b"1099 PRE-PRINTED FORMS 1099 PRE-PRINTED FORMSTFP 1099-DIV & 1099-R Packaged Sets Apex 1099-MISC, 1099-NEC, 1099-INT SetsTFP 1099-DIV LASER PACKAGED SET APEX DWMR or DWMRSTFP 5130 TFP 5131 TFP 5132 TFP 51009191 VOIDCORRECTED CORRECTED (if checked) VOIDCORRECTED Do Not Staple 6969PAYERS name, street address, city or town, state or province, country, ZIP 1aTotal ordinary dividendsOMB No. 1545-0110PAYERS name, street address, city or town, state or province, country, ZIP 1aTotal ordinary dividendsOMB No. 1545-0110PAYERS name, street address, city or town, state or province, country, ZIP 1aTotal ordinary dividendsOMB No. 1545-0110Form1096 Annual Summary and Transmittal of OMB No. 1545-0108or foreign postal code, and telephone no.$1b Form1099-DIVDividends andor foreign postal code, and telephone no. USING HEATINKS $1b Form1099-DIV Dividends and DETACH BEFORE MAILING or foreign postal code, and telephone no. USING HEATINKS $1b Form1099-DIVDividends and DETACH BEFORE MAILINGUSING HEATINKS Department of the TreasuryU.S. Information Returns 2023DETACH BEFORE MAILING DETACH BEFORE MAILINGRESISTANTRESISTANTRESISTANTMANUFACTUREDMANUFACTURED ON OCR LASER BOND PAPER USING HEAT RESISTANT INKSDETACH BEFORE MAILINGDETACH BEFORE MAILINGDETACH BEFORE MAILING(Rev. January 2022) Distributions(Rev. January 2022) Distributions(Rev. January 2022) DistributionsInternal Revenue Service$2aTotal capital gain distr. $For calendar year Copy A PAYERS TINRECIPIENTS TIN $2aTotal capital gain distr. $For calendar year Copy BPAYERS TINRECIPIENTS TIN $2aTotal capital gain distr. $For calendar year Copy C FILERS name APEX 1099-MISC LASER PACKAGED SET$ 2bUnrecap. Sec. 1250 gainCopy A 2bUnrecap. Sec. 1250 gain2bUnrecap. Sec. 1250 gain $2cSection 1202 gain2dCollectibles (28%) gainInternal Revenue For$2cSection 1202 gain2dCollectibles (28%) gainFor Recipient$2cSection 1202 gain2dCollectibles (28%) gainFor Payer Street address (including room or suite number)PAYERS TIN RECIPIENTS TIN and/or State $$Service Center$$$$ Copy 1 or Copy 2RECIPIENTS name$2eSection 897 ordinary dividends $2fSection 897 capital gainFile with Form 1096. RECIPIENT'S name, stret adres, city or town, state or province, country, and ZIP or foreign postal code $2eSection 897 ordinary dividends $2fSection 897 capital gainThis is important taxRECIPIENT'S name, stret adres, city or town, state or province, country, and ZIP or foreign postal code $2eSection 897 ordinary dividends $2fSection 897 capital gainFor Privacy ActCity or town, state or province, country, and ZIP or foreign postal code For Ofcial Use Only APEX LMA APEX LMB APEX LMCLM2 APEX L1096 BOND PAPERBOND PAPERBOND PAPER3Nondividend distributions 4Federal income tax withheld3Nondividend distributions 4Federal income tax withheld3Nondividend distributions 4Federal income tax withheld Name of person to contact Telephone number$$For Privacy Act$5Section 199A dividends $6Investment expensesinformation and is$5Section 199A dividends $6Investment expensesand PaperworkEmail address Fax number Do Not Staple CORRECTED5Section 199A dividends 6Investment expensesand Paperwork$$being furnished to$$Reduction Act9595 VOID CORRECTED CORRECTED (if checked)VOID 6969 1 Rents OMB No. 1545-0115 OMB No. 1545-0108Street address (including apt. no.)$$Reduction Actthe IRS. If you are9Cash liquidation distributions 8 Noncash liquidation distributionsNotice, see the1W-2G 1097-BTC1098 2 Social security number 74 3 Total number of forms $ 4 Federal income tax withheld $ 5 Total amount reported with this Form 1096 PAYERS name, street address, city or town, state or province, country, ZIP2 Royalties OMB No. 1545-0115 1 Rents Form1096 2 Royalties Annual Summary and Transmittal of 2023 ON OCR LASERON OCR LASERON OCR LASER7Foreign tax paid8Foreign country or U.S. possession Notice, see the7Foreign tax paid8Foreign country or U.S. possession return, a negligence7Foreign tax paidForeign country or U.S. possessioncurrent Generalor foreign postal code, and telephone no. PAYERS name, street address, city or town, state or province, country, ZIP PAYERS name, street address, city or town, state or province, country, ZIP Notice, see theOMB No. 1545-0115 MANUFACTUREDMANUFACTUREDMANUFACTURED ON OCR LASER BOND PAPER USING HEAT RESISTANT INKSMANUFACTURED ON OCR LASER BOND PAPER USING HEAT RESISTANT INKSMANUFACTURED ON OCR LASER BOND PAPER USING HEAT RESISTANT INKScurrent Generalpenalty or otheror foreign postal code, and telephone no.1 Rents or foreign postal code, and telephone no.City or town, state or province, country, and ZIP or foreign postal code $9Cash liquidation distributions10 Noncash liquidation distributions Instructions for Certain$9Cash liquidation distributions10 Noncash liquidation distributionssanction may be$10Instructions for632 50 81 1098-C1098-E1098-F1098-Q1098-T1099-A1099-B1099-C1099-CAP1099-DIV1099-G1099-INT1099-K $ Form1099-MISC $ Miscellaneous 1099-MISC $ Miscellaneous U.S. Information Returnsimposed on you ifCertain(Rev. January 2022) 2 Royalties Department of the TreasuryForm1099-MISC Miscellaneous Form Information this income is taxableInformation78 84 03 83 80 79 85 73 91 86 92 10 For calendar yearInternal Revenue Service Information (Rev. January 2022) Informationand the IRSInformation (Rev. January 2022) For calendar year $$Returns.$$determines that it has$$Returns.$ $ FILERS name $ 20For calendar year 11requirement 12Exempt-interest dividends13bond interest dividends 11requirement 12Exempt-interest dividends13bond interest dividends not been reported.11requirement 12Exempt-interest dividends13bond interest dividends 3 Other income 4 Federal income tax withheld3 Other income 4 Federal income tax withheld 4 Federal income tax withheld Copy C$$$$$$1099-LS 1099-LTC1099-MISC 1099-NEC 1099-OID1099-PATR 1099-Q1099-QA 1099-R1099-S1099-SA 1099-SB 3921392254985498-ESA5498-QAPAYERS TIN RECIPIENTS TINPAYERS TIN $ $ $ Copy A$ payments $ 3 Other income Copy B$ 6 Medical and health careor For PayerStreet address (including room or suite number)$$$16 93 95 71 96 97 31 1A 98 75 94 43 25 26 28 72 2A 5 Fishing boat proceeds ForFor Recipient payments StateCopy2Account number (see instructions)2nd TIN not.14State 15 16State tax withheld Account number (see instructions)14State 15 16State tax withheld Account number (see instructions)2nd TIN not.14State 15 16State tax withheld 5 Fishing boat proceedsRECIPIENTS TIN6 Medical and health care paymentsPAYERS TIN Internal Revenue5 Fishing boat proceeds orCopyRECIPIENTS TIN6 Medical and health care Service Center$City or town, state or province, country, and ZIP or foreign postal codeForm1099-DIV(Rev. 1-2022) 41-0852411 www.irs.gov/Form1099DIV $Department of the Treasury - Internal Revenue Service Form1099-DIV(Rev. 1-2022) (keep for your records)www.irs.gov/Form1099DIV $Department of the Treasury - Internal Revenue Service Form1099-DIV(Rev. 1-2022) www.irs.gov/Form1099DIV $Department of the Treasury - Internal Revenue Service 5498-SARECIPIENTS name RECIPIENT'S name, stret ad $ 7totaling $5,000 or more of$ $ totaling $5,000 or more of$ $ 7 Payer made direct sales$ Substitute payments in lieu For Privacy ActFor Ofcial Use Only$27 res, city or town, state or province, country, aRnEdC ZIPI EoNr Tfo'Sre niganm peo, starle ceto adedres File with Form 1096. 8 of dividends or interesttotaling $5,000 or more of8 of dividends or interestPayer made direct salesSubstitute payments in lieuFor Privacy ActTelephone numberName of person to contact, city or town, state or province, country, and ZIP or foreign postal codeDoNotCutorSeparateFormsonThisPage DoNotCutorSeparateFormsonThisPage consumer products to$ 8 of dividends or interest7 Payer made direct salesSubstitute payments in lieuThis is important taxFax number and Paperwork 9and Paperworkattorney consumer products to$ 10 Gross proceeds paid to anReduction Act5 Total amount reported with this Form 1096Reduction Act $ information and is consumer products tobeing furnished to Return this entire page to the Internal Revenue Service. Photocopies are not acceptable.Street address (including apt. no.) recipient for resale attorney recipient for resale Email address recipient for resale attorney Notice, see the 9191 VOIDCORRECTED OMB No. 1545-0110CORRECTED (if checked) OMB No. 1545-0110VOIDCORRECTED OMB No. 1545-0110Send this form, with the copies of the form checked in box 6, to the IRS in a at mailer (not folded). City or town, state or province, country, and ZIP or foreign postal code $ 9 Crop insurance proceeds $ $ Notice, see the1097-BTC 81 $ 1098-C the IRS. If you are74 3 Total number of formscurrent General 73 $ 1099-DIV1099-G1099-INT1099-K APEX 1099-NEC LASER PACKAGED SET* 10 Gross proceeds paid to an Crop insurance proceeds 10 Gross proceeds paid to an 9 Crop insurance proceedscurrent General2 Social security number 4 Federal income tax withheld1return, a negligence$PAYERS name, street address, city or town, state or province, country, ZIP 1aTotal ordinary dividendsPAYERS name, street address, city or town, state or province, country, ZIP 1aTotal ordinary dividendsPAYERS name, street address, city or town, state or province, country, ZIP 1aTotal ordinary dividendsUnder penalties of perjury, I declare that I have examined this return and accompanying documents and, to the best of my knowledge and belief, they are true, correct, and complete. 11 Fish purchased for resale Instructions forCertain$ 12 Section 409A deferrals penalty or otherInstructions for$6sanction may be or foreign postal code, and telephone no.$Form1099-DIVDividends andor foreign postal code, and telephone no.$Form1099-DIV Dividends andor foreign postal code, and telephone no.$Form1099-DIVDividends andSignature Title Date $ $ 12 Section 409A deferrals11 Fish purchased for resale 32$ 50 1098 11 Fish purchased for resale $ 12 Section 409A deferrals 1099-A1099-B Certain 91 86 92 10Information 78 imposed on you if1098-Q1098-T 80 79 InformationW-2G1098-E1098-F 83 Returns.84 this income is1099-C1099-CAP $ Returns. $ taxable and the IRS85031b (Rev. January 2022) Distributions1b (Rev. January 2022) Distributions1b (Rev. January 2022) DistributionsInstructions number), and TIN in the spaces provided on the form. The name, address,13 requirement 14 Excess golden parachute15 compensation 14 Excess golden parachute15 compensation 14 Excess golden parachute15compensationpayments 13 requirement payments 13 requirement payments determines that it $2aTotal capital gain distr. $For calendar year $2aTotal capital gain distr. $For calendar year Copy B$2aTotal capital gain distr. $For calendar year Copy C Future developments. For the latest information about developmentsupper left area of Form 1097, 1098, 1099, 3921, 3922, 5498, or W-2G. Account number (see instructions) 2nd TIN not. $ 16 State tax withheld $ $ $ 1099-LS 1099-LTC1099-MISC $1099-NEC96 has not been 1099-Q1099-QA 1099-R1099-S1099-SA 1099-SB 3921392254985498-ESA5498-QASTANDARD SETS (34 Sheets for 100 Recipients)reported.related to Form 1096, such as legislation enacted after it was published, go16 $ 93 95 71 1099-OID1099-PATR $ 31 1A 98 75 94 43 25 26 28 72 2A972bUnrecap. Sec. 1250 gain2bUnrecap. Sec. 1250 gain2bUnrecap. Sec. 1250 gainto www.irs.gov/Form1096. When to le. File Form 1096 as follows. Account number (see instructions) 17 State/Payers state no.16 State tax withheld18 State income 17 State/Payers state no. 18 State income 17 State/Payers state no. 18 State incomeAccount number (see instructions) 2nd TIN not.16 State tax withheldPAYERS TIN RECIPIENTS TIN $2cSection 1202 gain2dCollectibles (28%) gainCopy AForPAYERS TINRECIPIENTS TIN $2cSection 1202 gain2dCollectibles (28%) gainFor RecipientPAYERS TINRECIPIENTS TIN $2cSection 1202 gain2dCollectibles (28%) gainFor Payer Reminder. The only acceptable method of electronically through the FIRE February 28, 2024. Form1099-MISC(Rev. 1-2022)41-0852411 Form1099-MISC$ (keep for your records) $ 5498-SA$ $ $returns listed on this form in box 6 with the IRS is 1099-MISC $$ 27 Department of the Treasury - Internal Revenue ServiceDepartment of the Treasury - Internal Revenue Service$2eSection 897 ordinary dividends $2fSection 897 capital gainInternal Revenue$2eSection 897 ordinary dividends $2fSection 897 capital gain$2eSection 897 ordinary dividends $2fSection 897 capital gainand/or StateSystem. See Pub. 1220. anyWhere To File $ Form Department of the Treasury - Internal Revenue Service $ $ $ NEC959133-Part SET includes: (34 Sheets EACH) 1099-NEC Copy A, B, CService CenterCopy 1 or Copy 2 Purpose of form. Use this form to transmit paper Forms 1097, 1098,www.irs.gov/Form1099MISC (Rev. 1-2022) www.irs.gov/Form1099MISC1099, 3921, 3922, 5498, and W-2G to the IRS.(Rev. 1-2022) www.irs.gov/Form1099MISCCaution:Do Not Cut or Separate Forms on This PageDo Not Cut or Separate Forms on This PageRECIPIENTS name$3Nondividend distributions$4Federal income tax withheldFile with Form 1096. RECIPIENT'S name, stret adres, city or town, state or province, country, and ZIP or foreign postal code $3Nondividend distributions$4Federal income tax withheldThis is important taxRECIPIENT'S name, stret adres, city or town, state or province, country, and ZIP or foreign postal code $3Nondividend distributions$4Federal income tax withheld For Privacy Actapproved waiver, you may be subject to a penalty. The Taxpayer First ActIf your principal business, ofce orUse the following9595 VOID CORRECTED Return this entire page to the Internal Revenue Service. Photocopies are not acceptable.electronically but fail to do so, and you do not have an Street address (including apt. no.)$5Section 199A dividends $6Investment expensesFor Privacy Act$5Section 199A dividends $6Investment expensesinformation and is$5Section 199A dividends $6Investment expensesand Paperworkof 2019, enacted July 1, 2019, authorized the Department of the Treasuryagency, or legal residence in theaddress PAYERS name, street address, city or town, state or province, country, ZIPOMB No. 1545-0115 1 Rents Send this form, with the copies of the form checked in box 6, to the IRS in a at mailer (not folded). NEC959144-Part SET includes: (34 Sheets EACH) 1099-NEC Copy A, B, C, Cand Paperworkbeing furnished toand the IRS to issue regulations that reduce the 250-return requirement forcase of an individual, is located in or foreign postal code, and telephone no. or foreign postal code, and telephone no.1 Rents CORRECTED (if checked)VOID CORRECTED OMB No. 1545-0115 Title DateUnder 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.$$Reduction Act$$the IRS. If you are$$Reduction Act2022 tax returns. If those regulations are issued and effective for 2023 tax www.irs.gov/ Alabama, Arizona, Arkansas, Delaware,PAYERS name, street address, city or town, state or province, country, ZIPOMB No. 1545-01151 RentsPAYERS name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. Signature Form 7Foreign tax paid8Foreign country or U.S. possession Notice, see the7Foreign tax paid8Foreign country or U.S. possession return, a negligence7Foreign tax paid8Foreign country or U.S. possession Notice, see theForm1099 explaining the change. Until regulations are issued, however,Florida, Georgia, Kentucky, Maine,Internal Revenue Service $ Form1099-MISC $ Miscellaneous 1099-MISC $ Miscellaneous 1099-MISC Miscellaneous City or town, state or province, country, and ZIP or foreign postal code $9Cash liquidation distributions10 Noncash liquidation distributions current General$9Cash liquidation distributions10 Noncash liquidation distributionspenalty or other$9Cash liquidation distributions10 Noncash liquidation distributionscurrent GeneralInformation Returns. part F in the 2023 General Instructions for CertainMassachusetts, Mississippi, NewAustin, TX 78714-9213 $ 2 Royalties (Rev. January 2022) $ 2 Royalties Form$ 2 Royalties Information (Rev. January 2022) Information NEC959155-Part SET includes: (34 Sheets EACH) 1099-NEC Copy A, B, C, C, 2imposed on you ifinformation, see Hampshire, New Jersey, New Mexico,P.O. Box 149213Information For calendar year InstructionsInstructions for Certainsanction may beInstructions for Certainreturns. New York, North Carolina, Ohio, Texas,For calendar year(Rev. January 2022) For calendar yearnumber), and TIN in the spaces provided on the form. The name, address,this income is taxableInformationWho must le.Vermont, Virginia 3 Other income 4 Federal income tax withheld3 Other income Future developments. For the latest information about developmentsupper left area of Form 1097, 1098, 1099, 3921, 3922, 5498, or W-2G.Informationdetermines that it has$$Returns.Alaska, Colorado, Hawaii, Idaho,related to Form 1096, such as legislation enacted after it was published, goWhen to le. File Form 1096 as follows.and the IRSsubject to information return penalties. Do not use the name and/or TIN ofMichigan, Minnesota, Missouri,Internal Revenue Service CenterPAYERS TIN RECIPIENTS TINPAYERS TIN $ $ $ to www.irs.gov/Form1096. $ 3 Other income For Recipient 20 or or Copy C11requirement $12Exempt-interest dividends $13bond interest dividends Returns.11requirement $12Exempt-interest dividends $13bond interest dividends not been reported.11requirement 12Exempt-interest dividends13bond interest dividends Caution:Illinois, Indiana, Iowa, Kansas,P.O. Box 219256Copy A4 Federal income tax withheld Copy B$ 4 Federal income tax withheld For Payer$$$$$$the name and TIN used on your 94X series tax return(s) or you may beMontana, Nebraska, Nevada, North Kansas City, MO 64121-9256 5 Fishing boat proceedsRECIPIENTS TIN6 Medical and health care paymentsPAYERS TIN Reminder. The only acceptable method of electronically through the FIREFebruary 28, 2024.Account number (see instructions)2nd TIN not.14State 15 16State tax withheld Account number (see instructions)14State 15 16State tax withheld Account number (see instructions)2nd TIN not.14State 15 16State tax withheld your paying agent or service bureau. Dakota, Oklahoma, Oregon, Southreturns listed on this form in box 6 with the IRS is 6 Medical and health careStateCopy2 STANDARD SETS w/ Envelopes (34 Sheets for 100 Recipients)$For System. See Pub. 1220. Internal Revenue Utah, Washington, Wisconsin, Wyoming5 Fishing boat proceeds payments paymentsanyCopyRECIPIENTS TIN6 Medical and health care 5 Fishing boat proceedsPurpose of form. Use this form to transmit paper Forms 1097, 1098, Carolina, South Dakota, Tennessee, Service Center1099, 3921, 3922, 5498, and W-2G to the IRS. Caution:Where To File$$$$ $ $ $ $ $LDA 41-0852411 5130 www.irs.gov/Form1099DIV Department of the Treasury - Internal Revenue Service LDB 5131 www.irs.gov/Form1099DIV Department of the Treasury - Internal Revenue Service LDC 5132 www.irs.gov/Form1099DIV Department of the Treasury - Internal Revenue Service see the 2023 General Instructions for Certain Information Returns. totaling $5,000 or more of$ File with Form 1096.electronically but fail to do so, and you do not have anIf your principal business, ofce orUse the following Form1099-DIV(Rev. 1-2022) $Form1099-DIV(Rev. 1-2022) (keep for your records)$Form1099-DIV(Rev. 1-2022) $For more information and the Privacy Act and Paperwork Reduction Act Notice,L1096 41-0852411 5100 Form1096(2023) RECIPIENTS name RECIPIENT'S name, stret adres7 , city or town, state or province, country, aRndE CZIPI EoNr Tfo'Sre niganm peo, starle ceto dadedres 9, city or town, state or province, country, and ZIP or foreign postal code 7 Payer made direct sales$ 8 of dividends or interest For Privacy Actaddress NEC95913E3-Part SET includes: (34 Sheets EACH) 1099-NEC Copy A, B, C,Payer made direct sales8 of dividends or interest7 Payer made direct sales8 of dividends or interesttotaling $5,000 or more ofSubstitute payments in lieuagency, or legal residence in the consumer products toSubstitute payments in lieuFor Privacy Act Substitute payments in lieuThis is important taxcase of an individual, is located inapproved waiver, you may be subject to a penalty. The Taxpayer First Act recipient for resale totaling $5,000 or more ofconsumer products toand Paperwork of 2019, enacted July 1, 2019, authorized the Department of the Treasury and Paperworkinformation and is Street address (including apt. no.) 9 Crop insurance proceeds attorney recipient for resale and the IRS to issue regulations that reduce the 250-return requirement for www.irs.gov/ Alabama, Arizona, Arkansas, Delaware,Internal Revenue Serviceconsumer products torecipient for resale 10 Gross proceeds paid to anReduction Act Reduction Act $ being furnished to 2022 tax returns. If those regulations are issued and effective for 2023 tax Notice, see the attorney 9 Crop insurance proceeds attorney Florida, Georgia, Kentucky, Maine, 10 Gross proceeds paid to an Crop insurance proceeds 10 Gross proceeds paid to anthe IRS. If you areNotice, see the City or town, state or province, country, and ZIP or foreign postal code $ 11 Fish purchased for resale $ $ Form1099 explaining the change. Until regulations are issued, however,current General P.O. Box 149213+ DW19W (100)current General $ return, a negligenceMassachusetts, Mississippi, NewAustin, TX 78714-9213information, see part F in the 2023 General Instructions for CertainInstructions forInstructions forCertain$ 12 Section 409A deferrals $ 12 Section 409A deferrals Hampshire, New Jersey, New Mexico, Information Returns. penalty or otherNew York, North Carolina, Ohio, Texas, sanction may be Information imposed on you ifCertain 12 Section 409A deferrals11 Fish purchased for resale 11 Fish purchased for resale Vermont, Virginiareturns. Information$ Returns. $ 14 Excess golden parachute$ 15 compensation $ payments Returns.$ 15 compensation $ payments this income iscompensation Alaska, Colorado, Hawaii, Idaho,Internal Revenue Service Center 13 requirement Who must le.requirement taxable and the IRSIllinois, Indiana, Iowa, Kansas,P.O. Box 219256 Account number (see instructions) 13 requirement $ payments $ $ 14 Excess golden parachute$ 13 2nd TIN not. $ determines that itMichigan, Minnesota, Missouri, Kansas City, MO 64121-9256 NEC95914E4-Part SET includes: (34 Sheets EACH) 1099-NEC Copy A, B, C, C, Caution:14 Excess golden parachute15Montana, Nebraska, Nevada, North has not been the name and TIN used on your 94X series tax return(s) or you may beDakota, Oklahoma, Oregon, South reported.subject to information return penalties. Do not use the name and/or TIN ofCarolina, South Dakota, Tennessee,your paying agent or service bureau. $ 17 State/Payers state no. Utah, Washington, Wisconsin, Wyoming TFP 1099-R LASER PACKAGED SET Form1099-MISC(Rev. 1-2022)LMA Account number (see instructions) LMB 17 State/Payers state no.16 State tax withheld18 State income 17 State/Payers state no. $ 18 State income $ 18 State income L1096 41-0852411 5100 Form1096(2023) + DW19W (100)2nd TIN not.16 State tax withheld Account number (see instructions) 16 State tax withheld$ $ $ $$ $ For more information and the Privacy Act and Paperwork Reduction Act Notice, $ $ $41-0852411Form1099-MISC $ (keep for your records)5111(Rev. 1-2022) see the 2023 General Instructions for Certain Information Returns.(Rev. 1-2022) 1099-MISCwww.irs.gov/Form1099MISCLMC/LM2 www.irs.gov/Form1099MISC 51125110 www.irs.gov/Form1099MISC Form Department of the Treasury - Internal Revenue ServiceDepartment of the Treasury - Internal Revenue ServiceDepartment of the Treasury - Internal Revenue ServiceTFP 5140 TFP 5141 TFP 5142 TFP 5143 TFP 5100 NEC95915E5-Part SET includes: (34 Sheets EACH) 1099-NEC Copy A, B, C, C, 2,9898 VOID CORRECTED OMB No. 1545-0119 Distributions FromCORRECTED (if checked) OMB No. 1545-0119 Distributions FromCORRECTED (if checked) OMB No. 1545-0119 Distributions FromVOID CORRECTED OMB No. 1545-0119 Do Not Staple 6969 Annual Summary and Transmittal of OMB No. 1545-0108 + DW19W (100)PAYERS name, street address, city or town, state or province,$ 1Gross distribution 2023 PAYERS name, street address, city or town, state or province,$ 1Gross distribution 2023 PAYERS name, street address, city or town, state or province,$ 1Gross distribution 2023 PAYERS name, street address, city or town, state or province,$ 1Gross distribution 2023 Form1096 U.S. Information Returns 2023 (3) Transmittal 1096 forms are included with each set DETACH BEFORE MAILINGDETACH BEFORE MAILINGDETACH BEFORE MAILINGDETACH BEFORE MAILINGDETACH BEFORE MAILING MANUFACTURED ON OCR LASER BOND PAPER USING HEAT RESISTANT INKSMANUFACTURED ON OCR LASER BOND PAPER USING HEAT RESISTANT INKSMANUFACTURED ON OCR LASER BOND PAPER USING HEAT RESISTANT INKSMANUFACTURED ON OCR LASER BOND PAPER USING HEAT RESISTANT INKSMANUFACTURED ON OCR LASER BOND PAPER USING HEAT RESISTANT INKSDistributions From country, ZIP or foreign postal code, and telephone no. Pensions, Annuities, Pensions, Annuities, Pensions, Annuities, Pensions, Annuities,country, ZIP or foreign postal code, and telephone no. country, ZIP or foreign postal code, and telephone no. country, ZIP or foreign postal code, and telephone no.Retirement orRetirement orRetirement orDepartment of the Treasury Retirement or $ 2aTaxable amount Form 1099-R Prot-Sharing Plans,$ 2aTaxable amount Form 1099-R Prot-Sharing Plans,$ 2aTaxable amount Form 1099-R Prot-Sharing Plans,$ 2aTaxable amount Form 1099-R Internal Revenue Service STANDARD SET w/ Self-Seal Envelopes (34 Sheets for 100 Recipients)Prot-Sharing Plans, IRAs, InsuranceIRAs, InsuranceIRAs, InsuranceFILERS nameIRAs, Insurance Contracts, etc. Contracts, etc. Contracts, etc. Contracts, etc.PAYERS TIN RECIPIENTS TIN 2bTaxable amount4 TotalPAYERS TINCopy ARECIPIENTS TIN 2bTaxable amount4 TotalPAYERS TINCopy CRECIPIENTS TIN 2bTaxable amount4 TotalPAYERS TINCopy CRECIPIENTS TIN 2bnot determined 4 TotalCopy D Taxable amount not 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1099-MISC LASER PACKAGED SET* Tax Departmen 2 orCopy2 LocatDepoartmenDesignated Rothappreciation in RECIPIENTS name, stret adres, city or town, state or province, country and ZIP or foreign postal code Designated RothNet unrealized Copy contributions orNet unrealized RECIPIENTS name, stret adres, city or town, state or province, country and ZIP or foreign postal code insurance premiums Net unrealized Name of person to contact Telephone number + DW19WS (100), city or town, state or province, country and ZIP or foreign postal codecontributions oremployers securities For Privacy Actinsurance premiums employers securities Designated Rothemployers securities contributions oremployers securities For Privacy ActFax numberDesignated Roth insurance premiums and Paperworkcontributions orinsurance premiums Email address Reduction Act and Paperwork Reduction Act Street address (including apt. no.) $ 7DistributionSEP/ $ 8Other % Notice, see the$ 7DistributionIRA/ $ 8Other % This information is$ 7DistributionIRA/ $ 8Other % This information is$ 7DistributionIRA/ $ 8Other 1% Notice, see the2 Social security number 3 Total number of forms $ 4 Federal income tax withheld $ 5 Total amount reported with this Form 1096 STANDARD SETS (50 Sheets for 100 Recipients) MINI SETS (17 Sheets for 50 Recipients)code(s) IRA/2023 Generalcode(s) SEP/ code(s) SIMPLE code(s) SEP/2023 General SIMPLE $ Instructions for CertainSIMPLE $ SEP/ $ SIMPLE $ 6Instructions forCertainCity or town, state or province, country, and ZIP or foreign postal code9aYour percentage of total 9bTotal employee contributions Information9aYour percentage of total 9bTotal employee contributions being furnished to the IRS. 9aYour percentage of total 9bTotal employee contributions being furnished to the IRS. 9aYour percentage of total 9bTotal employee contributions 50 Information1098-C1098-E1098-F 1098-Q1098-T1099-A1099-B1099-C1099-CAP1099-DIV1099-G1099-INT1099-K10Amount allocable to IRR111st year of desig. 12 requirement$ 14 distribution %$ 15State/Payers state no.10 within 5 years Returns. 111st year of desig. 12 requirement$ 14 distribution %$ 15State/Payers state no.10Amount allocable to IRR111st year of desig. 12 requirement$ 14 distribution %$ 15State/Payers state no.10Amount allocable to IRR111st year of desig. 12 requirement$ 14 distribution %$ W-2G 1097-BTCReturns. 78 84 03 74 83 80 79 85 73 3921 91 86 92 10 959133-Part SET includes: (50 Sheets EACH) 1099-MISC Copy A, B, C NEC959184-Part SET includes: (17 Sheets EACH) 1099-NEC Copy A, B, C, C32 109881State tax withheld Amount allocable to IRRState tax withheld 16State distribution State tax withheld 16State distribution State tax withheld 15State/Payers state no.16State distribution16State distributionwithin 5 years Roth contrib. $ Roth contrib. within 5 years Roth contrib. within 5 years Roth contrib. $ 1099-LTC1099-MISC1099-NEC 1099-OID1099-PATR1099-Q1099-QA 1099-R1099-S1099-SA 1099-SB25 3922 54985498-ESA5498-QA $ $ 1099-LS93 95 71 96 97 31 1A 98 75 94 43 26 28 72 2A$ Account number (see instructions) 13Date of$ 17Local tax withheld 18Name of locality $ $ 19Local distribution 13Date of$ 17Local tax withheld 18Name of locality $ $ 19Local distribution 13Date of$ 17Local tax withheld 18Name of locality $ $ 19Local distribution 13Date of$ 17Local tax withheld 18Name of locality 16 $ 19Local distribution 959144-Part SET includes: (50 Sheets EACH) 1099-MISC Copy A, B, C, C MINI SETS w/ Envelopes (17 Sheets for 50 Recipients)Account number (see instructions) Account number (see instructions) Account number (see instructions)payment$ $ payment$ $ payment$ $ payment$ $$ $ $ $ $ $ $ 5498-SA 27 $Form 1099-R 41-0852411 www.irs.gov/Form1099R Department of the Treasury - Internal Revenue Service www.irs.gov/Form1099R Department of the Treasury - Internal Revenue Service www.irs.gov/Form1099R Department of the Treasury - Internal Revenue Service www.irs.gov/Form1099R Department of the Treasury - Internal Revenue ServiceForm 1099-R (keep for your records) Form 1099-R (keep for your records) Form 1099-RDoNotCutorSeparateFormsonThisPage DoNotCutorSeparateFormsonThisPage Return this entire page to the Internal Revenue Service. Photocopies are not acceptable.959155-Part SET includes: (50 Sheets EACH) 1099-MISC Copy A, B, C, C, 29898 VOID CORRECTED CORRECTED (if checked) CORRECTED (if checked) VOID CORRECTED Send this form, with the copies of the form checked in box 6, to the IRS in a at mailer (not folded). NEC95918E4-Part SET includes: (17 Sheets EACH) 1099-NEC Copy A, B, C, C,PAYERS name, street address, city or town, state or province,$ 1Gross distribution OMB No. 1545-0119PAYERS name, street address, city or town, state or province,$ 1Gross distribution OMB No. 1545-0119PAYERS name, street address, city or town, state or province,$ 1Gross distribution OMB No. 1545-0119 Distributions From$ 1Gross distribution OMB No. 1545-0119 Under 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. STANDARD SETS w/ Envelopes (50 Sheets for 100 Recipients) + DW19W (50)Distributions FromDistributions FromPAYERS name, street address, city or town, state or province,Distributions From country, ZIP or foreign postal code, and telephone no. Pensions, Annuities, Pensions, Annuities, country, ZIP or foreign postal code, and telephone no. Pensions, Annuities, Title Datecountry, ZIP or foreign postal code, and telephone no. country, ZIP or foreign postal code, and telephone no. Pensions, Annuities, Signature Retirement or Retirement orRetirement orRetirement or 2aTaxable amount 2023 Prot-Sharing Plans,2aTaxable amount 2023 Prot-Sharing Plans,2aTaxable amount 2023 Prot-Sharing Plans,2aTaxable amount 2023 Instructions number), and TIN in the spaces provided on the form. The name, address, Prot-Sharing Plans, IRAs, Insurance IRAs, InsuranceIRAs, InsuranceIRAs, InsuranceFuture developments. For the latest information about developments $ 2bTaxable amountForm 1099-R Contracts, etc. $ 2bTaxable amountForm 1099-R Contracts, etc. $ 2bTaxable amountForm 1099-R Contracts, etc. $ 2bTaxable amountForm 1099-R related to Form 1096, such as legislation enacted after it was published, goupper left area of Form 1097, 1098, 1099, 3921, 3922, 5498, or W-2G. 95913E3-Part SET includes: (50 Sheets EACH) 1099-MISC Copy A, B, C, MINI SETS w/ Self-Seal Envelopes (17 Sheets for 50 Recipients)Contracts, etc.to www.irs.gov/Form1096.PAYERS TIN RECIPIENTS TIN not determined 4 TotalPAYERS TINCopy ARECIPIENTS TIN not determined 4 TotalPAYERS TINCopy CRECIPIENTS TIN not determined 4 TotalPAYERS TINCopy CRECIPIENTS TIN not determined 4 TotalCopy DWhen to le. File Form 1096 as follows.distribution For3Capital gain (included indistribution For Recipient's3Capital gain (included indistribution For Recipient's3Capital gain (included indistribution Reminder. The only acceptable method of electronically through the FIREFebruary 28, 2024.returns listed on this form in box 6 with the IRS is3Capital gain (included inFederal income tax Internal Revenuebox 2a) Federal income tax Records and/or box 2a) Federal income tax Records and/or box 2a) Federal income tax Caution:Tax For PayerranyWhere To File + DWMR (100)System. See Pub. 1220.d/oror Local or Locatl State,anCity,lRECIPIENTS name $ box 2a) $ withheld Service Center$ 5Employee contributions/$ withheld RECIPIENTS name, stret ad State,City, $ 5Employee contributions/$ withheld RECIPIENTS name, stret ad State,City, $ 5Employee contributions/$ withheld Purpose of form. Use this form to transmit paper Forms 1097, 1098,If your principal business, ofce orUse the followingNEC95918ES 4-Part SET includes: (17 Sheets EACH) 1099-NEC Copy A, B, C, C,1099, 3921, 3922, 5498, and W-2G to the IRS. File with Form 1096. Tax Department Tax Departmen 2 LocatorCopy2 orCopy DepoartmenRECIPIENTS name, stret adres, city or town, state or province, country and ZIP or foreign postal code res, city or town, state or province, country and ZIP or foreign postal code res, city or town, state or province, country and ZIP or foreign postal codeelectronically but fail to do so, and you do not have an $ 5Employee contributions/ $ 6appreciation in For Privacy Act$ Designated Roth$ 6appreciation in $ Designated Roth$ 6appreciation in $ Designated Roth$ 6appreciation in approved waiver, you may be subject to a penalty. The Taxpayer First Actagency, or legal residence in theaddress 95914E4-Part SET includes: (50 Sheets EACH) 1099-MISC Copy A, B, C, C,+ DW19WS (50)Designated RothNet unrealized contributions orNet unrealized insurance premiums Net unrealized insurance premiums Net unrealized For Privacy Actcase of an individual, is located inof 2019, enacted July 1, 2019, authorized the Department of the Treasury and the IRS to issue regulations that reduce the 250-return requirement for contributions oremployers securities and Paperworkinsurance premiums employers securities contributions oremployers securities contributions oremployers securities and Paperwork insurance premiums Reduction Act2022 tax returns. If those regulations are issued and effective for 2023 tax www.irs.gov/ Alabama, Arizona, Arkansas, Delaware, Reduction Act Street address (including apt. no.) 7DistributionIRA/ 8Other Notice, see the7DistributionIRA/ 8Other 7DistributionIRA/ 8Other 7DistributionIRA/ 8Other Notice, see theFlorida, Georgia, Kentucky, Maine,Internal Revenue ServiceCity or town, state or province, country, and ZIP or foreign postal code code(s) SEP/ $ %2023 Generalcode(s) SEP/ $ % This information iscode(s) SEP/ $ % This information iscode(s) SEP/ $ Form1099 explaining the change. Until regulations are issued, however,Massachusetts, Mississippi, NewP.O. Box 149213+ DWMR (100) 2023 General Hampshire, New Jersey, New Mexico, 9a distribution SIMPLE $ 9bTotal employee contributions Instructions for Certain9a distribution SIMPLE $ 9bTotal employee contributions being furnished to the IRS. 9a distribution SIMPLE $ 9bTotal employee contributions being furnished to the IRS. 9a distribution SIMPLE $ 9b Information Returns. part F in the 2023 General Instructions for CertainNew York, North Carolina, Ohio, Texas,Austin, TX 78714-9213 VALUE SETS w/ Self-Seal Envelopes (7 Sheets for 20 Recipients)information, seeInstructions forInformationYour percentage of totalYour percentage of totalYour percentage of total% CertainVermont, Virginiareturns. Information Your percentage of totalReturns. % % % Total employee contributions Returns. Alaska, Colorado, Hawaii, Idaho,Internal Revenue Service Center $ 10Amount allocable to IRR111st year of desig. 12 requirement$ 14State tax withheld % 15State/Payers state no.10Amount allocable to IRR111st year of desig. 12 requirement$ 14State tax withheld 15State/Payers state no.10Amount allocable to IRR111st year of desig. 12 requirement$ 14State tax withheld 15State/Payers state no.10Amount allocable to IRR111st year of desig. 12 requirement$ 14State tax withheld Who must le.Illinois, Indiana, Iowa, Kansas,P.O. Box 21925695915E5-Part SET includes: (50 Sheets EACH) 1099-MISC Copy A, B, C, C, 2,16State distribution 16State distribution 16State distribution 15State/Payers state no.16State distribution Michigan, Minnesota, Missouri, within 5 years Roth contrib. 13Date of$ 17Local tax withheld 18Name of locality $ within 5 years Roth contrib. 13Date of$ 17Local tax withheld 18Name of locality $ within 5 years Roth contrib. 13Date of$ 17Local tax withheld 18Name of locality $ within 5 years Roth contrib. 13Date of$ 17Local tax withheld 18Name of locality the name and TIN used on your 94X series tax return(s) or you may beMontana, Nebraska, Nevada, North Kansas City, MO 64121-9256 NEC95903ES 3-Part SET includes: (7 Sheets EACH) 1099-NEC Copy A, B, C,$ $ $ Caution:Dakota, Oklahoma, Oregon, South $$ $ $ subject to information return penalties. Do not use the name and/or TIN ofCarolina, South Dakota, Tennessee,$Account number (see instructions) Account number (see instructions) Account number (see instructions) Account number (see instructions) your paying agent or service bureau. Utah, Washington, Wisconsin, Wyoming Form 1099-R LRA 41-0852411 5140 payment$ Form $ 19Local distribution LRC/LR2 payment$ 5142 Form $ 19Local distribution LRC/LR2 payment$ 5142 Form $ 19Local distribution 5143 payment$ $ 19Local distribution L1096 41-0852411 5100 Form1096(2023) + DWMR (100)$ $ (keep for your records) $ $ (keep for your records) $ $ LRD1 www.irs.gov/Form1099R $ For more information and the Privacy Act and Paperwork Reduction Act Notice,+ DW19WS (20)$1099-R 1099-R 1099-R see the 2023 General Instructions for Certain Information Returns.www.irs.gov/Form1099R Department of the Treasury - Internal Revenue Service www.irs.gov/Form1099R Department of the Treasury - Internal Revenue Service www.irs.gov/Form1099R Department of the Treasury - Internal Revenue Service Department of the Treasury - Internal Revenue ServiceSTANDARD SET w/ Self-Seal Envelopes (50 Sheets for 100 Recipients) NEC95904ES 4-Part SET includes: (7 Sheets EACH) 1099-NEC Copy A, B, C, C, Required Envelope: 95914ES4-Part SET includes: (50 Sheets EACH) 1099-MISC Copy A, B, C, C,+ DW19WS (20)(3) 1096 Transmittal forms are included with each set TFP: 77771 or 77772 + DWMRS (100)MINI SETS (25 Sheets 50 Recipients) APEX 1099-INT LASER PACKAGED SET* TFP 1099-DIV LASER PACKAGED SET* TFP 1099-R LASER PACKAGED SET959184-Part SET includes: (25 Sheets EACH) 1099-MISC Copy A, B, C, CMINI SETS w/ Envelopes (25 Sheets for 50 Recipients) STANDARD SETS (50 Sheets for 100 Recipients)FOR 50 EMPLOYEES FOR 50 EMPLOYEES 95918E4-Part SET includes: (25 Sheets EACH) 1099-MISC Copy A, B, C, C, 95924E4-Part SET includes: (50 Sheets EACH) 1099-INT Copy A, B, C, C, 61074-Part PRE-PACKAGED CONVENIENCE SET includes: 56466-Part PRE-PACKAGED CONVENIENCE SET includes: + DWMR (50) + DWMR (100)5130 (50), 5131 (50), 5132 (100), 5100 - 1096 (3) 5140 (50), 5141 (50), 5142 (100), 5143 (100), 5100 - 1096 (3) MINI SETS w/ Self-Seal Envelopes (25 Sheets for 50 Recipients) VALUE SETS w/ Self-Seal Envelopes (10 Sheets for 20 Recipients)FOR 25 EMPLOYEES FOR 25 EMPLOYEES 95918ES4-Part SET includes: (25 Sheets EACH) 1099-MISC Copy A, B, C, C, 95907ES3-Part SET includes: (10 Sheets EACH) 1099-INT Copy A, B, C 6107254-Part PRE-PACKAGED CONVENIENCE SET includes: 5644254-Part PRE-PACKAGED CONVENIENCE SET includes: + DWMRS (50) + DWMRS (20)5130 (25), 5131 (25), 5132 (50), 5100 - 1096 (3) 5140 (25), 5141 (25), 5142 (25), 5143 (25), 5100 - 1096 (3) VALUE SETS w/ Self-Seal Envelopes (10 Sheets for 20 Recipients)5646256-Part PRE-PACKAGED CONVENIENCE SET includes: 95904ES4-Part SET includes: (10 Sheets EACH) 1099-MISC Copy A, B, C, C, 5140 (25), 5141 (25), 5142 (50), 5143 (50), 5100 - 1096 (3) + DWMRS (20)48 49"