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. 1545-0108$1b Form1099-DIVDividends and DETACH BEFORE MAILINGUSING HEATINKS $1b Form1099-DIV Dividends and DETACH BEFORE MAILINGUSING HEATINKS $1b Form1099-DIVDividends and DETACH BEFORE MAILINGUSING HEATINKS U.S. Information Returns 2025DETACH BEFORE MAILING RESISTANTMANUFACTUREDRESISTANTRESISTANTMANUFACTUREDMANUFACTURED ON OCR LASER BOND PAPER USING HEAT RESISTANT INKSor foreign postal code, and telephone no.or foreign postal code, and telephone no.or foreign postal code, and telephone no. Department of the Treasury (Rev. January 2024) Distributions(Rev. January 2024) Distributions(Rev. January 2024) Distributions Internal Revenue ServiceFor calendar year For calendar year For calendar year FILERS name$$$ $2aTotal capital gain distr. $2bUnrecap. Sec. 1250 gainCopy A $2aTotal capital gain distr. $2bUnrecap. Sec. 1250 gainCopy B$2aTotal capital gain distr. $2bUnrecap. Sec. 1250 gainCopy 2Street address (including room or suite number)PAYERS TIN RECIPIENTS TIN 2cSection 1202 gain2dCollectibles (28%) gainPAYERS TINForRECIPIENTS TIN 2cSection 1202 gain2dCollectibles (28%) gainFor RecipientRECIPIENTS TIN 2cSection 1202 gain2dCollectibles (28%) gainTo be Filed withInternal RevenuePAYERS TINRecipients State or$$Service Center$$$$Local Income Tax2eSection 897 ordinary dividends2fSection 897 capital gainFile with Form 1096. $2eSection 897 ordinary dividends $2fSection 897 capital gain$2eSection 897 ordinary dividends $2fSection 897 capital gain Return, or Copy 1 For Ofcial Use Only BOND PAPERBOND PAPERBOND PAPERCity or town, state or province, country, and ZIP or foreign postal codeFor State Tax$$DepartmentRECIPIENTS name3Nondividend distributions 4Federal income tax withheld RECIPIENT'S name, stret adres, city or town, state or province, country, and ZIP or foreign postal code3Nondividend 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 withheld Name of person to contact Telephone number$$For Privacy Act$$This is important tax$$ information and is 5Section 199A dividends 6Investment expensesand Paperwork5Section 199A dividends 6Investment expensesbeing furnished to5Section 199A dividends 6Investment expensesEmail address Fax numberStreet address (including apt. no.)$$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$$32 50 81 78 84 03 74 83 80 79 85 73 7A 91 86 92 10and the IRSMANUFACTUREDReturns.determines that it has 11requirement 12Exempt-interest dividends13bond interest dividends 11requirement 12Exempt-interest dividends13 bond interest dividends not been reported.11requirement 12Exempt-interest dividends13bond interest dividends$$$$$$1099-LS 1099-LTC1099-MISC 1099-NEC 1099-OID1099-PATR 1099-Q1099-QA 1099-R1099-S1099-SA 1099-SB 3921392254985498-ESA5498-QA 16 93 95 71 96 97 31 1A 98 75 94 43 25 26 28 72 2AAccount number (see instructions)2nd TIN not.14State 15 16State tax withheld Account number (see instructions)14State 15 16State tax withheld Account number (see instructions)14State 15 16State tax withheld$$$ $$$5498-SA 27Form1099-DIV(Rev. 1-2024) 41-0852411 www.irs.gov/Form1099DIV Department of the Treasury - Internal Revenue ServiceForm1099-DIV(Rev. 1-2024) (keep for your records)www.irs.gov/Form1099DIV Department of the Treasury - Internal Revenue ServiceForm1099-DIV(Rev. 1-2024) www.irs.gov/Form1099DIV Department of the Treasury - Internal Revenue ServiceDoNotCutorSeparateFormsonThisPage DoNotCutorSeparateFormsonThisPageReturn this entire page to the Internal Revenue Service. Photocopies are not acceptable. Send this form, with the copies of the form checked in box 6, to the IRS in a at mailer (not folded).9191 VOIDCORRECTED CORRECTED (if checked) VOIDCORRECTED Under penalties of perjury, I declare that I have examined this return and accompanying documents and, to the best of my knowledge and belief, they are true, correct, and complete.PAYERS name, street address, city or town, state or province, country, ZIP 1aTotal ordinary dividendsOMB No. 1545-0110PAYERS name, street address, city or town, state or province, country, ZIP 1aTotal ordinary dividendsOMB No. 1545-0110PAYERS name, street address, city or town, state or province, country, ZIP 1aTotal ordinary dividendsOMB No. 1545-0110 or foreign postal code, and telephone no.or foreign postal code, and telephone no.or foreign postal code, and telephone no.Signature TitleDate$Form1099-DIVDividends and$Form1099-DIV Dividends and$Form1099-DIVDividends and 1b (Rev. January 2024) Distributions1b (Rev. January 2024) Distributions1b (Rev. January 2024) DistributionsWhen to le. If any date shown falls on a Saturday, Sunday, or legal InstructionsFuture developments. For the latest information about developments For calendar year For calendar year For calendar year related to Form 1096, such as legislation enacted after it was published, godate is the next business day. File Form 1096 in the calendar year following $$$2aTotal capital gain distr. 2bUnrecap. Sec. 1250 gaintoCopy 2 the year for which the information is being reported, as follows.www.irs.gov/Form1096.$2aTotal capital gain distr. $2bUnrecap. Sec. 1250 gainCopy A $2aTotal capital gain distr. $2bUnrecap. Sec. 1250 gainCopy B$$Caution: PAYERS TINForRECIPIENTS TIN 2cSection 1202 gain2dCollectibles (28%) gainPAYERS TINRECIPIENTS TIN 2cSection 1202 gain2dCollectibles (28%) gainTo be Filed with * Leap years do not impact the due date. See Announcement 91-179, PAYERS TIN RECIPIENTS TIN 2cSection 1202 gain2dCollectibles (28%) gainInternal RevenueFor RecipientRecipients State oror after January 1, 2024. Go to www.irs.gov/InfoReturn $$Service Center$$$$Local Income Tax 1991-49 I.R.B. 78, for more information. Also, see part F in the current General Instructions for Certain Information $2eSection 897 ordinary dividends $2fSection 897 capital gainFile with Form 1096. $2eSection 897 ordinary dividends $2fSection 897 capital gain$2eSection 897 ordinary dividends $2fSection 897 capital gain Return, or Copy 1 Where To FileReturns.For State TaxPurpose of form. Use this form to transmit paper Forms 1097, 1098, DepartmentRECIPIENTS name3Nondividend distributions 4Federal income tax withheld RECIPIENT'S name, stret adres, city or town, state or province, country, and ZIP or foreign postal code3Nondividend distributions 4Federal income tax withheldRECIPIENT'S name, stret adres, city or town, state or province, country, and ZIP or foreign postal code3Nondividend distributions 4Federal income tax withheld 1099, 3921, 3922, 5498, and W-2G to the IRS.If your principal business, ofce orUse the following Who must le. $$For Privacy Act$$This is important tax$$Caution:case of an individual, is located in: address:information and isagency, or legal residence in the 5Section 199A dividends 6Investment expensesand Paperwork5Section 199A dividends 6Investment expensesbeing furnished to5Section 199A dividends 6Investment expenses Street address (including apt. no.)$7Foreign tax paid$8Foreign country or U.S. possession Reduction Act$7Foreign tax paid$8Foreign country or U.S. possession the IRS. If you are$7Foreign tax paid$8Foreign country or U.S. possession the name and TIN used on your 94X series tax return(s) or you may beAlabama, Arizona, Arkansas, Delaware,Internal Revenue Service 77771 or 77772Notice, see thereturn, a negligencesubject to information return penalties. Do not use the name and/or TIN ofFlorida, Georgia, Kentucky, Maine, current Generalpenalty or otheryour paying agent or service bureau. Hampshire, New Jersey, New Mexico,P.O. Box 149213 Massachusetts, Mississippi, New 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 78714-9213sanction may be 9Cash 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, VirginiaInformationand the IRSAlaska, Colorado, Hawaii, Idaho, $$Returns.$$determines that it has$$Illinois, Indiana, Iowa, Kansas,Internal Revenue Service Center not been reported.Michigan, Minnesota, Missouri,P.O. Box 219256 11requirement 12Exempt-interest dividends13bond interest dividends 11requirement 12Exempt-interest dividends13bond interest dividends 11requirement 12Exempt-interest dividends13bond interest dividends Montana, Nebraska, Nevada, North Kansas City, MO 64121-9256Dakota, Oklahoma, Oregon, South $$$$$$Utah, Washington, Wisconsin, Wyoming Carolina, South Dakota, Tennessee,Account number (see instructions)2nd TIN not.14State 15 16State tax withheld Account number (see instructions)14State 15 16State tax withheld Account number (see instructions)14State 15 16State tax withheld$$$ $$$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 ServiceForm1099-DIV(Rev. 1-2024)LDB (keep for your records)5131www.irs.gov/Form1099DIV Department of the Treasury - Internal Revenue ServiceForm1099-DIV(Rev. 1-2024) 5132 www.irs.gov/Form1099DIV see the current General Instructions for Certain Information Returns.Department of the Treasury - Internal Revenue Service1099-R LASER PACKAGED SET5140 5141 5142 51009898 VOID CORRECTED CORRECTED (if checked) CORRECTED (if checked) Do Not Staple 6969country, ZIP or foreign postal code, and telephone no. Pensions, Annuities,Pensions, Annuities, Form1096 Annual Summary and Transmittal ofPAYERS name, street address, city or town, state or province,1Gross distribution OMB No. 1545-0119 Distributions From1Gross distribution OMB No. 1545-0119 Distributions From1Gross distribution OMB No. 1545-0119 Distributions FromOMB No. 1545-0108 DETACH BEFORE MAILINGDETACH BEFORE MAILINGDETACH BEFORE MAILINGDETACH BEFORE MAILING MANUFACTURED 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 INKSMANUFACTURED ON OCR LASER BOND PAPER USING HEAT RESISTANT INKSPAYERS name, street address, city or town, state or province,PAYERS name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. country, ZIP or foreign postal code, and telephone no. Pensions, Annuities,Retirement orRetirement orRetirement orU.S. Information Returns 2025$ 2aTaxable amount 2025 Prot-Sharing Plans,$ 2aTaxable amount 2025 Prot-Sharing Plans,$ 2aTaxable amount 2025 Department of the Treasury Prot-Sharing Plans, Internal Revenue ServiceIRAs, InsuranceIRAs, InsuranceIRAs, Insurance FILERS name$ Form 1099-R Contracts, etc. $ Form 1099-R Contracts, etc. $ Form 1099-R Contracts, etc.2bTaxable amountTotalCopy A2bTaxable amountTotalCopyB2bTaxable amountTotalCopy C PAYERS TIN RECIPIENTS TIN not determined distribution PAYERS TIN ForRECIPIENTS TIN not determined 4 distribution Report thisRECIPIENTS TIN not determined 4 distribution For Recipient's Street address (including room or suite number)3Capital gain (included in 4Federal income taxInternal Revenue3Capital gain (included inFederal income tax income on your3Capital gain (included inFederal income tax RecordsPAYERS TINbox 2a) withheld Service Centerbox 2a) withheld federal taxbox 2a) withheld City or town, state or province, country, and ZIP or foreign postal codereturn. If this $ $ $ $ form shows, city or town, state or province, country and ZIP or foreign postal code $ 5Employee contributions/$ 6Net unrealizedName of person to contact Telephone number For Ofcial Use OnlyRECIPIENTS name 5Designated Roth6Net unrealizedRECIPIENTS name, stret adres, city or town, state or province, country and ZIP or foreign postal code 5Employee contributions/ 6Net unrealized federal incomecontributions oremployers securities Email address Fax numberEmployee contributions/appreciation inPrivacy Act, andDesignated Rothappreciation in RECIPIENTS name, stret adres Designated Rothappreciation in contributions oremployers securities Paperwork Reductioncontributions oremployers securities tax withheld ininsurance premiumsinsurance premiums Act Notice, see the $ insurance premiums $ box 4, attach$ $ 12 Social security number 3 Total number of forms 4 Federal income tax withheld5 Total amount reported with this Form 1096Street address (including apt. no.) $ 7DistributionSEP/ $ 8Other General 7DistributionIRA/ 8Other this copy to7DistributionIRA/ 8Other This information is$ $code(s) IRA/ Instructionscode(s) SEP/ your return.code(s) SEP/SIMPLE % for CertainSIMPLE % This information isSIMPLE $ % being furnished to $ Information$ 6 City or town, state or province, country, and ZIP or foreign postal code9aYour percentage of total 9bTotal employee contributions Returns. 9aYour percentage of total 9bTotal employee contributions being furnished to the IRS. 9aYour percentage of total 9bTotal employee contributions W-2G 1097-BTC10981098-C1098-E1098-F1098-Q1098-T1099-A1099-B1099-C1099-CAP 1099-DA 1099-DIV1099-G1099-INT1099-Kthe IRS. 50 81 78 84 03 74 83 80 79 85 73 7A 91 86 92 10distribution % $ www.irs.gov/Form1099 distribution %$ distribution %$ 3210Amount allocable to IRR11Roth contrib. 12 requirement$ 14State tax withheld 15State/Payers state no. $ 1610State distribution 111st year of desig. 12 requirement$ 14State tax withheld 15State/Payers state no. $ 1610State distribution 111st year of desig. 12 requirement$ 14State tax withheld 15State/Payers state no. $ 16State distribution 1099-MISC 1099-NEC 1099-OID1099-PATR 1099-Q1099-QA 1099-R1099-S1099-SA 1099-SB 3921392254985498-ESA5498-QA within 5 years 1st year of desig.Amount allocable to IRRRoth contrib. Amount allocable to IRRRoth contrib. 1099-LS 1099-LTC 95 71 96 97 31 1A 98 75 94 43 25 26 28 72 2Awithin 5 years within 5 years$ $ $$ $ $$ $ $ 16 93Date ofAccount number (see instructions) 13Date of17 18Name of locality 19Local distribution 13Date of17 18Name of locality 19Local distributionAccount number (see instructions) 13payment$ 17Local tax withheld 18Name of locality $ 19Local distribution payment$ Local tax withheld $ Account number (see instructions) payment$ Local tax withheld $$ $ $ $ $ $ 5498-SA 27Form1099-R 41-0852411 www.irs.gov/Form1099R Department of the Treasury - Internal Revenue ServiceForm 1099-R www.irs.gov/Form1099R Department of the Treasury - Internal Revenue ServiceForm 1099-R (keep for your records) www.irs.gov/Form1099R 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 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.PAYERS name, street address, city or town, state or province,1Gross distribution OMB No. 1545-0119 Distributions From1Gross distribution OMB No. 1545-0119 Distributions From1Gross distribution OMB No. 1545-0119 Distributions From PAYERS name, street address, city or town, state or province,PAYERS name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. Pensions, Annuities,Pensions, Annuities, $ Pensions, Annuities, TitleDatecountry, ZIP or foreign postal code, and telephone no. country, ZIP or foreign postal code, and telephone no. SignatureRetirement orRetirement orRetirement or $ 2aTaxable amount 2025 Prot-Sharing Plans,$ 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 InstructionsIRAs, InsuranceIRAs, InsuranceIRAs, Insurancedate is the next business day. File Form 1096 in the calendar year following Future developments. For the latest information about developments $ Form 1099-R Contracts, etc. $ Form 1099-R Contracts, etc. $ Form 1099-R Contracts, etc. the year for which the information is being reported, as follows.related to Form 1096, such as legislation enacted after it was published, go to www.irs.gov/Form1096.2bnot determined TotalCopy Anot determined TotalCopyBnot determined TotalCopy C Taxable amount 2bTaxable amount2bTaxable amountCaution: PAYERS TIN RECIPIENTS TIN 3Capital gain (included indistribution PAYERS TIN ForRECIPIENTS TIN 3Capital gain (included in 4 distribution Report thisRECIPIENTS TIN 3Capital gain (included in 4 distribution For Recipient's* Leap years do not impact the due date. See Announcement 91-179, PAYERS TIN Recordsbox 2a) 4Federal income taxInternal Revenuebox 2a) Federal income tax income on yourbox 2a) Federal income tax Also, see part F in the current General Instructions for Certain Information1991-49 I.R.B. 78, for more information. or after January 1, 2024. Go to www.irs.gov/InfoReturn withheld Service Centerwithheld federal taxwithheld Returns.return. If thisPurpose of form. Use this form to transmit paper Forms 1097, 1098,Where To File$ $ $ $ form shows$ $ 1099, 3921, 3922, 5498, and W-2G to the IRS. RECIPIENTS name 5Employee contributions/ 6Net unrealizedRECIPIENTS name, stret adres, city or town, state or province, country and ZIP or foreign postal code 5Employee contributions/ 6Net unrealized federal income , city or town, state or province, country and ZIP or foreign postal code 5Employee contributions/ 6Net unrealizedWho must le.If your principal business, ofce orUse the following RECIPIENTS name, stret adresDesignated Rothappreciation in Designated Rothappreciation in Designated Rothappreciation inPrivacy Act, andcontributions oremployers securities tax withheld incontributions oremployers securities Caution:agency, or legal residence in theaddress:contributions oremployers securities Paperwork Reductioninsurance premiums box 4, attachinsurance premiums case of an individual, is located in:Street address (including apt. no.) insurance premiums 8Other Act Notice, see the $ 7DistributionIRA/ $ 8Other this copy to$ 7DistributionIRA/ $ 8Other subject to information return penalties. Do not use the name and/or TIN ofAlabama, Arizona, Arkansas, Delaware,Internal Revenue Service$ 7DistributionIRA/ $ General code(s) SEP/ your return.code(s) SEP/ the name and TIN used on your 94X series tax return(s) or you may beFlorida, Georgia, Kentucky, Maine,P.O. Box 149213 code(s) SEP/ InstructionsSIMPLE This information isSIMPLE $ % your paying agent or service bureau. Massachusetts, Mississippi, NewAustin, TX 78714-9213Hampshire, New Jersey, New Mexico, SIMPLE for CertainThis information isNew York, North Carolina, Ohio, Texas, number), and TIN in the spaces provided on the form. The name, address, $ % Information$ % being furnished toVermont, VirginiaCity or town, state or province, country, and ZIP or foreign postal code9aYour percentage of total 9bTotal employee contributions Returns. 9aYour percentage of total 9bTotal employee contributions being furnished to the IRS. 9aYour percentage of total 9bTotal employee contributions the IRS. Alaska, Colorado, Hawaii, Idaho, upper left area of Form 1097, 1098, 1099, 3921, 3922, 5498, or W-2G.distribution % $ www.irs.gov/Form1099 requirement$ distribution %$ $ Amount allocable to IRR1st year of desig.requirement$ distribution %$ $ Illinois, Indiana, Iowa, Kansas,Internal Revenue Service Center within 5 years 1st year of desig.Amount allocable to IRRRoth contrib. within 5 years Michigan, Minnesota, Missouri,P.O. Box 219256 10Amount allocable to IRR11Roth contrib. 12 requirement$ 14State tax withheld 15State/Payers state no. $ 1610State distribution 111st year of desig. 12 14State tax withheld 15State/Payers state no.1610State distribution 11 Roth contrib. 12 14State tax withheld 15State/Payers state no.16State distribution Montana, Nebraska, Nevada, North Kansas City, MO 64121-9256within 5 years Dakota, Oklahoma, Oregon, South $ $ $$ $ $$ $ $ Carolina, South Dakota, Tennessee,Account number (see instructions) 13Date of17Local tax withheld 18Name of locality 19Local distribution 13Date of17Local tax withheld 18Name of locality 19Local distribution 13Date of17Local tax withheld 18Name of locality 19Local distribution Utah, Washington, Wisconsin, Wyoming Account number (see instructions) Account number (see instructions)payment$ $ payment$ $ payment$ $$ $ $ $ $ $ For more information and the Privacy Act and Paperwork Reduction Act Notice,41-0852411 5100 Form1096(2025) Created 3/20/25see the current General Instructions for Certain Information Returns.Form1099-R 41-0852411 5140 www.irs.gov/Form1099R Department of the Treasury - Internal Revenue ServiceForm 1099-R LRB 5141 www.irs.gov/Form1099R Department of the Treasury - Internal Revenue ServiceForm 1099-R (keep for your records) LRC www.irs.gov/Form1099R 5142 Department of the Treasury - Internal Revenue Service(3) Transmittal 1096 forms are included with each set1099-DIV LASER PACKAGED SET1099-R LASER PACKAGED SET FOR 100 RECIPIENTS FOR 100 RECIPIENTS959344-Part Set includes: (50 Sheets EACH) 1099-DIV Copy A, B, C, C 95944E4-Part Set includes: (50 Sheets EACH) 1099-R Copy A, B, C + Gum Seal ENV (100)18"