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If you are requiredYour percentage of total 9b $ Form $has not beenThis information is Department of the Treasury - Internal Revenue Service7 Agriculture payments6 Taxable grants trade or businessReduction Act5iSeptember 5jOctober reported.$ $ 11 Work opportunity credit Certain InformationReturns.1st year of desig. 12 14 distribution 15State/Payers state no. being furnished to the IRS. Copy D negligence penalty or This is important taxother sanction may be1099-RAccount number (see instructions) $ 9 Market gain $ 9 Market gain trade or business11information and iscurrent GeneralAccount number (see instructions)$PAYEES TIN 5lDecember 1099-K Payment Card andForm1099-PATR(Rev. 1-2023) $ www.irs.gov/Form1099PATR $ imposed on you if thisAccount number (see instructions) Roth contrib. $ State tax withheld not determined 16State distributionTotalDistributions FromFor Payerr$ 2nd TIN not. $ income $ being furnished to theNotice, see the 5k November $(Rev. 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If you are requiredthe IRS determines that income is taxable and State income tax withheld Instructions for$$For calendar year 8 State income tax withheld $ it has not beenPAYERS name, street address, city or town, state or province, 17 CORRECTED (if checked) OMB No. 1545-0119 Federal income taxForm1099-G(Rev. 1-2022) 10a State 10b11$ negligence penalty orReturns. 6 State1a Gross amount of payment20 $ Copy CVOID www.irs.gov/Form1099PATR OMB No. 1545-0118 reported. country, ZIP or foreign postal code, and telephone no.payment 13Date of$ Local tax withheld $ box 2a) $ $ withheld Tax State,nCity,lCertain Informationother sanction may becard/third party network1Gross distribution18Name of locality 19Local distributionAccount number (see instructions) LGB (keep for your records) 5157 www.irs.gov/Form1099G $ imposed on you if thisForm1099-K(Rev. 1-2022)LKB(Keep for your records) 5326 $transactions 72 Merchant category code For FILERZIP or foreign postal code, and telephone no. CORRECTED Department of the Treasury - Internal Revenue Service Form 1099-R LRB RECIPIENTS name, stret adres $ $ 5Employee contributions/ Pensions, Annuities, LocatVOID CORRECTED State income tax withheld income is taxable andElectronic Payment Facilitator reported are: $transactions $ withheld $ and/or State $ 2 Nonpatronage distributions Form1099-PATR Distributions$ 2aTaxable amount Designated Roth$ 8Other Retirement orDepoartmenthe IRS determines that Department of the Treasury - Internal Revenue Service 1b Card Not PresentPAYERS name, street address, city or town, state or province, country, 1 Patronage dividends , city or town, state or province, country and ZIP or foreign postal code Prot-Sharing Plans, Form1099-G(Rev. 1-2022) www.irs.gov/Form1099G $ it has not beenCheck to indicate if FILER is a (an):Payment cardwww.irs.gov/Form1099K transactions Department of the Treasury - Internal Revenue Service $ Taxable5141 www.irs.gov/Form1099R 2023 6appreciation in and Paperwork Department of the Treasury - Internal Revenue Service Payment settlement entity (PSE) 3 Number of payment4 Federal income taxcontributions orNet unrealized Reduction Act reported. Check to indicate transactionsDepartment of the Treasury - Internal Revenue Service Contracts, etc.IRAs, Insurance For Privacy Act insurance premiums employers securitiesor foreign postal code, and telephone no. 1 Unemployment compensationOMB No. 1545-0120 (EPF)/Other third party stet ,cityortown,staeor Third party networkforeignpostalcode 5a January5b February Copy 1 or Copy 2 $ 3 Per-unit retain allocations (Rev. 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January 2022) Government5c March 5d April Reduction Actwithheld $ Total employee contributions Returns.For calendar yearPayments 5e May 5fJune current GeneralStateCopy Your percentage of totalor or LocatlInstructions forFor Privacy Actwithin 5 years Roth contrib. 512 requirement$ State tax withheld % Tax Departmen 2PAYERS TIN RECIPIENTS TIN 3 Box 2 amount is for tax year $ 20 Copy C $$Certain Information Returns. $ 8 Section 199A(a) qual. items $ 9 Section 199A(a) SSTB items and Paperwork$ Employee contributions/14 6Net unrealized 15 CopyState/Payers state no.16State distribution4 Federal income tax withheld For Payer 5g July5h August Reduction Actcontributions or$ employers securities $Designated Rothappreciation in $ $ Copy 1 or Copy 2 PSES name and telephone number $$10 Investment credit 11 Work opportunity credit Notice, see theAccount number (see instructions) $ 13Date of$ 17Local tax withheld 18Name of locality $ 19Local distributionRECIPIENT'Sname,stretadres,cityortown,stateorprovince,country,andZIPorforeignpostalcode 5 RTAA payments 6 Taxable grants and/or State 5iSeptember 5jOctober $ $ current General insurance premiums IRA/ $ 8Other $$ 7 Agriculture payments 8 trade or business For Privacy Act$$Account number (see instructions) 2nd TIN not. $ 12 Other credits and deductions $ 13Instructions forForm 1099-R 7payment$SEP/ $ % $Check if box 2 isand Paperwork5k November 5lDecember Certain InformationReturns. DistributionSIMPLE This information is code(s)9 Market gain income Reduction ActAccount number (see instructions)2nd TIN not. $$8 State income tax withheld $ www.irs.gov/Form1099R 9b Department of the Treasury - Internal Revenue ServiceNotice, see the6 State79aYour percentage of totalTotal employee contributions being furnished to the IRS.Account number (see instructions) 2nd TIN not. $ 10a State 10b11 State income tax withheld current GeneralForm1099-K(Rev. 1-2022) LKC www.irs.gov/Form1099K5327 $ Form1099-PATR(Rev. 1-2023) LPC www.irs.gov/Form1099PATR 5168 Department of the Treasury - Internal Revenue Service 10Amount allocable to IRR111st year of desig. 12 requirement$ 14 distribution %$ 15State/Payers state no. $ 16State distributionInstructions for State tax withheld$ Certain InformationReturns. $ within 5 years Roth contrib.$ Department of the Treasury - Internal Revenue Service $ VOID $ CORRECTED $ Distributions From Form1099-G(Rev. 1-2022) LGC 5158 www.irs.gov/Form1099G Department of the Treasury - Internal Revenue Service Account number (see instructions) Local tax withheld OMB No. 1545-0119 Pensions, Annuities,PAYERS name, street address, city or town, state or province, 17 1Gross distribution18Name of locality 19Local distributioncountry, ZIP or foreign postal code, and telephone no.payment 13Date of$ $ $ Retirement or Required Envelope: Form 1099-R (keep for your records) LRC/LR2 $ $ 2aTaxable amount 2023 Prot-Sharing Plans, $IRAs, Insurance www.irs.gov/Form1099R 5142 Department of the Treasury - Internal Revenue Service Contracts, etc.Form 1099-RRequired Envelope: Required Envelope: APEX/TFP: DW19W or DW19WS PAYERS TIN RECIPIENTS TIN 2bnot determined 4 TotalCopy D Taxable amount 3Capital gain (included indistribution For Payer box 2a) Federal income tax d/orwithheld State,anCity,lrAPEX/TFP: DW19W or DW19WS APEX: DWMR or DWMRS RECIPIENTS name, stret adres, city or town, state or province, country and ZIP or foreign postal code $ 5Employee contributions/$ 6appreciation in Tax LocatDepoartmencontributions orNet unrealized For Privacy Act Designated Rothemployers securities and Paperwork insurance premiums Reduction Act TFP: 77771 or 77772 $ 7DistributionIRA/ $ 8Other % Notice, see the SEP/2023 General code(s) SIMPLE $ Instructions forCertain9aYour percentage of total 9bTotal employee contributions Information distribution %$ Returns.10Amount allocable to IRR111st year of desig. 12 requirement$ 14State tax withheld 15State/Payers state no. $ 16State distributionwithin 5 years Roth contrib.$ $ $Account number (see instructions) 13Date of17Local tax withheld 18Name of locality 19Local distributionpayment$ $$ $Form 1099-R LRD1 5143 www.irs.gov/Form1099R Department of the Treasury - Internal Revenue ServiceRequired Envelope:APEX: DWMR or DWMRSTFP: 77771 or 77772APEX - Sheets per packTFP - Forms per pack APEX - Sheets per packTFP - Forms per pack50s500s100s1000sFORM DESCRIPTION 50s500s100s1000sFORM DESCRIPTIONLGAN/A5156N/A1099-G Federal Copy A1 Page Equals 3 Forms LPAN/A5166N/A1099-PATR Federal Copy A1 Page Equals 3 FormsLGBN/A5157N/A1099-G Recipient Copy B1 Page Equals 3 Forms LPBN/A5167N/A1099-PATR Recipient Copy B1 Page Equals 3 FormsLGCN/A5158N/A1099-G Payer Copy C and/or State/Copy 1, 21 Page Equals 3 Forms LPCN/A5168N/A1099-PATR Payer Copy C and/or State/Copy1 Page Equals 3 FormsLKALKA50053255325B1099-K Federal Copy A1 Page Equals 2 Forms LRALRA50051405140B1099-R Federal Copy A1 Page Equals 2 FormsLKBLKB50053265326B1099-K Payee Copy B1 Page Equals 2 Forms LRBLRB50051415141B1099-R Recipient Copy B1 Page Equals 2 FormsLKC LKC50053275327B1099-K Filer Copy C and/or State/Copy 1, 21 Page Equals 2 Forms LRCLR2LRCLR250051425142B1099-R Recipient Copy C and/or State, City or Local or Copy 21 Page Equals 2 FormsLRD1LRD150051435143B1099-R Payer Copy D and/or State, City or Local1 Page Equals 2 Forms40 41"