b'1099 PRE-PRINTED & BLANK FORMSPressure Seal 1099 Forms1A VOID CORRECTED (if checked) OMB No. 1545-0112 S2020 5115B 1A This proof is submitted for your review and approval. It is supplied for content, layout, and version review and does not reflect paper or ink match. Please review your proof carefully. S201 5177B19238 8510PAYERS name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.Payers RTN (optional)Form1099-INT Form 1099-R CORRECTED (if checked) Distributions24 Form 1099-R CORRECTED (if checked)OMB Distributions241 $ Interest income (Rev. 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It is supplied for content, layout, and version review and does not reflect paper or ink match. Please review your proof carefully. S2001 8510274A recipients return,incometax$ Tax-exempt interest Specified private activity bond interest whenrequired. 1A 5/DesignatedPAYERS TIN RECIPIENTS TIN Employee PRINTED IN USA10Market discount 11 $ Bond premium 3 Capital$ 4 Federal income tax withheld $ or insurance contributionsRoth premiumscontributions $ 3 Capital$ 4 Federal income tax withheld $ 5or insurance contributionsRoth premiumscontributionsin box 2a)gain (included in box 2a)gain (includedO 1 $2 $ Bond premium on Treasury obligations13 $ Bond premium on tax-exempt bond 17 $ State tax withheld O $6 Net unrealized securitiesappreciation7 Distribution code(s) SISIRA/ $ 8 Other % in employers7 Distribution code(s) SS IIRA/ $ /Designated%FATCA filingArequirement 14Tax-exemptno.and tax credit 15State16State identification no. in employersMEPPL/E $6 Net unrealized securitiesappreciation MEPPL/E 8 OtherAccount number (see instructions) bond CUSIPG Form 1099-INT www.irs.gov/Form1099INT Department of the Treasury - Internal$Revenue Service G $9a Your percentage of total distribution %$ 9b Total employee contributions 9a Your percentage of total distribution %$9b Total employee contributions MW1159RECIPIENTS name, street address (including apt. no.), city or town, state or province, country, and ZIP or foreign postal code RECIPIENTS name, street address (including apt. no.), city or town, state or province, country, and ZIP or foreign postal codeCORRECTED (if checked) OMB No. 1545-0112PAYERS name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.Payers RTN (optional)Form1099-INT1 $ Interest income (Rev. 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Roth contrib. $ 10 Amount allocable to IRR within 5 yearsFor calendar year202 $ Early withdrawal penalty Copy B $14 State tax withheld 15 State/Payers state no. $ 16 State distribution $14 State tax withheld 15 State/Payers state no. $ 16 State distributionPAYERS TIN RECIPIENTS TIN 3 $ Interest on U.S. Savings Bonds and Treas. obligations For Recipient O $ 17 Local tax withheld 2 18 Name of locality or 9R $ 19 Local distribution $17 Local tax withheld 2 18 Name of locality or R $ 19 Local distribution G4Federal income tax withheld5Investment expenses Thisinformation the G Copycopy with your state, city,DepartmentFile this copy with your state, city,DepartmentO is important and tax is www.irs.gov/Form10 Copywww.irs.gov/Form109RECIPIENTS name, Street address (including apt. no.), City or town, state or province, country, and ZIP or foreign postal code $ $ being furnished you toare File thisInternal Revenue of the ServiceTreasury local income tax return, when required. 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OMB No. 1545-0119 24 Form 1099-R CORRECTED (if checked)OMB No. 1545-0119 24required IRS.to file penalty Form 1099-R CORRECTED (if checked) Distributions From Pensions, 1 Gross distribution Department of the Treasury - Internal Revenue Service1 8Tax-exempt interest 11 9 $ $ Specified private activity bond interest other sanction may be $ 1 Gross distribution $ 2a Taxable amount 12 requiremfilingent Annuities, Retirement Plans, IRAs,or $ 2b Taxable$ 2a Taxable amount T 12 Distributions From Retirement Plans, Pensions,IRAs,orimposed this Profit-Sharing $0Market discount Bond premium income is on taxable you ifand Profit-SharingAnnuities, Contracts, etc.the IRS determines that Insurance Contracts, etc. FATCAInsurance 1 $2Bond premium on Treasury obligations13 $ Bond premium on tax-exempt bond it has not been reported. 2b TaxableTo FATCA13 Date of payment not determinedamount diosttarilbution requiremfilingent 13 Date of paymentnot determinedamount disttarilbutionAccount number (see instructions) FATCA filingnt 1 $4Tax-exempt and tax credit 15State16State identification no.17 $ State tax withheld PAYERS name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.PAYERS name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.PRINTED IN USArequiremebond CUSIP no.Form 1099-INT (keep for your records) www.irs.gov/Form1099INT Department of the Treasury - Internal Revenue Service $ O G G OPAYERS TIN RECIPIENTS TIN PAYERS TIN RECIPIENTS TIN2025 image not available $ 3 Capital4 Federal income tax withheld $ 52025 image not available $ $in box 2a)gain (included Employee3 Capital4 Federal income tax withheld5 Employee or insurance contributionsRoth premiumscontributions in box 2a)gain (included or insurance contributionsRoth premiumscontributions/Designated/Designated First-Class Mail 6 Net unrealized securitiesappreciation $7 Distribution code(s) SS IIRA/ 8 Other % 6 Net unrealized appreciation $7 Distribution code(s) SISIRA/ 8 Other %SEE REVERSE SIDE FOR OPENING INSTRUCTIONS PRINTED IN U.S.A.at time of printing. in employers%$9b MEPPL/E contributions at time of p $ rinting.ImportantTax Return in employers securities MEPPL/EDocumentEnclosed $9a Your percentage of total distributionTotal employee $ $9a Your percentage of total distribution 9b Total employee $ contributionsRECIPIENTS name, street address (including apt. no.), city or town, state or province, country, and ZIP or foreign postal code %RECIPIENTS name, street address (including apt. no.), city or town, state or province, country, and ZIP or foreign postal codePROOF 1 8510027759Account number (see instruc.) 11 1st year of desig. Roth contrib. $ 10 Amount allocable to IRR within 5 years Account number (see instruc.) 11 1st year of desig. Roth contrib. $ 10 Amount allocable to IRR within 5 years14 State tax withheld 15 State/Payers state no. 16 State distribution$17 Local tax withheld 18 Name of locality $ 19 Local distribution $14 State tax withheld 15 State/Payers state no. $ 16 State distribution17 Local tax withheld 18 Name of locality 19 Local distribution$ $ $ $Copy C For Recipients Records R DepartmentCopy B RThis informationon your federal tax return. If this form shows federalThis informationwww.irs.gov/F the IRS. Internal Revenue of the ServiceTreasury www.irs.gov/Form109 Report this income is being in box furnished 4, attach to this the copy IRS. to your return.(keep for your records) orm109 income tax withheld is being furnished to PROOF 1 85100277441099 R - Copy C1099 R - Copy BFACE; PERFS AS SHOWN; SCREEN 20%5178BFACE; PERFS AS SHOWNZFoldVFold1A This proof is submitted for your review and approval. It is supplied for content, layout, and version review and does not reflect paper or ink match. Please review your proof carefully. 851019247 S2020 5502BVOID CORRECTED (if checked) OMB1099-INT Interest IncomePAYERS name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.Payers RTN (optional) FormNo. 1545-0112A FATCA filing requirement\x1f 8 (Rev. 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ZFoldSheets per pack500FORM DESCRIPTION5115B11" 1099-INT Copy BZ-Fold Simplex1 Sheet Equals 1 Form 5502B 11"1099-INTMultipleAccountCopyBZ-FoldSimplex1 Sheet Equals 1 Form 5177B11" 1099-R 4-Up Box Copy B, C, 2, 2V-Fold Duplex1 Sheet Equals 1 Form5178B11" 1099-R4-UpBoxBlankw/InstructionsV-FoldDuplex1 Sheet Equals 1 Form20'