b"1099 & 1098 PRE-PRINTED FORMS 1098 PRE-PRINTED FORMSIndividual Laser Packs Individual Laser Packs1099-S (PROCEEDS FROM1099-R (RETIREMENT) REAL ESTATE TRANSACTIONS) 1098 (MORTGAGE INTEREST)CORRECTED (if checked) T fh urisn iisnhfoeRrdme tvaoet nitohunee iISsn ebterevrniincagel 2a $ 1Gross distribution 2bTaxable amountmined OMB No. F 1545-0119 APEX LR3 7575 VOID CORRECTED OMB No. 1545-0997 8181 VOIDCORRECTEDOMB No. 1545-1380PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and phone no. Taxable amount not deter 13Date of payment 2023 FILERS name, street address, city or town, state or province, country, 1Date of closing RECIPIENTS/LENDERS name, street address, city or town, state or1098-E (STUDENT LOAN STATEMENT) 1098-T (TUITION STATEMENT)Total distribution Doisrmtrib 1099-R ZIP or foreign postal code, and telephone number province, country, ZIP or foreign postal code, and telephone no. DETACH BEFORE MAILINGDETACH BEFORE MAILINGINKSRESISTANT MANUFACTURED ON OCR LASER BOND PAPER USING HEAT RESISTANT INKSMANUFACTURED ON OCR LASER BOND PAPER USING HEAT RESISTANT INKSDETACH BEFORE MAILINGDETACH BEFORE MAILINGUSING HEAT$ 3Capital gain (included 4Federal income tax R utions Ftorioemst-, Form1099-S Proceeds From RealForm1098 Mortgage PAYERS TIN RECIPIENTS TIN $ 5 in box 2a) $ 6 withheld In Pehetanirrseiinomgne sPn,ltaA onnrsn ,Pu IriRetc.cAtss,, $ 2Gross proceeds (Rev. January 2022) Estate Transactions (Rev. January 2022) Interest8484 VOID CORRECTED OMB No. 1545-1576 8383 VOID CORRECTED OMB No. 1545-1574Ssurance Contra For calendar year For calendar yearStatement RECIPIENTS/LENDERS name, street address, city or town, state orFILERS name, street address, city or town, state or province, country, ZIP or 1 Payments received forMANUFACTURED ON OCR LASER BOND PAPER USING HEAT RESISTANT INKSON OCR LASER BOND PAPERMANUFACTUREDRESISTANTRECIPIENT'S name, stret adres, city or town, state or province, country, and ZIP or foreign postal code $ 7 Employee contributions/ contributions $ 8 in employered appreciation F Copy B FILERS TIN TRANSFERORS TIN 3 20 Copy A RECIPIENTS/LENDERS TIN PAYERS/BORROWERS TIN $20 Copy Aprovince, country, ZIP or foreign postal code, and telephone number Studentforeign postal code, and telephone number $ 2expenses Tuition Designated Roth Net unrealizs securitiesor insurance premiums IRA/SEP/ Other Report this income on your FederalTRANSFERORS name Address (including city, state, and ZIP code) or legal description For1 Mortgage interest received from payer(s)/borrower(s) ForLoan InterestStatement9a Distribution code(s) SIMPLE 9bTotal Employee Contributions10 4, attach this copy to your return. 4 Check here if the transferor received or will receiveInternal Revenue2 Outstanding mortgage3 Mortgage origination date Internal RevenueRECIPIENTS TIN BORROWERS TIN 2023 Statement STUDENTS TIN 3 2023 Copy Aedetax return. If this form showsral income tax witheld in BoxYour percentage of %$ $ State/Payers state no. % 16 $ Amt alocable to IR within 5 yrs. Street address (including apt. no.)Service Center principal 5 Mortgage insuranceService Center$ 1 Student loan interest received by lenderForm1098-E Copy A STUDENTS name 4 Adjustments made for a Form1098-T For total distribution File with Form 1096.$ For Privacy Act4 Refund of overpaidFile with Form 1096.requirement 14 $ $ State tax withheld 15 $ $ State Distribution City or town, state or province, country, and ZIP or foreign postal code 5property or services as part of the consideration person . . . . . . . . and PaperworkPAYERS/BORROWERS name$ interest $ premiums For Privacy ActBORROWERS name ForStreet address (including apt. no.) $ prior year $ 5 Scholarships or grants Internal Revenue $ $ Check here if the transferor partnership, is a foreignReduction Act$and PaperworkInternal RevenueService CenterAccount number (see instructions)111st year of desig. Roth contrib.12 17Local tax withheld 18Name of locality 19Local distribution Account number (see instructions) (nonresident alien, . foreignforeign estate,Notice, see theStreet address (including apt. no.)6 Points paid on purchase of principal residence Reduction ActService Center Adjustments to 7 Checked if the amountFile with Form 1096.or foreign trust)current General 6Buyers part of real estate tax Instructions for7If address of property securing mortgage is the sameNotice, see theStreet address (including apt. no.) File with Form 1096. 6 scholarships or grantsin box 1 includesFor Privacy Act and FORM1099R www.irs.gov/Form1099R Department of the Treasury - Internal Revenue Service $ Certain Information Returns. as PAYERS/BORROWERS address, check the box, or entercurrent GeneralFor Privacy Act andamounts for anPaperwork Reduction Form(Rev. 1-2022) 41-0852411 www.irs.gov/Form1099S Department of the Treasury - Internal Revenue Service City or town, state or province, country, and ZIP or foreign postal code the address or description in box 8. Instructions for CertainCity or town, state or province, country, and ZIP or foreign postal code Paperwork ReductionCity or town, state or province, country, and ZIP or foreign postal code for a prior year beginning January Act Notice, see the T fh uirsn iisnhfoeRrdme tvaoet intohunee iISsn ebterervniincagel 2a $ $ 1Gross distribution 2bTaxable amount OMB No.1545-0119 Do1099-SFILERS name, street address, city or town, state or province, country, 1Date of closing OMB No. 1545-0997 Proceeds From Realmortgage province, country, ZIP or foreign postal code, and telephone no. CORRECTED (if checked) Form1098 InformationMortgageAccount number (see instructions) 41-0852411 2 and/or capitalized interest, and the loan was made. . . . . . . Act Notice, see theService Provider/Acct. No. (see instr.) 8 Checked if at least$ 9 Checked if a graduate$ academic period2023 GeneralNotCutorSeparateFormsonThisPageCORRECTED (if checked)DoNotCut orSeparateFormsonThisPage instructions) *Caution: The amount shown mayReturns. 2023 Generalhalf-time student studentMarch 2024 Instructions for PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and phone no. Taxable amount Total distribution Date of payment Form 2023 ZIP or foreign postal code, and telephone number Form1099-S 9 Number of properties securing the 10 Other 8 Address or description of property securing mortgage (see OMB No. 1545-1380 Check if box 1 does not include loan origination feesInstructions for10 Ins. contract reimb./refund Certain InformationReturns. DETACH BEFORE MAILINGDETACH BEFORE MAILINGINKS MANUFACTURED ON OCR LASER BOND PAPER USING HEAT RESISTANT INKSMANUFACTURED ON OCR LASER BOND PAPER USING HEAT RESISTANT INKSDETACH BEFORE MAILINGDETACH BEFORE MAILINGUSING HEATON OCR LASERINKSCORRECTED (if checked)3Capital gain (included 4 not determined13 R 1099-R 7575 VOID CORRECTED 2Gross proceedsOMB No. 1545-0997(Rev. January 2022) Estate Transactions RECIPIENTS/LENDERS name, street address, city or town, state ornot be fully deductible by you.(Rev. January 2022) InterestForm1098-E t Cut or Separate Forms on This Pagebefore September 1, 2004tt or Separate Forms o Certain InformationReturns.iForm1098-T 41-0852411 www.irs.gov/Form1098T Department of the Treasury - Internal Revenue ServiceLimits based on the loan amount utions From and the cost and value of the PAYERS TINRECIPIENTS TIN $ 5 in box 2a) 6 Federal income tax Ins stmroinbesn,tA onrn Pu IrRiotiAests-,, FILERS name, street address, city or town, state or province, country, 1Date of closing $ 3 Form1099-SFor calendar year Copy B Account number (see instructions) secured property may apply. Also,For calendar yearStatement DoNo 8484 VOID www.irs.gov/Form1098E Department of the Treasury - Internal Revenue Service StudentDo Not Cut or Separate Forms on This PageDo Not Cut or Separate Forms on This Page Tuition withheld PeDnisreiing Plans, ZIP or foreign postal code, and telephone number you may only deduct interest to the20 11 MortgageDCORRECTED (if checked) nThsPage foreign postal code, and telephone number CORRECTED OMB No. 1545-1574actually paid by you, and notoNo CuSehutairrance Contracts, Proceeds From Realextent it was incurred by you,acquisition date RECIPIENTS/LENDERS name, street address, city or town, state orOMB No. 1545-1576 FILERS name, street address, city or town, state or province, country, ZIP or 1 Payments received forMANUFACTURED ON OCR LASER BOND PAPER USING HEAT RESISTANT INKSBOND PAPERRECIPIENT'S name, stret adres, city or town, state or province, country, and ZIP or foreign postal code $ 7 Designated Roth IRA/SEP/ $ $ 8 in employered appreciation etc. FILERS TIN FILERS TIN TRANSFERORS TIN TRANSFERORS TIN2Gross proceeds (Rev. January 2022) 20 Copy A For Transferor Form1098 (Rev. 1-2022)RECIPIENTS/LENDERS TIN reimbursed by another person. Copy Bprovince, country, ZIP or foreign postal code, and telephone number OMB No. 1545-1576 2023 Loan Interest8383 VOID CORRECTED $ expenses 2023 TuitionStatementEstate TransactionsAddress (including city, state, and ZIP code) or legal description 1 Mortgage interest received from payer(s)/borrower(s)*Employee contributions/ contributions Net unrealiz s securities Copy C TRANSFEROR'S name, street address, city or town, state or province, country, and ZIP or foreign postal code For calendar year This is important tax41-0852411 $5 Mortgage insurance For Payer/RECIPIENTS TIN CORRECTED Form1098-E StudentStatement FILERS name, street address, city or town, state or province, country, ZIP or$ 1 Payments received for 2 3OMB No. 1545-1574 Form1098-T Copy B9a or insurance premiums 9b $ Other % 10 For ReRciepcieonrdt'ss TRANSFERORS name $ 3 420 . . information and is beingPAYERS/BORROWERS TINwww.irs.gov/Form1098principal2 Outstanding mortgage Department of the Treasury - Internal Revenue Service3 Mortgage origination date Borrower province, country, ZIP or foreign postal code, and telephone number 2023 Loan InterestCopy B foreign postal code, and telephone number STUDENTS TIN2expenses 2023 StatementRECIPIENTS/LENDERS name, street address, city or town, state or Distribution code(s) SIMPLE Address (including city, state, and ZIP code) or legal description ForDoNotCutorSeparateFormsonThisPageDoNotCutorSeparateFormsonThisPageThe information in boxes 1 Transferor received or will receive property or servicesfurnished to the IRS. If$through 9 and 11 isBORROWERS TIN 1 Student loan interest received by lender14 total distribution % 15 $ State/Payers state no. 16 $ State Distribution 4 Check here if the5as part of the consideration (if checked) . . . . . . . . Internal Revenue. . return, a negligence8181 name,stret VOID, ortown,state or province,country,andZIPorforeignpostalcode $ 4 Refund of overpaid$ premiums important tax informationRECIPIENTS TIN BORROWERSname,stretadres,cityortown,stateorprovince,country,andZIPorforeignpostalcode $ 1098-E Statement For Borrower STUDENTS name STUDENT'S name, stret adres, city or town, state or province, country, and ZIP or foreign postal code 3 4 Adjustments made for a 5 Scholarships or grants ForFor StudentYour percentage of Total Employee Contributions Amt alocable to IR within 5 yrs. or will.receiveService Center penalty or otherPAYER'S/BORROWER'S adrescity interest OMB No. 1545-1380 and is being furnished toBORROWERS TIN 1 Student loan interest received by lenderFormCopy A This is important taxSTUDENTS TIN prior year Form1098-T Copy A This is important alien, foreign (nonresidentimposed on you if thisRECIPIENTS/LENDERS name, street address, city or town, state or$the IRS. If you are requiredfurnished to the IRS. Ifand is being $ State tax withheld $ If checked, transferor is a foreign person estate, . File with Form 1096.sanction may beprovince, country, ZIP or foreign postal code, and telephone no. CORRECTED6 Points paid on purchase of principal residence may be imposed on you if$ information and is beingprior year $ scholarships or grants$ Internal Revenuetax information transferor received partnership, foreignor foreignitem is required to bepenalty or other sanction property or services as part of the considerationFor Privacy Actthe IRS determines trust)Account number (see instructions)111st year of desig. Roth contrib.12 requirement 17 $ Local tax withheld 18Name of locality 19 $ Local distribution Street address (including apt. no.)Account number (see instructions) 5 Check here if the foreign. . . . a. foreign. . . and Paperworkreported and the IRS7If address of property securing mortgage is the samethat an underpayment ofBORROWERS name Forreturn, a negligence4 Adjustments made for a6 Adjustments to5 Scholarships or grants7 Checked if the amountfurnished to the $ $ City or town, state or province, country, and ZIP or foreign postal code (nonresident alien, . $ 6Buyers part of real estate tax Reduction Actdetermines that it hasForm1098 Mortgagetax results because youInternal Revenuesanction may befor a prior year in box 1 includesmust be used to or foreign trust)transferor partnership, isforeign person estate,Notice, see the not been reported. as PAYERS/BORROWERS address, the box is checked, oroverstated a deduction forService Center penalty or otherService Center IRS. This form current Generalthe address or description is entered in box 8. Interestimposed on you if the$ $ amounts for ancomplete Form 8863 FORM1099R (Keep for your records) www.irs.gov/Form1099R Department of the Treasury - Internal Revenue Service Form1099-S(Rev. 1-2022) (keep for your records) www.irs.gov/Form1099S Department of the Treasury - Internal Revenue Service (Rev. January 2022) Statement these points, reported inAccount number (see instructions) File with Form 1096. IRS determines that anStreet address (including apt. no.) 6 scholarships or grantsin box 1 includesacademic periodto claim education CORRECTED (if checked) fh uirsn iisnhfoeRrdme vtaoet nitohuneei ISsn etberervinincagel $ 2aTaxable amount Total distribution13Date of payment Form 2023 Account number (see instructions) 41-0852411 $ 6Buyers part of real estate tax 1Date of closing Instructions forProceeds From RealmortgagePAYERS/BORROWERS TIN $VOID 8 Address or description of property securing mortgageFormthis mortgage interest or forMortgageStreet address (including apt. no.) (keep for your records) VOID If checked, box 1 does not . . . . For Privacy Act and. . . underpayment of taxCity or town, state or province, country, and ZIP or foreign postal code $ Adjustments to $ 9 Checked if a graduate$ File with Form 1096. tax preparer or use it to For calendar year VOID CORRECTED Certain Information Returns. CORRECTEDboxes 1 and 6; or because include loan originationresults because youService Provider/Acct. No. (see instr.) 8 Checked if at least7 Checked if the amount beginning Januarycredits. Give it to the Form(Rev. 1-2022) FILERS name, street address, city or town, state or province, country, OMB No. 1545-0997 RECIPIENTS/LENDERS name, street address, city or town, state or20 you didnt report the refundCity or town, state or province, country, and ZIP or foreign postal code 2 fees and/or capitalized interest for loans made beforefor student loan interest. for a prior year studentbeginning January March 20 For Privacy Act andprepare the tax return. 24 DETACH BEFORE MAILINGDETACH BEFORE MAILINGRESISTANT MANUFACTURED ON OCR LASER BOND PAPER USING HEAT RESISTANT INKSMANUFACTURED ON OCR LASER BOND PAPER USING HEAT RESISTANT INKSDETACH BEFORE MAILINGMANUFACTUREDDETACH BEFORE MAILINGUSING HEATZIP or foreign postal code, and telephone numberwww.irs.gov/Form1099S Department of the Treasury - Internal Revenue Service province, country, ZIP or foreign postal code, and telephone no.1 Mortgage interest received from payer(s)/borrower(s) OMB No. 1545-1380 Paperwork Reductionhalf-time student academic periodPaperwork Reduction of interest (box 4); oroverstated a deductionamounts for an10 Ins. contract reimb./refundPAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and phone no. T 1Gross distribution 2bTaxable amountmined OMB No.1545-0119 Do1099-SFILERS name, street address, city or town, state or province, country, 1Date of closing 2Gross proceedsOMB No. 1545-0997 Form1099-S Estate Transactions 9 Number of properties securing the 10 Other 2 Outstanding mortgage3 Mortgage origination date Copy Abecause you claimed aInterestForm1098-E September 1, 2004Act Notice, see theForm1098-T (keep for your records) VOID March 2024 Act Notice, see the 1098PAYERS TIN RECIPIENTS TIN $ $ 5 in box 2a) $ 6 not deter s securities In 1099-R , r it etc. , NotCutorSeparateFormsonThisPageCORRECTED (if checked)DoNotCut orSeparateFormsonThisPage Copy B Copy C RECIPIENTS/LENDERS TIN $ principal $ premiums $Fornondeductible item. Copy CAccount number (see instructions) tt rarate41-0852411 ron This PageDo Not C www.irs.gov/Form1098E t. r. . . r . te .Fo . rms on Th 2023 GeneraliStudentStudentService Provider/Acct. No. (see instr.) 8 Checked if at least9 Checked if a graduateCORRECTED 3 2023 General TuitionTuition 3Capital gain (included 4Federal income tax R Sshuarrainngc ePonrn oems-,t ZIP or foreign postal code, and telephone number 1Date of closing $ Form$ Form1099-S (Rev. January 2022) For Filer Account number (see instructions) $Internal RevenueStatement Form1098-E Cu o Sep Foms before September 1, 2004o CORRECTED Department of the Treasury - Internal Revenue Service Statement Form1098-T foreign postal code, and telephone number www.irs.gov/Form1098T 1 Payments received for Department of the Treasury - Internal Revenue ServiceOMB No. 1545-1574 Statementwithheld 7575 VOID CORRECTED For calendar year 4 Refund of overpaid(Rev. January 2022) RECIPIENTS/LENDERS name, street address, city or town, state or 2 and/or capitalized interest, and the loan was madeInstructions for FILERS name, street address, city or town, state or province, country, ZIP or$ expenses Instructions for 11 Mortgageprovince, country, ZIP or foreign postal code, and telephone number OMB No. 1545-1576 10 Ins. contract reimb./refundttiAonsPu Frio FILERS name, street address, city or town, state or province, country, TRANSFERORS TIN2Gross proceedsOMB No. 1545-09973Address (including city, state, and ZIP code) or legal description (Rev. January 2022) Proceeds From RealPAYERS/BORROWERS nameinterest Service CenterDoNo Check if box 1 does not include loan origination feesCertain InformationReturns. Loan Interesthalf-time student studentCORRECTED $ 2Certain InformationReturns. MANUFACTURED ON OCR LASER BOND PAPER USING HEAT RESISTANT INKSON OCR LASER BOND PAPERNet unrealiz PeeDtniirsseitorminbesun Claonns,t rIaRcAtss, ZIP or foreign postal code, and telephone numberFILERS TIN 1099-SFor calendar year 20 or State Copy Form1098$For calendar yearFor Recipient/www.irs.gov/Form1098E Sepaa OMB No. 1545-1576 s 2023 41-0852411 www.irs.gov/Form1098T Department of the Treasury - Internal Revenue Serviceacquisition dateFile with Form 1096.20 Department of the Treasury - Internal Revenue ServiceEstate Transactions 5 Mortgage insurance 1 Mortgage interest received from payer(s)/borrower(s) CORRECTED (if checked) Page Do Not Cut or Separate Forms on This PageDo Not Cut or Separate Forms on This PageFor Privacy ActRECIPIENTS/LENDERS name, street address, city or town, state oru FILERS name, street address, city or town, state or province, country, ZIP or 1 Payments received forOMB No. 1545-1574 2023RECIPIENT'S name, stret adres, city or town, state or province, country, and ZIP or foreign postal code 7 Employee contributions/ contributions 8 in employered appreciation income Copy 2 FILERS TIN TRANSFEROR'S name, street address, city or town, state or province, country, and ZIP or foreign postal code 20 Proceeds From RealFor Transferor For Privacy ActStreet address (including apt. no.) (Rev. 1-2022)RECIPIENTS/LENDERS TIN(Keep for your records)6 Points paid on purchase of principal residencePAYERS/BORROWERS TINwww.irs.gov/Form1098principal 2 Outstanding mortgage Department of the Treasury - Internal Revenue Service3 Mortgage origination date Lenderprovince, country, ZIP or foreign postal code, and telephone number OMB No. 1545-1576 Form1098-E Copy C foreign postal code, and telephone number CORRECTED $ 2 expenses 2023 Form1098-T Copy CAccount number (see instructions)1st year of desig. Roth contrib. requirement $ $ Designated Roth IRA/SEP/ $ $ Other 16 $ Filestate TRANSFERORS name (Rev. 1-2022) TRANSFERORS TIN2Gross proceeds 5$ 3 . trust). . . (Rev. January 2022) . . . . 5 4 . . . . . . here. ifif. 20 transferor. . . received . . or. will. receive .and PaperworkCity or town, state or province, country, and ZIP or foreign postal code stetadres,city 7If address of property securing mortgage is the same 4 Refund of overpaidor or and PaperworkMortgageor State CopyRECIPIENTS TIN 8484 name,stretadres VOID , name,stre or tad CORRECTED , province,country,andZIPorforeignpostalcode $ Form1098-E . Form. . Loan Interest. . . . For Recipient STUDENTS name 8383 t adres VOID t adres $ 3 2STUDENTS TIN $ 3$ OMB No. 1545-1574 $ Form1098-T $ TuitionStatement or For Fileror insurance premiums Estate Transactions Reduction Act 9a Distribution code(s) SIMPLE % 9b $ % 10Amt al when tax re qreturn,uired. FILERS TIN TRANSFEROR'S name, street address, city or town, state or province, country, and ZIP or foreign postal code 4Address (including city, state, and ZIP code) or legal description . foreignreturn, a negligenceReduction ActPAYER'S/BORROWER'Sname, as PAYERS/BORROWERS address, check the box, or enterNotice, see theFor Privacy ActRECIPIENTS TIN RECIPIENTS TIN rescityortown,state BORROWERS TIN $ 1 Student loan interest received by lender Statement orStateCopy FILERS name, street address, city or town, state or province, country, ZIP or 1 Payments received for2023 5 Scholarships or grants Copy B StateCopy this c,ocitypy w, oitrh l oycoaulr $ For calendar year thethe address or description in box 8. $current Generalprovince, country, ZIP or foreign postal code, and telephone number or 2023 Studentforeign postal code, and telephone number STUDENT'S name, stre expenses 4 Adjustments made for aCheck here5 Mortgage insuranceRECIPIENTS/LENDERS name, street address, city or town, state or total distribution Address (including city, state, and ZIP code) or legal description the Copy A furnished to the IRS. Ifcurrent General9 Number of properties securing the 10 Other CORRECTED (if checked)$Instructions for CertainReduction ActBORROWERS cityortown,stateprovince,country,andZIPorforeignpostalcode $ 1098-E For Borrower PaperworkSTUDENT'S name, stre STUDENTS TIN STUDENTS TIN prior year Form6 Adjustments to 7 Check if theamount inPaperwork Your percentage of Total Employee Contributions ocable to IR within 5 yrs. TRANSFERORS TIN 3 property or services as part of the consideration information and is being This is important tax person estate, Notice, see thetown,state or province,country,andZIPforeignpostalcode interest $ premiums and PaperworkBORROWERS BORROWERS TIN 1 Student loan interest received by lender Loan InterestCopy BFor Privacy Act and, city or town, state or province, country, and ZIP or foreign postal code $ prior year Statement For Privacy Act and 14 $ State tax withheld 15State/Payers state no. $ State Distribution 4 Check here if the5alien,$ Checkforeign persontransferor partnership, is aFor Instructions formortgage RECIPIENTS/LENDERS name, street address, city or town, state ornot be fully deductible by you.Form1098 InformationInterestNotice, see theBORROWERS TIN 2023 Statement This is important taxReduction Act 2023, city or town, state or province, country, and ZIP or foreign postal code4 Adjustments made for a Copy A For StudentReduction Act or foreign trust)province, country, ZIP or foreign postal code, and telephone no.instructions)8 Address or description of property securing mortgage (see 6 Points paid on purchase of principal residenceOMB No. 1545-1380Transferor received or will receive property or servicesforeign*Caution: The amount shown mayReturns.(nonresident alien, . Internal Revenuepenalty or other$ 7If address of property securing mortgage is the samecurrent General1 Student loan interest received by lenderFormCopy A Notice, see the1098-T This is importantNotice, see FORM1099R www.irs.gov/Form1099R Department of the Treasury - Internal Revenue Service LR3 City or town, state or province, country, and ZIP or foreign postal code or foreign trust)as part of the consideration (if checked) foreign . Service Center sanction may beAccount number (see instructions) Limits based on the loan amountFor calendar yearCopy BReturns. BORROWERS name Account number (see instructions) $ before September 1, 2004information and is beingStreet address (including apt. no.) Form$ 4 Adjustments made for a $ scholarships or grants$ beginning Januaryand is being the 2023 General foreignestate, (nonresidentas PAYERS/BORROWERS address, check the box, or enter transferoris a receiveFile with Form 1096.imposed on you if thisand the cost and value of the $ $ Account number (see instructions) If checked, foreign received transferor partnership, or 6Buyers part of real estate taxCertain Information Returns. secured property may apply. Also,(Rev. January 2022) Instructions for Certainfurnished to the IRS. If Instructions for for a prior year5 Scholarships or grantsacademic period box 1 includes amounts for antax information Instructions forwill or foreignitem is required to beyou may only deduct interest to the11 MortgageInformation2 Check if box 1 does not include loan origination fees return, a negligence penalty or otherService Provider/Acct. No. (see instr.)prior year 8 Check if at least5 Scholarships or grants in box 1 includesForCertain InformationReturns.property or services as part of the considerationFor Privacy Actthe address or description in box 8.11 12 17Local tax withheld 18Name of locality 19Local distribution Street address (including apt. no.)Account number (see instructions)Form1099-S(Rev. 1-2022) Check here if the 6Buyers part of real estate taxand Paperworkdetermines that it hasextent it was incurred by you,20 acquisition date Statement Internal Revenue ForGeneral6 Adjustments to student7 Checked if the amountfurnished to the reported and the IRS8 Address or description of property securing mortgage (see www.irs.gov/Form1099SforeignDepartment of the Treasury - Internal Revenue Service reimbursed by another person. March 2024 Form(keep for your records) transferor partnership, is aforeign person estate,Reduction Actnot been reported. actually paid by you, and notService Center Certain InformationReturns. half-time studentfor a prior year 9 Check if a graduate Internal Revenuecomplete Form 8863 1099-S(nonresident alien, . foreignCORRECTED Notice, see theForm1098 (Rev. 1-2022)RECIPIENTS/LENDERS TINmortgage9 Number of properties securing the PAYERS/BORROWERS TINwww.irs.gov/Form109810 Other $instructions)For Payer/Street address (including apt. no.) Form1098-E www.irs.gov/Form1098E and/or capitalized interest, and the loan was made sanction may be1098-T $ scholarships or grantsMarch 2024 Service Center must be used to 6Buyers part of real estate taxwww.irs.gov/Form1099S current GeneralL18A 41-0852411 5150 1 Mortgage interest received from payer(s)/borrower(s)* Borrower For Privacy Act andimposed on you if the6 Adjustments towww.irs.gov/Form1098T amounts for an10 Ins. contract reimb./refundIRS. This form Instructions foracademic periodDepartment of the Treasury - Internal Revenue ServiceAccount number (see instructions) VOID Department of the Treasury - Internal Revenue Service 2 Outstanding mortgage3 Mortgage origination date Account number (see instructions) 2File with Form 1096. IRS determines that anService Provider/Acct. No. (see instr.) scholarships or grants7 Checked if the amountFile with Form 1096. to claim education Form1099-S(Rev. 1-2022) LSA 41-0852411 5160 CORRECTED (if checked) Certain InformationProceeds From RealPAYER'S/BORROWER'Sname,stre Account number (see instructions) t , or andZIPorforeignpostalcode principal Department of the Treasury - Internal Revenue Service The information in boxes 1City or town, state or province, country, and ZIP or foreign postal code VOID fees and/or capitalized interest for loans made before. . . . . . . . Department of the Treasury - Internal Revenue Service City or town, state or province, country, and ZIP or foreign postal code 8 Checked if at leastVOID studentin box 1 includes$ beginning Januarycredits. Give it to the underpayment of tax ZIP or foreign postal code, and telephone number $ 1Date of closing Returns. adrescitytown,state or province,country, acquisition date Account number (see instructions) September 1, 2004Paperwork Reductionresults because you1098-T 8 Checked if at least$ for a prior year 9 Checked if a graduateFor Privacy Act andprepare the tax return. FILERS name, street address, city or town, state or province, country, OMB No. 1545-0997 through 9 and 11 is include loan originationfor student loan interest. half-time student academic periodPaperwork Reduction 11 Mortgageoverstated a deductionamounts for an10 Ins. contract reimb./refund tax preparer or use it to ZIP or foreign postal code, and telephone numberwww.irs.gov/Form1099S $5 Mortgage insuranceimportant tax informationIf checked, box 1 does not. Act Notice, see thebeginning January Act Notice, see the Department of the Treasury - Internal Revenue ServiceForm1099-S 4 Refund of overpaid$ premiums the IRS. If you are requiredForm1098-E (keep for your records) www.irs.gov/Form1098E 2023 General Service Provider/Acct. No. (see instr.)Form(keep for your records)9 Checked if a graduate March 2024 2023 GeneralMANUFACTUREDand is being furnished toInstructions for 10 Ins. contract reimb./refund Instructions for Required Envelope: FILERS name, street address, city or town, state or province, country, 1Date of closing $ 2Gross proceedsOMB No. 1545-0997 (Rev. January 2022) Estate Transactions Form1098 (Rev. 1-2022) $ interest Department of the Treasury - Internal Revenue Service Form1098-E L18EA 41-0852411 5185 Check if box 1 does not include loan origination fees . CORRECTED . . . . . . Department of the Treasury - Internal Revenue Service StudentForm1098-T L18TA half-time student 5180 studentwww.irs.gov/Form1098T 1 Payments received for Department of the Treasury - Internal Revenue ServiceOMB No. 1545-1574 Tuition CORRECTEDForm1099-SFor calendar year $www.irs.gov/Form1098 may be imposed on you ifRECIPIENTS/LENDERS name, street address, city or town, state or 2 and/or capitalized interest, and the loan was madeCertain InformationReturns.FILERS name, street address, city or town, state or province, country, ZIP orexpenses Certain InformationReturns. 20 6 Points paid on purchase of principal residence penalty or other sanctionprovince, country, ZIP or foreign postal code, and telephone numberbefore September 1, 2004OMB No. 1545-1576 foreign postal code, and telephone number $ Department of the Treasury - Internal Revenue ServiceFor calendar year Proceeds From RealCopy C 7If address of property securing mortgage is the samethat an underpayment ofwww.irs.gov/Form1098E Department of the Treasury - Internal Revenue Service Loan Interest41-0852411 www.irs.gov/Form1098T $ 2OMB No. 1545-1574 2023 StatementFILERS TIN FILERS TIN TRANSFERORS TIN TRANSFERORS TIN2Gross proceeds 3Address (including city, state, and ZIP code) or legal descriptionFor Filer as PAYERS/BORROWERS address, the box is checked, orthe IRS determinesCORRECTED (if checked) OMB No. 1545-1576 2023 StudentStatement foreign postal code, and telephone number CORRECTED 3 Form1098-T Copy C(Rev. January 2022) Estate TransactionsAPEX/TFP: DW19W or DW19WS TRANSFEROR'S name, street address, city or town, state or province, country, and ZIP or foreign postal code 4 Check here if20 transferor received orreceiveCopy B or State Copy VOID the address or description is entered in box 8. tax results because youRECIPIENTS/LENDERS name, street address, city or town, state or$ Form1098-E Copy C FILERS name, street address, city or town, state or province, country, ZIP or$ 1 Payments received for2 TuitionFor Filer$ For Transferor For Privacy Act8 Address or description of property securing mortgageoverstated a deduction forprovince, country, ZIP or foreign postal code, and telephone number 1 Student loan interest received by lenderFormLoan InterestSTUDENTS TIN expenses Statement3Address (including city, state, and ZIP code) or legal description this mortgage interest or for TRANSFEROR'S name, street address, city or town, state or province, country, and ZIP or foreign postal code thewill This is important tax and PaperworkCORRECTEDthese points, reported inRECIPIENTS TIN tadres,cityortown,state BORROWERS TIN ZIPorforeignpostalcode 2023 Statement For Recipient STUDENT'S name, stret adres, city or town, state or province, country, and ZIP or foreign postal code prior year 2023 5 Scholarships or grants orStateCopyboxes 1 and 6; or because you didnt report the refund property or services as part of the considerationRECIPIENTS/LENDERS name, street address, city or town, state orOMB No. 1545-138045 Check here if the foreign a. foreign. . person. Reduction Act9 Number of properties securing the province, country, ZIP or foreign postal code, and telephone no. Formof interest (box 4); orMortgageRECIPIENTS TIN BORROWERSname,stre BORROWERS TIN orprovince,country,and Form1098-E Copy B orStateCopy STUDENTS TIN 3$ 4 Adjustments made for a $ Copy B For Privacy Act and Transferor received or will receive property or servicesinformation and is beingcurrent Generalbecause you claimed a (nonresident alien, . . transferor partnership, isfurnished to the IRS. IfNotice, see themortgage10 Other 1098 Interest1 Student loan interest received by lender For Privacy Act andForm1098-T Paperwork foreign estate, nondeductible item.as part of the consideration (if checked)or foreign trust)return, a negligence(Rev. January 2022) 11 MortgageAdjustments to For StudentForm1099-S(Rev. 1-2022) trust)$ 6Buyers part of real estate taxpenalty or otherL18B $20 acquisition date Statement Account number (see instructions) information and is beingReduction Act 2023Service Provider/Acct. No. (see instr.) Adjustments made for a $ in box 1 includesThis is importantthe 2023 GeneralOMB No. 1545-0119 1Grossdistribution 2aTaxableamount OMB No. 1545-0119 APEX LR4Form1099-SAccount number (see instructions) 5161 5 If checked, transferor is a foreign person (nonresident or . . . . . . . . foreign. sanction may beInstructions forAccount number (see instructions) 5151 $For calendar yearCopy CBORROWERSname,stretadres,cityortown,stateorprovince,country,andZIPorforeignpostalcode $ before September 1, 2004. . . . For Borrower . PaperworkSTUDENT'S name, stret adres, city or town, state or province, country, and ZIP or foreign postal code $ 4prior year $ 6 scholarships or grants$ 7 Check if theamount in Reduction Act alien, foreign partnership, foreign estate,Certain Information Returns. This is important taxfor a prior year5 Scholarships or grantsacademic period box 1 includes amounts for an 1Grossdistribution CORRECTED (if checked) Distributions From Pensions,CORRECTED (if checked) Distributions From Pensions,Account number (see instructions) (keep for your records) www.irs.gov/Form1099S imposed on you if thisForm10981 Mortgage interest received from payer(s)/borrower(s) For Recipient/2 and/or capitalized interest, and the loan was madeNotice, see the8 Check if at leaststudentamounts for anbeginning January tax informationNotice, see 6Buyers part of real estate tax item is required to befurnished to the IRS. IfGeneral Adjustments to 9 Check if a graduate7 Checked if the amount March 2024 and is beingInstructions for Department of the Treasury - Internal Revenue Service return, a negligenceInstructions forCertain InformationReturns.reported and the IRS determines that it has Form 1099-R 2aTaxableamount FATCA Filing13 2023 Form 1099-R Total 12FATCA Filing13 2023 (Rev. 1-2022)LSB $ 1Date of closing not been reported.(Rev. 1-2022)RECIPIENTS/LENDERS TIN(Keep for your records)PAYERS/BORROWERS TINwww.irs.gov/Form1098principal 2 Outstanding mortgage Department of the Treasury - Internal Revenue Service3 Mortgage origination date stet , or or or State Copy Account number (see instructions) Check if box 1 does not include loan origination fees . Certain InformationReturns. Form8 Checked if at least6 scholarships or grantsacademic period10 Ins. contract reimb./refundfurnished to the IRS. This form $ 2bTaxableamount $distribution 12 Annuities, Retirement or$ 2bTaxableamount $distribution Prot-Sharing Plans, IRAs,TFP 5175 VOID www.irs.gov/Form1099S Department of the Treasury - Internal Revenue Service PAYER'S/BORROWER'Sname, adrescitytown,state or province,country,andZIPforeignpostalcode 4 Refund of overpaid$ 5 Mortgage insuranceLender Form1098-E www.irs.gov/Form1098E sanction may be1098-T half-time student half-time student $ beginning Januarymust be used to .penalty or other notdetermined Total Prot-Sharing Plans, IRAs,notdetermined Annuities, Retirement orZIP or foreign postal code, and telephone number CORRECTED OMB No. 1545-0997 interest premiums For Privacy Act2 fees and/or capitalized interest for loans made before. . . . . . . . IRS determines that anService Provider/Acct. No. (see instr.) $ for a prior year March 2024 complete Form 8863 imposed on you if the requirement Date of payment requirement Date of payment underpayment of tax9 Checked if a graduateto claim education Insurance Contracts, etc. Insurance Contracts, etc. FILERS name, street address, city or town, state or province, country, 2Gross proceeds Form1099-S Proceeds From Real$and PaperworkForm1098-E L18EB (keep for your records) 5186 If checked, box 1 does not include loan originationDepartment of the Treasury - Internal Revenue Service Form1098-T L18TB (keep for your records) 5181 www.irs.gov/Form1098T 10 Ins. contract reimb./refund credits. Give it to the Department of the Treasury - Internal Revenue Serviceresults because youtax preparer or use it to overstated a deductionstudentprepare the tax return. for student loan interest.PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and phone no.PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and phone no. 6 Points paid on purchase of principal residence Reduction ActSeptember 1, 2004 RECIPIENT COPIES (Rev. January 2022) Estate Transactions $ 7If address of property securing mortgage is the sameNotice, see theVOID www.irs.gov/Form1098E. Department of the Treasury - Internal Revenue Service foreign postal code, and telephone number VOID www.irs.gov/Form1098T 1 Payments received for Department of the Treasury - Internal Revenue ServiceOMB No. 1545-1574as PAYERS/BORROWERS address, check the box, or entercurrent GeneralCORRECTED OMB No. 1545-1576 CORRECTED$ $ PAYERS TIN 3 (included total $7 4Federal 1 Form 1099-R $Roth CORRECTED T % (ifchecked) $ $ 6 2a) OMBNo.1545-0119 2023 $ Form 1099-R 1 $ 5Roth CORRECTED $ (ifchecked) OMBNo.1545-0119 2023 FILERS TIN TRANSFERORS TIN 4 5 Check here ififthe transferor. . . For calendar year . . . . .Copy C 9 Number of properties securing the 10 Other the address or description in box 8. Instructions for CertainRECIPIENTS/LENDERS name, street address, city or town, state ort , postalcode $ 2023 or StudentFILERS name, street address, city or town, state or province, country, ZIP or$ 23 expenses $ 2023 or Tuition Capital 2a) income $ RECIPIENTS TIN Employeecontributionscontributions/Designatedor Taxableamount3 PAYERS TIN Distributions From Pensions,income RECIPIENTS TIN 2aTaxableamount 12 Distributions From Pensions,TRANSFEROR'S name, street address, city or town, state or province, country, and ZIP or foreign postal code $ 20 For Filer mortgage 8 Address or description of property securing mortgage (seeInformationprovince, country, ZIP or foreign postal code, and telephone number 1098-E Loan InterestSTUDENTS TIN Form1098-T StatementGross withheld 2a insurancepremiums Capitalgain(included Federal Grossdistribution Employeecontributionscontributions/Designatedorinsurancepremiums Prot-Sharing Plans, IRAs,3Address (including city, state, and ZIP code) or legal descriptionor State Copy instructions) Returns. Statementinbox gain tax distribution5 inbox Prot-Sharing Plans, IRAs,taxwithheld Annuities, Retirement or Annuities, Retirement or 4Insurance Contracts, etc.6Netunrealizedrs appreciation Distribution2bcode(s)Taxablenotdetermined $8Other $otal Netunrealizedrs12 Insurance Contracts, etc. determined $8Other distribution% FATCA Filing13Date of payment received or will receiveFor Privacy ActRECIPIENTS TIN BORROWERS TIN 1 Student loan interest received by lenderFormCopy C Copy CIRA/ requirement $7Distribution2bcode(s)Taxablenot IRA/inemployesecurities amount distribution inemploye FATCA Filing13Date of payment amount Total requirementSIMPLE appreciation SIMPLESEP/ securities SEP/9aYourpercentageof distribution PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and phone no.PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and phone no. property or services as part of the consideration and PaperworkAccount number (see instructions) acquisition date BORROWERSname,streadrescityortown,stateorprovince,country,andZIPorforeign For Recipient STUDENT'S name, stret adres, city or town, state or province, country, and ZIP or foreign postal code4 Adjustments made for a 5 Scholarships or grants For Filer% 9bTotalemployee$ contributions 9aYourpercentageoftotaldistribution % 9bTotalemployee$ contributions Check herethe transferor is a foreign personReduction Act11 MortgageStateCopy prior year StateCopyNotice, see the RECIPIENT'S name, street address, city or town, state or province, country, and ZIP or foreign postal code RECIPIENT'S name, street address, city or town, state or province, country, and ZIP or foreign postal code (nonresident alien, . foreign partnership, foreign estate, current GeneralFor Privacy Act and$ For Privacy Act and or foreign trust) Paperwork Instructions forPaperwork6 Adjustments to 7 Check if theamount in Reduction Act $ 14State tax withheld 15 $ PAYERS TIN 3 (included $ Local 4Federal RECIPIENTS TIN $ 5Roth contributions or insurance premiums 1 PAYERS TIN $ 3 6 (included $ $ State distribution7 $ 4Federal RECIPIENTS TIN $ 8 5Roth contributions insurancepremiums PAYER COPIES Account number (see instructions) 5162 $ 6Buyers part of real estate tax Certain Information Returns. Form1098 (Rev. 1-2022) L18C www.irs.gov/Form1098 5152 Department of the Treasury - Internal Revenue Service Account number (see instructions) www.irs.gov/Form1098E 2 and/or capitalized interest, and the loan was made. . . . . . . Reduction Act 2023 Service Provider/Acct. No. (see instr.) 8 Check if at least$ scholarships or grants$ amounts for anNotice, see box 1 includes Account number (see instructions) 1 $ 6 Capital 2a) $ 10 $7 incometax 14 withheld $8 Employeecontributions/Designated % Capital 2a) 10 incometaxwitheld Employeecontributionscontributions/Designatedor % Form1099-S(Rev. 1-2022) LSC www.irs.gov/Form1099S Department of the Treasury - Internal Revenue Service Check if box 1 does not include loan origination feesNotice, see the General half-time student for a prior year beginning January the 2023 Generalinbox gain inbox gain academic periodInstructions for1st year of desig. Roth contrib. appreciation Distributioncode(s) Account number (see instructions) 15 1st year of desig. Roth contrib. 16 Amount allocable to IRR within 5 yearsSIMPLE Other before September 1, 2004Instructions for 9 Check if a graduateMarch 2024 Certain InformationReturns. Netunrealizedssecurities IRA/ Other State/Payers state no.securities Distributioncode(s) SEP/ Certain InformationReturns. student10 Ins. contract reimb./refundAmount allocable to IRR within 5 yearsIRA/inemployer 16State distribution SIMPLE Net employer appreciationState/Payers state no. SEP/ in unrealizedsState tax withheld$ 17Local tax withheld 18Name of Locality9aYourpercentage19$oftotaldistribution 9b17 employee$ contributions 18Name of Locality9a$ Yourpercentage19$oftotal distribution 9bTotalemployee$ Form1098-E L18EC 5187 Department of the Treasury - Internal Revenue Service Form1098-T L18TC www.irs.gov/Form1098T 5182 Department of the Treasury - Internal Revenue Service distribution $TotalLocal tax withheld Localdistribution1 File this copy with your state, city, or Department of the Treasury $ 1 File this copy with your state, city, or Department of the Treasury $ Required Envelope:local income tax return, when required. Internal Revenue Service local income tax return, when required. Internal Revenue Service Required Envelope:www.irs.gov/Form1099R % %RECIPIENT'S name, street address, city or town, state or province, country, and ZIP or foreign postal code www.irs.gov/Form1099RRECIPIENT'S name, street address, city or town, state or province, country, and ZIP or foreign postal codeForm 1099-R CORRECTED (if checked) OMB No. 1545-0119 2023 Form 1099-R CORRECTED (if checked) OMB No. 1545-0119 2023Grossdistribution 2aTaxableamount Distributions From Pensions,Grossdistribution 2aTaxableamount Distributions From Pensions, Annuities, Retirement orAnnuities, Retirement or $ 2bTaxableamount $distribution $ $ 14 12FATCA Filing13Date of payment11st year of desig. Roth contrib.$ $ 10 $ $ Amount allocable to IRR within 5 years$ $ Account number (see instructions) Date of payment11st year of desig. Roth contrib. $ 10 $ $ Amount allocable to IRR within 5 yearsAPEX/TFP: DW19W or DW19WS APEX: DWMR or DWMRSInsurance Contracts, etc. Prot-Sharing Plans, IRAs, notdetermined Total Account number (see instructions)Prot-Sharing Plans, IRAs,2bTaxableamount $distribution 14 12 Insurance Contracts, etc. 16State distributionState tax withheld requirement 15 notdetermined Total State tax withheld FATCA Filing13 15State/Payers state no.State/Payers state no. 16State distribution requirementPAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and phone no.PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and phone no. 19Local distribution theService Required Envelope: Required Envelope:17Local tax withheld 18Name of Locality 19Local distribution 17Local tax withheld 18Name of LocalityPAYERS TIN securities $ 1 Payer's - State, Local or $ FileCopy $ 3 6 Capital 2a) OMBNo. DepartmenttheService $ 1 Payer's - State, Local or $ FileCopy OMBNo. Department Treasury TFP: 77771 or 77772InternalRevenueof Treasury InternalRevenueofwww.irs.gov/Form1099R www.irs.gov/Form1099RForm 1099-R CORRECTED(ifchecked) 1545-0119 2023Form 1099-R CORRECTED(ifchecked) 1545-0119 2023$ 3 6 Capitalgain(included $7 4Federalincome RECIPIENTS TIN $8Roth 2aTaxableamount PAYERS TIN Distributions From Pensions,income RECIPIENTS TIN $8Roth 2aTaxableamount 12 Distributions From Pensions,APEX/TFP: DW19W or DW19WS APEX/TFP: DW19W or DW19WSGross withheld Employeecontributionscontributions/Designatedorinsurancepremiums inbox gain(included Federal taxwithheld Employeecontributionscontributions/Designatedorinsurancepremiums RECIPIENT COPIES Annuities, Retirement or Annuities, Retirement or 4 Grossinbox2a) tax distribution5 Prot-Sharing Plans, IRAs,distribution5 Prot-Sharing Plans, IRAs, Insurance Contracts, etc.inemploye amount Other distribution% Netunrealizedrs12 Insurance Contracts, etc. determined Other distribution % FATCA Filing13Date of paymentIRA/ requirement $7Distribution2bcode(s)Taxablenot IRA/Netunrealizedrs appreciation Distribution2bcode(s)Taxablenotdetermined Total inemploye FATCA Filing13Date of payment amount Total requirementSIMPLE appreciation SIMPLESEP/ securities SEP/9bTotalemployee$ contributions 9aYourpercentageoftotaldistribution 9bTotalemployee$ contributions$ 9aYourpercentageoftotaldistribution PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and phone no.$ PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and phone no.RECIPIENT'S name, street address, city or town, state or province, country, and ZIP or foreign postal code $ RECIPIENT'S name, street address, city or town, state or province, country, and ZIP or foreign postal code $% %PAYERS TIN RECIPIENTS TIN PAYERS TIN RECIPIENTS TIN PAYER COPIES3Capital 2a) (included 4Federalincometaxwithheld5Roth contributions or insurance premiums 3Capital 2a) (included 4Federalincometaxwitheld5Roth insurancepremiumsinbox gain Employeecontributions/Designated inbox gain Employeecontributionscontributions/DesignatedorAccount number (see instructions) 15 11st year of desig. Roth contrib.$ 6 appreciation$ $7Distributioncode(s)Account number (see instructions) $ $ 15 % 1 $ $ 6 6 1st year of desig. Roth contrib. $ 10 $ Amount allocable to IRR within 5 years $ 7 9bTotal SIMPLE $8 $ Other %inemployer 10Amount allocable to IRR within 5 yearsIRA/ inemployersecurities State distribution IRA/$ 14State tax withheld Netunrealizedssecurities Department of the Treasury$ 9b $ 14 SEP/ $8Other 18Name of Locality9a Netunrealizeds appreciation Distribution % code(s) $ SEP/ contributionsState/Payers state no. 16State distribution SIMPLE State/Payers state no. 16State tax withheld$ 17Local tax withheld 18Name of Locality9a$ Yourpercentage$19$oftotal distribution 17TotalLocal tax withheld Yourpercentage19$oftotal distribution employeeLocaldistribution employeecontributions Localdistributionwww.irs.gov/Form1099R % LR4 Report this income on your federal tax return. www.irs.gov/Form1099R(5175)Copy C For Recipients Records is Service. Internal Revenue Service Copy B If this form shows federal income tax withheld Department of the TreasuryThisinformationbeingfurnishedtotheInternalRevenue in box 4, attach this copy to your return. Internal Revenue ServiceRECIPIENT'S name, street address, city or town, state or province, country, and ZIP or foreign postal code RECIPIENT'S name, street address, city or town, state or province, country, and ZIP or foreign postal codeAccount number (see instructions) 11st year of desig. Roth contrib. $ 10Amount allocable to IRR within 5 years Account number (see instructions) 11st year of desig. Roth contrib. $ 10Amount allocable to IRR within 5 years $ $ 14State tax withheld 15State/Payers state no. 16 $ $ State distribution theService $ $ 14State tax withheld 15State/Payers state no. 16 $ $ State distribution theService APEX LR4R 17Local tax withheld 18Name of Locality 19Local distribution 17Local tax withheld 18Name of Locality 19Local distributionPayer's - State, Local orFileCopy Department TreasuryPayer's - State, Local orFileCopy Department Treasurywww.irs.gov/Form1099R InternalRevenueofInternalRevenueof LR4R www.irs.gov/Form1099R5176 TFP 5176Required Envelope: APEX - Sheets per packTFP - Forms per packAPEX: DW4MW or DW4MWS 50s500s100s1000sFORM DESCRIPTIONTFP: 61611 or 61612 L18EAN/A5185N/A1098-E Federal Copy A1 Page Equals 3 FormsL18EBN/A5186N/A1098-E Borrower Copy B1 Page Equals 3 FormsAPEX - Sheets per packTFP - Forms per pack L18ECN/A5187N/A1098-E Recipient Copy C and/or State Copy1 Page Equals 3 Forms50s500s100s1000sFORM DESCRIPTION 50S500S100S1500SLR3N/AN/AN/A1099-R 3-Up Horizontal Recipient Copy B, C, 21 Page Equals 1 Form L18TAL18TA50051805180B1098-T Federal Copy A1 Page Equals 3 FormsLR4LR450051755175B1099-R 4-Up Box Recipient Copy B, C, 2, 21 Page Equals 1 Form L18TBL18TB50051815181B1098-T Student Copy B1 Page Equals 3 FormsLR4RLR4R50051765176B1099-R 4-Up Box Payer, State, Local or File Copy D, 1, 1, 11 Page Equals 1 Form L18TCL18TC50051825182B1098-T Filer Copy C and/or State Copy1 Page Equals 3 Forms50s500s100s1500sLSALSA50051605160B1099-S Federal Copy A1 Page Equals 3 FormsLSBLSB50051615161B1099-S Transfer or Copy B1 Page Equals 3 FormsLSCLSC50051625162B1099-S Filer Copy C and/or State Copy1 Page Equals 3 Forms50s500s100s1000sL18AL18A50051505150B1098 Federal Copy A1 Page Equals 2 FormsL18BL18B50051515151B1098 Payer/Borrower Copy B1 Page Equals 2 FormsL18CL18C50051525152B1098 Recipient/Lender Copy C and/or State Copy1 Page Equals 2 Forms42 43"