (50), 5100 - 1096 (3)19"