b"PRE-PRINTED W-2 FORMSAPEX 1099MISC & 1099INT SXEXTXSAPEX DWMR or DWMRSAPEX 1099MISC PACKAGED LASER SETAPEX LMA APEX LMB APEX LMCLM2 APEX L1096Do Not Staple 6969VOID CORRECTED CORRECTED (if checked)VOID CORRECTEDPAYERS name, street address, city or town, state or province, country, ZIPOMB No. 1545-01151 Rents Form1096 1 Rents OMB No. 1545-0115 OMB No. 1545-0108 DETACH BEFORE MAILINGDETACH BEFORE MAILINGMANUFACTURED ON OCR LASER BOND PAPER USING HEAT RESISTANT INKSDETACH BEFORE MAILINGMANUFACTURED ON OCR LASER BOND PAPER USING HEAT RESISTANT INKS MANUFACTURED ON OCR LASER BOND PAPER USING HEAT RESISTANT INKSOMB No. 1545-0115or foreign postal code, and telephone no.1 Rents or foreign postal code, and telephone no. (Rev. February 2021) $ Miscellaneous U.S. Information Returns 2021or 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, ZIPAnnual Summary and Transmittal ofMiscellaneousMiscellaneous $ 2 Royalties 2021 $ 2 Royalties Department of the Treasury2 Royalties Information 2021 InformationInformation 2021Internal Revenue ServiceFILERS name$ Form 1099-MISC$ Form 1099-MISC$ Form 1099-MISC$ 3 Other income $ 4 Federal income tax withheld3 Other income Copy A$ 4 Federal income tax withheld Copy B4 Federal income tax withheld Copy C3 Other incomePAYERS TIN RECIPIENTS TINPAYERS TIN 5 Fishing boat proceedsRECIPIENTS TIN6 PAYERS TIN $ 5 Fishing boat proceeds Street address (including room or suite number) $ 6 Medical and health care payments or For PayerMedical and health care payments For$ For Recipient StateInternal Revenue Medical and health care paymentsService Center or Copy2RECIPIENTS TIN65 Fishing boat proceedsCopyCity or town, state or province, country, and ZIP or foreign postal code$ consumer products to$ $ File with Form 1096. $ consumer products to$ Telephone number For Privacy ActFor Ofcial Use Onlytotaling $5,000 or more of8 Substitute payments in lieu ofFor Privacy Act $ 8 Substitute payments in lieu ofThis is important tax dividends or interestName of person to contactRECIPIENTS name RECIPIENT'S name, stret adres7 , city or town, state or province, country, aRnEdC ZIPI EoNr Tfo'Sre niganm peo, starle ceto adedres7 , city or town, state or province, country, and ZIP or foreign postal code7 totaling $5,000 or more of8 Substitute payments in lieu of Payer made direct salesdividends or interest totaling $5,000 or more ofdividends or interest Payer made direct sales Payer made direct sales Street address (including apt. no.) requirement 2nd TIN not. $ recipient for resale $ attorney $ payments and Paperwork $ attorney 1098 $ 1098-C information and is74 Fax number 1099-A and Paperwork73 91 $ 5 Total amount reported with this Form 1096 APEX 1099-NEC PACKAGED LASER SET*9 Crop insurance proceeds consumer products toEmail address recipient for resale $ attorney Reduction Act Reduction Actthe IRS. If you are3 Total number of forms Notice, see the recipient for resale being furnished to 10 Gross proceeds paid to anNotice, see the9 Crop insurance proceeds 10 Gross proceeds paid to an 9 Crop insurance proceeds 10 Gross proceeds paid to an $ 2021 General$ 2 Social security number $ 2021 General1return, a negligence$ 4 Federal income tax withheldCity or town, state or province, country, and ZIP or foreign postal code 11 Fish purchased for resale Instructions forCertainpenalty or otherInstructions for6sanction may be $ 12 Section 409A deferrals11 Fish purchased for resale 32 12 Section 409A deferrals11 Fish purchased for resale 12 Section 409A deferrals 80 1099-B Certain 1099-DIV1099-G1099-INT1099-K1099-LS Information1097-BTC 81 $ 78 1098-E1098-F $ 1098-Q1098-T 79 Information 86 92 10 16W-2Gimposed on you if1099-C1099-CAP 84 this income is85$ $ Returns.$ 50 taxable and the IRS83 Returns.03determines that it Account number (see instructions) Account number (see instructions) requirement 14 compensation2nd TIN not.13 Excess golden parachute14 compensation13 Excess golden parachute14 compensation requirement payments has not been payments Account number (see instructions)13 Excess golden parachute1099-NEC 1099-OID PATRreported. 1099-QA 1099-R1099-S1099-SA 1099-SB 3921392254985498-ESA5498-QA 5498-SA $ $ $ 93 $ 95 71 $ 96 1099- 31 $ 1A 98 75 17 State income 43 25 26 28 72 2A 27 PARTS1099-LTC1099-MISC97 1099-Q 9415 State tax withheld15 State tax withheld 16 State/Payers state no.15 State tax withheld17 State income 16 State/Payers state no. 17 State income 16 State/Payers state no.$ $ $ $ $ $$ $ $ $ $ $Form1099-MISC 41-0852411 Form1099-MISC (keep for your records)Form Department of the Treasury - Internal Revenue ServiceDepartment of the Treasury - Internal Revenue ServiceDepartment of the Treasury - Internal Revenue Service STANDARD SETS 34 sheets for 100 Recipientswww.irs.gov/Form1099MISC 1099-MISC Return this entire page to the Internal Revenue Service. Photocopies are not acceptable. www.irs.gov/Form1099MISC www.irs.gov/Form1099MISCDo Not Cut or Separate Forms on This PageDo Not Cut or Separate Forms on This PageSend this form, with the copies of the form checked in box 6, to the IRS in a at mailer (not folded).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, or foreign postal code, and telephone no. VOID CORRECTED 1 Rents and complete. CORRECTED OMB No. 1545-0115 Title Date NEC959133-Part SET includes: 34 Sheets EA Laser 1099MISC Copy A, B, CCORRECTED (if checked)VOID1 RentsPAYERS name, street address, city or town, state or province, country, ZIP PAYERS name, street address, city or town, state or province, country, ZIP PAYERS name, street address, city or town, state or province, country, ZIP OMB No. 1545-0115 Signatureor foreign postal code, and telephone no.1 Rents or foreign postal code, and telephone no. OMB No. 1545-0115 InstructionsMiscellaneousMiscellaneousMiscellaneous $ 2 Royalties 2021 $ 2 Royalties Information 2021 $ 2 Royalties Information 2021 Information$ Form 1099-MISC$ Future developments. For the latest information about developmentsform must be the same as those you enter in the upper left area ofNEC959144-Part SET includes: 34 Sheets EA Laser 1099MISC Copy A, B, C, Crelated to Form 1096, such as legislation enacted after it was published, go to www.irs.gov/Form1096. Form 1099-MISC Forms 1097, 1098, 1099, 3921, 3922, 5498, or W-2G.Form 1099-MISC$ When to le. File Form 1096 as follows.Reminder. The only acceptable method of electronically through $ 3 Other income $ 4 Federal income tax withheld3 Other income Copy A$ 4 Federal income tax withheld Copy B$ 4 Federal income tax withheld Copy C3 Other incomeinformation returns listed on this form in box 6 with the IRS isPAYERS TIN RECIPIENTS TINPAYERS TIN 5 Fishing boat proceedsRECIPIENTS TIN6 PAYERS TIN $ the FIRE System. See Pub. 1220.For Recipient 6 Medical and health care payments February 28, 2022. NEC959155-Part SET includes: 34 Sheets EA Laser 1099MISC Copy A, B, C, C, 2For$ 5 Fishing boat proceeds or For PayerPurpose of form. Use this form to transmit paper Forms 1097, 1098, Medical and health care payments Internal Revenue 6 Medical and health care payments State5 Fishing boat proceeds or Copy2RECIPIENTS TIN1099, 3921, 3922, 5498, and W-2G to the IRS. Service Center CopyCaution: $ $ $ File with Form 1096. $ $ Where To File$electronically but fail to do so, and you do not have an approvedRECIPIENTS name RECIPIENT'S name, stret adres7 , city or town, state or province, country, aRndE CZIPI EoNr Tfo'Sre niganm peo, starle ceto dadedres7recipient for resale waiver, you may be subject to a penalty. The Taxpayer First Act offollowing. Use the followingSTANDARD SETS w/Envelopes 34 Sheets for 100 RecipientsPayer made direct salesdividends or interest , city or town, state or province, country, and ZIP or foreign postal code7 Payer made direct salesdividends or interesttotaling $5,000 or more of8 Substitute payments in lieu ofFor Privacy Act Substitute payments in lieu ofThis is important tax8 Substitute payments in lieu ofFor Privacy Act consumer products to$ totaling $5,000 or more of8dividends or interest totaling $5,000 or more of$ If your principal business, ofce Payer made direct sales 2019, enacted July 1, 2019, authorized the Department of the and Paperworkinformation and is recipient for resale consumer products toconsumer products toand Paperwork Treasury and the IRS to issue regulations that reduce the 250-return Reduction Act $ recipient for resale 10 Gross proceeds paid to anor agency, or legal residence inaddressrequirement for 2021 tax returns. If those regulations are issued and being furnished to Street address (including apt. no.) 9 Crop insurance proceeds 10 Gross proceeds paid to an 9 Crop insurance proceeds 10 Gross proceeds paid to anthe IRS. If you areattorney Reduction Act attorney Notice, see the attorney 9 Crop insurance proceeds Notice, see the an article at www.irs.gov/Form1099 explaining the change. Untilthe case of an individual, is City or town, state or province, country, and ZIP or foreign postal code $ $ $ 2021 General$ $ return, a negligence2021 GeneralInternal Revenue ServiceNEC95913E3-Part SET includes: 34 Sheets EA Laser 1099MISC Copy A, B, C,located inregulations are issued, however, the number remains at 250, aspart F in theAlabama, Arizona, Arkansas, Delaware, 11 Fish purchased for resale Instructions forCertainpenalty or otherInstructions forCertain$2021 General Instructions for Certain Information Returns.sanction may be 12 Section 409A deferrals11 Fish purchased for resale 12 Section 409A deferrals imposed on you ifFlorida, Georgia, Kentucky, Maine,Austin Submission Processing Center Information11 Fish purchased for resale 12 Section 409A deferrals Massachusetts, Mississippi, NewP.O. Box 149213 of the number of returns. this income isInformation$ $ $ Returns.$ $ taxable and the IRSHampshire, New Jersey, New Mexico,Austin, TX 78714Account number (see instructions) requirement 2nd TIN not.13 Excess golden parachuterequirement payments Who must le.13 Excess golden parachute$ Returns. + 100 DW19determines that itNew York, North Carolina, Ohio, Texas, Account number (see instructions) 14 compensation requirement payments has not beenVermont, Virginiapayments Account number (see instructions)13 Excess golden parachute14 compensation2nd TIN not. 14 compensation$ $ $ $ $ reported.$Form1099-MISC LMA 41-0852411 Form 5110 15 State tax withheld 16 State/Payers state no.15 State tax withheld17 State income 16 State/Payers state no.15 State tax withheld17 State income 16 State/Payers state no. 17 State income L1096 41-0852411 5100 Form1096(2021) NEC95914E4-Part SET includes: 34 Sheets EA Laser 1099MISC Copy A, B, C, C, $ $ $ $ $ $$ $ $ For more information and the Privacy Act and Paperwork Reduction Act Notice, $ $ $1099-MISC LMB (keep for your records) 1099-MISC LMC/LM2 see the 2021 General Instructions for Certain Information Returns.www.irs.gov/Form1099MISC Form Department of the Treasury - Internal Revenue ServiceDepartment of the Treasury - Internal Revenue Service5112 Department of the Treasury - Internal Revenue Service5111 www.irs.gov/Form1099MISC www.irs.gov/Form1099MISC + 100 DW19NEC95915E5-Part SET includes: 34 Sheets EA Laser 1099MISC Copy A, B, C, C, 2,3 Transmittal 1096 forms are included with each set + 100 DW19 STANDARD SET with Self-seal Envelopes34 sheets for 100 RecipientsAPEX 1099-MISC PACKAGED LASER SETNEC95914ES4-Part SET includes: 34 Sheets EA Laser 1099MISC Copy A, B, C, C, + 100 DW19PARTS MINI SETS 17 Sheets 50 RecipientsSTANDARD SETS 34 sheets for 100 Recipients NEC959183-Part SET includes: 17 Sheets EA Laser 1099MISC Copy A, B, C959133-Part SET includes: 34 Sheets EA Laser 1099MISC Copy A, B, C MINI SETS W/Envelopes 17 Sheets 50 Recipients959144-Part SET includes: 34 Sheets EA Laser 1099MISC Copy A, B, C, CNEC95918E4-Part SET includes: 17 Sheets EA Laser 1099MISC Copy A, B, C, C,959155-Part SET includes: 34 Sheets EA Laser 1099MISC Copy A, B, C, C, 2 + 50 DW19STANDARD SETS w/Envelopes 34 Sheets for 100 Recipients MINI SETS W/Self-Seal Envelopes 17 Sheets for 50 Recipients95913E3-Part SET includes: 34 Sheets EA Laser 1099MISC Copy A, B, C, NEC95918ES4-Part SET includes: 17 Sheets EA Laser 1099MISC Copy A, B, C, C,+ 100 DWMR + 50 DW19S95914E4-Part SET includes: 34 Sheets EA Laser 1099MISC Copy A, B, C, C,VALUE SETS W/Self-Seal Envelopes 7 Sheets for 20 Recipients+ 100 DWMR NEC95903ES3-Part SET includes: 7 Sheets EA Laser 1099MISC Copy A, B, C,95915E5-Part SET includes: 34 Sheets EA Laser 1099MISC Copy A, B, C, C, 2, + 20 DW19S+ 100 DWMRNEC95904ES4-Part SET includes: 7 Sheets EA Laser 1099MISC Copy A, B, C, C, STANDARD SET with Self-seal Envelopes 34 sheets for 100 Recipients + 20 DW19S95914ES4-Part SET includes: 34 Sheets EA Laser 1099MISC Copy A, B, C, C,NEC95905ES5-Part SET includes: 7 Sheets EA Laser 1099MISC Copy A, B, C, C, 2,+ 100 DWMRS + 20 DW19SMINI SETS 17 Sheets 50 Recipients APEX 1099-INT PACKAGED LASER SET 959183-Part SET includes: 17 Sheets EA Laser 1099MISC Copy A, B, CMINI SETS W/Envelopes 17 Sheets 50 Recipients STANDARD SETS 34 sheets for 100 Recipients 95918E4-Part SET includes: 17 Sheets EA Laser 1099MISC Copy A, B, C, C, 959233 PART SET includes: 34 Sheets EA Laser 1099INT Copy A, B, C+ 50 DWMR 959244 PART SET includes: 34 Sheets EA Laser 1099INT Copy A, B, C, CMINI SETS W/Self-Seal Envelopes 17 Sheets for 50 Recipients STANDARD SETS W/Envelopes 34 Sheets for 100 Recipients95918ES4-Part SET includes: 17 Sheets EA Laser 1099MISC Copy A, B, C, C, 95923E3 PART SET includes: 34 Sheets EA Laser 1099INT Copy A, B, C + 50 DWMRS + 100 DWMRVALUE SETS W/Self-Seal Envelopes 7 Sheets for 20 Recipients 95924E4 PART SET includes: 34 Sheets EA Laser 1099INT Copy A, B, C, C 95903ES3-Part SET includes: 7 Sheets EA Laser 1099MISC Copy A, B, C, + 100 DWMR+ 20 DWMRS VALUE SETS W/Self-Seal Envelopes 7 Sheets for 20 Recipients95904ES4-Part SET includes: 7 Sheets EA Laser 1099MISC Copy A, B, C, C,95907ES3 PART SET includes: 7 Sheets EA Laser 1099INT Copy A, B, C + 20 DWMRS + 20 DWMRS95905ES5-Part SET includes: 7 Sheets EA Laser 1099MISC Copy A, B, C, C, 2, 95908ES4 PART SET includes: 7 Sheets EA Laser 1099INT Copy A, B, C, C + 20 DWMRS + 20 DWMRS43"