b"5498 PRE-PRINTED FORMS 1099 BLANK FORMSIndividual Laser Packs Individual Laser Packs5498 (IRS CONTRIBUTIONAPEX LM3BLAPEX L9BL APEX LMRNBINFORMATION) TFP 5173 TFP 5174APEX L9BLHTFP 5144 APEX LU4 TFP 5145 2828 VOID CORRECTED OMB No. 1545-0747 APEX LW2NB DETACH BEFORE MAILINGMANUFACTURED ON OCR LASER BOND PAPER USING HEAT RESISTANT INKSTRUSTEES or ISSUERS name, street address, city or town, state or1 IRA contributions (other province, country, and ZIP or foreign postal code $ 24, 810, 13a, and 14a) 2023 IRAThis panel TFP 5207than amounts in boxes Contribution 2 Rollover contributions Information Contains 1099-MISC$ 3 Roth IRA conversionForm 5498 Copy A Copy B Backeramount 4 Recharacterized TRUSTEES or ISSUERS TIN PARTICIPANTS TIN $ $ contributions ForInformation5 FMV of account 6 Life insurance cost included inInternal Revenue box 1 Service Center$ $ File with Form 1096.PARTICIPANTS name 7IRA SEP SIMPLE8 SEP contributions 9 SIMPLE contributionsRoth IRA$ $ For Privacy Act Street address (including apt. no.) 10 Roth IRA contributions 11 Check if RMD for 2024 and Paperwork $ Reduction Act 12a RMD date 12b RMD amount Notice, see the City or town, state or province, country, and ZIP or foreign postal code CORRECTED (if checked)$ 13c Code 2023 GeneralTRUSTEES or ISSUERS name, street address, city or town, state or 13a Postponed/late contrib.1 IRA contributions (other than amounts in boxes14b Code Instructions forCertain IRAThis panel13b Year OMB No. 1545-0747 DETACH BEFORE MAILINGMANUFACTURED ON OCR LASER BOND PAPER USING HEAT RESISTANT INKSprovince, country, and ZIP or foreign postal code $ 24, 810, 13a, and 14a) Information14a Repayments Returns.Account number (see instructions) $ assets $ 2 Rollover contributions 2023 ContributionContains 1099-MISCInformation15a$ 15b Code(s) Form 5498 Copy B Copy C Backer$ 3 Roth IRA conversion4 Recharacterized Form5498 41-0852411 PARTICIPANTS TINwww.irs.gov/Form5498 $ amount $ contributions InformationTRUSTEES or ISSUERS TIN Department of the Treasury - Internal Revenue ServiceDo Not Cut or Separate Forms on This PageDo Not Cut or Separate Forms on This Page5 FMV of account 6 Life insurance cost included inParticipantFor box 1$ $2828 name,stretadres VOID , ortown,stateorprovince,country,andZIPorforeignpostalcodeIRA SEP SIMPLE This information PARTICIPANT'S city CORRECTED 9 SIMPLE contributionsRoth IRA is being than amounts in boxes8 7TRUSTEES or ISSUERS name, street address, city or town, state or1 IRA contributions (other SEP contributionsOMB No. 1545-0747 $ furnished to province, country, and ZIP or foreign postal code $distribution for 2024 IRA 24, 810, 13a, and 14a)10 Roth IRA contributions 11 If checked, required minimumthe IRS.$ $ 2023 Contribution CORRECTED $ InformationVOID 12a RMD date 12b RMD amountTRUSTEES or ISSUERS name, street address, 2 Rollover contributions Form 5498 13b Year13c CodeOMB No. 1545-0747 DETACH BEFORE MAILINGMANUFACTURED ON OCR LASER BOND PAPER USING HEAT RESISTANT INKS$ city or town, state or1 IRA contributions (other TRUSTEES or ISSUERS TIN PARTICIPANTS TIN $ 3 Roth IRA conversion 13a Postponed/late contrib.4 Recharacterized contributions24, 810, 13a, and 14a)14b Code 2023 IRA province, country, and ZIP or foreign postal code than amounts in boxesamount $ Copy A14a Repayments $ ForContribution 5 FMV of account $ $ 6 Life insurance cost included inInternal RevenueInformation2 Rollover contributionsPARTICIPANTS name Account number (see instructions) $ 7IRA SEP 15a assets $ box 1$ 3 Roth IRA conversionService Center Copy CForm 5498amount15b Code(s) File with Form 1096.4 Recharacterized $ SIMPLE $ Roth IRA $ contributionsForm5498 TRUSTEES or ISSUERS TIN $ 8 SEP contributions $ 9 SIMPLE contributions For Privacy ActTrustee or IssuerFor PARTICIPANTS TIN Department of the Treasury - Internal Revenue Service(keep for your records) www.irs.gov/Form5498 FMV of account 6 Life insurance cost included in 5box 1Street address (including apt. no.) 10 Roth IRA contributions 11 Check if RMD for 2024 and Paperwork $ $ Reduction Act LU4$PARTICIPANT'Sname,stretadres,cityortown,12a RMD dateor country,andZIPorforeignpostalcodeIRA SEP Notice, see the City or town, state or province, country, and ZIP or foreign postal code stateprovince, 12b RMD amount8 7 SEP contributions 2023 GeneralFor Privacy ActLM3BL 51739 SIMPLE contributionsRoth IRASIMPLECORRECTED (if checked)$ $ Code Instructions for and Paperwork L9BL5174TRUSTEES or ISSUERS name, street address, city or town, state or10$province, country, and ZIP or foreign postal code 13a Postponed/late contrib.1 IRA contributions (other than amounts in boxes13b Year13c Roth IRA contributions Certain Reduction Act $ OMB No. 1545-074711 Check if RMD for 202414a Repayments 24, 810, 13a, and 14a) Information IRA 14b Code $ Returns. 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APEX LMBL LW2NB 52075170 www.irs.gov/Form5498 Department of the Treasury - Internal Revenue ServiceFMV of account $ $ 6 Life insurance cost included in PARTICIPANT'Sname,stret Account number (see instructions) , or or andZIPorforeignpostalcode $ 7 IRA 15a assets $ box 1 This informationTFP 5108 adrescity $ SIMPLEForm5498 town,stateprovince,country, www.irs.gov/Form5498 is being $ 8 SEP contributionsSEP $ 9 SIMPLE contributionsRoth IRADepartment of the Treasury - Internal Revenue Service APEX LRBLBC APEX LJH1500furnished to VOID 10 Roth IRA contributions 11 If checked, required minimumthe IRS. APEX LR4BL APEX L4BLNB TFP 5104TAX1$ distribution for 202412a RMD date 12b RMD amountCORRECTED $ OMB No. 1545-0747province, country, and ZIP or foreign postal code $ 1 IRA contributions (otherIRATFP 5179TFP 5221 TRUSTEES or ISSUERS name, street address, city or town, state orthan amounts in boxes13a Postponed/late contrib.24, 810, 13a, and 14a)14b Code 13c Code 2023 Contribution 13b Year14a Repayments $ 2 Rollover contributions Information$ $ Form 5498Account number (see instructions) 15a assets 3 Roth IRA conversion4 RecharacterizedCopy Camount15b Code(s) contributionsTRUSTEES or ISSUERS TIN 5171 $ $ 5 FMV of account $ 6 Life insurance cost included inThis panel containsForm5498 L58B (keep for your records) www.irs.gov/Form5498 Department of the Treasury - Internal Revenue Service 1099-MISC Copy B BackerPARTICIPANTS TINPARTICIPANT'Sname,stretadres,cityortown,stateorprovince,country,andZIPorforeignpostalcode $ 7 IRA $ box 1 Trustee or IssuerForThis panel contains$ 8 SEP contributionsSEP SIMPLE For Privacy Act1099-R Copy B Backer9 SIMPLE contributionsRoth IRA$ and Paperwork 10 Roth IRA contributions 11 Check if RMD for 2024 Reduction Act $ Notice, see the 12a RMD date 12b RMD amount 2023 General 13a Postponed/late contrib. $ 13c Code$ 13b Year Instructions forCertain 14a Repayments 14b Code Information$ Returns. MULTIPLE BACKER FORMS Account number (see instructions) 15a assets 15b Code(s)$Form5498 L58C 5172 www.irs.gov/Form5498 Department of the Treasury - Internal Revenue Service PRINTEDON 24#STOCKRequired Envelope: This panel contains1099-MISC Copy B Backer This panel containsAPEX: DWMR or DWMRS This panel This panel 1099-R Copy C BackerContains 1099-R Contains 1099RTFP: 77771 or 77772 Copy C Backer Copy B BackerInformation InformationRequired Envelope:APEX - Sheets per packTFP - Forms per pack APEX: DWJH or DWJHS50s500s100s500sFORM DESCRIPTION TFP: 12121 or 12122APEX - Sheets per packTFP - Forms per pack LM3BLLM3BL50051735173B1099-MISC 3-Up Blank w/ Copy B and Copy C Backer1 Page Equals 1 Form50s500s100s1000sFORM DESCRIPTION LR4BLLR4BL50051795179B1099-R Blank 4-Up Box w/ Copy B and C Backer1 Page Equals 1 FormL58AL58A50051705170B5498 Federal Copy A1 Page Equals 2 Forms L4BLNBL4BLNB50052215221B1099-R/W-2 4-Up Box Blank w/o Backer1 Page Equals 1 FormL58BL58B50051715171B5498 Participant Copy B1 Page Equals 2 Forms LU4LU4500N/AN/A1099/W-2 Universal Blank w/o Backer1 Page Equals 1 FormL58CL58C50051725172B5498 Trustee or Issuer Copy C1 Page Equals 2 Forms 50s500s100s1000sLMRNBLMRNB50051445144BUniversal Blank w/ Stub for all 1099-MISC, 1099-INT, 1099-R, 1099-DIV and 1099-BLW2NBLW2NB50052075207B1099/W-2 2-Up Blank w/o Backer1 Page Equals 2 FormsN/AN/A51595159B1099-MISC Blank w/ Recipient Copy B Backer Instructions w/ Stub1 Page Equals 2 FormsLMBLLMBL50051085108B1099-MISC Blank w/ Recipient Copy B Backer Instructions1 Page Equals 2 FormsLRBLBCLRBLBC500N/AN/A1099-R Blank w/ Recipient Copy B and Copy C Backer Instructions1 Page Equals 1 Form50s500s100s1500s L9BLL9BL50051745174B1099, 1098, 5498/W-2G Blank 3-Up Horizontal Perf w/ Stub1 Page Equals 3 FormsL9BLHL9BLH50051455145B1099, 1098, 5498 Blank 3-Up Horizontal Perf w/o Stub1 Page Equals 3 Forms50s500s100s500s LJH1LJH15005104TAX15104BTAX11099 Blank for 1099-A, 1099-B, 1099-C, 1099-S and 1098LJH2LJH25005105TAX25105BTAX21099 Blank for 1099-Q, 1099-R, 1099-INT and 5498LJH3LJH35005106TAX35106BTAX31099 Blank for 1099-MISC, 1099-OID, 1099-DIV and 1099-SA44 45"