b"1099 PRE-PRINTED FORMS1-Wide Continuous 1099-DIV COPY A 1099-MISC COPY A 1096Do Not Staple9191 VOIDCORRECTED OMB No. 1545-01109595 VOID CORRECTED OMB No. 1545-0115 Form1096 Annual Summary and Transmittal of OMB No. 1545-0108PAYERS name, street address, city or town, state or province, country, ZIP 1aTotal ordinary dividendsPAYERS name, street address, city or town, state or province, country, ZIP1 Rentsor foreign postal code, and telephone no.$Form1099-DIVDividends andor foreign postal code, and telephone no. $ Form1099-MISC MiscellaneousDepartment of the TreasuryU.S. Information Returns 2024Internal Revenue Service1b (Rev. January 2022) Distributions2 Royalties (Rev. January 2022) Information FILERS name$For calendar year For calendar yearCORRECTED (if checked) OMB No. 1545-0115 Street address (including room or suite number)20 $ 20 1 Rents __PAYERS name, street address, city or town, state or province, country, ZIP 2aTotal capital gain distr. 2bUnrecap. Sec. 1250 gainCopy A 3 Other income 4 Federal income tax withheld Copy Aor foreign postal code, and telephone no.PAYERS TIN RECIPIENTS TIN $2cSection 1202 gain$2dCollectibles (28%) gainForPAYERS TIN RECIPIENTS TIN $ 5 Fishing boat proceeds $ 6 Medical and health care$ 2Service Center Form1099-MISC MiscellaneousCity or town, state or province, country, and ZIP or foreign postal code$$2dCollectibles (28%) gainInternal Revenuepayments Internal Revenue For(Rev. January 2022) InformationService CenterRoyalties For calendar year Service Center RECIPIENTS name$2eSection 897 ordinary dividends $2fSection 897 capital gainFile with Form 1096. RECIPIENTS name $ 7 Payer made direct sales$ 8 of dividends or interest $ 3 Other income $ 20 Copy B Name of person to contact Telephone number For Ofcial Use OnlyFile with Form 1096. 4 Federal income tax withheld3Nondividend distributions 4Federal income tax withheldSubstitute payments in lieu$For Privacy Act6 Medical and health careFor Recipient Email address Fax number$$For Privacy ActPAYERS TINtotaling $5,000 or more of RECIPIENTS TIN and Paperworkpayments 12 Social security number 3 Total number of forms 4 Federal income tax withheld5 Total amount reported with this Form 10967152-4 / TC-D4 4PT M 7154-3 3PT / TCM35 Fishing boat proceeds5Section 199A dividends 6Investment expensesand Paperworkconsumer products to$ Reduction Act Street address (including apt. no.)$$Reduction ActStreet address (including apt. no.) recipient for resale 10 Gross proceeds paid to anNotice, see the$ $7Foreign tax paid8Foreign country or U.S. possession Notice, see the9 Crop insurance proceeds attorney current General$ 6 City or town, state or province, country, and ZIP or foreign postal code $current GeneralRECIPIENT'S name, stret addres, city or town, state or province, country, and ZIP or foreign postal code $ 7 Payer made direct sales8 of dividends or interest This is important taxW-2G 1097-BTC10981098-C1098-E1098-F1098-Q1098-T1099-A1099-B1099-C1099-CAP1099-DIV1099-G1099-INT1099-K$ $ Instructions for 9Cash liquidation distributions10 Noncash liquidation distributions Instructions for CertainCity or town, state or province, country, and ZIP or foreign postal code 11 Fish purchased for resale 12 Section 409A deferrals Certain$ Substitute payments in lieuinformation and is32 50 81 78 84 03 74 83 80 79 85 73 91 86 92 10Certaintotaling $5,000 or more of InformationInformationbeing furnished to consumer products to recipient for resale$$Returns.$ $ Returns. 10 Gross proceeds paid to anthe IRS. If you are FORM 9 Crop insurance proceedsFORFORM 13 14 Excess golden parachute15attorney penalty or other16 93 95 71 96 97 31 1A 98 75 94 43 25 26 28 72 2A11requirement 12Exempt-interest dividends13bond interest dividends requirement payments compensation $ $ return, a negligence1099-LS 1099-LTC1099-MISC 1099-NEC 1099-OID1099-PATR 1099-Q1099-QA 1099-R1099-S1099-SA 1099-SB 3921392254985498-ESA5498-QA $$$ $ 11 Fish purchased for resale 12 Section 409A deferrals sanction may be Account number (see instructions)2nd TIN not.14State 1516State tax withheld Account number (see instructions) 2nd TIN not.16 State tax withheld 17 State/Payers state no. 18 State income imposed on you if5498-SA this income is $$ $$ $ taxable and the IRS27determines that it Form1099-DIV(Rev. 1-2022) 41-0852411 www.irs.gov/Form1099DIV $Department of the Treasury - Internal Revenue Service Form1099-MISC(Rev. 1-2022)41-0852411 $ 13 requirement $14 Excess golden parachute15 compensation has not been paymentswww.irs.gov/Form1099MISC Department of the Treasury - Internal Revenue Service reported.DoNotCutorSeparateFormsonThisPage DoNotCutorSeparateFormsonThisPage Do Not Cut or Separate Forms on This PageDo Not Cut or Separate Forms o$n This Page $ Return this entire page to the Internal Revenue Service. Photocopies are not acceptable. Account number (see instructions) 16 State tax withheld 17 State/Payers state no. 18 State income Send this form, with the copies of the form checked in box 6, to the IRS in a at 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.9191 VOIDCORRECTED OMB No. 1545-01101099-MISC COPY B VOID CORRECTED (Rev. 1-2022) (keep for your records) $ $ Signature TitleDate9595 Form1099-MISCwww.irs.gov/Form1099MISC Department of the Treasury - Internal Revenue ServicePAYERS name, street address, city or town, state or province, country, ZIP 1aTotal ordinary dividendsPAYERS name, street address, city or town, state or province, country, ZIP1 Rents OMB No. 1545-0115or foreign postal code, and telephone no.FormDividends andor foreign postal code, and telephone no. $ Form1099-MISC MiscellaneousInstructions When to le. If any date shown falls on a Saturday, Sunday, or legal $1099-DIVFuture developments. For the latest information about developmentsthe due date is the next business day. File Form 1096 in the calendar 1b (Rev. January 2022) Distributions2 Royalties (Rev. January 2022) Information 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.For calendar year For calendar yearReminder.www.irs.gov/inforeturnfollows.$20 $ 20 returns. Go to 2aTotal capital gain distr. 2bUnrecap. Sec. 1250 gainCopy A 3 Other income 4 Federal income tax withheld Copy A the 2024 General Instructions for Certain Information Returns.$$For$ $ ForPurpose of form. Use this form to transmit paper Forms 1097, 1098,*Leap years do not impact the due date. See Announcement 91-179,PAYERS TIN RECIPIENTS TIN Required Envelope: Internal RevenuePAYERS TIN RECIPIENTS TIN 5 Fishing boat proceeds Required Envelope: 1099, 3921, 3922, 5498, and W-2G to the IRS.1991-49 I.R.B. 78, for more information.2cSection 1202 gain2dCollectibles (28%) gain6 Medical and health careInternal RevenueCaution: Where To File$$Service Centerpayments Service Center number of returns.2eSection 897 ordinary dividends2fSection 897 capital gainFile with Form 1096. $ $ File with Form 1096. Who must le.If your principal business, ofce orUse the following$$agency, or legal residence in theaddress:RECIPIENTS nameD IMOPCOURMTEANNTTETNACXL ROESTEUDRNAPEX:DWMR or DWMRS RECIPIENTS name 7 Payer made direct salesAPEX and TFP: DW19W or DW19WS Caution:case of an individual, is located in: Internal Revenue Service$3Nondividend distributions$4Federal income tax withheldFor Privacy Acttotaling $5,000 or more of8 of dividends or interest For Privacy Actthe name and TIN used on your 94X series tax return(s) or you may beAlabama, Arizona, Arkansas, Delaware, Substitute payments in lieu and Paperworkconsumer products to$ and Paperworksubject to information return penalties. Do not use the name and/or TIN ofFlorida, Georgia, Kentucky, Maine,P.O. Box 149213 7152-4 / TC-D4 4PT M 7154-3 3 PT/ TCM3Street address (including apt. no.)$5Section 199A dividends $6Investment expensesReduction ActStreet address (including apt. no.) recipient for resale 10 Gross proceeds paid to anReduction Act your paying agent or service bureau. Hampshire, New Jersey, New Mexico,Austin, TX 78714-9213Massachusetts, Mississippi, New 7Foreign tax paid8Foreign country or U.S. possession Notice, see the9 Crop insurance proceeds attorney Notice, see the number), and TIN in the spaces provided on the form. The name, address,New York, North Carolina, Ohio, Texas, current General City or town, state or province, country, and ZIP or foreign postal code TFP: 77771 or 77772 current GeneralCity or town, state or province, country, and ZIP or foreign postal code $ For: 1099-A, 1099-C, 1099-G, upper left area of Form 1097, 1098, 1099, 3921, 3922, 5498, or W-2G. Vermont, Virginia Internal Revenue Service Center $Instructions for11 Fish purchased for resale $ Instructions forCertain Alaska, Colorado, Hawaii, Idaho, 9Cash liquidation distributions10 Noncash liquidation distributions Certain12 Section 409A deferrals Information Illinois, Indiana, Iowa, Kansas,P.O. Box 219256 Returns.$ Returns.Montana, Nebraska, Nevada, North 11 requirement $12Exempt-interest dividends $13 bond interest dividends Information13 requirement $ payments 1099-PATR, 1099-S Michigan, Minnesota, Missouri, Kansas City, MO 64121-9256FORDakota, Oklahoma, Oregon, South 2nd TIN not.For: 1099-B, 1099-DIV, 1099-INT,Account number (see instructions) 2nd TIN not. 14 Excess golden parachute15 compensation 18 State income see the 2024 General Instructions for Certain Information Returns. Utah, Washington, Wisconsin, WyomingForm1096(2024)Carolina, South Dakota, Tennessee,$$$ $Account number (see instructions)1099-K, 1099-MISC, 1099-R 16 State tax withheld 17 State/Payers state no. $ For more information and the Privacy Act and Paperwork Reduction Act Notice, 14State 15 16State tax withheld$$$$ $Form1099-DIV(Rev. 1-2022) 41-0852411 www.irs.gov/Form1099DIV Department of the Treasury - Internal Revenue Service Form1099-MISC(Rev. 1-2022)41-0852411 www.irs.gov/Form1099MISC Department of the Treasury - Internal Revenue ServiceAPEXTFPFORM DESCRIPTIONTC-I4715041099-INT 4-Part Carbonless Copy A, B, State/LocalTC-M4715441099-MISC 4-Part Carbonless Copy A, State, B, State/Local TC-R4715941099-R 4-Part Carbonless Copy A, B, C, State/LocalTC-S4716041099-S 4-Part Carbonless Copy A, State, B, CTC18-3716831098 3-Part Carbonless Copy A, B, C1096109621096 2-Part Carbonless Annual Summary & Transmittal Of U.S. Information Returns*(5) 1096 Transmittal forms are included with each Federal Copy A (Red) form orderPARTS DESCRIPTION FOR 1099 & 1098 FORMS 1099-R 1099PAYERS COPIES PAYERS COPIESCopy AFor Internal Revenue Service Copy AFor Internal Revenue ServiceCopy 1For State, City or Local Tax Dept. StateFor State Copy Copy BFor Recipient to file with IRS Copy CFiler, Payer, Creditor, Lender or File CopyCopy CFor Recipients Records RECIPIENTS COPIESCopy 2For Recipient to file with State, City or Local Tax Dept.Copy BTransferor, Debtor, Recipient or Borrower Copy 2For Recipient to file with State 1098PAYERS COPIESCopy AFor Internal Revenue ServiceStateFor State CopyCopy CFor Recipient/Lender's RecordsRECIPIENTS COPYCopy BFor Payer/Borrower/Student25"