b"1099 PRE-PRINTED FORMSIndividual Laser Packs1099-INT (INTEREST) 1099-DIV (DIVIDEND)VOID CORRECTED VOIDCORRECTEDPAYERS name, street address, city or town, state or province, country, ZIP Payers RTN (optional) OMB No. 1545-0112 PAYERS 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-INT Interestor foreign postal code, and telephone no.$Form1099-DIVDividends and 1 Interest income (Rev. January 2024) Income 1b (Rev. January 2024) Distributions For calendar year For calendar year$ $ 2 Early withdrawal penalty Copy A $2aTotal capital gain distr. $2bUnrecap. Sec. 1250 gainCopy AInternal Revenue For PAYERS TIN RECIPIENTS TIN$ 3 Interest on U.S. Savings Bonds and Treasury obligations ForPAYERS TIN RECIPIENTS TIN $2cSection 1202 gain$2dCollectibles (28%) gainService Center Internal Revenue2eSection 897 ordinary dividends2fSection 897 capital gainFile with Form 1096.Service Center$ $$ RECIPIENTS name 4 Federal income tax withheld5 Investment expenses File with Form 1096. RECIPIENTS name3Nondividend distributions 4Federal income tax withheldFor Privacy Act $ $ $$and Paperwork 6 Foreign tax paid 7 Foreign country or U.S. territory For Privacy ActStreet address (including apt. no.)$5Section 199A dividends $6Investment expensesReduction Act Street address (including apt. no.) $ 8 Tax-exempt interest 9 interest and Paperwork7Foreign tax paid8Foreign country or U.S. possession Notice, see the Reduction Actcurrent General City or town, state or province, country, and ZIP or foreign postal code $ CORRECTED (if checked) Notice, see theCity or town, state or province, country, and ZIP or foreign postal code $9 CORRECTED (if checked) Instructions for $ 11 Bond premium current GeneralCash liquidation distributions10 Noncash liquidation distributions Certain PAYERS name, street address, city or town, state or province, country, ZIP 10 Market discount Payers RTN (optional) Instructions forPAYERS name, street address, city or town, state or province, country, ZIP 1aTotal ordinary dividendsOMB No. 1545-0110 or foreign postal code, and telephone no. OMB No. 1545-0112 $$Information requirement 12 Bond premium on Treasury obligations13 Bond premium on tax-exempt bond CertainInterestor foreign postal code, and telephone no. 11 requirement 12Exempt-interest dividends13$1b FormReturns.Dividends and $ $ 1 Interest income Information $$bond interest dividends 1099-DIV Distributions Form1099-INTReturns. (Rev. January 2024)$ $ (Rev. January 2024) Income For calendar yearAccount number (see instructions) 2nd TIN not.14 Tax-exempt and tax credit15 State16For calendar year Account number (see instructions)2nd TIN not.14State 15 16State tax withheldbond CUSIP no. $ 2 Early withdrawal penalty $ 17 State tax withheld Copy B $$2aTotal capital gain distr. $2bUnrecap. Sec. 1250 gainCopy B $ $$For Recipient Form1099-INT(Rev. 1-2024)PAYERS TIN RECIPIENTS TIN Department of the Treasury - Internal Revenue Service For Recipient Form1099-DIV(Rev. 1-2024) PAYERS TINRECIPIENTS TIN Department of the Treasury - Internal Revenue Service$ 2cSection 1202 gain2dCollectibles (28%) gain 3 Interest on U.S. Savings Bonds and Treasury obligations $$ 2eSection 897 ordinary dividends2fSection 897 capital gain $ $$ RECIPIENT'Sname,stretadres,cityortown,stateorprovince,country,andZIPorforeignpostalcode 4 Federal income tax withheld5 Investment expenses This is important taxRECIPIENT'S name, stret adres, city or town, state or province, country, and ZIP or foreign postal code3Nondividend distributions 4Federal income tax withheldThis is important tax VOID CORRECTED $ $ information and isVOIDCORRECTED $$information and is PAYERS name, street address, city or town, state or province, country, ZIP Payers RTN (optional) OMB No. 1545-0112 7 Foreign country or U.S. territory being furnished to thePAYERS name, street address, city or town, state or province, country, ZIP 1aTotal ordinary dividendsOMB No. 1545-01106Investment expensesbeing furnished to or foreign postal code, and telephone no. $ 6 Foreign tax paid 9 InterestIRS. If you areor foreign postal code, and telephone no.$Form$5Section 199A dividends $8Foreign country or U.S. possession the IRS. If you are Form1099-INT return, a negligence1099-DIVDividends andreturn, a negligence 8 Tax-exempt interest interest penalty or other1b 7Foreign tax paidDistributionspenalty or other 1 Interest income (Rev. January 2024) Income sanction may be(Rev. January 2024) imposed on you if sanction may be $ $For calendar year CORRECTEDimposed on you if$For calendar year CORRECTEDthis income is taxable VOID $ this income is$9Cash liquidation distributions10 Noncash liquidation distributionsand the IRS PAYERS name, street address, city or town, state or province, country, ZIP Payers RTN (optional) OMB No. 1545-0112 Total capital gain distr. $VOID$ 1aTotal ordinary dividendsdetermines that it has or foreign postal code, and telephone no. 10 Market discount 11 Bond premium taxable and the IRSPAYERS name, street address, city or town, state or province, country, ZIPCopy A OMB No. 1545-0110DETACH BEFORE MAILINGDETACH BEFORE MAILINGRESISTANT INKSUSING HEAT MANUFACTURED ON OCR LASER BOND PAPER USING HEAT RESISTANT INKSON OCR LASER BOND PAPERPAYERS TIN RECIPIENTS TIN$ 2 Early withdrawal penalty $ 12 Bond premium on Treasury obligations $ 13Copy A determines that it hasInterestPAYERS TIN RECIPIENTS TIN $2aTotal capital gain distr.11requirement 12Exempt-interest dividends13bond interest dividends not been reported.Dividends and 2bUnrecap. Sec. 1250 gain Form1099-INT $ requirement $ $ Bond premium on tax-exempt bond not been reported. Income or foreign postal code, and telephone no.$$$1b ForForm1099-DIVDistributions 1 Interest income (Rev. January 2022) $2cSection 1202 gain$2dCollectibles (28%) gainInternal Revenue(Rev. January 2022)Account number (see instructions) 3 Interest on U.S. Savings Bonds and Treasury obligations 15 State16ForFor calendar year Account number (see instructions)2eSection 897 ordinary dividends2fSection 897 capital gainService CenterFor calendar year14 Tax-exempt and tax creditInternal Revenue17 State tax withheld 14State 15 File with Form 1096.Service Center 16State tax withheldRECIPIENTS name $ 4 Federal income tax withheld bond CUSIP no. $ 2 Early withdrawal penalty $ 20 Copy C RECIPIENTS name$3Nondividend distributions$4 Federal income tax withheld$$2aTotal capital gain distr. 2bUnrecap. Sec. 1250 gainCopy CForm(Rev. 1-2024) PAYERS TIN 5 Investment expenses File with Form 1096. $ Form(Rev. 1-2024) $5Section 199A dividends $6Investment expensesFor Privacy Act$For Payer$$ 1099-INT$ (keep for your records) $ 7 Foreign country or U.S. territory Department of the Treasury - Internal Revenue Service 1099-DIV(keep for your records)RECIPIENTS TIN and Paperworkand/or State Street address (including apt. no.) $ 6 Foreign tax paid RECIPIENTS TIN $ 3 Interest on U.S. Savings Bonds and Treasury obligations For Payer Street address (including apt. no.)PAYERS TIN$Department of the Treasury - Internal Revenue Service2dCollectibles (28%) gainCopy 1 or Copy 22cSection 1202 gain For Privacy Act$Reduction Act$ $ 8 Tax-exempt interest t ,cityortown, 9 or interest country,andZIPorforeignpostal and Paperwork$ 5 Investment expenses Copyand/or1or State2 City or town, state or province, country, and ZIP or foreign postal code $7Foreign tax paid8Foreign country or U.S. possession Notice, see the$2fSection 897 capital gainFor Privacy Act 2eSection 897 ordinary dividendsReduction ActCopy current General $RECIPIENT'Sname,streadres stateprovince, Notice, see theRECIPIENT'S name, stret adres, city or town, state or province, country, and ZIP or foreign postal code $3Nondividend distributions 4Federal income tax withheldcode 4 Federal income tax withheld Instructions for City or town, state or province, country, and ZIP or foreign postal codePAYERS name, street address, city or town, state or province, country, ZIP 10 Market discount 11 Bond premium current General7 Foreign country or U.S. possession For Privacy Actor foreign postal code, and telephone no.9 CORRECTED (if checked) $Certain$6Investment expensesand Paperwork $$ CORRECTED (if checked) $ OMB No. 1545-0112 Cash liquidation distributions10 Noncash liquidation distributions Information Payers RTN (optional) Instructions for PAYERS name, street address, city or town, state or province, country, ZIP 1aTotal ordinary dividendsOMB No. 1545-0110 or foreign postal code, and telephone no. 12 Bond premium on Treasury obligations $ 13 Bond premium on tax-exempt bond $ 6 Foreign tax paid 9 Interestand Paperwork11requirement $12Exempt-interest dividends $13bond interest dividends $5Section 199A dividends Dividends andReduction Act requirement $ 1 Interest income Certaininterest Reduction Act$1b FormReturns.$8Foreign country or U.S. possession Notice, see the Form1099-INT 1099-DIVInformation 8 Tax-exempt interest Notice, see the$$(Rev. January 2024) Distributionscurrent General Returns.(Rev. January 2024) 7Foreign tax paid Account number (see instructions) 2nd TIN not. $ 14 Tax-exempt and tax credit$ 15 State16$For calendar year $ Income current GeneralAccount number (see instructions)2nd TIN not.14State 15 16State tax withheld For calendar year 10 Noncash liquidation distributionsInstructions for 10 Market discount Instructions for$9Cash liquidation distributions Certain bond CUSIP no. $ 2 Early withdrawal penalty $ 17 State tax withheld 11 Bond premium Certain$$2aTotal capital gain distr. $2bUnrecap. Sec. 1250 gain$Copy BInformationMANUFACTUREDForm(Rev. 1-2024) PAYERS TIN RECIPIENTS TIN $ $ $ 12 Bond premium on Treasury obligations $ 13Copy B InformationForm1099-DIV(Rev. 1-2024) PAYERS TINRECIPIENTS TIN $$11requirement $12Exempt-interest dividends13bond interest dividends Returns. 1099-INTDepartment of the Treasury - Internal Revenue Service For Recipient Returns. Department of the Treasury - Internal Revenue Service For Recipient requirement Bond premium on tax-exempt bond 2cSection 1202 gain2dCollectibles (28%) gain 3 Interest on U.S. Savings Bonds and Treasury obligations $ $2eSection 897 ordinary dividends $$14State 15 $16State tax withheld$ 2fSection 897 capital gain Account number (see instructions) 2nd TIN not.14 Tax-exempt and tax credit15 State1617 State tax withheld Account number (see instructions)2nd TIN not. RECIPIENT'Sname,stretadres,cityortown,stateorprovince,country,andZIPorforeignpostalcode $ 4 Federal income tax withheld bond CUSIP no. This is important tax$ RECIPIENT'S name, stret adres, city or town, state or province, country, and ZIP or foreign postal code $3Nondividend distributions$4Federal income tax withheld$This is important tax Form1099-INT(Rev. 1-2022) $ 6 Foreign tax paid $ 5 Investment expenses information and is$ Form1099-DIV(Rev. 1-2022) $www.irs.gov/Form1099DIV $Department of the Treasury - Internal Revenue Servicewww.irs.gov/Form1099INT Department of the Treasury - Internal Revenue Service $information and is 7 Foreign country or U.S. territory being furnished to the5Section 199A dividends 6Investment expensesbeing furnished to IRS. If you arethe IRS. If you are $ interest return, a negligence$7Foreign tax paid$8Foreign country or U.S. possession return, a negligence 8 Tax-exempt interest 9 penalty or otherpenalty or other sanction may besanction may be $ VOID CORRECTEDimposed on you if$ VOIDCORRECTED imposed on you if $ this income isPAYERS name, street address, city or town, state or province, country, ZIP 9Cash liquidation distributions10 1aTotal ordinary dividends this income is taxable PAYERS name, street address, city or town, state or province, country, ZIP 10 Market discount 11 Bond premium taxable and the IRSor foreign postal code, and telephone no. $$Noncash liquidation distributionsOMB No. 1545-0110 or foreign postal code, and telephone no. Payers RTN (optional) OMB No. 1545-0112 determines that it has and the IRS requirement $ 12 Bond premium on Treasury obligations $ 13 Bond premium on tax-exempt bond determines that it hasIncome $12Exempt-interest dividends $13bond interest dividends Form1099-DIVDividends and $ $ 1 Interest income Form1099-INT Interest11requirement $1b not been reported.Distributions not been reported.(Rev. January 2022) (Rev. January 2022)Account number (see instructions) 14 Tax-exempt and tax credit15 State16For calendar year Account number (see instructions)14State 15 $For calendar yearbond CUSIP no. $ 2 Early withdrawal penalty $ 20 Copy C $16State tax withheld $2bUnrecap. Sec. 1250 gainCopy C17 State tax withheld2aTotal capital gain distr.$ PAYERS TINRECIPIENTS TIN $ $2cSection 1202 gain2dCollectibles (28%) gainFor PayerForm1099-INT(Rev. 1-2024) PAYERS TIN RECIPIENTS TIN Department of the Treasury - Internal Revenue Service Form1099-DIV(Rev. 1-2024) (keep for your records)Department of the Treasury - Internal Revenue Service and/or State (keep for your records) $ $$Copy 1 or Copy 23 Interest on U.S. Savings Bonds and Treasury obligations For Payer 2eSection 897 ordinary dividends2fSection 897 capital gain $ Copyand/or1or State2 RECIPIENT'S name, stret adres, city or town, state or province, country, and ZIP or foreign postal code $3Nondividend distributions$4Federal income tax withheldCopyRECIPIENT'Sname,stretadres,cityortown,stateorprovince,country,andZIPorforeignpostalcode 4 Federal income tax withheld5 Investment expenses For Privacy Act $ 6 Foreign tax paid $ 7 Foreign country or U.S. possession For Privacy Act$5Section 199A dividends $6Investment expensesand Paperwork and Paperwork$$Reduction Act $ Reduction Act7Foreign tax paid8Foreign country or U.S. possession Notice, see the 8 Tax-exempt interest 9 interest current General $ 10 Market discount $ 11 Bond premium Notice, see the$9Cash liquidation distributions $10 Noncash liquidation distributionsInstructions for Certain current Generalrequirement 12 Bond premium on Treasury obligations13 Bond premium on tax-exempt bond Instructions forCertain $12Exempt-interest dividends $13bond interest dividends Information Information Returns. $ $ Returns. 11requirement$ $ Account number (see instructions)2nd TIN not.$14State 15 16State tax withheldAccount number (see instructions) 2nd TIN not.14 Tax-exempt and tax credit15 State1617 State tax withheld $ bond CUSIP no. $ $ Form1099-INT(Rev. 1-2022) LIC 5122 www.irs.gov/Form1099INT $ Form1099-DIV(Rev. 1-2022) LDC 5132 www.irs.gov/Form1099DIV Department of the Treasury - Internal Revenue ServiceDepartment of the Treasury - Internal Revenue ServiceRequired Envelope: Required Envelope:APEX: DWMR or DWMRS APEX: DWMR or DWMRSTFP: 77771 or 77772 TFP: 77771 or 77772APEX - Sheets per packTFP - Forms per pack50s500s100s1000sFORM DESCRIPTIONLIALIA50051205120B1099-INT Federal Copy A1 Page Equals 2 FormsLIBLIB50051215121B1099-INT Recipient Copy B1 Page Equals 2 FormsN/AN/A51225122B1099-INT State and/or File Copy1 Page Equals 2 FormsLDALDA50051305130B1099-DIV Federal Copy A1 Page Equals 2 FormsLDBLDB50051315131B1099-DIV Recipient Copy B1 Page Equals 2 FormsN/AN/A51325132B1099-DIV State and/or File Copy1 Page Equals 2 Forms9"