b'MISCELLANEOUS FORMS1042-S & W-2G1042-S LASER 1042-SAPEX L42A22TFP 532022 Used to report all income and/or tax with-Form1042-S Foreign Persons U.S. Source Income Subject to Withholding 2022 Form1042-S Foreign Persons U.S. Source Income Subject to WithholdingForeign Persons U.S. Source Income Subject to WithholdingForeign Persons U.S. Source Income Subject to Withholding 2022 OMB No. 1545-0096 held for non-resident aliens and foreign Department of the Treasury Form1042-S Foreign Persons U.S. Source Income Subject to Withholding 2022 Form1042-S2022 Copy CForm1042-S2022 OMB No. 1545-0096 AMENDED AMENDMENT NO. Copy E OMB No. 1545-0096 OMB No. 1545-0096Department of the TreasuryGo to www.irs.gov/Form1042S OMB No. 1545-0096for instructions and the latest information. AMENDMENT NO. Copy BGo to www.irs.gov/Form1042S for instructions and the latest information. AMENDMENT NO. Copy Dfor Recipient for Withholding AgentGo to www.irs.gov/Form1042S for instructions and the latest information. Copy AforGo to www.irs.gov/Form1042S for instructions and the latest information. for Recipient Go to www.irs.gov/Form1042S for instructions and the latest information.Department of the TreasuryInternal Revenue ServiceAMENDED Department of the Treasury Internal Revenue ServiceAMENDED Department of the Treasury Internal Revenue ServiceAMENDED UNIQUE FORM IDENTIFIER for Recipient Internal Revenue ServiceAMENDEDInternal Revenue Service UNIQUE FORM IDENTIFIER AMENDMENT NO. Internal Revenue Service UNIQUE FORM IDENTIFIER AMENDMENT NO. UNIQUE FORM IDENTIFIER UNIQUE FORM IDENTIFIER1 Income 2Gross income 3 Chapter indicator.Enter 3 or 4 . 1 Income. Gross incomes 3Exemption code .s 13f Ch. 4 status code 1 Income 13e2Recipients U.S. TIN, if any . Recipient.s 13f Ch. 4 status code. 1 Income 13e2Recipients U.S. TIN, if any Recipient.s 13fCh. 3 status code. 1 Income 13e2Recipients U.S. TIN, if any Recipient.s 13f Ch. 4 status code.13j 13eRecipients U.S. TIN, if any Recipients 13f Ch. 4 status code13jLOB codecorporations with United States income. code 3a 4a Exemption code code 13e2Recipients U.S. TIN, if any 13g Ch. 3 status code code Gross income 3Exemption code13g Ch. 3 status code code Gross income 3Exemption code13g Ch. 4 status code code Gross income 3Exemption code13g Ch. 3 status code 13g Ch. 3 status code3a Chapter indicator.Enter 3 or 4 3a Chapter indicator.Enter 3 or 4 3a Chapter indicator.Enter 3 or 4 3a Chapter indicator.Enter 3 or 44a Exemption code 4a Exemption code 4a Exemption code 4a Exemption code3b Exemption code 4b Tax rate 13hRecipient GIIN 3b Tax rate13iRecipient 4b Tax rate 13jLOB code GIIN 3b Tax rate13i number, if any 4b Tax rate 13jLOB code GIIN 3b Tax rate13i number, if any 4b Tax rate 13jLOB code GIIN 3b Tax rate13i number, if any 4b Tax rate LOB code GIIN13i number, if any13hRecipients 13hRecipients 13hRecipients 13hRecipients5Withholding allowanceTax rate 5Withholding allowance number, if any5Withholding allowance 5Withholding allowance 5Withholding allowance6Net income . 6Net income . . . . . . 6Net income . . . . . . 6Net income . . . . . . 6Net incomeRecipients account number . . . . . . 13kRecipients account number (However, resident aliens are treated the 13kRecipients account number 13kRecipients account number 13kRecipients account number 13k7aFederal tax withheld 7aFederal tax withheld 7aFederal tax withheld 7aFederal tax withheld 7aFederal tax withheld7bCheck if federal tax withheld was not deposited with the IRS because . . . . . . . . . . . . . . . . . . . 7bCheck if federal tax withheld was not deposited with the IRS because . . . . s . . . . . . . . . . 7bCheck if federal tax withheld was not deposited with the IRS because . . . . s . . . . . . . . . 7bCheck if federal tax withheld was not deposited with the IRS because . . . . s . . . . . . . . . . 7bCheck if federal tax withheld was not deposited with the IRS because . . . . s . . . . . . . . . . 13lRecipients date of birth (YYYYMMDD) s same as U.S. citizens; thus a regular W-2escrow procedures were applied (see instructions) escrow procedures were applied (see instructions) escrow procedures were applied (see instructions) escrow procedures were applied (see instructions) escrow procedures were applied (see instructions) 13lRecipients date of birth (YYYYMMDD) 13lRecipients date of birth (YYYYMMDD) 13lRecipients date of birth (YYYYMMDD) 13lRecipients date of birth (YYYYMMDD)7cCheck if withholding occurred in subsequent year with respect to a 7cCheck if withholding occurred in subsequent year with respect to a 7cCheck if withholding occurred in subsequent year with respect to a. 7cCheck if withholding occurred in subsequent year with respect to a 7cCheck if withholding occurred in subsequent year with respect to apartnership interest partnership interest partnership interest partnership interest partnership interest 8Tax withheld by other agents8Tax withheld by other agents Name (if applicable) 8Tax withheld by other agents Name (if applicable) 8Tax withheld by other agents Name (if applicable) 8Tax withheld by other agents Name (if applicable) 14aPrimary Withholding Agent Name (if applicable) Formmay be used for reporting. If in doubt 14aPrimary Withholding Agent 14aPrimary Withholding Agent 14aPrimary Withholding Agent 14aPrimary Withholding Agent9Overwithheld tax repaid to recipient pursuant to adjustment procedures (see instructions) 9 99Overwithheld tax repaid to recipient pursuant to adjustment procedures (see instructions) 9Overwithheld tax repaid to recipient pursuant to adjustment procedures (see instructions)Overwithheld tax repaid to recipient pursuant to adjustment procedures (see instructions)Overwithheld tax repaid to recipient pursuant to adjustment procedures (see instructions)14bPrimary Withholding Agents EIN 14bPrimary Withholding Agents EIN 14bPrimary Withholding Agents EIN()()()()() 14bPrimary Withholding Agents EIN 15Check if pro-rata basis reporting 10Total withholding credit (combine boxes 7a, 8, and 9) 14bPrimary Withholding Agents EIN 15Check if pro-rata basis reporting15Check if pro-rata basis reporting15Check if pro-rata basis reporting15Check if pro-rata basis reporting 10Total withholding credit (combine boxes 7a, 8, and 9) 15b Ch. 3 status code 10Total withholding credit (combine boxes 7a, 8, and 9) 15b Ch. 3 status code 10Total withholding credit (combine boxes 7a, 8, and 9) 15b Ch. 3 status code 10Total withholding credit (combine boxes 7a, 8, and 9) 15b Ch. 3 status code15c Ch. 4 status code15b Ch. 3 status code15c Ch. 4 status code whetheremployeequalifiesasaresidentor15a15a15a 15a15c Ch. 4 status code 15c Ch. 4 status code 15c Ch. 4 status code 15a 11Tax paid by withholding agent (amounts not withheld) (see instructions)11Tax paid by withholding agent (amounts not withheld) (see instructions)11Tax paid by withholding agent (amounts not withheld) (see instructions)11Tax paid by withholding agent (amounts not withheld) (see instructions)11Tax paid by withholding agent (amounts not withheld) (see instructions)12aWithholding agents EIN 12bCh. 3 status code12cCh. 4 status code 15d 15g 12bCh. 3 status code12cCh. 4 status code 15d 15g 12bCh. 3 status code12cCh. 4 status code 15d15g 12bCh. 3 status code12cCh. 4 status code 15d15g 12bCh. 3 status code12cCh. 4 status code 15d15g non-resident,checkwithlocalIRSoffices.)12aWithholding agents EIN 12aWithholding agents EIN 12aWithholding agents EIN 12aWithholding agents EIN12dWithholding agents name 15e Country codes name 15e Country codes name 15e 15e 15e15f 15f 15fCountry codes name 15fCountry codes name12dWithholding agent 12dWithholding agent 12dWithholding agent 12dWithholding agent 15fCountry code12eWithholding agent 12g 12eWithholding agent 12g 12eWithholding agent 12g 12eWithholding agent 12g 12eWithholding agent 12g 15hAddress (number and street) Only available in Laser format. 15hAddress (number and street) 15hAddress (number and street) 15hAddress (number and street) 15hAddress (number and street)12fCountry code 12fCountry code 12fCountry code 12fCountry code 12fCountry code 15iCity or town, state or province, country, ZIP or foreign postal code15iCity or town, state or province, country, ZIP or foreign postal code 15iCity or town, state or province, country, ZIP or foreign postal code 15iCity or town, state or province, country, ZIP or foreign postal code 15iCity or town, state or province, country, ZIP or foreign postal code12hAddress (number and street) 12hAddress (number and street) 16d16bPayers TIN12hAddress (number and street) 16d16bPayers TIN12hAddress (number and street) 16d16bPayers TIN12hAddress (number and street) 16d16bPayers TIN 16aPayers name16d16bPayers TIN Required Envelope: 16aPayers name16aPayers name16aPayers name16aPayers name 12iCity or town, state or province, country, ZIP or foreign postal code 12iCity or town, state or province, country, ZIP or foreign postal code16e 12iCity or town, state or province, country, ZIP or foreign postal code16e 12iCity or town, state or province, country, ZIP or foreign postal code16e 12iCity or town, state or province, country, ZIP or foreign postal code16e Ch. 4 status code Ch. 3 status code16e Ch. 4 status code16cPayers GIIN 16cPayers GIIN 16cPayers GIIN16cPayers GIIN Ch. 3 status code Ch. 4 status code Ch. 3 status code Ch. 4 status code Ch. 3 status code Ch. 4 status code Ch. 3 status code 16cPayers GIIN13aRecipients name 13bRecipients country code13a,c,d17aState income tax withheld 17bPayers state tax no.17c13a,c,dRecipients name, address, city, state and ZIP code13b Recipients country codeRecipients name, address, city, state and ZIP code13b Recipients country codeRecipients name, address, city, state and ZIP code13b Recipients country code 17bPayers state tax no.17cName of state APEX: SW42Recipients name, address, city, state and ZIP code13b Recipients country code 17bPayers state tax no.17c13a,c,d 17bPayers state tax no.17c13a,c,d 17bPayers state tax no.17cName of state17aState income tax withheldName of state17aState income tax withheld Name of state17aState income tax withheld Name of state17aState income tax withheld13cAddress (number and street)13dCity or town, state or province, country, ZIP or foreign postal code L42A 5320 Form1042-S(2022)L42B 5321 Form1042-S(2022)L42C 5322 Form For Privacy Act and Paperwork Reduction Act Notice, see instructions. (2022)L42E 5324 Form1042-S(2022) TFP: 21211For Privacy Act and Paperwork Reduction Act Notice, see instructions.(keep for your records) 1042-S(2022)L42D 5323 Form1042-SOrder by year:2022 = 222023 = 23To IRS/SSA and to Recipient Paper Filing due date: March 15W-2G LASER W-2G CONTINUOUSDATELESS W-2GApex LW2GATFP 5230 TFP 71936 Form W-2G is used to report gambling 3232 VOIDCORRECTED 2Date won OMB No. 1545-0238 3232 VOIDCORRECTED 2Date won OMB No. 1545-0238 winnings and any Federal income and ZIP or foreign postal code $ 3Type of wager $ 4Federal income tax withheld Form W-2G and ZIP or foreign postal code $ 3Type of wager $ 4Federal income tax withheld Form W-2G __ tax withheld on those winnings. The PAYERS name, street address, city or town, province or state, country, 1Reportable winnings PAYERS name, street address, city or town, province or state, country, 1Reportable winnings DETACH BEFORE MAILING MANUFACTURED ON OCR LASER BOND PAPER USING HEAT RESISTANT INKS7183-6/ W-2G 6PT M FOR CertainCertain GamblingGambling 5Transaction 7 6Race Winnings 5Transaction 7 6Race Winnings requirements for reporting and withholding (Rev. January 2021) (Rev. January 2021)For calendar year For calendar yearPAYERS telephone number $ 9Winnings from identical wagers8Cashier 20 PAYERS telephone number $ 9Winnings from identical wagers8Cashier 20 depend on the type of gambling, the amount 10Window 10WindowFor Privacy ActFor Privacy Act WINNERS name 11 12 and PaperworkWINNERS name 11 12 and Paperworkof the gambling winnings, and generally the Reduction ActReduction Act Notice, see theNotice, see the current Generalcurrent General Street address (including apt. no.) 13$ 14State winnings Instructions forStreet address (including apt. no.) 13$ 14State winnings Instructions forratio of the winnings to the wager. The types Certain Information Returns. Certain Information Returns.City or town, province or state, country, and ZIP or foreign postal code $ 15State income tax withheld $ 16Local winnings File with Form 1096 City or town, province or state, country, and ZIP or foreign postal code $ 15State income tax withheld $ 16Local winnings File with Form 1096 of gambling are grouped as follows: 1. Horse Under penalties of perjury, I declare that, to the best of my knowledge$ 17Local income tax withheld and18Name of locality number that I haveCopy AUnder penalties of perjury, I declare that, to the best of my knowledge$ 17Local income tax withheld and18Name of locality number that I haveCopy ARacing, Dog Racing, Jai Alai, and Other For Internal RevenueFor Internal Revenue Service Center Service Centercorrectly identify me as the recipient of this payment and any payments from identical wagers, and that no other person is entitled to any part of these payments. correctly identify me as the recipient of this payment and any payments from identical wagers, and that no other person is entitled to any part of these payments. Wagering Transactions, 2. Sweepstakes, and belief, the name, address,taxpayerfurnishedand belief, the name, address,taxpayerfurnished Signature Date Signature DateFormW-2G(Rev. 1-2021) 41-0852411 www.irs.gov/FormW2G Department of the Treasury - Internal Revenue Service FormW-2G(Rev. 1-2021) 41-0852411 www.irs.gov/FormW2G Department of the Treasury - Internal Revenue Service Wagering Pools, and Lotteries, 3. Bingo, Do Not Cut or Separate Forms on This PageDo Not Cut or Separate Forms on This Page Do Not Cut or Separate Forms on This PageDo Not Cut or Separate Forms on This Page3232 VOIDCORRECTED 2Date won OMB No. 1545-0238 3232 VOIDCORRECTED 2Date won OMB No. 1545-0238 Keno, and Slot Machines.PAYERS name, street address, city or town, province or state, country, 1Reportable winnings PAYERS name, street address, city or town, province or state, country, 1Reportable winningsand ZIP or foreign postal code Form W-2G and ZIP or foreign postal code Form W-2G$ 3Type of wager $ 4Federal income tax withheld Certain$ 3Type of wager $ 4Federal income tax withheld CertainDue to recent IRS changes we only offer GamblingGambling Winnings 5Transaction 6Race WinningsPAYERS telephone number $ 5Transaction 7 6Race (Rev. January 2021) PAYERS telephone number $ 7 Winnings from identical wagers8Cashier (Rev. January 2021) Dateless forms, available in both laser and For calendar year For calendar year Winnings from identical wagers8Cashier 20 20910Window For Privacy ActWINNERS name 910Window For Privacy Actcontinuous formats. and Paperworkand Paperwork WINNERS name 11 12 Reduction Act11 12 Reduction Act Notice, see theNotice, see the Street address (including apt. no.) 1314State winnings current GeneralStreet address (including apt. no.) 1314State winnings current GeneralRequired Envelope: DWW2GInstructions forInstructions for Certain Information Returns. Certain Information Returns. 7183-6/ W-2G 6PT M FOR $ $City or town, province or state, country, and ZIP or foreign postal code 15State income tax withheld16Local winnings City or town, province or state, country, and ZIP or foreign postal code 15State income tax withheld16Local winningsFile with Form 1096 File with Form 1096$ $ $ $17Local income tax withheld18Name of locality Copy A17Local income tax withheld18Name of locality Copy A For Internal RevenueFor Internal Revenue $ Service Center $ Service CenterUnder penalties of perjury, declare that, to the best of my knowledge and belief, the name, address, and taxpayernumber that have furnishedUnder penalties of perjury, I declare that, to the best of my knowledge and belief, the name, address, and taxpayernumber that I have furnished correctly identify me as the recipient of this payment and any payments from identical wagers, and that no other person is enti Itled to any part of these payments. Icorrectly identify me as the recipient of this payment and any payments from identical wagers, and that no other person is entitled to any part of these payments.Signature Date Signature DateFormW-2G(Rev. 1-2021)5230 LW2GA 41-0852411 www.irs.gov/FormW2G Department of the Treasury - Internal Revenue Service FormW-2G(Rev. 1-2021) 41-0852411 www.irs.gov/FormW2G Department of the Treasury - Internal Revenue Service1042-S FOREIGN PERSONS U.S. SOURCE INCOME SUBJECT TO WITHHOLDING W-2G CERTAIN GAMBLING WINNINGSAPEXTFP APEXTFP LASER FORMSLASER FORMS2022202320222023 LW2GA5230Laser W2-G Copy A L42A22L42A23532022532023Laser 1042-S Copy A LW2GB5231Laser W2-G Copy B L42B22L42B23532122532123Laser 1042-S Copy B LW2GC5232Laser W2-G Copy 2 and/or C L42C22L42C23532222532223Laser 1042-S Copy C LW2GD5233Laser W2-G Copy D L42D22L42D23532322532323Laser 1042-S Copy D L42E22L42E23532422532423Laser 1042-S Copy E CONTINUOUS FORMS71936W2-G 6-Part 1-Wide N/A Continuous Dateless53'