b"1099 PRE-PRINTED FORMS 1099 PRE-PRINTED FORMSIndividual Laser Packs Individual Laser Packs1099-INT (INTEREST) 1099-DIV (DIVIDEND) 1099-A (ACQUISITION) 1099-B (BROKER) 1099-C (CANCELLATION OF DEBT)9292 VOID CORRECTED 9191 VOIDCORRECTEDForm1099-INT Interest DETACH BEFORE MAILING $Form1099-DIVDividends and DETACH BEFORE MAILINGRESISTANTUSING HEATINKS LENDERS name, street address, city or town, state or province, country, ZIP orOMB No. 1545-0877 Acquisition oror foreign postal code, and telephone no. 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XYZ Co.)Returns.based on amount in 1dRECIPIENTS TIN Department of the Treasury - Internal Revenue Service For Recipient Certain Form1099-DIV(Rev. 1-2022) 5130 RECIPIENTS TIN $Department of the Treasury - Internal Revenue Service $ For RecipientAccount number (see instructions) (Rev. 1-2022) www.irs.gov/Form1099A Instructions for CertainLBA $ 41-0852411 1d Proceeds $ Net proceeds1cDate sold or disposed Copy B 2023 General (Rev. 1-2022) LCA (Rev. 1-2022) 41-0852411 www.irs.gov/Form1099C Act Notice, see thereported.12Exempt-interest dividendsGeneralcurrent General www.irs.gov/Form1099INT $ 12Bond premium on Treasury obligations Bond premium on tax-exempt bond Returns. $2cSection 1202 gain 11 2dCollectibles (28%) gainbond interest dividends CORRECTED Department of the Treasury - Internal Revenue Service 12Check if basis reported to 1b Date acquired13Bartering82023 on closed contracts 9 open contracts12/31/2022 Instructions for CORRECTED Instructions for $ 7 Fair market value of propertyDepartment of the Treasury - Internal Revenue Serviceprovince,country,andZIPforeignpostal 4 Federal income tax withheld $ This is important tax3Nondividend distributions2fSection 897 capital gainThis is important tax41-0852411 www.irs.gov/Form1099A Returns. CUSIP number 15 andZIPorforeignpostalcode requirement $ $ 1eCost or other basis Information ZIP or foreign postal code, and telephone no.www.irs.gov/Form1099C $ Certain Information Returns. of DebtRECIPIENT'Sname,stretadres,cityortown,state Account number (see instructions) or or code $ 3 Interest on U.S. Savings Bonds and Treasury obligations 15 State16$ 17 State tax withheld RECIPIENT'S name, stret adres, city or town, state or province, country, and ZIP or foreign postal code $2eSection 897 ordinary dividends $4 $14State 15 $16State tax withheld (Rev. 1-2022)LAA LENDERS name, street address, city or town, state or province, country, ZIP orOMB No. 1545-0877 InformationAcquisition orAccount number (see instructions)RECIPIENTS TIN www.irs.gov/Form1099B 2nd TIN not.Department of the Treasury - Internal Revenue Service For Recipient Certain CREDITORS name, street address, city or town, state or province, country,1 2 Amount of debt discharged OMB No. 1545-2281 Cancellation 2nd TIN not.14 Tax-exempt and tax creditIRS. If you areForm1099-DIV(Rev. 1-2022) 2nd TIN not.Federal income tax withheld$information and isforeign postal code, and telephone no.5146 Form1099-A OMB No. 1545-0877 RECIPIENT'Sname,stretad 14State name , stateorprovince,country, $ $ 1fAccrued market discount10 open contracts12/31/2023 $ Returns. 5137 Department of the Treasury - Internal Revenue Service$ $ 5 Investment expenses information and is$ $$Department of the Treasury - Internal Revenue Service foreign postal code, and telephone no. CORRECTED (if checked) (Rev. January 2022) Form1099-A Abandonment of$ 2 Short-term gain or loss 1g Wash sale loss disallowedon contracts CREDITORS name, street address, city or town, state or province, country,$ 3 Interest, if included in box 2 (Rev. January 2022)Form1099-INT(Rev. 1-2022) 6 Foreign tax paid 7bond CUSIP no. being furnished to the5Section 199A dividendswww.irs.gov/Form1099DIV6Investment expensesbeing furnished toLENDERS name, street address, city or town, state or province, country, ZIP orDepartment of the Treasury - Internal Revenue Service rescityortown, 16State tax withheld IRS $ Collectibles 11 ZIP or foreign postal code, and telephone no. CORRECTED (if checked)$ OMB No. 1545-2281 Form1099-C(Rev. January 2022)Foreign country or U.S. possession Department of the Treasury - Internal Revenue Service penalty or otherknowledge of abandonment 20 Acquisition or Secured Property Long-term gain or loss12Check if basis reported to$ being furnished toDEBTOR'Sname,stre province, country, ZIPorforeignpostalcode (Rev. January 2022) 20 CancellationFor Creditorinterest return, a negligence7Foreign tax paid8Foreign country or U.S. possession the IRS. If you areLENDERS TIN BORROWERS TIN 1 Date of lenders acquisition or$ For calendar yearCopy B or Copy C Form1099-B $ 4 Ordinary 3If checked, proceeds from: This is important taxCREDITORS TIN t adres, cityortown,stateor DEBTORS TIN and $ 3 Interest, if included in box 2 Form20 For calendar yearof Debt Copy Cwww.irs.gov/Form1099INT 13Bartering$ $$Abandonment ofQOF $ 1099-CFor calendar year 2 Balance of principal outstanding8 Tax-exempt interest 9 penalty or otherreturn, a negligence20 Secured Property For Lender www.irs.gov/Form1099B information and is2 Amount of debt discharged4 Debt descriptionIf checked, noncovered Department of the Treasury - Internal Revenue Serviceor foreign postal code, and telephone no. 11 Bond premium sanction may bePAYERS name, street address, city or town, state or province, country, ZIP 9Cash liquidation distributions $10 Noncash liquidation distributionsimposed on you ifLENDERS TIN t ad BORROWER'S name, stret adres, city or town, state or province, country, and ZIP or foreign postal code 3 $ 2 Balance of principal 4 Fair market value of property StateCopy VOID Federal income tax withheld5security the IRS. If you areCREDITORS TIN t adres, cityortown,stateor DEBTORS TIN andZIPorforeignpostalcode $ 4 Debt description For calendar year. . . . . . . .Copy B For Privacy Act sanction may be $ VOID $ Payers RTN (optional)imposed on you if$VOIDCORRECTEDthis income is taxableBORROWERS TIN 1 Date of lenders acquisition or 3 outstanding $ For BorrowerFor Privacy Act6Reported to IRS: 7Ifbased on amount in 1d return, a negligence5 Check here if the debtor was personally liable forFor Debtor and Paperwork CORRECTED this income isand the IRSknowledge of abandonment This is important taxand PaperworkGross proceedschecked, loss is not allowed PAYERS name, street address, city or town, state or province, country, ZIP 10 Market discount taxable and the IRS$1aTotal ordinary dividendsdetermines that it hasBORROWER'S name, stre res, city or town, state or province, country, and ZIP or foreign postal code 4 Fair market value of propertyinformation and is beingReduction ActAccount number (see instructions) CORRECTED penalty or otherDEBTOR'Sname,stre province, country, repayment of the debtinformation and is beingReduction Act OMB No. 1545-0112 OMB No. 1545-0110 requirement $ 12 Bond premium on Treasury obligations $ 13 Bond premium on tax-exempt bond determines that it hasInterestor foreign postal code, and telephone no. 11 requirement 12Exempt-interest dividends13 bond interest dividends Form1099-DIVDividends and5 Check if the borrower was personally liable for repayment of furnished to the IRS. If. . . . . . . . . . . . Notice, see thePAYERS name, street address, city or town, state or province, country, ZIP Net proceeds Applicable checkbox on Form 8949 OMB No. 1545-0715 Proceeds FromThis is important taxNotice, see the not been reported. $1b not been reported.Distributionsthe debt$current Generalor foreign postal code, and telephone no. 8 2023 on closed contracts 9 open contracts12/31/2022 sanction may beBroker andfurnished to the IRS. Ifcurrent General Form1099-INT $(Rev. January 2022) Account number (see instructions) of the debt . . 6 Description of property . . . . . . . .return, a negligenceInformationCUSIP number requirement $ open contracts12/31/2023 $ imposed on you ifTransactions Account number (see instructions) 5 If checked, the debtor was personally liable for. . . . . . . .return, a negligenceInstructions for $ bond CUSIP no. $ $ 1 Interest income $ (Rev. January 2022) Income Account number (see instructions)$14State 15 $16State tax withheld $For calendar year Copy C 1099-A(Rev. 1-2022) 5 If checked, the borrower was personally liable for repaymentsanction may beCertain14State name 15 16State tax withheld 10 to IRS 11on contracts 2023 Barter ExchangeForm 1099-C(Rev. 1-2022) 6 repayment of the debt 6 $ Certain Information Returns.Instructions forthis income is Account number (see instructions) 14 Tax-exempt and tax credit15 State1617 State tax withheld penalty or otherReturns. Form1099-B penalty or other For calendar year taxable and the IRS determines that it 5121 RECIPIENTS TIN $ 2 Early withdrawal penalty $ 20 Copy C LDBPAYERS TIN5131 RECIPIENTS TIN $$2aTotal capital gain distr. 2bUnrecap. Sec. 1250 gainFor Payer Account number (see instructions)Form6 Description of property imposed on you if$ $ 1a Description of property (Example: 100 sh. XYZ Co.) Account number (see instructions) www.irs.gov/Form1099C 7 Fair market value of propertysanction may be has not beenimposed on you if www.irs.gov/Form1099INT Department of the Treasury - Internal Revenue Service www.irs.gov/Form1099DIV $Department of the Treasury - Internal Revenue Service and/or Statewww.irs.gov/Form1099A taxable income results$ reported. taxable income results from this transaction Form1099-INT(Rev. 1-2022) (keep for your records) Form1099-DIV(Rev. 1-2022) (keep for your records)2cSection 1202 gain2dCollectibles (28%) gainand the IRS determines12If checked, basis reported 1b Date acquired13Bartering 1cDate sold or disposed from this transaction LIBPAYERS TIN Department of the Treasury - Internal Revenue Service 7 Fair market value of propertyDepartment of the Treasury - Internal Revenue Service3 Interest on U.S. Savings Bonds and Treasury obligations Copy1 For Payer RECIPIENT'S name, stret adres, city or town, state or province, country, and ZIP or foreign postal code $2eSection 897 ordinary dividends $2fSection 897 capital gain Copy 1 or Copy 2 Form1099-A(Rev. 1-2022)LAB (keep for your records) 5147 www.irs.gov/Form1099A that it has not been reported. Form1099-B PAYERS TIN $ RECIPIENTS TIN $ 1d$ $ 1eCost or other basis Copy1or Copy C Form 1099-C(Rev. 1-2022)LCB (keep for your records) 5138www.irs.gov/Form1099C 1 $ and the IRS determines that it has not been LBB 5154 (Keep for your records) www.irs.gov/Form1099BProceedsDepartment of the Treasury - Internal Revenue Service For Payer reported.and/or Department of the Treasury - Internal Revenue Service$ or State2 $$VOID CORRECTED 1fAccrued market discount 1g Wash sale loss disallowed and/orState, VOID CORRECTED Department of the Treasury - Internal Revenue ServiceCopyRECIPIENT'Sname,stretadres,cityortown,stateorprovince,country,andZIPorforeignpostalcode 4 Federal income tax withheld5 Investment expenses For Privacy Act$3Nondividend distributions$4Federal income tax withheld For Privacy ActLENDERS name, street address, city or town, state or province, country, ZIP orOMB No. 1545-0877 Acquisition orRECIPIENT'Sname,stretadres,cityortown,stateorprovince,country,andZIPorforeignpostalcode $ 2 Short-term gain or loss $ 3Check if proceeds from: Copy2 CREDITORS name, street address, city or town, state or province, country,2 Amount of debt discharged OMB No. 1545-2281 Cancellation $ 6 Foreign tax paid $ 7interest and Paperwork$5Section 199A dividends $8Foreign country or U.S. possession and Paperworkforeign postal code, and telephone no. Form1099-A Abandonment ofLong-term gain or loss Collectibles ZIP or foreign postal code, and telephone no. $ 3 Interest, if included in box 2 Form1099-C of DebtForeign country or U.S. possession 6Investment expensesReduction Act(Rev. January 2022)$ Reduction Act7Foreign tax paidNotice, see theFor calendar yearSecured Property Ordinary QOF (Rev. January 2022)8 Tax-exempt interest 9 Notice, see thecurrent General20 4Federal income tax withheld5Check if noncoveredFor calendar year current General$Instructions forLENDERS TIN BORROWERS TIN 1 Date of lenders acquisition or 2 Balance of principalCopy C $ 6Reported to IRS: security For Privacy ActCREDITORS TIN DEBTORS TIN $ 4 Debt description 20 Copy C$ 10 Market discount $ 11 Bond premium 9Cash liquidation distributions10 Noncash liquidation distributionsCertainknowledge of abandonment $ outstanding or For Lender Gross proceeds 7Check if loss is not allowedand PaperworkFor CreditorInstructions forCertain $$InformationBORROWER'S name, stret adres, city or town, state or province, country, and ZIP or foreign postal code3 4 Fair market value of property StateCopy Net proceeds based on amount in 1d Reduction ActDEBTOR'Sname,stret adres, cityortown,stateorprovince, country,andZIPorforeignpostalcodeAccount number (see instructions) requirement $ 12 Bond premium on Treasury obligations $ 13 Bond premium on tax-exempt bond Information Account number (see instructions)2nd TIN not.$12Exempt-interest dividends $13bond interest dividends Returns.the debt . . . . . . $ . . . . . . For Privacy ActAccount number (see instructions) 2nd TIN not. $ 82023 on closed contracts $ 9 open contracts12/31/2022 Notice, see the5 Check here if the debtor was personally liable for. . . . . . . .For Privacy Act $ $ Returns.11requirement and Paperwork2023 General and Paperwork 5 Check if the borrower was personally liable for repayment ofReduction ActCUSIP number requirement 10 open contracts12/31/2023 11on contracts Instructions forCertainrepayment of the debtReduction Act Notice, see the 2nd TIN not.14 Tax-exempt and tax credit15 State1617 State tax withheld 14State 15 16State tax withheld current GeneralInformationNotice, see the Returns.bond CUSIP no. $ $6 Description of property Instructions for Certaincurrent General Form(Rev. 1-2022) LIC 5122 www.irs.gov/Form1099INT $ Form(Rev. 1-2022) LDC 5132 www.irs.gov/Form1099DIV $Department of the Treasury - Internal Revenue Service Account number (see instructions) Information14State name 15 16State tax withheld $ IRS $ Account number (see instructions) 6 7 Fair market value of property Instructions for 1099-INTDepartment of the Treasury - Internal Revenue Service 1099-DIVReturns. $ 12Check if basis reported to 13Bartering Certain Information Returns.$ $ $Form1099-A(Rev. 1-2022) LAC www.irs.gov/Form1099A 5148 Department of the Treasury - Internal Revenue Service Form1099-B LBC 5155 www.irs.gov/Form1099B Department of the Treasury - Internal Revenue Service Form 1099-C(Rev. 1-2022) LCC 5139 www.irs.gov/Form1099C Department of the Treasury - Internal Revenue ServiceRequired Envelope: Required Envelope: Required Envelope: Required Envelope: Required Envelope:APEX: DWMR or DWMRS APEX: DWMR or DWMRS APEX/TFP: DW19W or DW19WS APEX: DWMR or DWMRS APEX/TFP: DW19W or DW19WSTFP: 77771 or 77772 TFP: 77771 or 77772 TFP: 77771 or 77772(5) 1096 Transmittal forms are included with each Federal Copy A (Red) form orderAPEX - Sheets per packTFP - Forms per pack APEX - Sheets per packTFP - Forms per pack50s500s100s1000sFORM DESCRIPTION 50s100sFORM DESCRIPTIONLIALIA50051205120B1099-INT Federal Copy A1 Page Equals 2 Forms LAA51461099-A Federal Copy A1 Page Equals 3 FormsLIBLIB50051215121B1099-INT Recipient Copy B1 Page Equals 2 Forms LAB51471099-A Borrower Copy B1 Page Equals 3 FormsLICLIC50051225122B1099-INT Payer Copy C and/or State Copy1 Page Equals 2 Forms LAC51481099-A Lender Copy C and/or State Copy1 Page Equals 3 FormsLDALDA50051305130B1099-DIV Federal Copy A1 Page Equals 2 Forms LBA51531099-B Federal Copy A1 Page Equals 2 FormsLDBLDB50051315131B1099-DIV Recipient Copy B1 Page Equals 2 Forms LBB51541099-B Recipient Copy B1 Page Equals 2 FormsLDCLDC50051325132B1099-DIV Payer Copy C and/or State Copy1 Page Equals 2 Forms LBC51551099-B Payer Copy C and/or State/Copy 1, 21 Page Equals 2 FormsLCA51371099-C Federal Copy A1 Page Equals 3 FormsLCB51381099-C Debtor Copy B1 Page Equals 3 FormsLCC51391099-C Creditor Copy C1 Page Equals 3 Forms38 39"