b"PRE-PRINTED 1099 FORMS PRE-PRINTED 1099 FORMSContinuous 1099 Forms Continuous 1099 Forms1099-R9898 VOID CORRECTED OMB No. 1545-0119 Distributions FromCOPY A9191 VOIDCORRECTED OMB No. 1545-01101099-DIV7171 VOID CORRECTED OMB No. 1545-0116 1099-NECPAYERS name, street address, city or town, state or province,1Gross distribution Pensions, Annuities, DETACH BEFORE MAILINGM7152-4 / TC-D4 4PT FOR MANUFACTURED ON OCR LASER BOND PAPER USING HEAT RESISTANT INKSPAYERS name, street address, city or town, state or province, country, ZIP$1aTotal ordinary dividendsForm1099-DIVDividends andCOPY A PAYERS name, street address, city or town, state or province, country, ZIPForm1099-NEC NonemployeeCOPY A country, ZIP or foreign postal code, and telephone no. $ Retirement or or foreign postal code, and telephone no.1b (Rev. January 2022) Distributionsor foreign postal code, and telephone no. (Rev. 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January 2022) Compensation Account number (see instructions) payment17 19Local distribution$$www.irs.gov/Form1099NEC Department of the Treasury - Internal Revenue Service3Nondividend distributions 4Federal income tax withheldFor Privacy ActDo Not Cut or Separate Forms on This PageDo Not Cut or Separate Forms on This Page For calendar year $ $Street address (including apt. no.)$7Foreign tax paid$8Foreign country or U.S. possession and Paperwork7171 VOID CORRECTED PAYERS TIN RECIPIENTS TIN $ 1 Nonemployee compensation Copy B Form 1099-R 41-0852411 www.irs.gov/Form1099R Department of the Treasury - Internal Revenue Service5Section 199A dividends 6Investment expensesReduction Act$ $M7152-4 / TC-D4 4PT FOR $$Notice, see theFor Recipientcurrent GeneralPAYERS name, street address, city or town, state or province, country, ZIPRECIPIENT'S name, street addres OMB No. 1545-0116 2 Payer made direct sales totaling $5,000 or more ofThis is important tax City or town, state or province, country, and ZIP or foreign postal code $9Cash liquidation distributions10 Noncash liquidation distributions Instructions foror foreign postal code, and telephone no. 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January 2022) Information Street address (including apt. no.) Paperwork Reduction Actcountry, ZIP or foreign postal code, and telephone no. Pensions, Annuities,For Privacy Act and For calendar yearStreet address (including room or suite number)$ 3 Other income 20 Copy A City or town, state or province, country, and ZIP or foreign postal code $ 4 Federal income tax withheld General Instructions forcurrentRetirement or Notice, see the PAYERS TIN RECIPIENTS TIN $ 5 Fishing boat proceeds $ 4 Federal income tax withheld ForAccount number (see instructions) 2nd TIN not.$ 5 State tax withheld 6 State/Payers state no. $ Certain InformationReturns. Form1099-NEC Nonemployee$ 2023 Prot-Sharing Plans, CORRECTED (if checked)PAYERS name, street address, city or town, state or province, country, ZIP City or town, state or province, country, and ZIP or foreign postal codeOMB No. 1545-0116or foreign postal code, and telephone no. 7 State income6 Medical and health careInternal Revenue2aTaxable amountpayments Service Center $ Name of person to contact Telephone number For Ofcial Use Only IRAs, Insurance $RECIPIENTS name $ 7 totaling $5,000 or more of$ 8 of dividends or interest File with Form 1096. Form1099-NEC(Rev. 1-2022)NECLMA41-0852411NEC5110 www.irs.gov/Form1099NEC Department of the Treasury - Internal Revenue Service (Rev. January 2022) Compensation Form 1099-R Contracts, etc.Payer made direct salesSubstitute payments in lieuFor Privacy ActEmail address Fax numberFor calendar year $Street address (including apt. no.) consumer products to$ attorney and PaperworkOMB No. 1545-0115 1099-MISCPAYERS TIN 1 RECIPIENTS TIN 2 Social security number $ Copy B Total amount reported with this Form 1096 2bTaxable amountTotalCopy A recipient for resale Reduction Act1 Nonemployee compensation3 Total number of forms 4 Federal income tax withheld5 9 Crop insurance proceeds 10 Gross proceeds paid to anNotice, see the$ For Recipient not determined distributionCORRECTED (if checked) $City or town, state or province, country, and ZIP or foreign postal code $ $ current General Form1099-MISC MiscellaneousCOPY B RECIPIENT'S name, street addres, city or town, state or province, country, and ZIP or foreign postal code 2 Payer made direct sales totaling $5,000 or more of79 1099-C This is important tax1099-DIV1099-G1099-INT1099-K PAYERS TIN RECIPIENTS TIN 3Capital gain (included in 4Federal income taxFor PAYERS name, street address, city or town, state or province, country, ZIP1 Rents 6consumer products to recipient for resale information and is being Instructions forfurnished to the IRS. If you are or foreign postal code, and telephone no.12 Section 409A deferrals Certain$ 2 Royalties (Rev. January 2022) Information W-2G 1097-BTC10981098-C1098-E1098-F 1098-Q1098-T1099-A1099-B 85 1099-CAP91 86 92 10 box 2a) withheld Internal Revenue 11 Fish purchased for resale Information32 50 81 78 384 03 74 83 80 negligence penalty or other 73M FORM FOR$ $ Returns. For calendar year4 Federal income tax withheld sanction may be imposed onService Center 13 requirement 14 Excess golden parachute15compensation $ 20 1099-LS 1099-LTC1099-MISC 1099-NEC 1099-OID1099-PATR 1099-Q1099-QA 1099-R1099-S you if this income is taxable3922 54985498-ESA5498-QA payments 3 Other income 4 Federal income tax withheld Copy B 16 93 95 71 $ 96 97 31 1A 98 75 1099-SA 1099-SB 3921 26 28 72 2Aand the IRS determines that it 94 has not been reported.Account number (see instructions) 2nd TIN not. $ PAYERS TIN $ 18 State income $ 5 Fishing boat proceeds $ 6 Medical and health careFor Recipient Account number (see instructions) $ 5 State tax withheld 6 State/Payers state no. $ 7 State income 25 $ $ File with Form 1096.4316 State tax withheld 17 State/Payers state no.RECIPIENTS TIN $ payments 5498-SA$ $ RECIPIENTS name 5Employee contributions/6Net unrealized $Form1099-MISC(Rev. 1-2022)41-0852411 $ RECIPIENT'S name, stret adres $ $ e totaling $5,000 or more of$ 8 Substitute payments in lieuThis is important taxForm1099-NEC(Rev. 1-2022)NECLMB(keep for your records)NEC5111www.irs.gov/Form1099NEC Department of the Treasury - Internal Revenue Service Designated Rothappreciation inFor Privacy Act www.irs.gov/Form1099MISC Department of the Treasury - Internal Revenue Service 27Do Not Cut or Separate Forms on This PageDo Not Cut or Separate Forms on This Pag 7 Payer made direct salesof dividends or interest contributions oremployers securities and Paperwork , city or town, state or province, country, and ZIP or foreign postal code consumer products to$ information and isReturn this entire page to the Internal Revenue Service. Photocopies are not acceptable.$ insurance premiums $ Reduction Act 9595 VOID CORRECTED $ recipient for resale 10 Gross proceeds paid to anbeing furnished toSend this form, with the copies of the form checked in box 6, to the IRS in a at mailer (not folded). IRA/ 8Other Notice, see the or foreign postal code, and telephone no. 9 Crop insurance proceeds $ attorney the IRS. If you areUnder 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. Street address (including apt. no.) 7DistributionSEP/2023 General PAYERS name, street address, city or town, state or province, country, ZIP1 Rents OMB No. 1545-0115 return, a negligence $ 2 Royalties (Rev. January 2022) 11 Fish purchased for resale 12 Section 409A deferrals penalty or otherSignature Title Date SIMPLE Instructions for Form1099-MISC Miscellaneoussanction may becode(s)imposed on you if $ taxable and the IRSCertain $ For calendar yearInformation $ this income isInstructions number), and TIN in the spaces provided on the form. The name, address,$ % Information determines that it $ 3 Other income $ 20 13 requirement 14 Excess golden parachute15 compensation has not beenFuture developments. For the latest information about developmentsupper left area of Form 1097, 1098, 1099, 3921, 3922, 5498, or W-2G. City or town, state or province, country, and ZIP or foreign postal code 9aYour percentage of total9bTotal employee contributions Returns.paymentsPAYERS TIN RECIPIENTS TIN 5 Fishing boat proceeds 4 Federal income tax withheld Copy A$ For$ reported. related to Form 1096, such as legislation enacted after it was published, goWhen to le. File Form 1096 as follows. distribution % $16 State tax withheld 17 State/Payers state no. 18 State income to www.irs.gov/Form1096.Account number (see instructions)6 Medical and health careInternal RevenueReminder. The only acceptable method of electronically payments $ $ returns listed on this form in box 6 with the IRS is through the FIREFebruary 28, 2024. 10Amount allocable to IRR111st year of desig. 12 14State tax withheld 15State/Payers state no. 16State distributionService Center$ $ System. See Pub. 1220. RECIPIENTS name $ Form1099-MISC(Rev. 1-2022) (keep for your records)File with Form 1096. Department of the Treasury - Internal Revenue Service Purpose of form. Use this form to transmit paper Forms 1097, 1098, anyWhere To File within 5 years Roth contrib. requirement $ $$ www.irs.gov/Form1099MISC 1099, 3921, 3922, 5498, and W-2G to the IRS. 7 totaling $5,000 or more of8 Substitute payments in lieuFor Privacy ActCaution: Payer made direct sales$ of dividends or interest and Paperwork electronically but fail to do so, and you do not have an$ $ $consumer products to7154-3 3 PT/ TCM3Street address (including apt. no.) recipient for resale 10 Gross proceeds paid to anReduction Act approved waiver, you may be subject to a penalty. The Taxpayer First ActIf your principal business, ofce orUse the followingAccount number (see instructions) 13Date of17Local tax withheld 18Name of locality 19Local distributionCity or town, state or province, country, and ZIP or foreign postal code 9 Crop insurance proceeds attorney Notice, see the of 2019, enacted July 1, 2019, authorized the Department of the Treasuryagency, or legal residence in theaddress payment$ $current General and the IRS to issue regulations that reduce the 250-return requirement forcase of an individual, is located in$ $ Instructions for11 Fish purchased for resale 12 Section 409A deferrals Certain2022 tax returns. If those regulations are issued and effective for 2023 tax www.irs.gov/ Alabama, Arizona, Arkansas, Delaware, $ $ Information Form1099 explaining the change. Until regulations are issued, however,Florida, Georgia, Kentucky, Maine,Internal Revenue Service $ $13 requirement 14 Excess golden parachute15compensation Returns.information, see Massachusetts, Mississippi, NewP.O. Box 149213Form 1099-R LRA 41-0852411 5140 www.irs.gov/Form1099R Department of the Treasury - Internal Revenue Service part F in the 2023 General Instructions for CertainHampshire, New Jersey, New Mexico,Austin, TX 78714-9213payments Information Returns. New York, North Carolina, Ohio, Texas, Vermont, Virginia$ $ returns. Alaska, Colorado, Hawaii, Idaho, Account number (see instructions) 2nd TIN not.16 State tax withheld 17 State/Payers state no. 18 State income Who must le.Illinois, Indiana, Iowa, Kansas,Internal Revenue Service Center $ $ Michigan, Minnesota, Missouri,P.O. Box 219256 $ $ Caution:Montana, Nebraska, Nevada, North Kansas City, MO 64121-9256Form1099-MISC(Rev. 1-2022)41-0852411 www.irs.gov/Form1099MISC Department of the Treasury - Internal Revenue Service the name and TIN used on your 94X series tax return(s) or you may beDakota, Oklahoma, Oregon, South subject to information return penalties. Do not use the name and/or TIN ofCarolina, South Dakota, Tennessee,your paying agent or service bureau. Utah, Washington, Wisconsin, Wyoming For more information and the Privacy Act and Paperwork Reduction Act Notice,L1096 41-0852411 5100 Form1096(2023)see the 2023 General Instructions for Certain Information Returns.5 Transmittal 1096 forms are included with each Red Federal Copy A form order MFG SKUMFG IDFORM DESCRIPTIONMFG SKUMFG ID TC-R4715944-Part 1099-R 1 WD Carbonless Dated Copy A, B, C, DFORM DESCRIPTION TC-S4716044-Part 1099-S 1 WD Carbonless Copy A, State, B, C1096109622-Part 1096 Carbonless Annual Summary & Transmittal Of U.S. Information Returns TC18-3716833-Part 1098 1 WD Carbonless Copy A, B, CTC-D4715244-Part 1099-DIV 1 Wd Carbonless Copy A, B, C *TC-I4715044-Part 1099-INT 1 Wd Carbonless Copy A, B, CTC-M3715433-Part 1099-MISC 1 Wd Carbonless Copy A, B, C * BASIC 1099 INFORMATION FOR CONTINUOUS FORMS 1099-MISC: ELECTRONIC FILINGNECTC-M3NEC715433-Part 1099-NEC 1 Wd Carbonless Copy A, B, C *TC-M4715444-Part 1099-MISC 1 Wd Carbonless Copy A, State, B, C * The Federal Government requires that all 1099s not filed electronically be submittedCopy A has been deleted from these forms for those who file electronically.in 11 segments. Forms 1099-MISC, 1099-DIV, 1099-R, 1099-B, 1099-INT, must be NECTC-M4NEC715444-Part 1099-NEC 1 Wd Carbonless Copy A, State, B, C * two-to-a page while all others arethree forms PER page. If filing 250 or more you must TC-M5715455-Part 1099-MISC 1 Wd Carbonless Copy A, State, B, 2, C * submit them electronically. 1099-DIV: OPTICALLY SCANNABLE REPORTINGNECTC-M5NEC715455-Part 1099-NEC 1 Wd Carbonless Copy A, State, B, 2, C * 1099-MISC: OPTICALLY SCANNABLE REPORTING These forms include Copy A printed in red dropout ink for OCR scanning.These forms include Copy A printed in red dropout ink for OCR scanning.18 19"