b"1099 PRE-PRINTED FORMSIndividual Laser Packs1099-INT (INTEREST) 1099-DIV (DIVIDEND)9292 VOID CORRECTED 5120 9191 VOIDCORRECTED 5130or foreign postal code, and telephone no. Form1099-INT Interest DETACH BEFORE MAILING or foreign postal code, and telephone no.$Form1099-DIVDividends and DETACH BEFORE MAILINGRESISTANT INKSUSING HEAT MANUFACTURED ON OCR LASER BOND PAPER USING HEAT RESISTANT INKSON OCR LASER BOND PAPERRESISTANTPAYERS name, street address, city or town, state or province, country, ZIP Payers RTN (optional) OMB No. 1545-0112 PAYERS name, street address, city or town, state or province, country, ZIP 1aTotal ordinary dividendsOMB No. 1545-0110 1 Interest income (Rev. January 2024) Income 1b (Rev. January 2024) Distributions For calendar year For calendar year$ $ 2 Early withdrawal penalty Copy A $2aTotal capital gain distr. $2bUnrecap. Sec. 1250 gainCopy AFor Total capital gain distr.Internal Revenue PAYERS TIN RECIPIENTS TIN$ 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 Street address (including apt. no.) $ 6 Foreign tax paid 7 Foreign country or U.S. territory For Privacy ActStreet address (including apt. no.)$5Section 199A dividends $6Investment expensesReduction Act 8 Tax-exempt interest 9 interest and Paperwork7Foreign tax paid8Foreign country or U.S. possession Notice, see the City or town, state or province, country, and ZIP or foreign postal code $ 10 Market discount CORRECTED (if checked) Reduction Act5121 City or town, state or province, country, and ZIP or foreign postal code $9 CORRECTED (if checked) current General5131Notice, see theInstructions for $ current GeneralCash liquidation distributions10 Noncash liquidation distributions Certain 11 Bond premium Instructions for PAYERS name, street address, city or town, state or province, country, ZIP 1aTotal ordinary dividendsInformationDETACH BEFORE MAILINGDETACH BEFORE MAILINGINKSUSING HEAT MANUFACTURED ON OCR LASER BOND PAPER USING HEAT RESISTANT INKSMANUFACTUREDRESISTANTPAYERS name, street address, city or town, state or province, country, ZIP Payers RTN (optional) OMB No. 1545-0112 $$OMB No. 1545-0110 or foreign postal code, and telephone no. 12 Bond premium on Treasury obligations13 Bond premium on tax-exempt bond Certainor foreign postal code, and telephone no.12Exempt-interest dividends $1b Returns.Dividends and requirement $ $ InformationInterest11requirement 13bond interest dividends Form1099-DIVForm1099-INTReturns.$ $ 1 Interest income (Rev. January 2024) Income $$(Rev. January 2024) Distributions For calendar yearAccount number (see instructions) 2nd TIN not.14 Tax-exempt and tax credit15 State1617 State tax withheld Account number (see instructions)2nd TIN not.14State 15 16State tax withheld For calendar year(Rev. 1-2024) PAYERS TIN bond CUSIP no. S $ $ For Recipient Form1099-DIV(Rev. 1-2024) PAYERS TINRECIPIENTS TIN $$2aTotal capital gain distr. $2bUnrecap. Sec. 1250 gainCopy B 41-0852411 RECIPIENTS TIN $ 2 Early withdrawal penalty $ Copy B 41-0852411 www.irs.gov/Form1099DIV $$2cSection 1202 gain2dCollectibles (28%) gainFor Recipient Form1099-INTwww.irs.gov/Form1099INT Department of the Treasury - Internal Revenue Service Department of the Treasury - Internal Revenue ServiceDo Not Cut or Separate Forms on This PageDo Not Cut or eparate Forms on This Page DoNotCutorSeparateFormsonThisPage DoNotCutorSeparateFormsonThisPage3 Interest on U.S. Savings Bonds and Treasury obligations $$BOND PAPERON OCR LASERMANUFACTURED2eSection 897 ordinary dividends2fSection 897 capital gain $ $$ 9292 RECIPIENT'S VOID tadres,city CORRECTED or or country,andZIPorforeignpostalcode $ 4 Federal income tax withheld $ 5 Investment expenses This is important tax9191 RECIPIENT'S name, stret adres, city or town, state or province, country, and ZIP or foreign postal code $3Nondividend distributions$4Federal income tax withheldThis is important tax name,stre town,stateprovince, VOIDCORRECTED 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 information and isPAYERS 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 being furnished to theor foreign postal code, and telephone no.5Section 199A dividends $the IRS. If you are IRS. If you are 1 Interest income Form1099-INT 9 Interestreturn, a negligence$1b Form $1099-DIVDividends andreturn, a negligence $$ $ 8 Tax-exempt interest $ interest penalty or other5122 $(Rev. January 2024) Distributionssanction may be51327Foreign tax paid8Foreign country or U.S. possession(Rev. January 2024) Income sanction may beFor calendar year penalty or other For calendar yearimposed on you if$imposed on you if or foreign postal code, and telephone no. VOID 11 Bond premium taxable and the IRSor foreign postal code, and telephone no.VOIDCORRECTED Fordetermines that it has 2 Early withdrawal penalty 10 Market discount CORRECTED this income is$2aTotal capital gain distr. $$9Cash liquidation distributions $10 Noncash liquidation distributions this income is taxable and the IRS Copy A determines that it hasPAYERS name, street address, city or town, state or province, country, ZIPCopy A not been reported. PAYERS name, street address, city or town, state or province, country, ZIP Payers RTN (optional) OMB No. 1545-0112 2bUnrecap. Sec. 1250 gain1aTotal ordinary dividendsOMB No. 1545-0110 3 Interest on U.S. Savings Bonds and Treasury obligations $ For$ (Rev. January 2024) IncomeDETACH BEFORE MAILING RECIPIENTS name$2eSection 897 ordinary dividends $$14State 15 $$1b (Rev. January 2024) Distributions DETACH BEFORE MAILINGINKSUSING HEAT MANUFACTURED ON OCR LASER BOND PAPER USING HEAT RESISTANT INKSON OCR LASER BOND PAPERPAYERS TIN RECIPIENTS TIN$ requirement $ 12 Bond premium on Treasury obligations $ 13 Bond premium on tax-exempt bond not been reported. InterestPAYERS TIN RECIPIENTS TIN $2cSection 1202 gain 11requirement2dCollectibles (28%) gain 12Exempt-interest dividends $13bond interest dividends Form1099-DIVDividends and Form1099-INT Internal Revenue 1 Interest income Service Center $ Internal Revenue2fSection 897 capital gainFile with Form 1096. For calendar yearService Center For calendar yearAccount number (see instructions) $ 14 Tax-exempt and tax credit15 State1617 State tax withheld Account number (see instructions)$16State tax withheldRECIPIENTS name Form1099-INT(Rev. 1-2024) $ 4 Federal income tax withheld $ 7bond CUSIP no. $ 2 Early withdrawal penalty$ Copy 2 Form1099-DIV(Rev. 1-2024) $3Nondividend distributions$4Federal income tax withheld$$2aTotal capital gain distr. $2bUnrecap. Sec. 1250 gainCopy 25 Investment expenses File with Form 1096. For Privacy Act $ 6 Foreign tax paid www.irs.gov/Form1099INT Department of the Treasury - Internal Revenue Service To be Filed with Street address (including apt. no.)(keep for your records)RECIPIENTS TIN and PaperworkTo be Filed withStreet address (including apt. no.) $ (keep for your records) Foreign country or U.S. territory For Privacy ActRecipients State or Street address (including apt. no.)PAYERS TIN$6Investment expensesReduction Act$2dCollectibles (28%) gainRecipients State orPAYERS TIN RECIPIENTS TIN $ Local Income Tax $5Section 199A dividends www.irs.gov/Form1099DIV Department of the Treasury - Internal Revenue Service Local Income Tax2cSection 1202 gain City or town, state or province, country, and ZIP or foreign postal code 8 Tax-exempt interest t ,cityortown, 9 interest or country,andZIPorforeignpostal and Paperwork5 Investment expensesReturn, or Copy 1 City or town, state or province, country, and ZIP or foreign postal code $7Foreign tax paid8Foreign country or U.S. possession $2eSection 897 ordinary dividends $2fSection 897 capital gain Return, or Copy 13 Interest on U.S. Savings Bonds and Treasury obligations Notice, see the Reduction ActFor State Tax current GeneralFor State TaxNotice, see theDepartment Instructions forDepartment$ $ $ name,streadres $ province, current General RECIPIENT'S name, stret adres, city or town, state or province, country, and ZIP or foreign postal code3 Certain4Federal income tax withheldstate Cash liquidation distributions10 Noncash liquidation distributions $Nondividend distributions RECIPIENT'S CORRECTED (if checked) code $ 4 Federal income tax withheld $ 7 Foreign country or U.S. territory PAYERS name, street address, city or town, state or province, country, ZIP 9 CORRECTED (if checked) Information$6Investment expenses PAYERS name, street address, city or town, state or province, country, ZIP 10 Market discount 11 Bond premium Instructions for$$1aTotal ordinary dividendsOMB No. 1545-0110 or foreign postal code, and telephone no. 12 Bond premium on Treasury obligations13 Payers RTN (optional) OMB No. 1545-0112 9 Interestor foreign postal code, and telephone no. 11 requirement 12Exempt-interest dividends13 bond interest dividends Form $Returns.Dividends and Certain 6 Foreign tax paid 5Section 199A dividendsrequirement $ $Bond premium on tax-exempt bond Information $1b 1099-DIV $8Foreign country or U.S. possessionForm1099-INT$Returns. (Rev. January 2024) Distributions 8 Tax-exempt interest Income 7Foreign tax paid $ $ 1 Interest income (Rev. January 2024) interest Account number (see instructions)2nd TIN not.$14State 15 $16State tax withheld For calendar yearFor calendar yearAccount number (see instructions) 2nd TIN not.14 Tax-exempt and tax credit15 State1617 State tax withheld $ 11 Bond premium $$2aTotal capital gain distr. $9Cash liquidation distributions10 Noncash liquidation distributions bond CUSIP no. $ 2 Early withdrawal penalty $ $ 10 Market discount Copy B Form1099-DIV(Rev. 1-2024) PAYERS TINRECIPIENTS TIN $$$2bUnrecap. Sec. 1250 gain$13 Copy B $ $For RecipientMANUFACTUREDForm1099-INT(Rev. 1-2024) LIAPAYERS TIN 5120 RECIPIENTS TIN Department of the Treasury - Internal Revenue Service $ For Recipient 41-0852411 www.irs.gov/Form1099DIV Department of the Treasury - Internal Revenue Service bond interest dividends41-0852411 www.irs.gov/Form1099INT $ requirement $ 12 Bond premium on Treasury obligations13Bond premium on tax-exempt bond $2cSection 1202 gain 11requirement2dCollectibles (28%) gain 12Exempt-interest dividends3 Interest on U.S. Savings Bonds and Treasury obligations $ $ bond CUSIP no. $ $ RECIPIENT'S name, stret adres Account number (see instructions)$2eSection 897 ordinary dividends $2fSection 897 capital gain$16State tax withheld$ Account number (see instructions) $ 14 Tax-exempt and tax credit15 State1617 State tax withheld 3Nondividend distributions 4 14State 15 $ RECIPIENT'Sname,stretadres,cityortown,stateorprovince,country,andZIPorforeignpostalcode 4 Federal income tax withheld5 Investment expenses This is important tax, city or town, state or province, country, and ZIP or foreign postal code $$Federal income tax withheldThis is important tax Form1099-INT(Rev. 1-2024) $ 6 Foreign tax paid $ 7 Foreign country or U.S. territory information and is$ Form1099-DIV(Rev. 1-2024) 5Section 199A dividendswww.irs.gov/Form1099DIV6Investment expenses$being furnished to www.irs.gov/Form1099INT being furnished to theinformation and is Department of the Treasury - Internal Revenue Service Department of the Treasury - Internal Revenue ServiceIRS. If you arethe IRS. If you are $ return, a negligence$7Foreign tax paid$8Foreign country or U.S. possession return, a negligence 8 Tax-exempt interest 9 interest penalty or othersanction may be sanction may bepenalty or other $ VOID $ 11 Bond premiumimposed on you if$9Cash liquidation distributions10 Noncash liquidation distributionsimposed on you if 10 Market discount CORRECTED this income isVOIDCORRECTEDthis income is taxable PAYERS name, street address, city or town, state or province, country, ZIP Payers RTN (optional) taxable and the IRSPAYERS name, street address, city or town, state or province, country, ZIP 1aTotal ordinary dividendsand the IRS OMB No. 1545-0112 OMB No. 1545-0110 or foreign postal code, and telephone no. determines that it hasor foreign postal code, and telephone no. 11 requirement $12Exempt-interest dividends $13 bond interest dividends determines that it hasDividends and requirement $ 12 Bond premium on Treasury obligations $ 13 Bond premium on tax-exempt bond not been reported. Interest$not been reported. Form1099-INT Form1099-DIV $ $ 1 Interest income (Rev. January 2024) Income $$1b (Rev. January 2024) Distributions Account number (see instructions) 14 Tax-exempt and tax credit15 State16For calendar year Account number (see instructions)14State 15 16State tax withheld For calendar year17 State tax withheldbond CUSIP no. $ 2 Early withdrawal penalty $ Copy 2 $$2aTotal capital gain distr. 2bUnrecap. Sec. 1250 gainCopy 2$ To be Filed with Form1099-DIV(Rev. 1-2024)LDB PAYERS TIN5131RECIPIENTS TIN $$2cSection 1202 gain$2dCollectibles (28%) gainTo be Filed withForm1099-INT(Rev. 1-2024)LIB (keep for your records) 5121 RECIPIENTS TIN Department of the Treasury - Internal Revenue Service Recipients State or (keep for your records)www.irs.gov/Form1099DIV Department of the Treasury - Internal Revenue Service Recipients State orPAYERS TIN www.irs.gov/Form1099INT $ Local Income Tax $$Local Income Tax3 Interest on U.S. Savings Bonds and Treasury obligationsReturn, or Copy 1 2eSection 897 ordinary dividends2fSection 897 capital gain Return, or Copy 1For State Tax For State Tax$ Department $$DepartmentRECIPIENT'Sname,stretadres,cityortown,stateorprovince,country,andZIPorforeignpostalcode 4 Federal income tax withheld5 Investment expenses RECIPIENT'S name, stret adres, city or town, state or province, country, and ZIP or foreign postal code3Nondividend distributions 4Federal income tax withheld$ $ $$ 6 Foreign tax paid 7 Foreign country or U.S. territory 5Section 199A dividends 6Investment expenses $ $$ 8 Tax-exempt interest 9 interest 7Foreign tax paid8Foreign country or U.S. possession$ $ $ 10 Market discount 11 Bond premium 9Cash liquidation distributions10 Noncash liquidation distributions $$ requirement $ 12 Bond premium on Treasury obligations $ 13 Bond premium on tax-exempt bond 11requirement 12Exempt-interest dividends13bond interest dividends$ $ $$ Account number (see instructions) 14 Tax-exempt and tax credit15 State1617 State tax withheld Account number (see instructions)14State 15 16State tax withheldbond CUSIP no. $ $ $ $ Form1099-INT(Rev. 1-2024) 5122 www.irs.gov/Form1099INT Department of the Treasury - Internal Revenue Service Form1099-DIV(Rev. 1-2024) 5132 www.irs.gov/Form1099DIV Department of the Treasury - Internal Revenue ServiceRequired Envelope: Required Envelope:77771 or 77772 77771 or 77772Sheets per pack2550500FORM DESCRIPTION5120255120505120B1099-INT Federal Copy A1 Sheet Equals 2 Forms5121255121505121B1099-INT Recipient Copy B1 Sheet Equals 2 Forms5122255122505122B1099-INT State and/or File Copy1 Sheet Equals 2 Forms5130255130505130B1099-DIV Federal Copy A1 Sheet Equals 2 Forms5131255131505131B1099-DIV Recipient Copy B1 Sheet Equals 2 Forms5132255132505132B1099-DIV State and/or File Copy1 Sheet Equals 2 Forms7"