b"PRE-PRINTED AND BLANK 1099 FORMSINDIVIDUAL LASER PACKS1099MISC MISCELLANEOUSor foreign postal code, and telephone no. VOID CORRECTED OMB No. 1545-0115 APEX LMA PAYER'S name, stretadres,city CORRECTED(ifchecked) postal code$ 31Rents $ 4 2 Royalties OMBNo.1545-0115PAYERS name, street address, city or town, state or province, country, ZIP$ 1 Rents or town, state or province,country, and ZIP or foreign $ 5Other income proceeds $ 6Federal income tax withheld21 APEX LM3$ 3 Other income Form 1099-MISC Copy A TFP 5110 PAYERS TIN RECIPIENTS TIN $ 7Payer made direct sales $ 8 Substitute payments in lieu of is Information is _DETACH BEFORE MAILING ON OCR LASER BOND PAPER USING HEAT RESISTANT INKSMANUFACTUREDMiscellaneous 2 Royalties 2021 Information Fishingboat Medical and health care payments Miscellaneous PAYERS TIN RECIPIENTS TIN $ 5 Fishing boat proceeds $ 4 Federal income tax withheld ForAccount number (see instructions) requirement 9consumer products to $ dividends or interest Thisinformation you tax TFP 51146 Medical and health care paymentsInternal Revenueof $5,000 or more of 10 Gross proceeds paid to anbeing importantandarerecipient for resalethe IRS.furnishedIf toService Center Crop insurance proceeds attorney required penaltynegligenceto you return,beorRECIPIENTS name $ 7 totaling $5,000 or more of$ 8 Substitute payments in lieu ofFile with Form 1096. RECIPIENT'S name,stretadres,cityor town,stateorprovince,country,andZIP or foreignpostal code $ 11 Fish purchased for resale $ 12 Section 409A deferrals aother itishas amaythisifPayer made direct salesdividends or interest For Privacy Act$ 13 Excess golden parachute $ 14compensation the imposedsanctionontaxablebeen APEX income determines andIRS not thatStreet address (including apt. no.) consumer products to$ 10 Gross proceeds paid to anand Paperwork$ 15payments withheld $ 16 State/Payers state number17 State income reported.City or town, state or province, country, and ZIP or foreign postal code $ recipient for resale $ attorney Reduction ActForm (Keepfor $ $ Statetax DepartmentoftheTreasury $ $ -InternalRevenueService LM3BL9 Crop insurance proceeds Notice, see the2021 General 11 Fish purchased for resale 12 Section 409A deferrals Instructions forCertainyourrecords.)Account number (see instructions) or foreign postal code, and telephone no. $ payments CORRECTED (if checked) Information MiscellaneousAPEX LMB VOID tadres,city CORRECTED(ifchecked) postal code$ 31Rents $ 4 2 Royalties OMBNo.1545-0115PAYERS name, street address, city or town, state or province, country, ZIPReturns. requirement 2nd TIN not. $ 13 Excess golden parachute$ $ 1 Rents OMB No. 1545-0115 Information PAYER'S name, stre or town, state or province,country, and ZIP or foreign Other income Federal income tax withheld21 TFP 5173 DETACH BEFORE MAILINGMANUFACTURED ON OCR LASER BOND PAPER USING HEAT RESISTANT INKS14 compensation15 State tax withheld $ 2 Royalties 2021 $ 5 Fishingboatproceeds $ 6 Medical and health care payments Miscellaneous Form41-0852411 $ 16 State/Payers state no. $ 17 State income Copy B TFP 5111 $ 7Payer made direct sales $ 8 Substitute payments in lieu of Information$ 3 Other income $ Form 1099-MISC$ 4 Federal income tax withheld1099-MISC PAYERS TIN www.irs.gov/Form1099MISC $ 5 Fishing boat proceeds $ 6 Medical and health care payments For Recipient PAYERS TIN RECIPIENTS TIN of $5,000 or more of dividends or interest ForPrivacyActRECIPIENTS TIN Department of the Treasury - Internal Revenue ServiceDo Not Cut or Separate Forms on This PageDo Not Cut or Separate Forms on This Page consumer products toAccount number (see instructions) requirement 2nd TIN not.9recipient for resale$ 10 Gross proceeds paid to anandPaperworkActRECIPIENT'S name, stret adres, city or town, state or province, country, and ZIP or foreign postal code $ 7 Payer made direct sales$ 8 Substitute payments in lieu ofThis is important taxRECIPIENT'S name,stretadres,cityor town,stateorprovince,country,andZIP or foreignpostal code $ Crop insurance proceeds $ 12attorney Reduction theor foreign postal code, and telephone no. VOID CORRECTED OMB No. 1545-0115 $ dividends or interest information and is$ 11 Fish purchased for resale $ 14Section 409A deferrals Notice,see forPAYERS name, street address, city or town, state or province, country, ZIP 1 Rents totaling $5,000 or more of10 Gross proceeds paid to anbeing furnished to13 Excess golden parachute compensation InstructionsGeneralCertain2021consumer products to recipient for resale9 Crop insurance proceeds MiscellaneousReturns.$ 2 Royalties 2021 Information the IRS. If you are$ 15payments withheld $ 16 State/Payers state number17Information$ 1099-MISC $ attorney return, a negligence$ Statetax $ State incomePAYERS TIN Account number (see instructions) $ 3 Other income $ Form 11 Fish purchased for resale $ 12 Section 409A deferrals penalty or otherMiscellaneousAPEXForm $ $ -sanction may be VOID CORRECTED imposed on you if 4 Federal income tax withheld Copy A OMB No. 1545-0115 DepartmentoftheTreasuryInternalRevenueService$ 5 Fishing boat proceeds 6$ 13 Excess golden parachute Internal Revenuethis income isDETACH BEFORE MAILINGMANUFACTURED ON OCR LASER BOND PAPER USING HEAT RESISTANT INKSRECIPIENTS TIN PAYERS name, street address, city or town, state or province, country, ZIP1 Rents Fortaxable and the IRS requirement Medical and health care payments Service Center 2021 This panel OMBNo.or foreign postal code, and telephone no. $ payments $ 14 compensation determines that itInformation LMCLM2 VOID tadres,city CORRECTED(ifchecked) postal code$ 31Rents Contains 1099 MISC 4 1545-0115$ 2 Royalties has not been reported.RECIPIENTS name $ 7 Payer made direct sales$ $ 15 State tax withheld File with Form 1096. $ 17 State income Copy C PAYER'S name, stre or town, state or province,country, and ZIP or foreign Other income $ 2 Royalties 21Street address (including apt. no.) totaling $5,000 or more ofdividends or interest 16 State/Payers state no. $ $ Form 1099-MISC or For Payer $ 5 Fishingboatproceeds $ 6Copy C Backer Information$ 3 Other income8 Substitute payments in lieu ofFor Privacy Act4 Federal income tax withheld Federal income tax withheldMiscellaneous Form1099-MISC consumer products to$ $ and Paperwork6 Medical and health care payments StateCopy2 TFP 5112 $ 7Payer made direct sales $ 8InformationPAYERS TIN RECIPIENTS TIN $ 5 Fishing boat proceeds(keep for your records) www.irs.gov/Form1099MISC Reduction ActMedical and health care paymentsrecipient for resale Gross proceeds paid to anDepartment of the Treasury - Internal Revenue Service orCopy of $5,000 or more of Substitute payments in lieu of9 Crop insurance proceeds 10 attorney Notice, see the City or town, state or province, country, and ZIP or foreign postal code $ 11 Fish purchased for resale $ 12 Section 409A deferrals 2021 General $ 8 Substitute payments in lieu ofFor Privacy ActPAYERS TIN RECIPIENTS TIN 2nd TIN not.9consumer products to $ dividends or interestAccount number (see instructions) requirement RECIPIENT'S name, stret adres CORRECTED (if checked) Instructions forCertaindividends or interest and PaperworkAccount number (see instructions) t , stateorprovince, requirement postal code $ recipient for resale$ 10 Gross proceeds paid to an $ Payer made direct sales 2nd TIN not. payments , city or town, state or province, country, and ZIP or foreign postal code Information MiscellaneousReduction ActRECIPIENT'S name,streadrescityor town, country,andZIP or foreign Crop insurance proceeds 12attorneyPAYERS name, street address, city or town, state or province, country, ZIP1 Rents 7 totaling $5,000 or more of$ 10 Gross proceeds paid to anNotice, see the$ 11 Fish purchased for resale $ 14Section 409A deferralsor foreign postal code, and telephone no. $ 13 Excess golden parachute$ 14 compensation Returns. attorney 2021 General13 Excess golden parachute compensationOMB No. 1545-0115consumer products to 9 recipient for resale$ 15 State tax withheld $ $ 2 Royalties 2021 Information Information 15payments withheld $ 16 State/Payers state number17 State incomeCrop insurance proceedsForm1099-MISC LMA 41-0852411 5110 $ 16 State/Payers state no. $ $ 6$ 1099-MISC $ 12 Section 409A deferrals Returns. APEX LMBL Form LM3 $ $ $ Statetax 5114 DepartmentoftheTreasury $ $ -InternalRevenueService$ $ 3 Other income $ 17 State income $ 14Copy B Instructions forCertain Form 11 Fish purchased for resale4 Federal income tax withheldAccount number (see instructions) $ 5 Fishing boat proceeds 2nd TIN not. $ 13 Excess golden parachutecompensationPAYERS TIN www.irs.gov/Form1099MISC Department of the Treasury - Internal Revenue Service For RecipientRECIPIENTS TIN requirement Medical and health care paymentspaymentsRECIPIENT'S name, stret adres, city or town, state or province, country, and ZIP or foreign postal code $ 7 totaling $5,000 or more of$ $ 15 State tax withheld $ 16 State/Payers state no. $ 17 State income TFP 5108$Payer made direct sales8 Substitute payments in lieu ofThis is important tax$$ information and is Form1099-MISC consumer products to$ dividends or interest being furnished to 9 recipient for resalewww.irs.gov/Form1099MISC the IRS. If you are Department of the Treasury - Internal Revenue ServiceCrop insurance proceeds 10 Gross proceeds paid to anFront Blankattorney return, a negligence $ 11 Fish purchased for resale $ 12 Section 409A deferrals penalty or other sanction may be VOID CORRECTED imposed on you if Account number (see instructions) PAYERS name, street address, city or town, state or province, country, ZIP$ 1 Rents with W2 Instructions $ 13 Excess golden parachute$ 14 compensation this income isMiscellaneous OMB No. 1545-0115or foreign postal code, and telephone no. taxable and the IRSrequirement payments determines that it $ 15 State tax withheld $ $ 2 Royalties $ 2021 Information LM3BL 5173has not been reported.$ 16 State/Payers state no. $ on back side. Copy C TFP 515917 State incomeForm 1099-MISC$ $ 3 Other income $ 4 Federal income tax withheld For PayerForm1099-MISC LMB (keep for your records) 5111www.irs.gov/Form1099MISC Department of the Treasury - Internal Revenue Service orStateCopy2 Apex DWM3PAYERS TIN RECIPIENTS TIN 5 Fishing boat proceeds 6 Medical and health care paymentsorCopyRECIPIENT'S name, stret adres, city or town, state or province, country, and ZIP or foreign postal code $ 7 totaling $5,000 or more of$ 8 Substitute payments in lieu ofFor Privacy Act Payer made direct salesdividends or interest and Paperwork consumer products to$ 10 Gross proceeds paid to anFront Blank TFP 52521 required envelope9 recipient for resale attorney Reduction Act Crop insurance proceeds Notice, see the $ 11 Fish purchased for resale $ 12 Section 409A deferrals 2021 GeneralInstructions forCertainAccount number (see instructions) requirement 2nd TIN not. $ 13 Excess golden parachute$ 14 compensation with W2 Instructions InformationReturns.payments$ 15 State tax withheld $ 16 State/Payers state no. 17 State income___$ on back side.$Form1099-MISC LMC/LM2 $ 5112 $ CORRECTED (if checked) OMB No. 1545-0115 APEX LMB2www.irs.gov/Form1099MISC Department of the Treasury - Internal Revenue Service __ PAYERS name, street address, city or town, state or province, country, ZIP1 Rents _ DETACH BEFORE MAILINGMANUFACTURED ON OCR LASER BOND PAPER USING HEAT RESISTANT INKSor foreign postal code, and telephone no.Miscellaneous $ 2 Royalties 2021 InformationTHIS PANEL CONTAINS Form 1099-MISC$ 3 Other income 4 Federal income tax withheld Copy B1099MISC COPY B BACKER INFORMATION PAYERS TIN RECIPIENTS TIN $ 5 Fishing boat proceeds $ 6 Medical and health care payments For Recipient$ Payer made direct sales$ 8 Substitute payments in lieu ofThis is important tax RECIPIENT'S name, stret adres, city or town, state or province, country, and ZIP or foreign postal code7 totaling $5,000 or more ofdividends or interest information and is consumer products to$ Gross proceeds paid to anbeing furnished to recipient for resale the IRS. If you are 9 Crop insurance proceeds 10 attorney return, a negligence $ 11 Fish purchased for resale $ 12 Section 409A deferrals penalty or other sanction may be imposed on you if this income is Account number (see instructions) requirement $ 13 Excess golden parachute$ 14 compensation taxable and the IRS payments determines that it THIS PANEL CONTAINS $ 15 State tax withheld $ 16 State/Payers state no. reported. Do Not Staple 6969 OMB No. 1545-0108 APEX L1096has not been $ $ 17 State income Form1096 Annual Summary and Transmittal of DETACH BEFORE MAILING MANUFACTURED ON OCR LASER BOND PAPER USING HEAT RESISTANT INKS(keep for your records) $ $ (Rev. February 2021) U.S. Information Returns 2021COPY B BACKER INFORMATION Form1099-MISC www.irs.gov/Form1099MISC Department of the Treasury - Internal Revenue Service Department of the TreasuryTFP 5100Internal Revenue Service__ FILERS nameCORRECTED (if checked) OMB No. 1545-0115 Street address (including room or suite number)PAYERS name, street address, city or town, state or province, country, ZIP1 Rentsor foreign postal code, and telephone no. City or town, state or province, country, and ZIP or foreign postal codeMiscellaneous $ 2 Royalties 2021 Information Name of person to contact Telephone number For Ofcial Use Only$ 3 Other income Form 1099-MISC Email address Fax number4 Federal income tax withheldPAYERS TIN RECIPIENTS TIN $ 5 Fishing boat proceeds $ 6 Medical and health care payments Copy 2 12 Social security number 3 Total number of forms $ 4 Federal income tax withheld $ 5 Total amount reported with this Form 1096To be led with recipient's state6 income tax return,W-2G 1097-BTC10981098-C1098-E1098-F1098-Q1098-T1099-A1099-B1099-C1099-CAP 1099-DIV1099-G1099-INT1099-K1099-LS RECIPIENT'S name, stret adres, city or town, state or province, country, and ZIP or foreign postal code $ 7 Payer made direct sales$ 8 Substitute payments in lieu ofwhen required. 32 50 81 78 84 03 74 83 80 79 85 73 91 86 92 10 16totaling $5,000 or more ofdividends or interestApex DWMR or DWMRS $ consumer products to$ 10 Gross proceeds paid to an1099-LTC1099-MISC 1099-NEC 1099-OID PATR1099-Q1099-QA 1099-R1099-S1099-SA 1099-SB 3921392254985498-ESA5498-QA 5498-SA recipient for resale 1099- 31 1A 98 75 94 43 25 26 28 72 2A 279 Crop insurance proceeds attorney 93 95 71 96 9711 Fish purchased for resale $ 12 Section 409A deferralsReturn this entire page to the Internal Revenue Service. Photocopies are not acceptable. TFP 77771 or 77772 required envelope Account number (see instructions) requirement 2nd TIN not. $ 13 Excess golden parachute$ 14 compensation Send this form, with the copies of the form checked in box 6, to the IRS in a at mailer (not folded).payments 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.$ 15 State tax withheld $ 16 State/Payers state no. 17 State income SignatureTitleDate $ $Form1099-MISC LMB2 $ $ Instructionswww.irs.gov/Form1099MISC Department of the Treasury - Internal Revenue Service related to Form 1096, such as legislation enacted after it wasform must be the same as those you enter in the upper left area of Future developments. For the latest information about developments published, go to www.irs.gov/Form1096. Forms 1097, 1098, 1099, 3921, 3922, 5498, or W-2G.Reminder. The only acceptable method of electronically information returns listed on this form in box 6 with the IRS is throughWhen to le. File Form 1096 as follows.the FIRE System. See Pub. 1220.February 28, 2022.Purpose of form. Use this form to transmit paper Forms 1097, 1098, 1099, 3921, 3922, 5498, and W-2G to the IRS. Caution:Where To Fileelectronically but fail to do so, and you do not have an approved waiver, you may be subject to a penalty. The Taxpayer First Act offollowing.2019, enacted July 1, 2019, authorized the Department of the Treasury and the IRS to issue regulations that reduce the 250-return requirement for 2021 tax returns. If those regulations are issued andIf your principal business, ofceUse the following or agency, or legal residence inaddressthe case of an individual, is an article at www.irs.gov/Form1099 explaining the change. Untilpart F in thelocated inregulations are issued, however, the number remains at 250, as 2021 General Instructions for Certain Information Returns. Alabama, Arizona, Arkansas, Delaware,Internal Revenue Service of the number of returns. Florida, Georgia, Kentucky, Maine,Austin Submission Processing Center Massachusetts, Mississippi, NewP.O. Box 149213 Hampshire, New Jersey, New Mexico, Who must le.New York, North Carolina, Ohio, Texas,Austin, TX 78714Vermont, VirginiaFor more information and the Privacy Act and Paperwork Reduction Act Notice,L1096 41-0852411 5100 Form1096(2021)see the 2021 General Instructions for Certain Information Returns.5 Transmittal 1096 forms are included with each Red Federal Copy A form orderAPEX Sheets per packTFP Forms per pack50s500s100s1000sFORM DESCRIPTION( 10 or 25 forms(500 forms L1096L10965005100per package) 5100Bper package) Laser 1096 Annual Transmittal For U.S. Information ReturnsLMALMA50051105110BLaser 1099MISC Federal Copy A1 Page Equals 2 FormsLMBLMB50051115111BLaser 1099MISC Recipient Copy B1 Page Equals 2 FormsLMCLM2LMCLM250051125112BLaser 1099MISC Payer Copy C and/or State Copy1 Page Equals 2 FormsLMBLLMBL50051085108BLaser 1099MISC Blank With Backer Instructions Copy B1 Page Equals 2 FormsN/AN/A51595159BLaser 1099MISC Blank With Copy B Backer With Stub1 Page Equals 2 Forms50s500s100s500sLM3LM350051145114BLaser 1099MISC 3-Up Recipient Copy B and Payer Copy C and State or File Copy1 page equals 1 formLM3BLLM3BL50051735173BLaser 1099MISC Blank Copy B, C Backer1 Page Equals 1 FormLMB2LMB2500N/AN/ALaser 1099MISC Recipient Copy B, 21 Page Equals 1 Form30"