Attention: Copy A of this form is provided for informational purposes only. Copy A appears in red, similar to the official IRS form. The official printed version of Copy A of this IRS form is scannable, but the online version of it, printed from this website, is not. Do not print and file copy A downloaded from this website; a penalty may be imposed for filing with the IRS information return forms that can’t be scanned. See part O in the current General Instructions for Certain Information Returns, available at www.irs.gov/form1099, for more information about penalties. Please note that Copy B and other copies of this form, which appear in black, may be downloaded and printed and used to satisfy the requirement to provide the information to the recipient. To order official IRS information returns, which include a scannable Copy A for filing with the IRS and all other applicable copies of the form, visit www.IRS.gov/orderforms. Click on Employer and Information Returns, and we’ll mail you the forms you request and their instructions, as well as any publications you may order. Information returns may also be filed electronically using the IRS Filing Information Returns Electronically (FIRE) system (visit www.IRS.gov/FIRE) or the IRS Affordable Care Act Information Returns (AIR) program (visit www.IRS.gov/AIR). See IRS Publications 1141, 1167, and 1179 for more information about printing these tax forms. |
9191 VOID CORRECTED PAYER’S name, street address, city or town, state or province, country, ZIP 1a Total ordinary dividends OMB No. 1545-0110 or foreign postal code, and telephone no. Form 1099-DIV $ Dividends and 1b Qualified dividends (Rev. January 2022) Distributions For calendar year $ 20 2a Total capital gain distr. 2b Unrecap. Sec. 1250 gain Copy A $ $ For PAYER’S TIN RECIPIENT’S TIN 2c Section 1202 gain 2d Collectibles (28%) gain Internal Revenue $ $ Service Center 2e Section 897 ordinary dividends 2f Section 897 capital gain File with Form 1096. $ $ RECIPIENT’S name 3 Nondividend distributions 4 Federal income tax withheld $ $ For Privacy Act 5 Section 199A dividends 6 Investment expenses and Paperwork Street address (including apt. no.) $ $ Reduction Act Notice, see the 7 Foreign tax paid 8 Foreign country or U.S. possession current General Instructions for City or town, state or province, country, and ZIP or foreign postal code $ Certain 9 Cash liquidation distributions 10 Noncash liquidation distributions Information $ $ Returns. 11 FATCA filing 12 Exempt-interest dividends 13 Specified private activity requirement bond interest dividends $ $ Account number (see instructions) 2nd TIN not. 14 State 15 State identification no. 16 State tax withheld $ $ Form 1099-DIV (Rev. 1-2022) Cat. No. 14415N www.irs.gov/Form1099DIV Department of the Treasury - Internal Revenue Service Do Not Cut or Separate Forms on This Page — Do Not Cut or Separate Forms on This Page |
VOID CORRECTED PAYER’S name, street address, city or town, state or province, country, ZIP 1a Total ordinary dividends OMB No. 1545-0110 or foreign postal code, and telephone no. Form 1099-DIV $ Dividends and 1b Qualified dividends (Rev. January 2022) Distributions For calendar year $ 20 2a Total capital gain distr. 2b Unrecap. Sec. 1250 gain Copy 1 $ $ For State Tax PAYER’S TIN RECIPIENT’S TIN 2c Section 1202 gain 2d Collectibles (28%) gain Department $ $ 2e Section 897 ordinary dividends 2f Section 897 capital gain $ $ RECIPIENT’S name 3 Nondividend distributions 4 Federal income tax withheld $ $ 5 Section 199A dividends 6 Investment expenses Street address (including apt. no.) $ $ 7 Foreign tax paid 8 Foreign country or U.S. possession City or town, state or province, country, and ZIP or foreign postal code $ 9 Cash liquidation distributions 10 Noncash liquidation distributions $ $ 11 FATCA filing 12 Exempt-interest dividends 13 Specified private activity requirement bond interest dividends $ $ Account number (see instructions) 14 State 15 State identification no. 16 State tax withheld $ $ Form 1099-DIV (Rev. 1-2022) www.irs.gov/Form1099DIV Department of the Treasury - Internal Revenue Service |
CORRECTED (if checked) PAYER’S name, street address, city or town, state or province, country, ZIP 1a Total ordinary dividends OMB No. 1545-0110 or foreign postal code, and telephone no. Form 1099-DIV $ Dividends and 1b Qualified dividends (Rev. January 2022) Distributions For calendar year $ 20 2a Total capital gain distr. 2b Unrecap. Sec. 1250 gain Copy B $ $ PAYER’S TIN RECIPIENT’S TIN 2c Section 1202 gain 2d Collectibles (28%) gain For Recipient $ $ 2e Section 897 ordinary dividends 2f Section 897 capital gain $ $ RECIPIENT’S name 3 Nondividend distributions 4 Federal income tax withheld This is important tax $ $ information and is 5 Section 199A dividends 6 Investment expenses being furnished to Street address (including apt. no.) $ $ the IRS. If you are required to file a 7 Foreign tax paid 8 Foreign country or U.S. possession return, a negligence penalty or other sanction may be City or town, state or province, country, and ZIP or foreign postal code $ imposed on you if Cash liquidation distributions 10 Noncash liquidation distributions this income is taxable 9 and the IRS $ $ determines that it has FATCA filing 12 Exempt-interest dividends 13 Specified private activity not been reported. 11 requirement bond interest dividends $ $ Account number (see instructions) 14 State 15 State identification no. 16 State tax withheld $ $ Form 1099-DIV (Rev. 1-2022) (keep for your records) www.irs.gov/Form1099DIV Department of the Treasury - Internal Revenue Service |
Instructions for Recipient indirect foreign owners or beneficiaries. It is generally treated as effectively Recipient’s taxpayer identification number (TIN). For your protection, this connected to a trade or business within the United States. See the instructions form may show only the last four digits of your TIN (SSN, ITIN, ATIN, or EIN). for your tax return. However, the issuer has reported your complete TIN to the IRS. Box 3. Shows a return of capital. To the extent of your cost (or other basis) in Account number. May show an account or other unique number the payer the stock, the distribution reduces your basis and is not taxable. Any amount assigned to distinguish your account. received in excess of your basis is taxable to you as capital gain. See Pub. 550. Box 1a. Shows total ordinary dividends that are taxable. Include this amount on Box 4. Shows backup withholding. A payer must backup withhold on certain the “Ordinary dividends” line of Form 1040 or 1040-SR. Also report it on payments if you did not give your TIN to the payer. See Form W-9 for Schedule B (Form 1040), if required. information on backup withholding. Include this amount on your income tax Box 1b. Shows the portion of the amount in box 1a that may be eligible for return as tax withheld. reduced capital gains rates. See the Instructions for Form 1040 for how to Box 5. Shows the portion of the amount in box 1a that may be eligible for the determine this amount and where to report. 20% qualified business income deduction under section 199A. See the The amount shown may be dividends a corporation paid directly to you as a instructions for Form 8995 and Form 8995-A. participant (or beneficiary of a participant) in an employee stock ownership plan Box 6. Shows your share of expenses of a nonpublicly offered RIC, generally a (ESOP). Report it as a dividend on your Form 1040 or 1040-SR but treat it as a nonpublicly offered mutual fund. This amount is included in box 1a. plan distribution, not as investment income, for any other purpose. Box 7. Shows the foreign tax that you may be able to claim as a deduction or a Box 2a. Shows total capital gain distributions from a regulated investment credit on Form 1040 or 1040-SR. See the Instructions for Form 1040. company (RIC) or real estate investment trust (REIT). See How To Report in the Box 8. This box should be left blank if a RIC reported the foreign tax shown in Instructions for Schedule D (Form 1040). But, if no amount is shown in boxes 2b, box 7. 2c, 2d, and 2f and your only capital gains and losses are capital gain distributions, Boxes 9 and 10. Show cash and noncash liquidation distributions. you may be able to report the amounts shown in box 2a on your Form 1040 or Box 11. If the FATCA filing requirement box is checked, the payer is reporting 1040-SR rather than Schedule D. See the Instructions for Form 1040. on this Form 1099 to satisfy its account reporting requirement under chapter 4 Box 2b. Shows the portion of the amount in box 2a that is unrecaptured section of the Internal Revenue Code. You may also have a filing requirement. See the 1250 gain from certain depreciable real property. See the Unrecaptured Section Instructions for Form 8938. 1250 Gain Worksheet in the Instructions for Schedule D (Form 1040). Box 12. Shows exempt-interest dividends from a mutual fund or other RIC paid Box 2c. Shows the portion of the amount in box 2a that is section 1202 gain to you during the calendar year. See the Instructions for Form 1040 for where to from certain small business stock that may be subject to an exclusion. See the report. This amount may be subject to backup withholding. See Box 4 above. Schedule D (Form 1040) instructions. Box 13. Shows exempt-interest dividends subject to the alternative minimum Box 2d. Shows the portion of the amount in box 2a that is 28% rate gain from tax. This amount is included in box 12. See the Instructions for Form 6251. sales or exchanges of collectibles. If required, use this amount when completing Boxes 14–16. State income tax withheld reporting boxes. the 28% Rate Gain Worksheet in the Instructions for Schedule D (Form 1040). Box 2e. Shows the portion of the amount in box 1a that is section 897 gain Nominees. If this form includes amounts belonging to another person, you are attributable to disposition of U.S. real property interests (USRPI). considered a nominee recipient. You must file Form 1099-DIV (with a Form 1096) with the IRS for each of the other owners to show their share of the Box 2f. Shows the portion of the amount in box 2a that is section 897 gain income, and you must furnish a Form 1099-DIV to each. A spouse is not attributable to disposition of USRPI. required to file a nominee return to show amounts owned by the other spouse. Note: Boxes 2e and 2f apply only to foreign persons and entities whose income See the current General Instructions for Certain Information Returns. maintains its character when passed through or distributed to its direct or |
VOID CORRECTED PAYER’S name, street address, city or town, state or province, country, ZIP 1a Total ordinary dividends OMB No. 1545-0110 or foreign postal code, and telephone no. Form 1099-DIV $ Dividends and 1b Qualified dividends (Rev. January 2022) Distributions For calendar year $ 20 2a Total capital gain distr. 2b Unrecap. Sec. 1250 gain Copy 2 $ $ PAYER’S TIN RECIPIENT’S TIN 2c Section 1202 gain 2d Collectibles (28%) gain To be filed with recipient’s state $ $ income tax return, 2e Section 897 ordinary dividends 2f Section 897 capital gain when required. $ $ RECIPIENT’S name 3 Nondividend distributions 4 Federal income tax withheld $ $ 5 Section 199A dividends 6 Investment expenses Street address (including apt. no.) $ $ 7 Foreign tax paid 8 Foreign country or U.S. possession City or town, state or province, country, and ZIP or foreign postal code $ 9 Cash liquidation distributions 10 Noncash liquidation distributions $ $ 11 FATCA filing 12 Exempt-interest dividends 13 Specified private activity requirement bond interest dividends $ $ Account number (see instructions) 14 State 15 State identification no. 16 State tax withheld $ $ Form 1099-DIV (Rev. 1-2022) www.irs.gov/Form1099DIV Department of the Treasury - Internal Revenue Service |
VOID CORRECTED PAYER’S name, street address, city or town, state or province, country, ZIP 1a Total ordinary dividends OMB No. 1545-0110 or foreign postal code, and telephone no. Form 1099-DIV $ Dividends and 1b Qualified dividends (Rev. January 2022) Distributions For calendar year $ 20 2a Total capital gain distr. 2b Unrecap. Sec. 1250 gain Copy C $ $ For Payer PAYER’S TIN RECIPIENT’S TIN 2c Section 1202 gain 2d Collectibles (28%) gain $ $ 2e Section 897 ordinary dividends 2f Section 897 capital gain $ $ RECIPIENT’S name 3 Nondividend distributions 4 Federal income tax withheld $ $ For Privacy Act 5 Section 199A dividends 6 Investment expenses and Paperwork Street address (including apt. no.) $ $ Reduction Act Notice, see the 7 Foreign tax paid 8 Foreign country or U.S. possession current General Instructions for City or town, state or province, country, and ZIP or foreign postal code $ Certain 9 Cash liquidation distributions 10 Noncash liquidation distributions Information $ $ Returns. 11 FATCA filing 12 Exempt-interest dividends 13 Specified private activity requirement bond interest dividends $ $ Account number (see instructions) 2nd TIN not. 14 State 15 State identification no. 16 State tax withheld $ $ Form 1099-DIV (Rev. 1-2022) www.irs.gov/Form1099DIV Department of the Treasury - Internal Revenue Service |
Instructions for Payer To complete Form 1099-DIV, use: Foreign dividend recipient. If the recipient of the • The current General Instructions for Certain dividend is a nonresident alien, you may have to Information Returns, and withhold federal income tax and file Form 1042-S. See the Instructions for Form 1042-S and Pub. 515. • The current Instructions for Form 1099-DIV. Need help? If you have questions about reporting on To order these instructions and additional forms, go Form 1099-DIV, call the information reporting customer to www.irs.gov/EmployerForms. service site toll free at 866-455-7438 or 304-263-8700 Caution: Because paper forms are scanned during (not toll free). Persons with a hearing or speech processing, you cannot file certain Forms 1096, 1097, disability with access to TTY/TDD equipment can call 1098, 1099, 3921, or 5498 that you print from the IRS 304-579-4827 (not toll free). website. Filing and furnishing. For filing and furnishing instructions, including due dates, and to request filing or furnishing extensions, see the current General Instructions for Certain Information Returns. |