b"1099 PRE-PRINTED FORMSApex 1099-DIV & 1099-R Packaged SetsAPEX 1099-DIV LASER PACKAGED SETAPEX LDA APEX LDB APEX LDC APEX L10969191 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. 1545-0108$1b Form1099-DIVDividends and DETACH BEFORE MAILINGINKS $1b Form1099-DIV Dividends and DETACH BEFORE MAILINGUSING HEATINKS 1b Form1099-DIVDividends and DETACH BEFORE MAILINGUSING HEATINKS U.S. Information Returns 2022DETACH BEFORE MAILING RESISTANTRESISTANTRESISTANTMANUFACTUREDMANUFACTURED ON OCR LASER BOND PAPER USING HEAT RESISTANT INKSor foreign postal code, and telephone no.or foreign postal code, and telephone no.or foreign postal code, and telephone no. Department of the Treasury (Rev. January 2022) Distributions(Rev. January 2022) Distributions(Rev. January 2022) Internal Revenue ServiceDistributions For calendar year For calendar year For calendar year FILERS name$20 $20 $20$USING HEATBOND PAPERBOND PAPERBOND PAPERCopy A$2aTotal capital gain distr. $2bUnrecap. Sec. 1250 gainCopy A $2aTotal capital gain distr. $2bUnrecap. Sec. 1250 gainCopy B$2aTotal capital gain distr. $2bUnrecap. Sec. 1250 gainCopy CPAYERS TIN RECIPIENTS TIN 2cSection 1202 gain2dCollectibles (28%) gainInternal Revenue ForRECIPIENTS TIN 2cSection 1202 gain2dCollectibles (28%) gainFor RecipientRECIPIENTS TIN 2cSection 1202 gain2dCollectibles (28%) gainStreet address (including room or suite number)PAYERS TINPAYERS TINFor Payer$$Service Center$$$$and/or State Copy 1 or Copy 2$2eSection 897 ordinary dividends $2fSection 897 capital gainFile with Form 1096. $2eSection 897 ordinary dividends $2fSection 897 capital gain$2eSection 897 ordinary dividends $2fSection 897 capital gainCity or town, state or province, country, and ZIP or foreign postal code For Ofcial Use OnlyRECIPIENTS name3Nondividend distributions 4Federal income tax withheld RECIPIENT'S name, stret adres, city or town, state or province, country, and ZIP or foreign postal code3Nondividend distributions 4Federal income tax withheld RECIPIENT'S name, stret adres, city or town, state or province, country, and ZIP or foreign postal code3Nondividend distributions 4Federal income tax withheldName of person to contact Telephone number$$For Privacy Act$$This is important tax$$For Privacy Act information and isand Paperwork 5Section 199A dividends 6Investment expensesand Paperwork5Section 199A dividends 6Investment expensesbeing furnished to5Section 199A dividends 6Investment expensesEmail address Fax numberStreet address (including apt. no.)$$Reduction Act$$the IRS. If you are$$Reduction ActON OCR LASERON OCR LASERON OCR LASER7Foreign tax paid8Foreign country or U.S. possession Notice, see the7Foreign tax paid8Foreign country or U.S. possession return, a negligence7Foreign tax paid8Foreign country or U.S. possession1Notice, see the2 Social security number 3 Total number of forms 4 Federal income tax withheld5 Total amount reported with this Form 1096Notice, see the current Generalpenalty or othercurrent General$ $City or town, state or province, country, and ZIP or foreign postal code $9Cash liquidation distributions10 Noncash liquidation distributions Instructions for Certain$9Cash liquidation distributions10 Noncash liquidation distributions this income is taxable$9Cash liquidation distributions10 Noncash liquidation distributionsInstructions for10981098-C1098-E1098-F 1098-Q1098-T1099-A1099-B1099-C1099-CAP 1099-DIV1099-G1099-INT1099-K1099-LS sanction may be imposed on you if6W-2GCertain81 78 84 03 74 83 80 79 85 73 91 86 92 10 16Informationdetermines that it has$$32 Information and the IRS1097-BTC50 MANUFACTUREDMANUFACTURED$$Returns.$$not been reported.12Exempt-interest dividends13bond interest dividends Returns. 11requirement 12Exempt-interest dividends13bond interest dividends 11requirement 12Exempt-interest dividends13bond interest dividends 11requirement$$$$$$1099-LTC1099-MISC 1099-NEC 1099-OID1099-PATR1099-Q1099-QA 1099-R1099-S1099-SA 1099-SB 3921392254985498-ESA5498-QA 5498-SA Account number (see instructions)2nd TIN not.14State 1516State tax withheld Account number (see instructions)14State 1516State tax withheld Account number (see instructions)2nd TIN not.14State 1516State tax withheld 93 95 71 96 97 31 1A 98 75 94 43 25 26 28 72 2A 27$$$ $ $$$ $ Form1099-DIV(Rev. 1-2022) 41-0852411 www.irs.gov/Form1099DIV Department of the Treasury - Internal Revenue ServiceForm1099-DIV(Rev. 1-2022) (keep for your records)www.irs.gov/Form1099DIV Department of the Treasury - Internal Revenue ServiceForm1099-DIV(Rev. 1-2022) www.irs.gov/Form1099DIV Department of the Treasury - Internal Revenue ServiceDoNotCutorSeparateFormsonThisPage DoNotCutorSeparateFormsonThisPage Return this entire page to the Internal Revenue Service. Photocopies are not acceptable. Send 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, and complete.9191 VOIDCORRECTED CORRECTED (if checked) VOIDCORRECTED Title DatePAYERS 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. 1545-0110Signatureor foreign postal code, and telephone no.or foreign postal code, and telephone no.or foreign postal code, and telephone no. $Form1099-DIVDividends and$Form1099-DIV Dividends and$Form1099-DIVDividends and Instructions1b (Rev. January 2022) Distributions1b (Rev. January 2022) Distributions1b (Rev. January 2022) Future developments. For the latest information about developmentsform must be the same as those you enter in the upper left area of Distributions For calendar year For calendar year For calendar year related to Form 1096, such as legislation enacted after it wasForms 1097, 1098, 1099, 3921, 3922, 5498, or W-2G.published, go to www.irs.gov/Form1096.$2aTotal capital gain distr. $20 $2aTotal capital gain distr. $20 Copy B$2aTotal capital gain distr. $20 Reminder. The only acceptable method of electronically throughWhen to le. File Form 1096 as follows.information returns listed on this form in box 6 with the IRS isPAYERS TIN RECIPIENTS TIN $2cSection 1202 gain2bUnrecap. Sec. 1250 gainPAYERS TINCopy AForRECIPIENTS TIN $2cSection 1202 gain2bUnrecap. Sec. 1250 gainFor RecipientRECIPIENTS TIN $2cSection 1202 gain2bUnrecap. Sec. 1250 gainCopy C February 28, 2023.the FIRE System. See Pub. 1220. 2dCollectibles (28%) gainInternal Revenue2dCollectibles (28%) gainPAYERS TIN2dCollectibles (28%) gainFor PayerPurpose of form. Use this form to transmit paper Forms 1097, 1098, and/or State $$Service Center$$$$1099, 3921, 3922, 5498, and W-2G to the IRS. Copy 1 or Copy 22eSection 897 ordinary dividends2fSection 897 capital gainFile with Form 1096. $2eSection 897 ordinary dividends $2fSection 897 capital gain$2eSection 897 ordinary dividends $2fSection 897 capital gainCaution: electronically but fail to do so, and you do notWhere To File$$have an approved waiver, you may be subject to a penalty. Thefollowing.RECIPIENTS name$3Nondividend distributions$4Federal income tax withheld RECIPIENT'S name, stret adres, city or town, state or province, country, and ZIP or foreign postal code $3Nondividend distributions$4Federal income tax withheld RECIPIENT'S name, stret adres, city or town, state or province, country, and ZIP or foreign postal code $3Nondividend distributions$4Federal income tax withheld Taxpayer First Act of 2019, enacted July 1, 2019, authorized theIf your principal business, ofceUse the followingAPEX DWMR or DWMRSFor Privacy ActThis is important taxFor Privacy Act information and isDepartment of the Treasury and the IRS to issue regulations that 5Section 199A dividends 6Investment expensesand Paperwork5Section 199A dividends 6Investment expensesbeing furnished to5Section 199A dividends 6Investment expensesand Paperworkor agency, or legal residence inaddressreduce the 250-return requirement for 2021 tax returns. If those Street address (including apt. no.)$7Foreign tax paid$8Foreign country or U.S. possession Reduction Act$7Foreign tax paid$8Foreign country or U.S. possession the IRS. If you are$7Foreign tax paid$8Foreign country or U.S. possession regulations are issued and effective for 2022 tax returns required to be www.irs.gov/Form1099the case of an individual, is Reduction Act Notice, see thereturn, a negligenceNotice, see thelocated incurrent Generalpenalty or otherexplaining the change. Until regulations are issued, however, the current General 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 distributions this income is taxable$9Cash liquidation distributions10 Noncash liquidation distributionsInstructions for CertainAlabama, Arizona, Arkansas, Delaware,Internal Revenue Servicesanction may beinformation, seeimposed on you ifInformation Returns. part F in the 2022 General Instructions for CertainFlorida, Georgia, Kentucky, Maine, and the IRSMassachusetts, Mississippi, NewP.O. Box 149213 Informationdetermines that it has$$InformationNew York, North Carolina, Ohio, Texas,Austin, TX 78714-9213$$Returns.$$not been reported.11 requirement 12Exempt-interest dividends13 bond interest dividends of the number of returns. Hampshire, New Jersey, New Mexico, Returns.Vermont, Virginia11requirement 12Exempt-interest dividends13bond interest dividends 11requirement 12Exempt-interest dividends13bond interest dividends Who must le. $$$$$$Caution: Your name and TIN must match the name and TIN used on Account number (see instructions)2nd TIN not.14State 1516State tax withheld Account number (see instructions)14State 1516State tax withheld Account number (see instructions)2nd TIN not.14State 1516State tax withheld your 94X series tax return(s) or you may be subject to information $$$return penalties. Do not use the name and/or TIN of your paying agent or service bureau.$$$For more information and the Privacy Act and Paperwork Reduction Act Notice,L1096 41-0852411 5100 Form1096(2022)Form1099-DIV(Rev. 1-2022) LDA 41-0852411 5130 www.irs.gov/Form1099DIV Department of the Treasury - Internal Revenue ServiceForm1099-DIV(Rev. 1-2022)LDB (keep for your records)5131 www.irs.gov/Form1099DIV Department of the Treasury - Internal Revenue ServiceForm1099-DIV(Rev. 1-2022) LDC 5132 www.irs.gov/Form1099DIV Department of the Treasury - Internal Revenue Servicesee the 2022 General Instructions for Certain Information Returns.APEX 1099-R LASER PACKAGED SETAPEX LRA APEX LRB APEX LRCLR2 APEX LRD1 APEX L10969898 VOID CORRECTED CORRECTED (if checked) CORRECTED (if checked) VOID CORRECTED Do Not Staple 6969PAYERS 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. 1545-0119PAYERS name, street address, city or town, state or province,1Gross distribution OMB No. 1545-0119 Form1096 Annual Summary and Transmittal of OMB No. 1545-0108 DETACH BEFORE MAILINGDETACH BEFORE MAILINGDETACH BEFORE MAILINGDETACH BEFORE MAILINGDETACH BEFORE MAILINGDistributions FromDistributions FromDistributions FromDistributions FromMANUFACTURED 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 INKScountry, ZIP or foreign postal code, and telephone no. Pensions, Annuities, Pensions, Annuities, country, ZIP or foreign postal code, and telephone no. Pensions, Annuities,country, ZIP or foreign postal code, and telephone no. country, ZIP or foreign postal code, and telephone no. Pensions, Annuities,Retirement orRetirement orRetirement orRetirement orU.S. Information Returns 2022$ 2aTaxable amount 2022 Prot-Sharing Plans,$ 2aTaxable amount 2022 Prot-Sharing Plans,$ 2aTaxable amount 2022 Prot-Sharing Plans,$ 2aTaxable amount 2022 Department of the Treasury Prot-Sharing Plans, IRAs, InsuranceInternal Revenue ServiceIRAs, InsuranceIRAs, InsuranceContracts, etc. IRAs, Insurance $ Form 1099-R Contracts, etc. $ Form 1099-R Contracts, etc. $ Form 1099-R $ Form 1099-R FILERS nameContracts, etc.2bTaxable amountTotalCopy A2bTaxable amountTotalCopyB2bTaxable amountTotalCopy C2bTaxable amountTotalCopy D PAYERS TIN RECIPIENTS TIN not determined 4 distribution PAYERS TINForRECIPIENTS TIN not determined 4 distribution PAYERS TINReport thisRECIPIENTS TIN not determined 4 distribution For Recipient'sRECIPIENTS TIN not determined 4 distribution Street address (including room or suite number)3Capital gain (included inFederal income tax Internal Revenue3Capital gain (included inFederal income tax income on your3Capital gain (included inFederal income taxPAYERS TIN State,City, 3Capital gain (included inFederal income tax For Payer box 2a) withheld Service Centerbox 2a) withheld federal taxbox 2a) withheld Records and/or box 2a) withheld a r d/orreturn. If thisor Locatl Tax State,nCity,lRECIPIENTS name $ 5Employee contributions/$ 6appreciation inFile with Form 1096. $ 5Employee contributions/$ 6appreciation in RECIPIENTS name, stre form shows$ 5Employee contributions/$ 6appreciation in RECIPIENTS name, stret adres orCopy2 $ 5Employee contributions/$ 6appreciation in Locat Telephone number For Ofcial Use OnlyDepoartmenTax Departmen City or town, state or province, country, and ZIP or foreign postal codeDesignated RothNet unrealized RECIPIENTS name, stret adres, city or town, state or province, country and ZIP or foreign postal code Designated RothNet unrealized federal incomecontributions orNet unrealized , city or town, state or province, country and ZIP or foreign postal code contributions orNet unrealized Name of person to contact Fax numbert adres, city or town, state or province, country and ZIP or foreign postal codecontributions oremployers securities For Privacy Actcontributions oremployers securities tax withheld inDesignated Rothemployers securities Designated Rothemployers securities For Privacy Act insurance premiums and Paperworkinsurance premiums box 4, attachinsurance premiums insurance premiums Email address Reduction Act and Paperwork $ code(s) IRA/ $ 8Other Reduction Act$ 7DistributionSEP/ $ 8Other this copy to$ 7DistributionIRA/ $ 8Other This information is$ 7DistributionIRA/ $ 8Other 1Notice, see the2 Social security number 3 Total number of forms $ 4 Federal income tax withheld $ 5 Total amount reported with this Form 1096SIMPLE Notice, see thecode(s) IRA/ your return.code(s) SEP/ code(s) SEP/ 6 %2022 General Street address (including apt. no.) 7DistributionSEP/ $ %2022 GeneralSIMPLE $ % This information isSIMPLE $ % SIMPLE $ Instructions forCertainInstructions for Certain City 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-CAP 1099-DIV1099-G1099-INT1099-K1099-LS distribution % Returns. distribution % distribution % distribution % W-2G 1097-BTCReturns. 78 84 03 74 83 80 79 85 73 91 86 92 10 1632 10988110Amount 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.10 $ 16State distribution 111st 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. $ 16State distribution16State distribution Amount allocable to IRR16State distributionwithin 5 years Roth contrib. within 5 years Roth contrib. within 5 years Roth contrib. within 5 years Roth contrib.$ $$ $ $ $ $ $ $ $ $ $ $ 1099-LTC1099-MISC 1099-NEC 1099-OID1099-PATR1099-Q1099-QA 1099-R1099-S1099-SA 1099-SB 3921392254985498-ESA5498-QA 5498-SA 93 $ 19Local distribution 96 97 31 1A 98 75 94 43 25 26 28 72 2A 27Account number (see instructions) 13Date of17Local tax withheld 18Name of localityAccount number (see instructions) 13Date of17Local tax withheld 18Name of localityAccount number (see instructions) 13Date of17Local tax withheld 18Name of localityAccount number (see instructions) 13Date of17Local tax withheld 18Name of locality 95 7119Local distribution 19Local distribution 19Local distributionpayment$ $ payment$ $ payment$ $ payment$ $$ $ $ $ $ $ $ $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 Form 1099-R (keep for your records) Form 1099-R Return this entire page to the Internal Revenue Service. Photocopies are not acceptable. DoNotCutorSeparateFormsonThisPage DoNotCutorSeparateFormsonThisPage Send 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, and complete.9898 VOID CORRECTED CORRECTED (if checked) CORRECTED (if checked) VOID CORRECTED Title DatePAYERS 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 From1Gross distribution OMB No. 1545-0119 Distributions From1Gross distribution OMB No. 1545-0119 SignatureDistributions FromPAYERS name, street address, city or town, state or province,PAYERS name, street address, city or town, state or province,Distributions 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 orInstructionsRetirement or $ 2aTaxable amount 2022 Prot-Sharing Plans,$ 2aTaxable amount 2022 Prot-Sharing Plans,$ 2aTaxable amount 2022 Prot-Sharing Plans,$ 2aTaxable amount 2022 Future developments. For the latest information about developmentsform must be the same as those you enter in the upper left area of Prot-Sharing Plans, IRAs, Insurance IRAs, InsuranceIRAs, InsuranceIRAs, Insurancerelated to Form 1096, such as legislation enacted after it was Contracts, etc. Contracts, etc.published, go to www.irs.gov/Form1096.$ Form 1099-R Contracts, etc. $ Form 1099-R Contracts, etc. $ Form 1099-R $ Form 1099-R Reminder. The only acceptable method of electronically throughForms 1097, 1098, 1099, 3921, 3922, 5498, or W-2G.Taxable amountinformation returns listed on this form in box 6 with the IRS is When to le. File Form 1096 as follows.2bTaxable amountTotalCopy A2bnot determined TotalCopyB2bTaxable amountTotalCopy CRECIPIENTS TIN 2bTaxable amount4 TotalCopy DFebruary 28, 2023.not determined distribution distribution Report thisRECIPIENTS TIN not determined 4 distribution For Recipient'snot determined distribution the FIRE System. See Pub. 1220. For Payer box 2a) withheld Internal Revenue Forbox 2a) withheld income on yourbox 2a) withheld Records and/or box 2a) withheld 1099, 3921, 3922, 5498, and W-2G to the IRS. PAYERS TIN RECIPIENTS TIN 3Capital gain (included in 4Federal income taxPAYERS TINRECIPIENTS TIN 3Capital gain (included in 4Federal income taxPAYERS TIN3Capital gain (included inFederal income taxPAYERS TIN State,City, 3Capital gain (included inFederal income tax Purpose of form. Use this form to transmit paper Forms 1097, 1098, and/orService Centerfederal taxor Locatl Caution:Tax State, r City,l Where To File$ $File with Form 1096. $ $ return. If this$ $ Tax Departmen 2 $ $ Locatform showsorCopy Depoartmen electronically but fail to do so, and you do not RECIPIENTS name, stret adres, city or town, state or province, country and ZIP or foreign postal code have an approved waiver, you may be subject to a penalty. The RECIPIENTS name 5Employee contributions/ 6appreciation in RECIPIENTS name, stret adres, city or town, state or province, country and ZIP or foreign postal code 5Employee contributions/ 6appreciation in federal income5Employee contributions/ 6appreciation in RECIPIENTS name, stret adres, city or town, state or province, country and ZIP or foreign postal code 5Employee contributions/ 6appreciation in Taxpayer First Act of 2019, enacted July 1, 2019, authorized thefollowing.Designated RothNet unrealized For Privacy Actcontributions orNet unrealized tax withheld incontributions orNet unrealized insurance premiums Net unrealized For Privacy ActIf your principal business, ofceUse the following contributions orDesignated RothDesignated RothDesignated RothDepartment of the Treasury and the IRS to issue regulations that employers securities and Paperwork insurance premiums employers securities and Paperworkinsurance premiums employers securities box 4, attachinsurance premiums employers securities contributions orreduce the 250-return requirement for 2021 tax returns. If thoseor agency, or legal residence inaddressIRA/ 8Other Reduction Act7DistributionIRA/ 8Other this copy to$ 7DistributionIRA/ $ 8Other $ 7DistributionIRA/ $ 8Other regulations are issued and effective for 2022 tax returns required to be www.irs.gov/Form1099the case of an individual, is Reduction Act Street address (including apt. no.) $ 7DistributionSEP/ $ Notice, see the$ code(s) SIMPLE $ your return.code(s) SIMPLE This information iscode(s) SIMPLE Notice, see thelocated in 2022 GeneralSEP/ SEP/ SEP/ explaining the change. Until regulations are issued, however, the code(s) SIMPLE $ % Instructions for Certain$ % This information is$ % $ %2022 General Alabama, Arizona, Arkansas, Delaware,Internal Revenue ServiceInstructions forInformation Returns. part F in the 2022 General Instructions for CertainMassachusetts, Mississippi, NewP.O. Box 149213 information, see Certain City 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 InformationFlorida, Georgia, Kentucky, Maine,Austin, TX 78714-9213distribution %$ Returns. distribution %$ distribution %$ distribution %$ Returns. Hampshire, New Jersey, New Mexico, of the number of returns. New York, North Carolina, Ohio, Texas, 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 15State/Payers state no. $ 16State distribution Vermont, Virginia16State distribution 16State distribution 16State distribution Who must le. within 5 years Roth contrib. within 5 years Roth contrib. within 5 years Roth contrib. within 5 years Roth contrib.$ $ $ Caution: Your name and TIN must match the name and TIN used on $ $ $ $ $ $ $ $ $ $ $ $Account number (see instructions) 13Date of17Local tax withheld 18Name of localityAccount number (see instructions) 13Date of17Local tax withheld 18Name of localityAccount number (see instructions) 13Date of17Local tax withheld 18Name of localityAccount number (see instructions) 13Date of17Local tax withheld 18Name of locality your 94X series tax return(s) or you may be subject to information 19Local distribution 19Local distribution 19Local distribution 19Local distributionreturn penalties. Do not use the name and/or TIN of your paying agent payment$ $ payment$ $ payment$ $ payment$ or service bureau.$$ $ $ $ $ $ $ For more information and the Privacy Act and Paperwork Reduction Act Notice,L1096 41-0852411 5100 Form1096(2022)$Form 1099-R LRB Form 1099-R (keep for your records) Form 1099-R LRD1 see the 2022 General Instructions for Certain Information Returns.Form 1099-R LRA 41-0852411 5140 www.irs.gov/Form1099R Department of the Treasury - Internal Revenue Service 5141 www.irs.gov/Form1099R Department of the Treasury - Internal Revenue Service LRC/LR2 www.irs.gov/Form1099R 5142 Department of the Treasury - Internal Revenue Service 5143 www.irs.gov/Form1099R Department of the Treasury - Internal Revenue Service(3) Transmittal 1096 forms are included with each setAPEX 1099-DIV LASER PACKAGED SETAPEX 1099-R LASER PACKAGED SET STANDARD SETS (50 Sheets for 100 Recipients) STANDARD SETS (50 Sheets for 100 Recipients)959333-Part SET includes: (50 Sheets EACH) 1099-DIV Copy A, B, C 959444-Part SET includes: (50 Sheets EACH) 1099-R Copy A, B, C, D959344-Part SET includes: (50 Sheets EACH) 1099-DIV Copy A, B, C, C 959466-Part SET includes: (50 Sheets EACH) 1099-R Copy A, B, C, D, 1, 2STANDARD SETS w/ Envelopes (50 Sheets for 100 Recipients) STANDARD SETS w/ Envelopes (50 Sheets for 100 Recipients)95933E3-Part SET includes: (50 Sheets EACH) 1099-DIV Copy A, B, C,95944E4-Part SET includes: (50 Sheets EACH) 1099-R Copy A, B, C, D, + DWMR (100) + DWMR (100)95934E4-Part SET includes: (50 Sheets EACH) 1099-DIV Copy A, B, C, C,95946E6-Part set includes: (50 Sheets EACH) 1099-R Copy A, B, C, D, 1, 2, + DWMR (100) + DWMR (100)VALUE SETS w/ Self-Seal Envelopes (10 Sheets for 20 Recipients)95910ES4-Part SET includes: (10 Sheets EACH) 1099-DIV Copy A, B, C, C, + DWMRS (20)43"