b"1099 PRE-PRINTED FORMS1099-DIV & 1099-R Packaged Sets1099-DIV LASER PACKAGED SET5130 5131 5132 51009191 VOIDCORRECTED CORRECTED (if checked) VOIDCORRECTED Do Not Staple 6969PAYERS 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 and DETACH BEFORE MAILINGINKSUSING HEAT or foreign postal code, and telephone no.$1b Form1099-DIV Dividends and DETACH BEFORE MAILINGUSING HEATINKS or foreign postal code, and telephone no.$1b Form1099-DIVDividends and DETACH BEFORE MAILINGUSING HEATINKS Department of the TreasuryU.S. Information Returns 2025DETACH BEFORE MAILING RESISTANTMANUFACTUREDRESISTANTMANUFACTUREDRESISTANTMANUFACTUREDMANUFACTURED ON OCR LASER BOND PAPER USING HEAT RESISTANT INKS(Rev. January 2024) Distributions(Rev. January 2024) Distributions(Rev. January 2024) DistributionsInternal Revenue ServiceFor calendar year For calendar year For calendar year FILERS name$$$ $2aTotal capital gain distr. $2bUnrecap. Sec. 1250 gainCopy A $2aTotal capital gain distr. $2bUnrecap. Sec. 1250 gainCopy B$2aTotal capital gain distr. $2bUnrecap. Sec. 1250 gainCopy 2 Street address (including room or suite number)PAYERS TIN RECIPIENTS TIN 2cSection 1202 gain2dCollectibles (28%) gainInternal Revenue ForPAYERS TINRECIPIENTS TIN 2cSection 1202 gain2dCollectibles (28%) gainFor RecipientPAYERS TINRECIPIENTS TIN 2cSection 1202 gain2dCollectibles (28%) gainTo be Filed withRecipients State or$$Service Center$$$$Local Income Tax2eSection 897 ordinary dividends2fSection 897 capital gainFile with Form 1096. $2eSection 897 ordinary dividends $2fSection 897 capital gainRECIPIENT'S name, stret adres, city or town, state or province, country, and ZIP or foreign postal code $2eSection 897 ordinary dividends $2fSection 897 capital gain Return, or Copy 1 City or town, state or province, country, and ZIP or foreign postal code For Ofcial Use Only BOND PAPERBOND PAPERBOND PAPERFor State Tax$$DepartmentRECIPIENTS name3Nondividend distributions 4Federal income tax withheldRECIPIENT'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$3Nondividend distributions$4Federal income tax withheld Name of person to contact Telephone number$$For Privacy Act$$information and isEmail address Fax number5Section 199A dividends 6Investment expensesand Paperwork5Section 199A dividends 6Investment expensesbeing furnished to5Section 199A dividends 6Investment expenses Street address (including apt. no.)$$Reduction Act$$the IRS. If you are$$ON OCR LASERON OCR LASERON OCR LASER7Foreign tax paid8Foreign country or U.S. possession Notice, see the7Foreign tax paid8Foreign country or U.S. possession return, a negligence7Foreign tax paid8Foreign country or U.S. possession 12 Social security number 3 Total number of forms 4 Federal income tax withheld5 Total amount reported with this Form 1096current Generalpenalty or other$ $City or town, state or province, country, and ZIP or foreign postal code $Instructions for$sanction may be$6 9Cash liquidation distributions10 Noncash liquidation distributions Certain9Cash liquidation distributions10 Noncash liquidation distributionsimposed on you if9Cash liquidation distributions10 Noncash liquidation distributionsW-2G 1097-BTC10981098-C1098-E1098-F1098-Q1098-T1099-A1099-B1099-C1099-CAP 1099-DA 1099-DIV1099-G1099-INT1099-K$$Information$$ this income is taxable$$32 50 81 78 84 03 74 83 80 79 85 73 7A 91 86 92 10and the IRS Returns.determines that it has 11requirement 12Exempt-interest dividends13bond interest dividends 11requirement 12Exempt-interest dividends13 bond interest dividends not been reported.11requirement 12Exempt-interest dividends13bond interest dividends$$$$$$1099-LS 1099-LTC1099-MISC 1099-NEC 1099-OID1099-PATR 1099-Q1099-QA 1099-R1099-S1099-SA 1099-SB 3921392254985498-ESA5498-QA 16 93 95 71 96 97 31 1A 98 75 94 43 25 26 28 72 2AAccount number (see instructions)2nd TIN not.14State 15 16State tax withheld Account number (see instructions)14State 15 16State tax withheld Account number (see instructions)14State 15 16State tax withheld$$$ $$$5498-SA Form1099-DIV(Rev. 1-2024) 41-0852411 www.irs.gov/Form1099DIV Department of the Treasury - Internal Revenue Service Form1099-DIV(Rev. 1-2024) (keep for your records)www.irs.gov/Form1099DIV Department of the Treasury - Internal Revenue Service Form1099-DIV(Rev. 1-2024) www.irs.gov/Form1099DIV Department of the Treasury - Internal Revenue Service 27DoNotCutorSeparateFormsonThisPage 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).9191 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 2024) DistributionsInstructions When to le. If any date shown falls on a Saturday, Sunday, or legal Future developments. For the latest information about developments $For calendar year $For calendar year $For calendar year related to Form 1096, such as legislation enacted after it was published, godate is the next business day. File Form 1096 in the calendar year following to www.irs.gov/Form1096. the year for which the information is being reported, as follows.$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 2 Caution: ForPAYERS TINRECIPIENTS TIN 2cSection 1202 gain2dCollectibles (28%) gainFor RecipientPAYERS TINRECIPIENTS TIN 2cSection 1202 gain2dCollectibles (28%) gainTo be Filed with or after January 1, 2024. Go to www.irs.gov/InfoReturn* Leap years do not impact the due date. See Announcement 91-179, PAYERS TIN RECIPIENTS TIN 2cSection 1202 gain2dCollectibles (28%) gainInternal RevenueRecipients State or$$Service Center$$$$Local Income Tax Also, see part F in the current General Instructions for Certain Information1991-49 I.R.B. 78, for more information. 2eSection 897 ordinary dividends2fSection 897 capital gainFile with Form 1096. $2eSection 897 ordinary dividends $2fSection 897 capital gain$2eSection 897 ordinary dividends $2fSection 897 capital gain Return, or Copy 1 Returns. Use this form to transmit paper Forms 1097, 1098,Where To FileFor State Tax$$Department Purpose of form. RECIPIENTS name3Nondividend distributions 4Federal income tax withheldRECIPIENT'S name, stret adres, city or town, state or province, country, and ZIP or foreign postal code3Nondividend 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 1099, 3921, 3922, 5498, and W-2G to the IRS.If your principal business, ofce orUse the following $$For Privacy Act$$information and isWho must le.agency, or legal residence in theaddress:5Section 199A dividends 6Investment expensesand Paperwork5Section 199A dividends 6Investment expensesbeing furnished to5Section 199A dividends 6Investment expensesCaution:case of an individual, is located in:Street address (including apt. no.)$$Reduction Act$$the IRS. If you are$$the name and TIN used on your 94X series tax return(s) or you may beAlabama, Arizona, Arkansas, Delaware, 7Foreign tax paid8Foreign country or U.S. possession Notice, see the7Foreign tax paid8Foreign country or U.S. possession return, a negligence7Foreign tax paid8Foreign country or U.S. possession subject to information return penalties. Do not use the name and/or TIN ofFlorida, Georgia, Kentucky, Maine,Internal Revenue Servicecurrent Generalpenalty or otheryour paying agent or service bureau. Massachusetts, Mississippi, NewP.O. Box 149213 sanction may beHampshire, New Jersey, New Mexico, City or town, state or province, country, and ZIP or foreign postal code $Instructions for$imposed on you if$number), and TIN in the spaces provided on the form. The name, address,New York, North Carolina, Ohio, Texas,Austin, TX 78714-92139Cash liquidation distributions10 Noncash liquidation distributions Certain9Cash liquidation distributions10 Noncash liquidation distributions this income is taxable9Cash liquidation distributions10 Noncash liquidation distributionsupper left area of Form 1097, 1098, 1099, 3921, 3922, 5498, or W-2G. Vermont, VirginiaInformationdetermines that it has$$Alaska, Colorado, Hawaii, Idaho, and the IRS $$Returns.$12Exempt-interest dividends $13bond interest dividends not been reported.11requirement 12Exempt-interest dividends13bond interest dividends Illinois, Indiana, Iowa, Kansas,Internal Revenue Service Center 11requirement 12Exempt-interest dividends13bond interest dividends 11 requirement Michigan, Minnesota, Missouri, Kansas City, MO 64121-9256Montana, Nebraska, Nevada, NorthP.O. Box 219256 Dakota, Oklahoma, Oregon, South $$$$$$Carolina, South Dakota, Tennessee,Account number (see instructions)2nd TIN not.14State 15 16State tax withheld Account number (see instructions)14State 15 16State tax withheld Account number (see instructions)14State 15 16State tax withheld Utah, Washington, Wisconsin, Wyoming $$$ $$$For more information and the Privacy Act and Paperwork Reduction Act Notice,41-0852411 5100 Form1096(2025) Created 3/20/25Form1099-DIV(Rev. 1-2024) 41-0852411 www.irs.gov/Form1099DIV Department of the Treasury - Internal Revenue Service Form1099-DIV(Rev. 1-2024)LDB (keep for your records)5131www.irs.gov/Form1099DIV Department of the Treasury - Internal Revenue Service Form1099-DIV(Rev. 1-2024) 5132 www.irs.gov/Form1099DIV Department of the Treasury - Internal Revenue Service see the current General Instructions for Certain Information Returns.1099-R LASER PACKAGED SET5140 5141 5142 51009898 VOID CORRECTED CORRECTED (if checked) CORRECTED (if checked)Distributions FromPAYERS name, street address, city or town, state or province,Do Not Staple 6969 DETACH BEFORE MAILINGDETACH BEFORE MAILINGDETACH BEFORE MAILINGPAYERS 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 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 INKSDETACH BEFORE MAILINGMANUFACTURED ON OCR LASER BOND PAPER USING HEAT RESISTANT INKSPensions, Annuities,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, Pensions, Annuities, OMB No. 1545-0108$ 2aTaxable amount 2025 Prot-Sharing Plans,$ 2aTaxable amount 2025 Prot-Sharing Plans,$ 2aTaxable amount 2025 Form1096 Annual Summary and Transmittal of 2025Retirement orRetirement orRetirement or IRAs, InsuranceIRAs, InsuranceProt-Sharing Plans,U.S. Information ReturnsIRAs, Insurance 2bTaxable amountForm 1099-R Contracts, etc. $ 2bTaxable amountForm 1099-R Contracts, etc. $ 2bTaxable amountForm 1099-R Department of the Treasury Contracts, etc.$ Internal Revenue ServiceFILERS namenot determined TotalCopy Anot determined TotalCopyBnot determined TotalCopy C distributionPAYERS TIN RECIPIENTS TIN 3Capital gain (included indistribution ForRECIPIENTS TIN 3Capital gain (included in 4Federal income taxPAYERS TIN Report thisRECIPIENTS TIN 3Capital gain (included in 4 distribution For Recipient's 4Federal income tax PAYERS TIN box 2a) withheld income on yourbox 2a) Federal income tax Street address (including room or suite number)box 2a) withheld Internal Revenuefederal taxwithheld RecordsService Center return. If this $ contributions or$ RECIPIENTS name, stret adres, city or town, state or province, country and ZIP or foreign postal code $ 5Employee contributions/$ 6Net unrealizedRECIPIENTS name, stre form shows$ 5Employee contributions/$ 6appreciation in City or town, state or province, country, and ZIP or foreign postal code For Ofcial Use Onlyfederal income RECIPIENTS name 5Employee contributions/ 6appreciation in Privacy Act, andDesignated Rothappreciation int adres, city or town, state or province, country and ZIP or foreign postal code contributions orNet unrealized Name of person to contact Telephone numberDesignated RothNet unrealized contributions oremployers securities tax withheld inDesignated Rothemployers securitiesinsurance premiums employers securities Paperwork Reduction$ insurance premiums IRA/ $ 8Other box 4, attach$ insurance premiums IRA/ $ 8Other Email address 2 Social security number Fax number 4 Federal income tax withheld5 Total amount reported with this Form 1096$ code(s) SIMPLE $ % Act Notice, see the 7DistributionSEP/ $ % this copy to7DistributionSEP/ $ 1This information is3 Total number of forms $ $Street address (including apt. no.) 7DistributionIRA/ 8Other Generalcode(s) SIMPLE your return.code(s) SIMPLESEP/ Instructions for CertainThis information is%City or town, state or province, country, and ZIP or foreign postal code9aYour percentage of total$ 9bTotal employee contributions Information9aYour percentage of total 9bTotal employee contributions being furnished to9aYour percentage of total 9bTotal employee contributions 6being furnished to the IRS. 1098-C1098-E1098-F1098-Q1098-T1099-A1099-B1099-C1099-CAP 1099-DA 1099-DIV1099-G1099-INT1099-Kwithin 5 years Returns. 1st year of desig. 12 requirement$ 14 distribution %$ 15State/Payers state no.10 within 5 years the IRS. 111st year of desig. 12 requirement$ 14 distribution %$ 15State/Payers state no. W-2G 1097-BTC1098 78 84 03 74 83 80 79 85 73 7A 91 86 92 10distribution % $ www.irs.gov/Form1099 11 Roth contrib. State tax withheld Amount allocable to IRRRoth contrib. State tax withheld $ 32 50 8110Amount allocable to IRR111st year of desig. 12 14State tax withheld 15State/Payers state no.10Amount allocable to IRR16State distribution 16State distribution16State distributionwithin 5 years Roth contrib. requirement$ $ $ $ $ $ $ 1099-LS 1099-LTC1099-MISC 1099-NEC 1099-OID1099-PATR 1099-Q1099-QA 1099-R1099-S1099-SA 1099-SB 3921392254985498-ESA5498-QA $ $ $ 13Date of17Local tax withheld 18Name of locality $ 19Local distribution 13Date of17Local tax withheld 18Name of locality $ 16 93 95 71 96 97 31 1A 98 75 94 43 25 26 28 72 2AAccount number (see instructions) 13Date of17Local tax withheld 18Name of locality Account number (see instructions) payment$ Account number (see instructions) payment$ $ 19Local distribution19Local distributionpayment$ $ $ $ $ 5498-SA $ Form $ www.irs.gov/Form1099R Form $ (keep for your records) www.irs.gov/Form1099R $ 271099-R 1099-RForm1099-R 41-0852411 www.irs.gov/Form1099R Department of the Treasury - Internal Revenue Service Department of the Treasury - Internal Revenue Service Department of the Treasury - Internal Revenue ServiceDoNotCutorSeparateFormsonThisPage 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 OMB No. 1545-0119 country, ZIP or foreign postal code, and telephone no. CORRECTED (if checked) OMB No. 1545-0119 Distributions FromCORRECTED (if checked) OMB No. 1545-0119 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,1Gross distribution PAYERS name, street address, city or town, state or province,1Gross distribution PAYERS name, street address, city or town, state or province,1Gross distribution Distributions From Distributions FromPensions, Annuities, Signaturecountry, ZIP or foreign postal code, and telephone no. Pensions, Annuities,country, ZIP or foreign postal code, and telephone no. Pensions, Annuities, TitleDateRetirement orRetirement or $ 2aTaxable amount 2025 Retirement or$ 2aTaxable amount 2025 Prot-Sharing Plans,$ 2aTaxable amount 2025 Prot-Sharing Plans,When to le. If any date shown falls on a Saturday, Sunday, or legal Prot-Sharing Plans,IRAs, InsuranceInstructions date is the next business day. File Form 1096 in the calendar year following IRAs, Insurance Future developments. For the latest information about developments $ Form 1099-R IRAs, Insurance$ 2bTaxable amountForm 1099-R Contracts, etc. $ 2bTaxable amountForm 1099-R related to Form 1096, such as legislation enacted after it was published, gothe year for which the information is being reported, as follows.Contracts, etc.Contracts, etc. to www.irs.gov/Form1096.2bTaxable amountTotalCopy Anot determined TotalCopyBnot determined distribution Copy C TotalCaution: For Recipient's PAYERS TIN RECIPIENTS TIN not determined distribution ForRECIPIENTS TIN 3Capital gain (included in 4 distributionPAYERS TIN Report thisRECIPIENTS TIN 3Capital gain (included in 4Federal income taxor after January 1, 2024. Go to www.irs.gov/InfoReturn* Leap years do not impact the due date. See Announcement 91-179, Internal Revenuebox 2a) Federal income tax income on yourbox 2a) withheld Returns. Records 1991-49 I.R.B. 78, for more information. 3Capital gain (included in 4Federal income tax PAYERS TIN withheld federal taxAlso, see part F in the current General Instructions for Certain InformationWhere To Filebox 2a) withheld Service Centerreturn. If this$ $ Purpose of form. Use this form to transmit paper Forms 1097, 1098, 1099, 3921, 3922, 5498, and W-2G to the IRS. RECIPIENTS name $ 5Designated Roth$ 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, stre form shows5Employee contributions/ 6appreciation in Who must le.If your principal business, ofce orUse the following t adres, city or town, state or province, country and ZIP or foreign postal code agency, or legal residence in the Employee contributions/Net unrealized Privacy Act, andcontributions orNet unrealized federal incomeinsurance premiums Net unrealized Caution:case of an individual, is located in: address:Designated Roth contributions oremployers securities Paperwork ReductionDesignated Rothemployers securities tax withheld in$ contributions or$ employers securities the name and TIN used on your 94X series tax return(s) or you may beAlabama, Arizona, Arkansas, Delaware,Internal Revenue Serviceinsurance premiums box 4, attachsubject to information return penalties. Do not use the name and/or TIN ofFlorida, Georgia, Kentucky, Maine, insurance premiums Act Notice, see the $ 7DistributionIRA/ $ 8Other this copy to7DistributionIRA/ 8Other your paying agent or service bureau. Massachusetts, Mississippi, NewP.O. Box 149213 $ $ General code(s) SIMPLE your return.code(s) SEP/ $ number), and TIN in the spaces provided on the form. The name, address,Hampshire, New Jersey, New Mexico,Austin, TX 78714-9213Street address (including apt. no.) 7DistributionIRA/ 8Other InstructionsSEP/ This information isSIMPLE % This information isNew York, North Carolina, Ohio, Texas, SEP/ Vermont, VirginiaCity or town, state or province, country, and ZIP or foreign postal code code(s) SIMPLE 9b % for Certain9aYour percentage of total$ % being furnished to the IRS. 9aYour percentage of total % $ 9bTotal employee contributions being furnished to the IRS. Alaska, Colorado, Hawaii, Idaho,Internal Revenue Service Center $ Information9bTotal employee contributions distribution upper left area of Form 1097, 1098, 1099, 3921, 3922, 5498, or W-2G. Illinois, Indiana, Iowa, Kansas, 9aYour percentage of totalTotal employee contributions within 5 years Returns. Roth contrib. $ distribution %$ $ Amount allocable to IRR111st year of desig. 12 requirement$ 14State tax withheld 15State/Payers state no. $ 16State distribution Michigan, Minnesota, Missouri,P.O. Box 219256 www.irs.gov/Form1099 within 5 years Montana, Nebraska, Nevada, North 10Amount allocable to IRR1st year of desig. 12 distribution % $ 15State/Payers state no.10Amount allocable to IRR111st year of desig. 12 requirement $ 14State tax withheld 15State/Payers state no.10 $ 16State distribution Roth contrib. 13Date of$ 17Local tax withheld 18Name of locality $ 19Local distribution Carolina, South Dakota, Tennessee,Kansas City, MO 64121-9256Dakota, Oklahoma, Oregon, South within 5 years 11Roth contrib. requirement$ 14State tax withheld $ $ 16State distribution $ Utah, Washington, Wisconsin, Wyoming $ $ $ 13Date of$ 17Local tax withheld 18Name of locality Account number (see instructions) payment$ For more information and the Privacy Act and Paperwork Reduction Act Notice,41-0852411 5100 Form1096(2025) Created 3/20/25Account number (see instructions) 13Date of17Local tax withheld 18Name of locality Account number (see instructions) 5141 payment$ Form $ 19Local distribution LRC $ 5142 $19Local distribution see the current General Instructions for Certain Information Returns.payment$ $ www.irs.gov/Form1099R $ (keep for your records) www.irs.gov/Form1099R $Form41-0852411 5140 $ Form 1099-R 1099-R Department of the Treasury - Internal Revenue Service$ Department of the Treasury - Internal Revenue Service1099-R www.irs.gov/Form1099R Department of the Treasury - Internal Revenue ServiceBLRRequired Envelope:(3) 1096 Transmittal forms are included with each set 77771 or 777721099-DIV LASER PACKAGED SET 1099-R LASER PACKAGED SETFOR 50 EMPLOYEES FOR 25 EMPLOYEES61075644254-Part Set includes: Copy A, B, State/File, State/File4-Part Set includes:Copy A, B, State/File, State/File(25 sheets each) 3 Transmittals (13 sheets each) 3 TransmittalsFOR 25 EMPLOYEES6107254-Part Set includes: Copy A, B, State/File, State/File (13 sheets each) 3 Transmittals16"