b'MISCELLANEOUS FORMS 1042S & W2GXXX1042S LASER 1042S CONTINUOUSDATED 1042S CONTINUOUSDATELESS 1042SAPEX L42A21TFP 532021 APEX 1042S21TFP 10425D21 TFP 1042521 Used to report all income and/or tax with-Form1042-S Foreign Persons U.S. Source Income Subject to Withholding 2021 Copy Afor1042-S Foreign Persons U.S. Source Income Subject to Withholding 2021 OMB No. 1545-0096 Form1042-S Foreign Persons U.S. Source Income Subject to Withholding 2021 OMB No. 1545-0096Department of the TreasuryGo to www.irs.gov/Form1042S for instructions and the latest information. AMENDMENT NO. OMB No. 1545-0096 2Gross incomeGo to www.irs.gov/Form1042S for instructions and the latest information. AMENDMENT NO. Copy Afor Department of the Treasury 3 Go to www.irs.gov/Form1042S for instructions and the latest information. AMENDMENT NO. Copy Afor held for non-resident aliens and foreign Form Department of the Treasury Internal Revenue Service UNIQUE FORM IDENTIFIER AMENDED Internal Revenue Service UNIQUE FORM IDENTIFIER AMENDED Internal Revenue Service Internal Revenue Service UNIQUE FORM IDENTIFIER AMENDED Internal Revenue ServiceInternal Revenue Service1 Income 2Gross income 3 Chapter indicator.Enter 3 or 4 . . 13eRecipients U.S. TIN, if any s Recipients 13fCh. 3 status code 1 Income3 Chapter indicator.Enter 3 or 4 . . 13eRecipients U.S. TIN, if any s Recipients 13fCh. 3 status code 13jLOB code1 Income 2Gross income3a Chapter indicator.Enter 3 or 4 . . 13eRecipients U.S. TIN, if any s Recipients 13fCh. 3 status code 13jLOB codecorporations with United States income. code 3a Exemption code 13g Ch. 4 status code code 3a Exemption code 4a Exemption code 13g Ch. 4 status code codeExemption code 4a Exemption code 13g Ch. 4 status code5Withholding allowance 3b Exemption code 4a Tax rate 13hRecipient GIIN13i number, if any 13jLOB code3b Tax rate 4b Tax rate 13hRecipient GIIN13i number, if any 5Withholding allowance 3b Tax rate 4b Tax rate 13hRecipient GIIN13i number, if any Tax rate 4b5Withholding allowance6Net income . 13kRecipients account number 6Net income . . . . . . 13kRecipients account number 6Net income . . . . . . 13kRecipients account number (However, resident aliens are treated the 7aFederal tax withheld 7aFederal tax withheld 7aFederal tax withheld7bCheck if federal tax withheld was not deposited with the IRS because . . . . . 13lRecipients date of birth (YYYYMMDD) 7bCheck if federal tax withheld was not deposited with the IRS because 13lRecipients date of birth (YYYYMMDD) 7bCheck if federal tax withheld was not deposited with the IRS because 13lRecipients date of birth (YYYYMMDD) escrow procedures were applied (see instructions). . . . . . . . . . . . . .escrow procedures were applied (see instructions). . . . . . . . . . . . . . 14aPrimary Withholding Agents Name (if applicable)escrow procedures were applied (see instructions). . . . . . . . . . . . . . 14aPrimary Withholding Agents Name (if applicable) same as U.S. citizens; thus a regular W2 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 8Tax withheld by other agents14aPrimary Withholding Agents Name (if applicable) 8Tax withheld by other agents14bPrimary Withholding Agents EIN 15Check if pro-rata basis reporting8Tax withheld by other agents14bPrimary Withholding Agents EIN 15Check if pro-rata basis reportingFormmay be used for reporting. If in 9Overwithheld tax repaid to recipient pursuant to adjustment procedures (see instructions) 9Overwithheld tax repaid to recipient pursuant to adjustment procedures (see instructions) 9Overwithheld tax repaid to recipient pursuant to adjustment procedures (see instructions) 10425D21 5PT M10425D21 5PT M() 14bPrimary Withholding Agents EIN () ()10Total withholding credit (combine boxes 7a, 8, and 9) 15Check if pro-rata basis reporting10Total withholding credit (combine boxes 7a, 8, and 9)10Total withholding credit (combine boxes 7a, 8, and 9)11Tax paid by withholding agent (amounts not withheld) (see instructions) 15a 15b Ch. 3 status code15c Ch. 4 status code 15a 15b Ch. 3 status code15c Ch. 4 status code 11Tax paid by withholding agent (amounts not withheld) (see instructions) 15a 15b Ch. 3 status code15c Ch. 4 status code doubt whether employee qualifies as a 11Tax paid by withholding agent (amounts not withheld) (see instructions)15d15d15d 12aWithholding agents EIN 12bCh. 3 status code12cCh. 4 status code 15e Country code 15g FOR12aWithholding agents EIN 12bCh. 3 status code12cCh. 4 status code 15e Country code 15g FOR12aWithholding agents EIN 12bCh. 3 status code12cCh. 4 status code 15e Country code 15g resident or non-resident, check with local 12dWithholding agents name 15f 12dWithholding agents name 15f 12dWithholding agents name 15f12eWithholding agent 15hAddress (number and street) 12eWithholding agent 12g 15hAddress (number and street) 12eWithholding agent 12g 15hAddress (number and street) IRS offices.)12fCountry code 12g 15iCity or town, state or province, country, ZIP or foreign postal code12fCountry code 15iCity or town, state or province, country, ZIP or foreign postal code 12fCountry code 15iCity or town, state or province, country, ZIP or foreign postal code12hAddress (number and street) 16aPayers name16d16bPayers TIN12hAddress (number and street) 16aPayers name16d16bPayers TIN 12hAddress (number and street) 16aPayers name16d16bPayers TIN Dated forms are available in Laser and 12iCity or town, state or province, country, ZIP or foreign postal code 16cPayers GIIN Ch. 3 status code16e Ch. 4 status code 16cPayers GIIN Ch. 3 status code16e Ch. 4 status code 12iCity or town, state or province, country, ZIP or foreign postal code 16cPayers GIIN Ch. 3 status code16e Ch. 4 status code12iCity or town, state or province, country, ZIP or foreign postal code13aRecipients name 13bRecipients country code 17aState income tax withheld 17bPayers state tax no.17cName of state 13bRecipients country code 17aState income tax withheld 17bPayers state tax no.17cName of state 13aRecipients name 13bRecipients country code 17aState income tax withheld 17bPayers state tax no.17cName of state Continuous formats. Dateless forms are 13aRecipients name13cAddress (number and street) 13cAddress (number and street) 13cAddress (number and street) only available in Continuous format. 13dCity or town, state or province, country, ZIP or foreign postal code 13dCity or town, state or province, country, ZIP or foreign postal code 13dCity or town, state or province, country, ZIP or foreign postal codeFor Privacy Act and Paperwork Reduction Act Notice, see instructions. L42A 5320 Form1042-S(2021) Form1042-S(2021) For Privacy Act and Paperwork Reduction Act Notice, see instructions. Form1042-S(2021) Require envelope Apex SW42 or TFP For Privacy Act and Paperwork Reduction Act Notice, see instructions.21211.Order by year:2021 = 212022 = 22To IRS/SSA and to Recipient Paper Filing due date: March 15W2G LASER W2G CONTINUOUSDATELESS W2GApex LW2GATFP 5230 TFP 71936 Form W2G 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 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 and 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 Certaintax withheld on those winnings. GamblingGambling Winnings Winnings5Transaction 7 6Race (Rev. January 2021) 5Transaction 7 6Race (Rev. January 2021) The requirements for reporting and For calendar year For calendar year Winnings from identical wagers8Cashier 20Winnings from identical wagers8Cashier 20PAYERS telephone number $ 910Window For Privacy ActPAYERS telephone number $ 910Window For Privacy Actwithholding depend on the type of and Paperworkand Paperwork WINNERS name 11 12 Reduction ActWINNERS name 11 12 Reduction Actgambling, the amount of the gambling Notice, see theNotice, see the current Generalcurrent General Instructions forInstructions for Street address (including apt. no.) 13$ 14State winnings Certain Information Returns. Street address (including apt. no.) 13$ 14State winnings Certain Information Returns. winnings, and generally the ratio of the 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 winnings to the wager. The types of 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 Agambling are grouped as follows: 1. Horse For Internal RevenueFor Internal Revenue Service Center Service Centerand belief, the name, address,taxpayerfurnishedcorrectly identify me as the recipient of this payment and any payments from identical wagers, and that no other person is enti furnished and belief, the name, address,taxpayertled 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. Signature 41-0852411 www.irs.gov/FormW2G Date Racing, Dog Racing, Jai Alai, and Other Signature DateFormW-2G(Rev. 1-2021) 41-0852411 www.irs.gov/FormW2G Department of the Treasury - Internal Revenue Service FormW-2G(Rev. 1-2021) Department of the Treasury - Internal Revenue ServiceDo 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 Page Wagering Transactions, 2. Sweepstakes, 3232 VOIDCORRECTED 2Date won OMB No. 1545-0238 3232 VOIDCORRECTED 2Date won OMB No. 1545-0238 Wagering Pools, and Lotteries, 3. Bingo, 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 CertainKeno, and Slot Machines.GamblingGambling Winnings 5Transaction 6Race Winnings5Transaction 6Race (Rev. January 2021) (Rev. January 2021)PAYERS telephone number $ 7 Winnings from identical wagers8Cashier For calendar year PAYERS telephone number $ 7 Winnings from identical wagers8Cashier For calendar year Due to recent IRS changes we only offer 20 20910Window For Privacy Act910Window For Privacy ActDateless forms, available in both laser and and Paperworkand Paperwork WINNERS name 11 12 Reduction ActWINNERS name 11 12 Reduction Act Street address (including apt. no.) 1314State winnings Notice, see theStreet address (including apt. no.) 1314State winnings Notice, see thecontinuous formats. Requires envelope current Generalcurrent General Instructions forInstructions for City or town, province or state, country, and ZIP or foreign postal code 15State income tax withheld $ 16Local winnings Certain Information Returns. City or town, province or state, country, and ZIP or foreign postal code 15State income tax withheld $ 16Local winnings Certain Information Returns. DWW2G. 7183-6/ W-2G 6PT M FOR File 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, I declare that, to the best of my knowledge and belief, the name, address, and taxpayernumber that I have furnishedcorrectly 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. I Under penalties of perjury, declare that, to the best of my knowledge and belief, the name, address, and taxpayernumber that have furnished 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.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 Service1042S FOREIGN PERSONS U.S. SOURCE INCOME SUBJECT TO WITHHOLDING W2G CERTAIN GAMBLING WINNINGSAPEXTFP APEXTFP LASER FORMSLASER FORMS L42A21L42A22532021532022LASER 1042S Copy A LW2GA5230LASER W2G COPY A L42B21L42B22532121532122LASER 1042S Copy B LW2GB5231LASER W2G COPY B L42C21L42C22532221532222LASER 1042S Copy C LW2GC5232LASER W2G COPY 2 AND/OR C L42D21L42D22532321532322LASER 1042S Copy D LW2GD5233LASER W2G COPY D L42E21L42E22532421532422LASER 1042S Copy E2021202220212022CONTINUOUS FORMSCONTINUOUS FORMS 1N/A71936W2G 6-Part 1 WIDE 1042S211042S2210425D2110425D221042S 5-Part 1 Wide Continuous Dated CONTINUOUS DATELESS N/AN/A104252110425221042S 5-Part 1 Wide Continuous Dateless54'