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RECIPIENTS/LENDERS name, street address, city or town, state oryou didnt report the refundDETACH BEFORE MAILINGDETACH BEFORE MAILING MANUFACTURED ON OCR LASER BOND PAPER USING HEAT RESISTANT INKSMANUFACTURED ON OCR LASER BOND PAPER USING HEAT RESISTANT INKSZIP or foreign postal code, and telephone numberwww.irs.gov/Form1099S OMB No. 1545-0997 province, country, ZIP or foreign postal code, and telephone no.1 Mortgage interest received from payer(s)/borrower(s) Copy Aof interest (box 4); or T fu hrisn iisnhfoeRrdme vtaoet intohuneei IsSn etberevrniincagel Taxable amountmined OMB No.1545-0119 Do1099-SFILERS name, street address, city or town, state or province, country, Department of the Treasury - Internal Revenue ServiceForm1099-S Estate Transactions RECIPIENTS/LENDERS TINmortgagePAYERS/BORROWERS TIN 2 Outstanding mortgage3 Mortgage origination date Form1098 Interest 1Gross distribution 2b not deter 2022 NotCutorSeparateFormsonThisPageCORRECTED (if checked)DoNotCut orSeparateFormsonThisPage Forbecause you claimed a Internal Revenuenondeductible item.PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and phone no. $ $ 5 3Capital gain (included $ 6 4Federal income tax R P Forsmtrib a ir uttiA oonnrns P uFriotrioemts-, ZIP or foreign postal code, and telephone number 1Date of closing $ Form$ 2Gross proceedsOMB No. 1545-0997 (Rev. 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If State tax withheld State Distribution (nonresident alien, . foreign partnership, foreign estate, Instructions forprovince, 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. 1545-1380 current General 4Transferor received or will receive property or servicesFor RECIPIENTS/LENDERS name, street address, city or town, state or*Caution: The amount shown may as part of the consideration (if checked)or foreign trust)Internal Revenuereturn, a negligencenot be fully deductible by you. 17Local tax withheld 18Name of locality 19Local distribution Street address (including apt. no.) 1099-SCheck heretransferorwill . foreignService Center penalty or othermortgage 10 Other Limits based on the loan amount1098 InterestInstructions for Certain trust)is a receiveFile with Form 1096.imposed on you if this7If address of property securing mortgage is the same (nonresident foreign person estate, or foreignas PAYERS/BORROWERS address, check the box, or enter Account number (see instructions) If checked, foreign received transferor partnership, or 6Buyers part of real estate taxCertain Information Returns. and the cost and value of the(Rev. 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Form1098 (Rev. 1-2022)RECIPIENTS/LENDERS TINmortgage9 Number of properties securing the PAYERS/BORROWERS TINwww.irs.gov/Form109810 Other 1 Mortgage interest received from payer(s)/borrower(s)* Copy Bcurrent General 1099-S(keep for your records) Department of the Treasury - Internal Revenue Service L18A 41-0852411 5150 $Department of the Treasury - Internal Revenue ServiceFor Payer/ 6Buyers part of real estate taxwww.irs.gov/Form1099S Instructions for2 Outstanding mortgage3 Mortgage origination date BorrowerCertain Information LSA 41-0852411 5160 $ VOID CORRECTED Returns. principal The information in boxes 1 Form1099-S(Rev. 1-2022) FILERS name, street address, city or town, state or province, country, 1Date of closing OMB No. 1545-0997 $through 9 and 11 is ZIP or foreign postal code, and telephone numberwww.irs.gov/Form1099S 11 Mortgage FILERS name, street address, city or town, state or province, country, Department of the Treasury - Internal Revenue ServiceForm1099-S Proceeds From RealPAYER'S/BORROWER'Sname,stre Account number (see instructions) t , or andZIPorforeignpostalcode 4 Refund of overpaid$ 5 Mortgage insuranceimportant tax information CORRECTED (if checked) acquisition dateand is being furnished to Required Envelope: ZIP or foreign postal code, and telephone number 1Date of closing $ 2Gross proceedsOMB No. 1545-0997 (Rev. January 2022) Estate Transactions adrescitytown,state or province,country, $ interest premiums the IRS. If you are required $ Form1099-SFor calendar year Form1098 (Rev. 1-2022) www.irs.gov/Form1098 Department of the Treasury - Internal Revenue Service6 Points paid on purchase of principal residence penalty or other sanction FILERS TIN (Rev. 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Formof interest (box 4); orMortgage Check here if the transferor partnership, isinformation and is beingcurrent Generalbecause you claimed a 4 Transferor received or will receive property or services. . a. foreign furnished to the IRS. If. . . Notice, see themortgage10 Other 1098 Interest person (nonresident alien, . foreign.foreign estate, Instructions fornondeductible item.as part of the consideration (if checked)or foreign trust)return, a negligence(Rev. 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Information gain Grossdistribution Employeecontributionscontributions/Designatedorinsurance amount Capital 2a) (included Federal Gross withheld 2a insurancepremiums Annuities, Retirement or3Address (including city, state, and ZIP code) or legal descriptionor State Copy 8 Address or description of property securing mortgage (seeReturns.inbox taxwithheld inbox Annuities, Retirement or 4 tax distribution5 Prot-Sharing Plans, IRAs,instructions)Taxableamount$8 distribution inemploye Prot-Sharing Plans, IRAs,amount distribution Insurance Contracts, etc.Insurance Contracts, etc.$ 6Net employesecurities $7Distribution 2b code(s)determinedOther $otal Net 12FATCA Filing13Date of payment determined $8Other Total % FATCA Filing13Date of payment received or willFor Privacy Actmortgagein unrealizedrs appreciation not SIMPLE unrealizedrs requirement $7Distribution2bcode(s)Taxablenot SEP/ requirementSEP/ securities IRA/IRA/ appreciation SIMPLE9aYourpercentageof 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. $ Check heretheforeign. . . . a. foreign. . receive .and PaperworkAccount number (see instructions) acquisition date9bTotalemployee$ contributions 9aYourpercentageoftotaldistribution 9bTotalemployee$ contributions property or services as part of the consideration Reduction Act11 Mortgage 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, . transferor partnership, isforeign estate, current General % % or foreign trust)personNotice, see the Instructions for $ 14State tax withheld 15 $ PAYERS TIN 3 (included $ total 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 ServiceAccount number (see instructions) 1 $ 6 Capital 2a) $ 10 $7 incometax 14 withheld $8 Employeecontributions/Designated % Capital 2a) 10 incometaxwitheld Employeecontributionscontributions/Designatedor % Form1099-S(Rev. 1-2022) LSC www.irs.gov/Form1099S Department of the Treasury - Internal Revenue Serviceinbox gain inbox gain1st year of desig. Roth contrib. Amount allocable to IRR within 5 years Account number (see instructions) 1st year of desig. Roth contrib. Amount allocable to IRR within 5 yearsIRA/ OtherNetunrealizeds appreciation Distributioncode(s) IRA/ Other 15 Netunrealizeds appreciation Distributioncode(s) SIMPLEState/Payers state no.inemployersecurities State tax withheld State/Payers state no.securities SEP/SEP/16State distribution SIMPLE inemployer 16$ 17Local tax withheld 18Name of Locality9aYourpercentage19$ofLocaldistribution 9b17 employee$ contributions 18Name of Locality9a$ Yourpercentage19$oftotal distribution 9bTotalemployee$ 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%RECIPIENT'S name, street address, city or town, state or province, country, and ZIP or foreign postal code www.irs.gov/Form1099RForm 1099-R CORRECTED (if checked) OMB No. 1545-0119 2022Form 1099-R CORRECTED (if checked) OMB No. 1545-0119 2022Grossdistribution 2aTaxableamount Distributions From Pensions,Grossdistribution 2aTaxableamount Distributions From Pensions, Annuities, Retirement orAnnuities, Retirement or $ Taxableamount $distribution $ Account number (see instructions)12 Prot-Sharing Plans, IRAs,$ 2bTaxable$ 10 $ State distribution $distribution $ 14 12 Insurance Contracts, etc.11st year of desig. Roth contrib. $ 10 $ Amount allocable to IRR within 5 yearsAPEX: DWMR or DWMRS2b notdetermined Total 14State tax withheld Insurance Contracts, etc.11st year of desig. Roth contrib. 16 Amount allocable to IRR within 5 years Account number (see instructions)Prot-Sharing Plans, IRAs,16State distribution$ 17Local tax withheld FATCA Filing13Date of payment notdetermined $ Department Total $ 17 State tax withheld FATCA Filing13Date of payment 19 $ Local distribution theService APEX/TFP: DW19W or DW19WSrequirement 15State/Payers state no. amount requirement 15State/Payers state no.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.18Name of Locality 19Local distribution Local tax withheld 18Name of LocalityPAYERS TIN 1 Payer's - State, Local orFileCopy $ Capital 2a) OMBNo. InternalRevenueoftheService $ 1 Payer's - State, Local or $ FileCopy OMBNo. Department Treasury TFP: 77771 or 77772Treasury InternalRevenueofwww.irs.gov/Form1099R www.irs.gov/Form1099RForm 1099-R CORRECTED(ifchecked) 1545-0119 2022Form 1099-R CORRECTED(ifchecked) 1545-0119 2022RECIPIENTS TIN PAYERS TIN RECIPIENTS TINsecurities amount Other distribution% Netunrealizedrs12 Prot-Sharing Plans, IRAs,2bTaxableamount$8Other Total % RECIPIENT COPIES Insurance Contracts, etc.inbox2a) tax distribution5Roth 2a insurancepremiums (included Federal Grossdistribution5Roth 2aTaxableamount Annuities, Retirement or $ 3 6 Capitalgain(included $7 4Federalincome $ Gross withheld $8 Employeecontributionscontributions/Designatedor $ Taxableamount3 6 inbox gainDistributions From Pensions,income not taxwithheld Employeecontributionscontributions/Designatedorinsurancepremiums 12 Distributions From Pensions, Annuities, Retirement or 4 Prot-Sharing Plans, IRAs, Total Insurance Contracts, etc. code(s) determined distribution FATCA Filing13Date of paymentin unrealizedrs IRA/ securities $7Distribution SEP/Net employe appreciation Distribution2bcode(s)Taxablenotdetermined inemploye FATCA Filing13Date of payment SIMPLE requirementSIMPLE requirement IRA/SEP/ appreciation9bTotalemployee$ 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 $% %PAYERS TIN RECIPIENTS TIN PAYERS TIN RECIPIENTS TIN PAYER COPIES3Capital 2a) (included 4Federalincometaxwithheld5Roth contributions or insurance premiums 3Capital 2a) (included 4Federalincometaxwitheld5Roth insurancepremiumsinbox gain Employeecontributions/Designated inbox gain Employeecontributionscontributions/DesignatedorAccount number (see instructions) 11st year of desig. Roth contrib.$ 6 appreciation$ $7Distributioncode(s)Account number (see instructions) % 1$ 6 6 1st year of desig. Roth contrib. $ 10Amount allocable to IRR within 5 yearsIRA/ $8Other %10Amount allocable to IRR within 5 years $ $ 14State tax withheld 15 $ 9a Netunrealizedssecurities $ $ distribution 9b $ 14 IRA/ $8Other 15 $ 9a Netunrealizeds appreciation $ $ $7Distributioncode(s) Total SIMPLE contributionsState/Payers state no.inemployer 16State distribution State tax withheld State/Payers state no. securities State distribution SEP/SEP/SIMPLE inemployer 1617Local tax withheld 18 Yourpercentage19oftotal $Totalemployee$ contributions 18 Yourpercentageoftotaldistribution 9b employee$Name of Locality Local distribution 17Local tax withheld Name of Locality 19Local distributionReport this income on your federal tax return. Internal Revenue ServiceCopy C For Recipients Records is Service. Department of the Treasury$Copy B If this form shows federal income tax withheld Department of the Treasury$RECIPIENT'S name, street address, city or town, state or province, country, and ZIP or foreign postal code %www.irs.gov/Form1099R % RECIPIENT'S name, street address, city or town, state or province, country, and ZIP or foreign postal codeThisinformationbeingfurnishedtotheInternalRevenue Internal Revenue Service LR4 in box 4, attach this copy to your return. www.irs.gov/Form1099R(5175)Account 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 TreasuryInternalRevenueof InternalRevenueofwww.irs.gov/Form1099R LR4R www.irs.gov/Form1099R5176 TFP 5176Required Envelope:APEX: DW4MW or DW4MWSTFP: 61611 or 61612APEX - Sheets per packTFP - Forms per pack50s500s100s1000sFORM DESCRIPTIONLR3N/AN/AN/A1099-R 3-Up Horizontal Recipient Copy B, C, 21 Page Equals 1 FormLR4LR450051755175B1099-R 4-Up Box Recipient Copy B, C, 2, 21 Page Equals 1 FormLR4RLR4R50051765176B1099-R 4-Up Box Payer, State, Local or File Copy D, 1, 1, 11 Page Equals 1 Form50s500s100s1500sLSALSA50051605160B1099-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 Forms35"