PDF document

- 1 -

Page 1 of 66  Fileid: … ns/p1179/202309/a/xml/cycle03/source 13:58 - 5-Sep-2023

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

Revenue 

Procedure 

2023-30

Reprinted from IR Bulletin 2023-40
Dated October 02, 2023

Publication 1179

General Rules and 

Specifications for Substitute 

Forms 1096, 1098, 1099, 5498, 

and Certain Other Information 

Returns

IRS
Department of the Treasury
Internal Revenue Service
Publication 1179 (Rev. 10-2023)
Catalog Number 47022Q
www.irs.gov

- 2 -

Page 2 of 66  Fileid: … ns/p1179/202309/a/xml/cycle03/source                                                       13:58 - 5-Sep-2023

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

NOTE. This revenue procedure will be reproduced as the next revision of IRS 
Publication 1179, General Rules and Specifications for Substitute Forms 1096, 
1098, 1099, 5498, and Certain Other Information Returns.

Forms and instructions. (Also, Part 1, sections 101, 162(f), 170, 199A, 220, 223, 401(a), 
403(a), 403(b), 408, 408A, 457(b), 529, 529A, 530, 853A, 892, 1400Z-1, 1400Z-2, 
1441, 6041, 6041A, 6042, 6043, 6044, 6045, 6047, 6049, 6050A, 6050B, 6050D, 
6050E, 6050H, 6050J, 6050N, 6050P, 6050Q, 6050R, 6050S, 6050U, 6050W, 6050X, 
6050Y, 6071, 1.402A-2, 1.408-5, 1.408-7, 1.408-8, 1.408A-7, 1.1441-1 through 
1.1441-5, 1.1471-4, 1.6041-1, 1.6042-2, 1.6042-4, 1.6043-4, 1.6044-2, 1.6044-5, 
1.6045-1, 1.6045-2, 1.6045-4, 1.6047-1, 1.6047-2, 1.6049-4, 1.6049-6, 1.6049-7, 
1.6050A-1, 1.6050B-1, 1.6050D-1, 1.6050E-1, 1.6050H-1, 1.6050H-2, 1.6050J-1T, 
1.6050N-1, 1.6050P-1, 1.6050S-1, 1.6050S-3, 1.6050W-1, 1.6050W-2, 1.6050X-1, 
1.6050Y-1, 1.6050Y-2, and 1.6050Y-3.)

Rev. Proc. 2023-30
TABLE OF CONTENTS

Part 1 – GENERAL INFORMATION
             Section 1.1 – Overview of Revenue Procedure 2023-30 / What's New                    . . . . . . . . . . . . .   1
             Section 1.2 – Definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
             Section 1.3 – General Requirements for Acceptable Substitute Forms 1096, 1097-
             BTC, 1098, 1099, 3921, 3922, 5498, W-2G, and 1042-S . . . . . . . . . . . . .                                   6
Part 2 – SPECIFICATIONS FOR SUBSTITUTE FORMS 1096 AND COPIES 
A OF FORMS 1098, 1099, 3921, 3922, AND 5498 (ALL FILED WITH THE 
IRS)
             Section 2.1 – Specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
             Section 2.2 – Instructions for Preparing Paper Forms That Will Be Filed With the 
             IRS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .             14
Part 3 – SPECIFICATIONS FOR SUBSTITUTE FORM W-2G (FILED WITH 
THE IRS)
             Section 3.1 – General . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
             Section 3.2 – Specifications for Copy A of Form W-2G . . . . . . . . . . . . . . . . . . . . . .              17
Part 4 – SUBSTITUTE STATEMENTS TO FORM RECIPIENTS AND 
FORM RECIPIENT COPIES
             Section 4.1 – Specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  18
             Section 4.2 – Composite Statements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .      23
             Section 4.3 – Additional Information for Substitute and Composite Forms 1099-B                      . . . .   24
             Section 4.4 – Required Legends    . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .   25
             Section 4.5 – Miscellaneous Instructions for Copies B, C, D, E, 1, and 2 . . . . . . . . . . .                27
             Section 4.6 – Electronic Delivery of Recipient Statements           . . . . . . . . . . . . . . . . . . . .   29
Part 5 – ADDITIONAL INSTRUCTIONS FOR SUBSTITUTE FORMS 1097-
BTC, 1098, 1099, 5498, W-2G, AND 1042-S
             Section 5.1 – Paper Substitutes for Form 1042-S         . . . . . . . . . . . . . . . . . . . . . . . . . .   31
             Section 5.2 – OMB Requirements for All Forms in This Revenue Procedure                      . . . . . . . .   33
             Section 5.3 – Ordering Forms and Instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . .         34
             Section 5.4 – Effect on Other Revenue Procedures          . . . . . . . . . . . . . . . . . . . . . . . . .   34
Part 6 – EXHIBITS
             Section 6.1 – Exhibits of Forms in This Revenue Procedure             . . . . . . . . . . . . . . . . . . .   34

- 3 -

Page 3 of 66  Fileid: … ns/p1179/202309/a/xml/cycle03/source                            13:58 - 5-Sep-2023

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

                                                  Part 1

                              General Information

Section 1.1 – Overview of Revenue Procedure 2023-30 / What's New

1.1.1        .
             The purpose of this revenue procedure is to set forth the 2023 requirements for:
Purpose
             •     Using official Internal Revenue Service (IRS) forms to file information 
                   returns with the IRS,
             •     Preparing acceptable substitutes of the official IRS forms to file 
                   information returns with the IRS, and
             •     Using official or acceptable substitute forms to furnish information to 
                   recipients.

1.1.2        .
             This revenue procedure contains specifications for the following information 
Which Forms 
             returns.
Are Covered?

                   Form                                      Title
              1096            Annual Summary and Transmittal of U.S. Information Returns
              1097-BTC        Bond Tax Credit
              1098            Mortgage Interest Statement
              1098-C          Contributions of Motor Vehicles, Boats, and Airplanes
              1098-E          Student Loan Interest Statement
              1098-F          Fines, Penalties, and Other Amounts 
              1098-MA         Mortgage Assistance Payments
              1098-Q          Qualifying Longevity Annuity Contract Information
              1098-T          Tuition Statement
              1099-A          Acquisition or Abandonment of Secured Property
              1099-B          Proceeds From Broker and Barter Exchange Transactions
              1099-C          Cancellation of Debt
              1099-CAP        Changes in Corporate Control and Capital Structure
              1099-DIV        Dividends and Distributions
              1099-G          Certain Government Payments
              1099-H          Health Coverage Tax Credit (HCTC) Advance Payments
              1099-INT        Interest Income
              1099-K          Payment Card and Third Party Network Transactions
              1099-LS         Reportable Life Insurance Sale
              1099-LTC        Long-Term Care and Accelerated Death Benefits
              1099-MISC       Miscellaneous Information
              1099-NEC        Nonemployee Compensation
              1099-OID        Original Issue Discount
              1099-PATR       Taxable Distributions Received From Cooperatives

                                                         1

- 4 -

Page 4 of 66 Fileid: … ns/p1179/202309/a/xml/cycle03/source 13:58 - 5-Sep-2023

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

Form Title
1099-Q Payments From Qualified Education Programs (Under Sections 529 and 530)
1099-QA Distributions From ABLE Accounts
Distributions From Pensions, Annuities, Retirement or Profit-Sharing Plans,
1099-R
IRAs, Insurance Contracts, etc.
1099-S Proceeds From Real Estate Transactions
1099-SA Distributions From an HSA, Archer MSA, or Medicare Advantage MSA
1099-SB Seller's Investment in Life Insurance Contract
3921 Exercise of an Incentive Stock Option Under Section 422(b)
Transfer of Stock Acquired Through an Employee Stock Purchase Plan
3922
Under Section 423(c)
5498 IRA Contribution Information
5498-ESA Coverdell ESA Contribution Information
5498-QA ABLE Account Contribution Information
5498-SA HSA, Archer MSA, or Medicare Advantage MSA Information
W-2G Certain Gambling Winnings
1042-S Foreign Person’s U.S. Source Income Subject to Withholding

1.1.3 .
For purposes of this revenue procedure, a substitute form or statement is one
Scope
that is not published by the IRS. For a substitute form or statement to be
acceptable to the IRS, it must conform to the official form or the specifications
outlined in this revenue procedure. Do not submit any substitute forms or
statements listed above to the IRS for approval. Privately published forms may
not state, “This is an IRS approved form.”

Filers making payments to certain recipients during a calendar year are required
by the Internal Revenue Code (the Code) to file information returns with the
IRS for these payments. These filers must also provide this information to their
recipients. In some cases, this also applies to payments received. See Part 4 for
specifications that apply to recipient statements (generally Copy B).

In general, section 6011 of the Code authorizes the Secretary of Treasury to
publish regulations that require filers to file information returns according to
those regulations and the corresponding forms and instructions. A filer who is
required to file 10or more information returns during a calendar year must file
those returns electronically. See Electronic filing of returns, later, for more
information.

Caution. Financial institutions that are required to report payments made under
chapter 3 or 4 must file Forms 1042-S electronically, regardless of the number
of returns required to be filed.

Note. If you file electronically, do not file the same returns on paper.

Filers required to file fewer than 10 information returns during a calendar year
are encouraged to file the information returns electronically. See the
requirements for filing information returns (and providing a copy to a payee) in
the 2023 General Instructions for Certain Information Returns and the 2023
Instructions for Form 1042-S. In addition, see the current revision of Pub. 1220,

- 5 -

Page 5 of 66 Fileid: … ns/p1179/202309/a/xml/cycle03/source 13:58 - 5-Sep-2023

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

Specifications for Electronic Filing of Forms 1097, 1098, 1099, 3921, 3922,
5498, and W-2G, for electronic filing through the IRS Filing Information
Returns Electronically (FIRE) system.

1.1.4 .
The IRS prints and provides the forms on which various payments must be
For More
Information reported. See Section 5.3 for ordering forms and instructions. Alternately, filers
may prepare substitute copies of these IRS forms and use such forms to report
payments to the IRS.
The Internal Revenue Service/Information Returns Branch (IRS/IRB)
maintains a centralized customer service call site to answer questions
related to information returns (Forms W-2, W-3, W-2c, W-3c, 1099
series, 1096, etc.). You can reach the call site at 866-455-7438 (toll free) or
outside the United States at 304-263-8700 (not a toll-free number). Deaf or
hard-of-hearing customers may call any of our toll-free numbers using their
choice of relay service.

You may also send questions to the call site via the Internet at
mccirp@irs.gov. Do not submit employee information via email
because it is not secure and the information may be compromised.

The IRS/IRB does not process information returns which are filed on
paper forms. See Pub. 1220 for information on waivers and extensions
CAUTION! of time.

For other tax information related to business returns or accounts, call
800-829-4933. Deaf or hard-of-hearing customers may call any of our
toll-free numbers using their choice of relay service.

Further information impacting Pub. 1179, such as issues arising after
TIP its final release, will be posted on IRS.gov at IRS.gov/Pub1179.

1.1.5 .
The following changes have been made to this year’s revenue procedure. For
What’s New
further information about each form listed below, see the separate reporting
instructions.

Electronic filing of returns. The Taxpayer First Act of 2019 authorized the
Department of the Treasury and the IRS to issue regulations that reduce the
250-return e-file threshold. T.D. 9972, published February 23, 2023, lowered the
e-file threshold to 10 (calculated by aggregating all information returns),
effective for information returns required to be filed on or after January 1, 2024.
Go to IRS.gov/InfoReturn for e-file options.

Electronic filing of Forms 1099. Under section 2102 of The Taxpayer First
Act, the IRS developed an online portal, the Information Return Intake System
(IRIS), that allows taxpayers to electronically file Forms 1099 for tax years
2022 and later, as an alternative to using the FIRE system. Users should follow
the specifications in Pub. 5717, IRIS Taxpayer Portal User Guide. See Part F in
the 2023 General Instructions for Certain Information Returns or go to IRS.gov/
IRIS for additional information and updates.

- 6 -

Page 6 of 66 Fileid: … ns/p1179/202309/a/xml/cycle03/source 13:58 - 5-Sep-2023

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

Form 1099-H. The Health Coverage Tax Credit expired on December 31,
2021. The form is listed for reference purposes only.

Continuous use conversion. Form 1099-PATR and its instructions have been
converted from annual updates to continuous use. The form and its instructions
will be updated as needed.

Exhibits. All of the exhibits in this publication were updated to include all of
the 2023 revisions of those forms that have been revised.

Editorial changes. We made editorial changes throughout, including updated
references. Redundancies were eliminated as much as possible.

Available Instructions

In addition to the general instructions, which contain general information
concerning Forms 1096, 1097, 1098, 1099, 3921, 3922, 5498, and W-2G,
specific form instructions are provided separately. Use the instructions to
prepare acceptable substitutes of the official IRS forms to file information
returns with the IRS.

• Instructions for Form 1097-BTC.
• Instructions for Form 1098.
• Instructions for Form 1098-C.
• Instructions for Forms 1098-E and 1098-T.
• Instructions for Form 1098-F.
• Instructions for Form 1098-Q.
• Instructions for Forms 1099-A and 1099-C.
• Instructions for Form 1099-B.
• Instructions for Form 1099-CAP.
• Instructions for Form 1099-DIV.
• Instructions for Form 1099-G.
• Instructions for Form 1099-H.
• Instructions for Forms 1099-INT and 1099-OID.
• Instructions for Form 1099-K.
• Instructions for Form 1099-LS.
• Instructions for Form 1099-LTC.
• Instructions for Forms 1099-MISC and 1099-NEC.
• Instructions for Form 1099-PATR.

• Instructions for Form 1099-Q.
• Instructions for Forms 1099-QA and 5498-QA.
• Instructions for Forms 1099-R and 5498.

- 7 -

Page 7 of 66 Fileid: … ns/p1179/202309/a/xml/cycle03/source 13:58 - 5-Sep-2023

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

• Instructions for Form 1099-S.
• Instructions for Form 1099-SB.
• Instructions for Forms 3921 and 3922.
• Instructions for Form 5498-ESA.
• Instructions for Forms W-2G and 5754.
You can also obtain the latest developments for each of the forms and
instructions listed here by visiting their information pages at IRS.gov. See the
separate instructions for each form on the webpage via the link.

Section 1.2 – Definitions

1.2.1 .
Form recipient means the person to whom you are required by law to furnish a
Form Recipient
copy of the official form or information statement. The form recipient may be
referred to by different names on various Forms 1099 and related forms
(beneficiary, borrower, debtor, donor, employee, filer, homeowner, insured,
participant, payee, payer, payer/borrower, payment recipient, policyholder,
seller, shareholder, student, transferor, or, in the case of Form W-2G, the
winner). See Section 1.3.4.

1.2.2 .
Filer means the person or organization required by law to file with the IRS a
Filer
form listed in Section 1.1.2. A filer may be a payer, creditor, payment settlement
entity, recipient of mortgage or student loan interest payments, educational
institution, broker, barter exchange, or person reporting real estate transactions;
a trustee or issuer of any educational or ABLE Act savings account, individual
retirement arrangement, or medical savings account; a lender who acquires an
interest in secured property or who has reason to know that the property has
been abandoned; a corporation reporting a change in control and capital
structure or transfer of stock to an employee; certain donees of motor vehicles,
boats, and airplanes; or an acquirer or issuer of a life insurance contract.

1.2.3 .
Substitute form means a paper substitute of Copy A of an official form listed in
Substitute Form
Section 1.1.2 that completely conforms to the provisions in this revenue
procedure.

1.2.4 .
Substitute form recipient statement means a paper or electronic statement of the
Substitute Form
Recipient information reported on a form listed in Section 1.1.2. For the remainder of this
Statement revenue procedure, we will refer to this as a “recipient statement.” This
(Recipient statement must be furnished to a person (form recipient), as defined under the
Statement) applicable provisions of the Code and the applicable regulations.

1.2.5 .
Composite substitute statement means one in which two or more required
Composite
Substitute statements (for example, Forms 1099-INT and 1099-DIV) are furnished to the
Statement recipient on one document. However, each statement must be designated
separately and must contain all the requisite Form 1099 information except as
provided under Section 4.2. A composite statement may not be filed with the
IRS.

- 8 -

Page 8 of 66     Fileid: … ns/p1179/202309/a/xml/cycle03/source                      13:58 - 5-Sep-2023

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

Section 1.3 – General Requirements for Acceptable Substitute Forms 1096, 
1097-BTC, 1098, 1099, 3921, 3922, 5498, W-2G, and 1042-S

1.3.1           .
                Paper substitutes for Form 1096 and Copy A of Forms 1097-BTC, 1098, 1099, 
Introduction
                3921, 3922, 5498, W-2G, and 1042-S that completely conform to the 
                specifications listed in this revenue procedure may be privately printed and filed 
                as returns with the IRS. The reference to the Department of the Treasury – 
                Internal Revenue Service should be included on all such forms.

                If you are uncertain of any specification and want it clarified, you may submit a 
                letter citing the specification, stating your understanding and interpretation of 
                the specification, and enclosing an example of the form (if appropriate) to:

                       Internal Revenue Service
                       Attn: Substitute Forms Program
                       SE:W:CAR:MP:P:TP:TP
                       NCFB
                       5000 Ellin Road
                       Mail Stop C6-175
                       Lanham, MD 20706

                Note. Allow at least 30 days for the IRS to respond.

                You may also contact the Substitute Forms Program via email at 
                substituteforms@irs.gov. Please enter “Substitute Forms” on the subject line.

                Note. Do not send completed forms to the Substitute Forms Program via email 
                or mail as they are unable to process those forms. Any examples/samples of 
                substitute forms sent to the Substitute Forms Program should not contain 
                taxpayer information.

                Forms 1096, 1097-BTC, 1098, 1099, 3921, 3922, 5498, W-2G, and 1042-S are 
                subject to annual review and possible change. Therefore, filers are cautioned 
                against overstocking supplies of privately printed substitutes.

1.3.2           .
                Some Forms 1097-BTC, 1098, 1099, 3921, 3922, 5498, W-2G, and 1042-S that 
Logos, Slogans, 
and             include logos, slogans, and advertisements may not be recognized as important 
Advertisements  tax documents. A payee may not recognize the importance of the payee copy for 
                tax reporting purposes due to the use of logos, slogans, and advertisements. 
                Accordingly, the IRS has determined that logos, slogans, and advertising are not 
                allowed on the payee copies of the above forms, on Copy A filed with the IRS, 
                or on Form 1096, with the following exceptions.

                •    The exact name of the payer, broker, or agent, primary trade name, 
                     trademark, service mark, or symbol of the payer, broker, or agent, an 
                     embossment or watermark on the information return and payee copies 
                     that is a representation of the name, a primary trade name, trademark, 
                     service mark, or symbol of the payer, broker, or agent, that is:
                     – Presented in any typeface, font, stylized fashion, or print color 
                       normally used by the payer, broker, or agent, and used in a 
                       non-intrusive manner; and

                                                6

- 9 -

Page 9 of 66 Fileid: … ns/p1179/202309/a/xml/cycle03/source 13:58 - 5-Sep-2023

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

– As long as these items do not materially interfere with the ability
of the recipient to recognize, understand, and use the tax
information on the payee copies.
The IRS e-file logo on the IRS official payee copies may be included, but it is
not required, on any of the substitute form copies.
The information return and payee copies must clearly identify the payer’s name
associated with its employer identification number (EIN).
Logos and slogans may be used on permissible enclosures, such as a check or
account statement, other than information returns and payee copies.
If you have comments about the restrictions on including logos, slogans, and
advertising on information returns and payee copies, send your comments to:

Internal Revenue Service
Attn: Substitute Forms Program
SE:W:CAR:MP:P:TP:TP
NCFB
5000 Ellin Road
Mail Stop C6-175
Lanham, MD 20706

or email them to substituteforms@irs.gov.

Note. Do not send completed forms to the Substitute Forms Program via email
or mail as they are unable to process those forms. Any examples/samples of
substitute forms sent to the Substitute Forms Program should not contain
taxpayer information.

1.3.3 .
Proposed substitutes of Copy A must be exact replicas of the official IRS form
Copy A
Specifications with respect to layout and content. Proposed substitutes for Copy A that do not
conform to the specifications in this revenue procedure are not acceptable.
Further, if you file such forms with the IRS, you may be subject to a penalty for
failure to file a correct information return under section 6721 of the Code. The
amount of the penalty is based on when you file the correct information return.

Penalties. The amounts of the penalty for returns required to be filed in 2023 is
shown under Penalties in part O of the 2023 General Instructions for Certain
Information Returns.

1.3.4 .
Copy B and Copy C of the following forms must contain the information in Part
Copy B and
Copy C 4 to be considered a “statement” or “official form” under the applicable
Specifications provisions of the Code. The format of this information is at the discretion of the
filer with the exception of the location of the tax year, the form number, the
form name, and the information for composite Form 1099 statements, as
outlined under Section 4.2.
Copy B, of the forms below, is for the following recipients.

- 10 -

Page 10 of 66  Fileid: … ns/p1179/202309/a/xml/cycle03/source               13:58 - 5-Sep-2023

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

                         Form                                  Recipient
              1098                      For Payer/Borrower
              1098-C                    For Donor
              1098-E; 1099-A            For Borrower
              1098-F                    For Payer
              1098-MA                   For Homeowner
              1098-Q                    For Participant
              1098-T                    For Student
              1099-C                    For Debtor
              1099-CAP                  For Shareholder
              1099-K                    For Payee
              1099-LS                   For Payment Recipient
              1099-LTC                  For Policyholder
                                        Copy B may be required to be attached to the filer's federal 
              1099-R; W-2G
                                        income tax return.
              1099-S                    For Transferor 
              1099-SB                   For Seller
              All remaining Forms 1099; 
                                        For Recipient
              1097-BTC; 1042-S
              3921; 3922                For Employee 
              5498; 5498-SA             For Participant
              5498-QA; 5498-ESA         For Beneficiary

              Copy C of the following forms is for the following recipients.

                         Form                                  Recipient
              1097-BTC                  For Payer
              1098                      For Recipient/Lender
              1098-C                    For Donor’s Records 
              1042-S; 1098-E            For Recipient
              1098-F; 1098-MA; 1098-T; 
                                        For Filer
              1099-K
              1098-Q                    For Issuer
              1099-CAP; 3921; 3922      For Corporation 
              1099-LTC                  For Insured
              1099-QA                   For Payer
              1099-R                    For Recipient’s Records
              All other Forms 1099      See Section 4.5.2.
              5498                      For Trustee or Issuer
              5498-ESA; 5498-SA         For Trustee
              5498-QA                   For Issuer
              W-2G                      For Winner’s Records

                                                   8

- 11 -

Page 11 of 66 Fileid: … ns/p1179/202309/a/xml/cycle03/source 13:58 - 5-Sep-2023

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

Note. On Copy C of Form 1099-LTC, you may reverse the locations of the
policyholder’s and the insured’s name, street address, city, state, and ZIP code
for easier mailing.

Part 2

Specifications for Substitute Forms 1096 and
Copies A of Forms 1098, 1099, 3921, 3922, and
5498 (All Filed With the IRS)

Section 2.1 – Specifications

2.1.1 .
Due to the very low volume of paper Forms 1097-BTC, 1098-C, 1098-F,
Online Fillable
Forms 1098-MA, 1099-A, 1099-CAP, 1099-LTC, 1099-Q, 1099-QA, 1099-SA, 3922,
5498-ESA, 5498-QA, and 5498-SA received and processed by the IRS each
year, these forms have been converted to fillable online PDFs.

Note. The instructions for substitute Forms 1042-S, also available in a fillable
online format, are found separately in Part 5.
These forms in their fillable formats can be found at IRS.gov/FormsPubs.
All the instructions regarding the substitute forms found in Part 1, and Sections
2.1.2, 2.1.7, 2.1.9, and 2.1.10, and the remainder of this publication, unless
specified differently immediately below, remain in effect if you are going to
produce the online fillable forms as paper or online substitute forms.

• Copy A of privately printed substitutes of the forms listed above must
be exact replicas of the official forms with respect to layout and
content. Use the official form, found on IRS.gov, printed actual size on
an 8½ inch by 11 inch sheet of paper. The forms will print one to a
page.
• All printing must be in high quality nongloss black ink.
• Paper for Copy A must be white chemical wood bond, or equivalent,
20 pounds (basis 17 x 22-500), plus or minus 5% (0.05); or offset book
paper, 50 pounds (basis 25 x 38-500). No optical brighteners may be
added to the pulp or paper during manufacture. The paper must consist
of principally bleached chemical wood pulp or recycled printed paper.
It must also be suitably sized to accept ink without feathering.
Note. If you want to print the forms as they formerly appeared to save paper,
with the exception of Forms 1097-BTC (printed 2-to-a-page) and 1098-C
(single-form page), they are all printed 3-to-a-page. Follow the 3-to-a-page
measurements in Section 6. Form 1098-C can be found at IRS.gov/Form1098C.
Print the form to actual size with no scaling.

- 12 -

Page 12 of 66 Fileid: … ns/p1179/202309/a/xml/cycle03/source 13:58 - 5-Sep-2023

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

2.1.2 .
Form identifying numbers (for example, 9191 for Form 1099-DIV) must be
General
Requirements printed in nonreflective black carbon-based ink in print positions 15 through 19
using an optical character recognition (OCR) A font. The checkboxes to the
right of the form identifying numbers must be 10-point boxes. The “VOID”
checkbox is in print position 25 (1.9 inches from left vertical line of the form).
The “CORRECTED” checkbox is in print position 33 (2.7 inches from left
vertical line of the form). Measurements are generally from the left edge of the
paper, not including the perforated strip.
The substitute form Copy A must be an exact replica of the official IRS form
with respect to layout and content. To determine the correct form measurements,
see Exhibits A through CC at the end of this publication.
Hot wax and cold carbon spots are not permitted on any of the internal form
plies. These spots are permitted on the back of a mailer top envelope ply.
Use of chemical transfer paper for Copy A is acceptable.
The Government Publishing Office (GPO) symbol must be deleted.

2.1.3 .
Color and paper quality for Copy A (cut sheets and continuous pinfeed forms)
Color and Paper
as specified by JCP Code 0-25, dated November 29, 1978, must be white 100%
Quality
bleached chemical wood, OCR bond produced in accordance with the following
specifications.

Note. Reclaimed fiber in any percentage is permitted, provided the requirements
of this standard are met.

Acidity: Ph value, average, not less than 4.5
Basis Weight: 17 x 22-500 cut sheets 18-20
Metric equivalent–g/m2 75
A tolerance of ±5 pct. is allowed.
Stiffness: Average, each direction, not less than-milligrams 50
Tearing strength: Average, each direction, not less than-grams 40
Opacity: Average, not less than-percent 82
Thickness: Average-inch 0.0038
Metric equivalent-mm 0.097
A tolerance of +0.0005 inch (0.0127 mm) is allowed. Paper cannot vary more than
0.0004 inch (0.0102 mm) from one edge to the other.
Porosity: Average, not less than-seconds 10
Finish (smoothness): Average, each side-seconds 20-55
For information only, the Sheffield equivalent-units 170-100
Dirt: Average, each side, not to exceed-parts per million 8

- 13 -

Page 13 of 66 Fileid: … ns/p1179/202309/a/xml/cycle03/source 13:58 - 5-Sep-2023

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

2.1.4 .
Chemical transfer paper is permitted for Copy A only if the following standards
Chemical
Transfer Paper are met.
• Only chemically backed paper is acceptable for Copy A. Front and
back chemically treated paper cannot be processed properly by
machine.
• Carbon-coated forms are not permitted.
• Chemically transferred images must be black.

All copies must be clearly legible. Fading must be minimized to assure
legibility.

2.1.5 .
All print on Copy A of Forms 1097-BTC, 1098, 1098-C, 1098-E, 1098-F,
Printing
1098-MA, 1098-Q, 1098-T, 1099-A, 1099-B, 1099-C, 1099-DIV, 1099-G,
1099-INT, 1099-K, 1099-LS, 1099-MISC, 1099-NEC, 1099-OID, 1099-PATR,
1099-Q, 1099-R, 1099-S, 1099-SB, 3921, 3922, and 5498; and the print on
Form 1096 above the statement, “Return this entire page to the Internal Revenue
Service. Photocopies are not acceptable.” must be in Flint J-6983 red OCR
dropout ink or an exact match. However, the 4-digit form identifying number
must be in nonreflective carbon-based black ink in OCR A font.

The shaded areas of any substitute form should generally correspond to the
format of the official form.

The printing for the Form 1096 jurat statement and the text that follows may be
in any shade or tone of black ink. Black ink should only appear on the lower
part of the reverse side of Form 1096, where it will not bleed through and
interfere with scanning.

Note. The instructions on the front and back of Form 1096, which include filing
addresses, must be printed.

Separation between fields must be 0.1 inch.

Other printing requirements are discussed in Sections 2.1.5 through 2.1.9.

2.1.6 .
You must initiate, or have, a quality control program to assure OCR ink density.
OCR
Specifications Readings will be made when printed on approved 20 lb. white OCR bond with a
reflectance of not less than 80% (0.80). Black ink must not have a reflectance
greater than 15% (0.15). These readings are based on requirements of the
“BancTec IntelliScan XDS” Optical Scanner using Flint J-6983 red OCR
dropout ink or an exact match.

The following testers and ranges are acceptable.

Important information: The forms produced under these specifications must
be guaranteed to function properly when processed through High Speed
Scan-Optics 9000 mm scanners. Forms require precision spacing, printing, and
trimming.

Density readings on the solid Flint J-6983 (red) must be between the ranges of
0.95 to 0.90. The optimal scanning range is 0.93. Density readings on the solid

- 14 -

Page 14 of 66 Fileid: … ns/p1179/202309/a/xml/cycle03/source 13:58 - 5-Sep-2023

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

black must be between the ranges of 112 to 108. The optimal scanning range is
110.

Note. The readings are taken using an Ex-Rite 500 series densitometer, in Status
T with Absolute or – paper setting under an Illuminate 5000 Kelvin Watt Light.
You must maintain print contrast specification of ink and densitometer
reflectivity reading throughout the entire production run.

• MacBeth PCM-II. The tested Print Contrast Signal (PCS) values when
using the MacBeth PCM-II tester on the “C” scale must range from .01
minimum to .06 maximum.
• Kidder 082A. The tested PCS values when using the Kidder 082A
tester on the Infra Red (IR) scale must range from .12 minimum to .21
maximum. White calibration disc must be 100%. Sensitivity must be
set at one (1).
• Alternative testers must be approved by the IRS to establish tested PCS
values. You may obtain approval by writing to the following address.

Internal Revenue Service
Attn: Substitute Forms Program
SE:W:CAR:MP:P:TP:TP
NCFB
5000 Ellin Road
Mail Stop C6-175
Lanham, MD 20706

2.1.7 .
Type must be substantially identical in size and shape to the official form. All
Typography
rules are either 1/2-point or 3/ -point.4Rules must be identical to those on the
official IRS form.

Note. The form identifying number must be nonreflective carbon-based black
ink in OCR A font.

2.1.8 .
Generally, three Copies A of Forms 1098, 1099, 3921, and 3922 are contained
Dimensions
on a single page (3-to-a-page), 8 inches wide (without any snap-stubs and/or
pinfeed holes) by 11 inches deep.

Exceptions. Forms 1097-BTC, 1098, 1098-Q, 1099-B, 1099-DIV, 1099-INT,
1099-K, 1099-MISC, 1099-OID, 1099-R, and 5498 contain two copies on a
single page (2-to-a-page). Forms 1098-C and 1042-S are single-page
documents.

There is a 0.33 inch top margin from the top of the corrected box, and a 0.2 to
0.25 inch right margin, with a +/- 1/ 20(0.05) inch tolerance for the right margin.
If the right and top margins are properly aligned, the left margin for all forms
will be correct. All margins must be free of print. See Exhibits A through CC in
Part 6 for correct form measurements.

These measurements are constant for certain Forms 1098, 1099, and 5498.
These measurements are shown only once in this publication, on Form
1097-BTC (Exhibit B) 2-to-a-page and on Form 1098-E (Exhibit E) 3-to-a-page.

- 15 -

Page 15 of 66 Fileid: … ns/p1179/202309/a/xml/cycle03/source 13:58 - 5-Sep-2023

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

Exceptions to these measurements, and form-specific measurements are shown
on the rest of the exhibits.

The depth of the individual trim size of each 3-to-a-page form must be 3 2/3
inches, the same depth as the official form, unless otherwise indicated.

The depth of the individual trim size of each 2-to-a-page form is 5 1/ 2inches.

2.1.9 .
Copy A (3-to-a-page and 2-to-a-page) of privately printed continuous substitute
Perforation
forms must be perforated at each 11 inches page depth. No perforations are
allowed between forms on the Copy A page.

Exception. Copy A of Form W-2G may be perforated.

The words “Do Not Cut or Separate Forms on This Page” must be printed using
Flint J-6983 red OCR dropout ink or an exact match (see Section 2.1.5) between
the 3-to-a-page or 2-to-a-page. This statement should not be included after the
last form on the page.

Separations are required between all the other individual copies (Copy B, and
Copies 1 and 2 of Forms 1099-B; and Copy C of Forms 1099-DIV, 1099-G,
1099-INT, 1099-K, 1099-MISC, 1099-NEC, 1099-OID, and 1099-R; and Copy
D of Forms 1099-LS, 1099-LTC, 1099-R, and 1042-S) in the set. Any recipient
copies printed on a single sheet of paper must be easily separated. The best
method of separation is to provide perforations between the individual copies.
Each copy should be easily distinguished, whatever method of separation is
used.

Note. Perforation does not apply to printouts of copies that are furnished
electronically to recipients (as described in Regulations section 31.6051-1(j)).
However, these recipients should be cautioned to carefully separate any copies.
See Section 4.6.1 for information on electronically furnishing statements to
recipients.

2.1.10 .
You must include the Office of Management and Budget (OMB) number on
Required
Inclusions/ Copies A and Form 1096 in the same location as on the official form.
Exclusions The following Privacy Act and Paperwork Reduction Act Notice phrases must
be printed on Copy A of the forms as follows. It must also be printed on the
Copy C, D, or E of the form retained by the filer, if applicable.

• “For Privacy Act and Paperwork Reduction Act Notice, see the current
version of the General Instructions for Certain Information Returns” on
Forms 3921 and 3922.
• “For more information and the Privacy Act and Paperwork
Reduction Act Notice, see the 2023 General Instructions for
Certain Information Returns” on Form 1096.
• “For Privacy Act and Paperwork Reduction Act Notice, see
instructions” on Form 1042-S.
• “For Privacy Act and Paperwork Reduction Act Notice, see the 2023
General Instructions for Certain Information Returns” must be
printed on all other forms listed in Section 1.1.2.

- 16 -

Page 16 of 66 Fileid: … ns/p1179/202309/a/xml/cycle03/source 13:58 - 5-Sep-2023

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

A postal indicia may be used if it meets the following criteria.

• It is printed in the OCR ink color prescribed for the form.
• No part of the indicia is within one print position of the scannable area.
The printer’s symbol (GPO) must not be printed on substitute Copy A. Instead,
the EIN or the vendor code of the form's printer must be entered in place of the
Catalog Number (Cat. No.). The 4-digit vendor code, preceded by four zeros
and a slash, for example, 0000/9876, must appear in 12-point Arial font, or a
close approximation, on Copy A only of Forms 1096, 1097-BTC, 1098, 1099,
3921, 3922, 5498, and W-2G. The vendor code is used to identify the forms
producer. Vendor codes can be obtained free of charge from the National
Association of Computerized Tax Processors (NACTP) via email at
president@nactp.org. The use of a vendor code is recommended.

Note. Vendor codes from the NACTP are required by those companies
producing the 1099 family of forms (Forms 1096, 1097-BTC, 1098, 1099, 3921,
3922, 5498, and W-2G) as part of a product for resale to be used by multiple
issuers. Issuers developing 1099 family forms to be used only for their
individual company do not require a vendor code.
The Cat. No. shown on the forms is used for IRS distribution purposes and
should not be printed on any substitute forms.
The form must not contain the statement “IRS approved” or any similar
statement.

Section 2.2 – Instructions for Preparing Paper Forms That Will Be Filed With
the IRS

2.2.1 .
The form recipient's name, street address, city, state, ZIP code, and telephone
Recipient
Information number (if required) should be typed or machine printed in black ink in the same
format as shown on the official IRS form. The city, state, and ZIP code must be
on the same line.
The following rules apply to the form recipient's name(s).

• The name of the appropriate form recipient must be shown on the first
or second name line in the area provided for the form recipient's name.
• No descriptive information or other name may precede the form
recipient's name.
• Only one form recipient's name may appear on the first name line of
the form.
• If multiple recipients’ names are required on the form, enter on the first
name line the recipient name that corresponds to the recipient taxpayer
identification number (TIN) shown on the form. Place the other form
recipients’ names on the second name line (only 2 name lines are
allowable).

- 17 -

Page 17 of 66 Fileid: … ns/p1179/202309/a/xml/cycle03/source 13:58 - 5-Sep-2023

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

Because certain states require that trust accounts be provided in a different
format, filers should generally provide information returns reflecting payments
to trust accounts with the:

• Trust’s EIN in the recipient's TIN area,
• Trust’s name on the recipient's first name line, and
• Name of the trustee on the recipient's second name line.

Although handwritten forms will be accepted, the IRS prefers that filers type or
machine print data entries. Also, filers should insert data as directed by shading,
or in the middle of blocks, well separated from other printing and guidelines,
and take measures to guarantee clear, dark black, sharp images. Photocopies are
not acceptable.

Truncating payee TIN on payee statements. Where permitted, filers may
truncate a payee's TIN (social security number (SSN), individual taxpayer
identification number (ITIN), adoption taxpayer identification number (ATIN),
or EIN) on the payee statement (including substitute and composite substitute
statements) furnished to the payee in paper form or electronically. Generally, the
payee statement is that copy of an information return designated "Copy B" on
the form. To truncate where allowed, replace the first 5 digits of the 9-digit
number with asterisks (*) or Xs (for example, an SSN xxx-xx-xxxx would
appear on the paper payee statement as ***-**-xxxx or XXX-XX-xxxx). See
Treasury Decision 9675, 2014-31 I.R.B. 242, available at IRS.gov/irb/
2014-31_IRB#TD-9675.

Caution. Recipient TINs must not be truncated on Copy A filed with the IRS.

2.2.2 .
Use the account number box on all Forms 1098, 1099, 3921, 3922, 5498, and
Account Number
W-2G for an account number designation when required by the official IRS
Box
form. The account number is required if you have multiple accounts for a
recipient for whom you are filing more than one information return of the same
type. Additionally, the IRS encourages you to include the recipients’ account
numbers on paper forms if your system of records uses the account number
rather than the name or TIN for identification purposes. Also, the IRS will
include the account number in future notices to you about backup withholding.
If you are using window envelopes to mail statements to recipients and using
reduced rate mail, be sure the account number does not appear in the window.
The Postal Service may not accept these for reduced rate mail.

Exception. Form 1098-T can have third-party provider information.

2.2.3 .
Specifications • Machine-printed forms should be printed using a 6 lines/inch option,
and Restrictions and should be printed in 10 pitch pica (10 print positions per inch) or
12 pitch elite (12 print positions per inch). Proportional spaced fonts
are unacceptable.

• Substitute forms prepared in continuous or strip form must be burst and
stripped to conform to the size specified for a single sheet before they
are filed with the IRS. The size specified does not include pinfeed
holes. Pinfeed holes must not be present on forms filed with the IRS.

- 18 -

Page 18 of 66 Fileid: … ns/p1179/202309/a/xml/cycle03/source 13:58 - 5-Sep-2023

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

• Do not use a felt tip marker. The machine used to “read” paper forms
generally cannot read this ink type.
• Do not use dollar signs ($), ampersands (&), asterisks (*), commas (,),
or other special characters in the numbered money boxes. Exception.
Use decimal points to indicate dollars and cents (for example, 2000.00
is acceptable).
• Do not use apostrophes (’), asterisks (*), or other special characters on
the payee name line.
• Do not fold Forms 1097-BTC, 1098, 1099, 3921, 3922, or 5498 mailed
to the IRS. Mail these forms flat in an appropriately sized envelope or
box. Folded documents cannot be readily moved through the machine
used in IRS processing.
• Do not staple Forms 1096 to the transmitted returns. Any staple holes
near the return code number may impair the IRS’s ability to machine
scan the type of documents.
• Do not type other information on Copy A.
• Do not cut or separate the individual forms on the sheet of forms of
Copy A (except Forms W-2G).

2.2.4 .
Mail completed paper forms to the IRS Service Center shown in the instructions
Where To File
for Form 1096 and in the 2023 General Instructions for Certain Information
Returns. Specific information needed to complete the forms mentioned in this
revenue procedure are given in the specific form instructions. A chart showing
which form must be filed to report a particular payment is included in the 2023
General Instructions for Certain Information Returns.

Part 3

Specifications for Substitute Form W-2G (Filed
With the IRS)

Section 3.1 – General

3.1.1 .
The following specifications give the format requirements for substitute Form
Purpose
W-2G (Copy A only), which is filed with the IRS.
A filer may use a substitute Form W-2G to file with the IRS (referred to as
“substitute Copy A”). The substitute form must be an exact replica of the
official form with respect to layout and content.

- 19 -

Page 19 of 66 Fileid: … ns/p1179/202309/a/xml/cycle03/source 13:58 - 5-Sep-2023

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

Section 3.2 – Specifications for Copy A of Form W-2G

3.2.1 .
You must follow these specifications when printing substitute Copy A of the
Substitute Form
W-2G (Copy A) Form W-2G.
Caution. The payee's TIN (SSN, ITIN, ATIN, or EIN) must not be truncated on
Copy A of Form W2-G.

Item Substitute Form W-2G (Copy A)
Paper for Copy A must be white chemical wood bond, or equivalent, 20
pounds (basis 17 x 22-500), plus or minus 5% (0.05). The paper must
Paper Color and
consist substantially of bleached chemical wood pulp. It must be free
Quality
from unbleached or ground wood pulp or post-consumer recycled paper.
It must also be suitably sized to accept ink without feathering.
Ink Color and Quality All printing must be in a high quality nongloss black ink.
The type must be substantially identical in size and shape to the official
form. All rules on the document are either 1/ 2point (0.007 inch), 1 point
Typography
(0.015 inch), or 3 point (0.045 inch). Vertical rules must be parallel to
the left edge of the document; horizontal rules to the top edge.
The official form is 8 inches wide x 51/ 2inches deep, exclusive of a snap
stub. Any substitute Copy A can be between 8 inches and 81/ 2inches
wide by 5 inches deep. The snap feature is not required on substitutes.
All margins must be free of print. There is a 0.33 inch top margin from
Dimensions 1 2
the top of the corrected box, and a / inch left margin. If the top and left
margins are properly aligned, the right margin for all forms will be
correct. If the substitute forms are in continuous or strip form, they must
be burst and stripped to conform to the size specified for a single form.
Hot Wax and Cold Hot wax and cold carbon spots are not permitted on any of the internal
Carbon Spots form plies. These spots are permitted on the back of a mailer top
envelope ply.
The GPO symbol must not be printed on substitute Forms W-2G.
Instead, the EIN of the form’s printer must be printed in the bottom
Printer’s Symbol
margin on the face of each individual Copy A on a sheet. The form must
not contain the statement “IRS approved” or any similar statement.
The Cat. No. shown on Form W-2G is used for IRS distribution
Cat. No.
purposes and should not be printed on any substitute forms.

Part 4

Substitute Statements to Form Recipients and
Form Recipient Copies

- 20 -

Page 20 of 66 Fileid: … ns/p1179/202309/a/xml/cycle03/source 13:58 - 5-Sep-2023

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

Section 4.1 – Specifications

4.1.1 .
If you do not use the official IRS form to furnish statements to recipients, you
Introduction
must furnish an acceptable substitute statement. Information presented in
substitute statements should be in a point size large enough to be easily read by
recipients. To be acceptable, your substitute statement must comply with the
rules in this part. If you are furnishing a substitute form, see Regulations
sections 1.6042-4, 1.6044-5, 1.6049-6, and 1.6050N-1 to determine how the
following statements must be provided to recipients for most Forms 1099-DIV
and 1099-INT, all Forms 1099-OID and 1099-PATR, and Form 1099-MISC, or
Form 1099-S for royalties. Generally, information returns may be furnished
electronically with the consent of the recipient. See Section 4.6.1.
Note. A trustee of a grantor-type trust may choose to file Forms 1099 and
furnish a statement to the grantor under Regulations sections 1.671-4(b)(2)(iii)
and (b)(3)(ii). The statement required by those regulations is not subject to the
requirements outlined in this section.

4.1.2 .
The rules in this section apply to Form 1099-B, 1099-DIV (except for section
Substitute
Statements to 404(k) dividends), 1099-INT (except for interest reportable under section 6041),
Recipients for 1099-OID, and 1099-PATR only. You may furnish form recipients with Copy B
Certain Forms of the official Form 1099 or a substitute Form 1099 (recipient statement) if it
1099-B, 1099- contains the same information as the official IRS form (such as aggregate
DIV, 1099-INT, amounts paid to the form recipient; any backup withholding; the name, address,
1099-OID, and
and TIN of the person making the return; and any other information required by
1099-PATR
the official form). Information not required by the official form should not be
included on the substitute form except for state income tax withholding
information. But see Section 4.3 regarding additional information that may be
included on substitute and composite Forms 1099-B, such as basis for
noncovered securities.
Note. Many of the information returns now include boxes for providing state
withholding information as part of the official form, with additional copies for
convenience. Payers may, however, provide the state withholding information
separately (such as on a separate page or section) in order to assist the payee
with completing a state income tax return that requires the attachment of any
information return that includes state withholding amounts and payer numbers.
Exception for supplementary information. The substitute form may include
supplementary information that will assist the payee with completing the tax
return. Such information could include expense and cost basis factors related to
the reporting for widely held fixed investment trusts (WHFITs), as required
under Regulations section 1.671-5. The substitute statement should disclose to
the payee that such supplementary information is not furnished to the IRS. See
Section 4.3 for additional requirements when providing supplemental
information with the Form 1099-B that is not furnished to the IRS.
Form 1099-B. For transactions reportable on Form 8949, brokers that use
substitute statements should segregate dispositions of noncovered securities
from covered securities, and further segregate long-term and short-term
dispositions of covered securities. They may also segregate long-term from
short-term dispositions of noncovered securities, to the extent that the date

- 21 -

Page 21 of 66 Fileid: … ns/p1179/202309/a/xml/cycle03/source 13:58 - 5-Sep-2023

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

acquired is known. For 2023 dispositions, the substitute Forms 1099-B may
have up to five separate sections, each with a heading identifying which
securities are included in the list, and each separately totaled. Each section, after
totaling or within the heading for the section, should indicate how to report the
transactions on Form 8949, as indicated.

1. Short-term transactions for which basis isreported to the IRS—Report on
Form 8949, Part I, with Box A checked.

2. Short-term transactions for which basis is not reported to the IRS—Report
on Form 8949, Part I, with Box B checked.

3. Long-term transactions for which basis isreported to the IRS—Report on
Form 8949, Part II, with Box D checked.

4. Long-term transactions for which basis is not reported to the IRS—Report
on Form 8949, Part II, with Box E checked.

5. Transactions for which basis is not reported to the IRS and for which
short-term or long-term determination is unknown (to Broker). You must
determine short term or long term based on your records and report on Form
8949, Part I, with Box B checked, or on Form 8949, Part II, with Box E
checked, as appropriate.
For each section, each transaction may include information not reported to the
IRS, such as basis, date acquired, and gain or loss. Therefore, for short-term
dispositions where basis was not reported to the IRS, basis and date acquired
may be shown just as they would be shown for short-term dispositions where
basis was reported to the IRS.
For 2023 dispositions, each of the applicable sections must have Sales Price and
Cost or Other Basis (if known) separately totaled. Net gain or loss, if included
for any of the sections, may also be totaled.
Brokers may also use substitute Form 1099-B for transactions that are not
directly reported on Form 8949. Examples include transactions involving
regulated futures contracts, foreign currency contracts, and section 1256 option
contracts. Any additional sections created for this purpose should be segregated
from those transactions directly reportable on Form 8949.

The substitute form requirements in the following paragraphs also apply to
Form 1099-B.
Form 1099-INT, 1099-DIV, 1099-OID, or 1099-PATR. A substitute recipient
statement for Form 1099-INT, 1099-DIV, 1099-OID, or 1099-PATR must
comply with the following requirements.

• Box captions and numbers that are applicable must be clearly
identified, using the same wording and numbering as on the official
form.

• The recipient statement (Copy B) must contain all applicable recipient
instructions as provided on the front and back of the official IRS form.
You may provide those instructions on a separate sheet of paper.

- 22 -

Page 22 of 66 Fileid: … ns/p1179/202309/a/xml/cycle03/source 13:58 - 5-Sep-2023

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

• The box caption “Federal income tax withheld” must be in boldface
type or otherwise highlighted on the recipient statement.
• The recipient statement must contain the OMB number as shown on the
official IRS form. See Section 5.2.
• The recipient statement must contain the tax year (for example, 2023),
form number (for example, Form 1099-INT), and form name (for
example, Interest Income) of the official IRS Form 1099. This
information must be displayed prominently together in one area of the
statement. For example, the tax year, form number, and form name
could be shown in the upper right part of the statement. Each copy
must be appropriately labeled (such as Copy B, For Recipient). See
Section 4.5.2 for applicable labels and arrangement of assembly of
forms. Note. Do not include the words “Substitute for” or “In lieu of”
on the recipient statement.
• Layout and format of the statement is at the discretion of the filer.
However, the IRS encourages the use of boxes so that the statement has
the appearance of a form and can be easily distinguished from other
nontax statements.
• Each recipient statement of Form 1099-B, 1099-DIV, 1099-INT,
1099-OID, or 1099-PATR must include the direct access telephone
number of an individual who can answer questions about the statement.
Include that telephone number conspicuously anywhere on the
recipient statement.
A mutual fund family may furnish one statement (for example, one piece of
paper) on which it reports the dividend income earned by a recipient from
multiple funds within the family of mutual funds, as required by Form
1099-DIV. However, each fund and its earnings must be stated separately. The
statement must contain an instruction to the recipient that each fund’s dividends
and name, not the name of the mutual fund family, must be reported on the
recipient's tax return. The statement cannot contain an aggregate total of all
funds. In addition, a mutual fund family may furnish a single statement (as a
single filer) for Form 1099-INT, 1099-DIV, or 1099-OID information (see
Section 4.2.1). Each fund and its earnings must be stated separately. The
statement must contain an instruction to the recipient that each fund’s earnings
and name, not the name of the mutual fund family, must be reported on the
recipient's tax return. The statement cannot contain an aggregate total of all
funds.
You may enter a total of the individual accounts listed on the statement only if
they have been paid by the same payer. For example, if you are listing interest
paid on several accounts by one financial institution on Form 1099-INT, you
may also enter the total interest amount. You may also enter a date next to the
CORRECTED box if that box is checked.

- 23 -

Page 23 of 66       Fileid: … ns/p1179/202309/a/xml/cycle03/source                     13:58 - 5-Sep-2023

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

4.1.3             .
                  Statements to form recipients for Forms 1097-BTC, 1098, 1098-C, 1098-E, 
Substitute 
Statements to     1098-F, 1098-MA, 1098-Q, 1098-T, 1099-A, 1099-C, 1099-CAP, 1099-G, 
Recipients for    1099-K, 1099-LS, 1099-LTC, 1099-MISC, 1099-NEC, 1099-Q, 1099-QA, 
Certain Forms     1099-R, 1099-S, 1099-SA, 1099-SB, 3921, 3922, 5498, 5498-ESA, 5498-QA, 
1098, 1099, 5498, 5498-SA, W-2G, 1099-DIV (only for section 404(k) dividends reportable under 
and W-2G          section 6047), and 1099-INT (only for interest of $600 or more made in the 
                  course of a trade or business reportable under section 6041) can be copies of the 
                  official forms or acceptable substitutes.
                  Caution. The IRS does not require a donee to use Form 1098-C as the written 
                  acknowledgment for contributions of motor vehicles, boats, and airplanes. 
                  However, if you choose to use copies of Form 1098-C or an acceptable 
                  substitute as the written acknowledgment, then you must follow the 
                  requirements of this section.
                  To be acceptable, a substitute recipient statement must meet the following 
                  requirements.

                  • The tax year, form number, and form name must be the same as on the 
                    official form and must be displayed prominently together in one area 
                    on the statement. For example, they may be shown in the upper right 
                    part of the statement.
                  • The statement must contain the same information as the official IRS 
                    form, such as aggregate amounts paid to the form recipient; any backup 
                    withholding; the name, address, and TIN of the filer and of the 
                    recipient; and any other information required by the official form.
                  • Each substitute recipient statement for Forms W-2G, 1097-BTC, 1098, 
                    1098-C, 1098-E, 1098-F, 1098-T, 1099-A, 1099-C, 1099-CAP, 
                    1099-DIV, 1099-G (excluding state and local income tax refunds), 
                    1099-K, 1099-INT, 1099-LS, 1099-LTC, 1099-MISC (excluding 
                    fishing boat proceeds), 1099-NEC, 1099-Q, 1099-R (for qualified 
                    long-term care insurance contracts under combined arrangements 
                    only), 1099-S, 1099-SA, 1099-SB, and 5498-SA must include the 
                    direct access telephone number of an individual who can answer 
                    questions about the statement.
                  • Include the telephone number conspicuously anywhere on the recipient 
                    statement. Although not required, payers reporting on Forms 1099-QA, 
                    1099-R (payments other than qualified long-term care insurance 
                    contracts under combined arrangements), 3921, 3922, 5498, 
                    5498-ESA, and 5498-QA are encouraged to furnish telephone numbers 
                    at which recipients of the form(s) can reach a person familiar with the 
                    information reported.
                  • All applicable money amounts and information, including box numbers 
                    required to be reported to the form recipient, must be titled on the 
                    recipient statement in substantially the same manner as those on the 
                    official IRS form. The box caption “Federal income tax withheld” 
                    must be in boldface type on the recipient statement.

                                                  21

- 24 -

Page 24 of 66 Fileid: … ns/p1179/202309/a/xml/cycle03/source 13:58 - 5-Sep-2023

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

Exception. If you are reporting a payment as “Other income” in box 3 of
Form 1099-MISC, you may substitute appropriate language for the box
title. For example, for payments of accrued wages and leave to a
beneficiary of a deceased employee, you might change the title of box 3 to
“Beneficiary payments” or something similar.

Note. You cannot make this change on Copy A.

• If federal income tax is withheld and shown on Form 1099-R or W-2G,
Copy B and Copy C must be furnished to the recipient. If federal
income tax is not withheld, only Copy C of Forms 1099-R and W-2G
must be furnished. However, for Form 1099-R, instructions similar to
those on the back of the official Copy B and Copy C of Form 1099-R
must be furnished to the recipient. For convenience, you may choose to
provide both Copies B and C of Form 1099-R to the recipient.
• You must provide appropriate instructions to the form recipient similar
to those on the official IRS form, to aid in the proper reporting on the
form recipient's income tax return. For payments reported on Forms
1099-B and 1099-CAP, the requirement to include instructions
substantially similar to those on the official IRS form may be satisfied
by providing form recipients with a single set of instructions for all
Forms 1099-B and 1099-CAP statements required to be furnished in a
calendar year.
• If you use carbonless sets to produce recipient statements, the quality
of each copy in the set must meet the following standards.

1. All copies must be clearly legible.

2. All copies must be able to be photocopied.

3. Fading must not diminish legibility and the ability to photocopy.
• In general, black chemical transfer inks are preferred, but other colors
are permitted if the above standards are met. Hot wax and cold carbon
spots are not permitted on any of the internal form plies. The back of a
mailer top envelope ply may contain these spots.
• For reporting state income tax withholding and state payments, you
may add an additional box(es) to recipient copies, as appropriate. In
addition, the state withholding information may be provided separately
and apart from the other information in the event the recipient must
attach a copy to the recipient's tax return. Note. You cannot make this
change on Copy A.
• On Copy C of Form 1099-LTC, you may reverse the location of the
policyholder’s and the insured’s name, street address, city, state, and
ZIP code for easier mailing.
• If an institution insurer uses a third-party service provider to file Form
1098-T, then in addition to the institution’s or insurer’s name, address,
and telephone number, the same information may be included for the
third-party service provider in the space provided on the form.

- 25 -

Page 25 of 66 Fileid: … ns/p1179/202309/a/xml/cycle03/source 13:58 - 5-Sep-2023

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

• Forms 1099-A and 1099-C transactions, if related, may be combined
on Form 1099-C.

4.1.4 .
Copies B, C, D, 1, and 2, as applicable, to be furnished to recipients and kept in
Online Fillable
Copies B, C, D, the filers’ records, have been made online fillable at IRS.gov/forms-instructions
1, and 2 for many forms referenced in these instructions. See the separate instructions for
Forms 1098, 1098-E & T, 1098-F, 1098-Q, 1099-A & C, 1099-B, 1099-DIV,
1099-G, 1099-INT & OID, 1099-K, 1099-LS, 1099-MISC & NEC, 1099-PATR,
1099-R & 5498, 1099-S, 1099-SB, and 3921.

Section 4.2 – Composite Statements

4.2.1 .
A composite recipient statement is permitted for reportable payments consisting
Composite
Substitute of the proceeds of brokerage and barter transactions, dividends, interest, original
Statements for issue discount, patronage dividends, and royalties. The following forms may be
Certain Forms included on a composite substitute statement, when one payer is reporting more
1099-B, 1099- than one of these payments during a calendar year to the same form recipient.
DIV, 1099-INT,
1099-MISC, • Form 1099-B.
1099-OID, 1099-
• Form 1099-DIV (except for section 404(k) dividends).
PATR, and 1099-
S • Form 1099-INT (except for interest reportable under section 6041).

• Form 1099-MISC (only for royalties or substitute payments in lieu of
dividends and interest).
• Form 1099-OID.
• Form 1099-PATR.
• Form 1099-S (only for royalties).
Generally, do not include any other Form 1099 information (for example, Form
1099-A or 1099-C) on a composite statement with the information required on
the forms listed in the preceding sentence.
Although the composite recipient statement may be on one sheet, the format of
the composite recipient statement must satisfy the following requirements in
addition to the requirements listed earlier inSections 4.1.2,4.3, and 4.4, as
applicable.

• All information pertaining to a particular type of payment must be
located and blocked together on the form and separate from any
information covering other types of payments included on the form.
For example, if you are reporting interest and dividends, the Form
1099-INT information must be presented separately from the Form
1099-DIV information.
• The composite recipient statement must prominently display the form
number and form name of the official IRS form together in one area at
the beginning of each appropriate block of information. The tax year
must only be placed on each block of information if it is not

- 26 -

Page 26 of 66 Fileid: … ns/p1179/202309/a/xml/cycle03/source 13:58 - 5-Sep-2023

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

prominently displayed elsewhere on the page on which the information
appears.
• Any information required by the official IRS forms that would
otherwise be repeated in each information block is required to be listed
only once in the first information block on the composite form. For
example, there is no requirement to report the name of the filer in each
information block. This rule does not apply to any money amounts (for
example, federal income tax withheld) or to any other information that
applies to money amounts.
• A composite statement is an acceptable substitute only if the type of
payment, and the recipient's tax obligation with respect to the payment,
is as clear as if each required statement were furnished separately on an
official form.

4.2.2 .
A composite recipient statement for the forms specified in Section 4.1.2 or 4.1.3
Composite
Substitute is permitted when one filer is reporting more than one type of payment during a
Statements to calendar year to the same form recipient. A composite statement is not allowed
Recipients for for a combination of forms listed in Sections 4.1.2 and 4.1.3.
Forms Specified
Exceptions.
in Sections 4.1.2
and 4.1.3 • Substitute payments in lieu of dividends or interest reported in box 8 of
Form 1099-MISC may be reported on a composite substitute statement
with Form 1099-DIV.
• Form 1099-B information may be reported on a composite form with
the forms specified in Section 4.1.2, as described in Section 4.2.1.
• Royalties reported on Form 1099-MISC or 1099-S may be reported on
a composite form only with the forms specified in Section 4.1.2.
Although the composite recipient statement may be on one sheet, the format of
the composite recipient statement must satisfy the requirements listed in Section
4.2.1 as well as the requirements in Section 4.1.3. A composite statement of
Forms 1098 and 1099-INT (for interest reportable under section 6049) is not
allowed.

Section 4.3 – Additional Information for Substitute and Composite Forms
1099-B

4.3.1 .
A filer may include Form 1099-B information on a composite form with the
General
Requirements forms listed in Section 4.1.2. Therefore, supporting, explanatory, or comparable
for Presenting relevant information for covered and noncovered lots on the 1099-B portion of
Additional Form the composite statement can be included. This information includes display on
1099-B the payee statement of data elements such as basis for noncovered lots,
Information explanatory remarks on permissible basis adjustments for covered lots,
descriptions of the type of transaction (merger, buy to close, redemption, etc.),
identification of contingent payment debt obligations, and lot relief methods.
If you wish to provide additional information to the investor on the same
substitute recipient Form 1099-B, the form must follow the rules set forth in this

- 27 -

Page 27 of 66 Fileid: … ns/p1179/202309/a/xml/cycle03/source 13:58 - 5-Sep-2023

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

Section 4.3 and should clearly delineate how the information is presented. Any
information presented should make reference to its corresponding number on the
official form, as appropriate. You should clearly categorize each type of
information you are reporting.

4.3.2 .
An additional separate legend is required that explains exactly which pieces of
Added Legend
for Providing information are and which are not reported to the IRS, to the extent, if any, the
Additional 1099- information is not already identified as not being reported to the IRS, as
B Information described in Section 4.1.2. It should clearly explain how the information is
presented. You may present this legend in a way that is consistent with your
design as long as it clearly indicates which information is being provided to the
IRS. Additionally, a reminder to taxpayers that they are ultimately responsible
for the accuracy of their tax returns is also required.

Section 4.4 – Required Legends

4.4.1 .
Form 1098 recipient statements (Copy B) must contain the following legends.
Required
Legends for • Form 1098:
Forms 1098
1. “The information in boxes 1 through 9 and 11 is important tax
information and is being furnished to the IRS. If you are required
to file a return, a negligence penalty or other sanction may be
imposed on you if the IRS determines that an underpayment of tax
results because you overstated a deduction for the mortgage
interest or for these points, reported in boxes 1 and 6; or because
you did not report the refund of interest (box 4); or because you
claimed a nondeductible item.”

2. Caution. “The amount shown may not be fully deductible by you.
Limits based on the loan amount and the cost and value of the
secured property may apply. Also, you may only deduct interest to
the extent it was incurred by you, actually paid by you, and not
reimbursed by another person.”
• Form 1098-C: Copy B — “In order to take a deduction of more than
$500 for this contribution, you must attach this copy to your federal tax
return. Unless box 5a or 5b is checked, your deduction cannot
exceed the amount in box 4c.” Copy C — “This information is being
furnished to the IRS unless box 7 is checked.”
• Form 1098-E: “This is important tax information and is being furnished
to the IRS. If you are required to file a return, a negligence penalty or
other sanction may be imposed on you if the IRS determines that an
underpayment of tax results because you overstated a deduction for
student loan interest.”
• Forms 1098-F and 1098-MA: “This is important tax information and is
being furnished to the IRS.”
• Form 1098-Q: “This information is being furnished to the IRS.”

- 28 -

Page 28 of 66    Fileid: … ns/p1179/202309/a/xml/cycle03/source                      13:58 - 5-Sep-2023

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

               • Form 1098-T: “This is important tax information and is being furnished 
                 to the IRS. This form must be used to complete Form 8863 to claim 
                 education credits. Give it to the tax preparer or use it to prepare the tax 
                 return.”

4.4.2          .
Required       • Forms 1099-A, 1099-C, 1099-CAP, and 1099-K: Copy B — “This is 
Legends for      important tax information and is being furnished to the IRS. If you are 
Forms 1099 and   required to file a return, a negligence penalty or other sanction may be 
W-2G             imposed on you if taxable income results from this transaction and the 
                 IRS determines that it has not been reported.”
               • Forms 1099-B, 1099-DIV, 1099-G, 1099-INT, 1099-MISC, 1099-NEC, 
                 1099-OID, 1099-PATR, 1099-Q, and 1099-QA: Copy B — “This is 
                 important tax information and is being furnished to the IRS. If you are 
                 required to file a return, a negligence penalty or other sanction may be 
                 imposed on you if this income is taxable and the IRS determines that it 
                 has not been reported.”
               • Form 1099-LS: Copy B — “This is important tax information and is 
                 being furnished to the IRS. If you are required to file a return, a 
                 negligence penalty or other sanction may be imposed on you if this 
                 item is required to be reported and the IRS determines that it has not 
                 been reported.” Copy C — “Copy C is provided to you for information 
                 only. Only the payment recipient is required to report this information 
                 on a tax return.”
               • Form 1099-LTC: Copy B — “This is important tax information and is 
                 being furnished to the IRS. If you are required to file a return, a 
                 negligence penalty or other sanction may be imposed on you if this 
                 item is required to be reported and the IRS determines that it has not 
                 been reported.” Copy C — “Copy C is provided to you for information 
                 only. Only the policyholder is required to report this information on a 
                 tax return.”
               • Form 1099-R: Copy B — “Report this income on your federal tax 
                 return. If this form shows federal income tax withheld in box 4, 
                 attach this copy to your return.” Copy C — “This information is 
                 being furnished to the IRS.”
               • Forms 1099-S and 1099-SB: Copy B — “This is important tax 
                 information and is being furnished to the IRS. If you are required to file 
                 a return, a negligence penalty or other sanction may be imposed on you 
                 if this item is required to be reported and the IRS determines that it has 
                 not been reported.”
               • Form 1099-SA: Copy B — “This information is being furnished to the 
                 IRS.”
               • Form W-2G: Copy B — “This information is being furnished to the 
                 IRS. Report this income on your federal tax return. If this form 
                 shows federal income tax withheld in box 4, attach this copy to 
                 your return.” Copy C — “This is important tax information and is 
                 being furnished to the IRS. If you are required to file a return, a 

                                             26

- 29 -

Page 29 of 66 Fileid: … ns/p1179/202309/a/xml/cycle03/source 13:58 - 5-Sep-2023

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

negligence penalty or other sanction may be imposed on you if this
income is taxable and the IRS determines that it has not been reported.”

4.4.3 .
Required • Form 1097-BTC: Copy B — “This is important tax information and is
Legends for being furnished to the IRS. If you are required to file a return, a
Forms 1097- negligence penalty or other sanction may be imposed on you if an
BTC, 3921, 3922,
amount of tax credit exceeding the amount reported on this form is
and 5498
claimed on your income tax return.”
• Form 3921: Copy B — “This is important tax information and is being
furnished to the IRS. If you are required to file a return, a negligence
penalty or other sanction may be imposed on you if this item is
required to be reported and the IRS determines that it has not been
reported.” Copy C — “This copy should be retained by the corporation
whose stock has been transferred under Section 422(b).”
• Form 3922: Copy B — “This is important tax information and is being
furnished to the IRS.” Copy C — “This copy should be retained by the
corporation.”
• Form 5498: Copy B — “This information is being furnished to the
IRS.” Note. If you do not provide another statement to the participant
because no contributions were made for the year, the statement of the
fair market value, and any required minimum distribution of the
account, must contain this legend and a designation of which
information is being provided to the IRS.
• Forms 5498-ESA, 5498-QA, and 5498-SA: Copy B — “This
information is being furnished to the IRS.”

Section 4.5 – Miscellaneous Instructions for Copies B, C, D, E, 1, and 2

4.5.1 .
Copies B, C, and in some cases D, E, 1, and 2 are included in the official
Copies
assembly for the convenience of the filer. You are not legally required to include
all these copies with the privately printed substitute forms. Furnishing Copy B,
and in some cases Copy C, will satisfy the legal requirement to provide
statements of information to form recipients.

Note. If an amount of federal income tax withheld is shown on Form 1099-R or
W-2G, Copy B (to be attached to the tax return) and Copy C must be furnished
to the recipient. Copy D (Forms 1099-R and W-2G) may be used for payer
records. Only Copy A should be filed with the IRS.

4.5.2 .
Copy A (“For Internal Revenue Service Center”) of all forms must be on top.
Arrangement of
Assembly The rest of the assembly must be arranged, from top to bottom, as follows.

- 30 -

Page 30 of 66  Fileid: … ns/p1179/202309/a/xml/cycle03/source                                     13:58 - 5-Sep-2023

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

                   Form                                       Title
              1098          Copy B “For Payer/Borrower”; Copy C “For Recipient/Lender.”
              1098-C        Copy B “For Donor”; Copy C “For Donor’s Records”; Copy D “For Donee.”
              1098-E        Copy B “For Borrower”; Copy C “For Recipient.”
              1098-F        Copy B “For Payer”; Copy C “For Filer.”
              1098-MA       Copy B “For Homeowner”; Copy C “For Filer.”
              1098-Q        Copy B “For Participant”; Copy C “For Issuer.”
              1098-T        Copy B “For Student”; Copy C “For Filer.”
              1099-A        Copy B “For Borrower”; Copy C “For Lender.”
              1097-BTC, 
              1099-PATR, 
                            Copy B “For Recipient”; Copy C “For Payer.”
              1099-Q, and 
              1099-QA 
              1099-C        Copy B “For Debtor”; Copy C “For Creditor.”
              1099-CAP      Copy B “For Shareholder”; Copy C “For Corporation.”
              1099-B        Copy 1 “For State Tax Department”; Copy B “For Recipient”; and Copy 2 
                            “To be filed with recipient's state income tax return, when required.”
              1099-DIV, 
              1099-G, 
                            Copy 1 “For State Tax Department”; Copy B “For Recipient”; Copy 2 “To be 
              1099-INT, 
                            filed with recipient's state income tax return, when required.”; and Copy C 
              1099-MISC, 
                            “For Payer.”
              1099-NEC, and 
              1099-OID
                            Copy 1 “For State Tax Department”; Copy B “For Payee”; Copy 2 “To be 
              1099-K        filed with the recipient's state income tax return, when required.”; Copy C 
                            “For Filer.”
                            Copy B “For Payment Recipient”; Copy C “For Issuer”; Copy D “For 
              1099-LS
                            Acquirer.”
              1099-LTC      Copy B “For Policyholder”; Copy C “For Insured”; Copy D “For Payer.”
                            Copy 1 “For State, City, or Local Tax Department”; Copy B “Report this 
                            income on your federal tax return. If this form shows federal income tax 
              1099-R        withheld in box 4, attach this copy to your return.”; Copy C “For Recipient’s 
                            Records”; Copy 2 “File this copy with your state, city, or local income tax 
                            return, when required.”; Copy D “For Payer.”
              1099-S        Copy B “For Transferor”; Copy C “For Filer.”
              1099-SA       Copy B “For Recipient”; Copy C “For Trustee/Payer.”
              1099-SB       Copy B “For Seller”; Copy C “For Issuer.”
                            Copy B “For Employee”; Copy C “For Corporation”; Copy D “For 
              3921          Transferor.”
              3922          Copy B “For Employee”; Copy C “For Corporation.”
              5498          Copy B “For Participant”; Copy C “For Trustee or Issuer.”
              5498-ESA      Copy B “For Beneficiary”; Copy C “For Trustee.”
              5498-QA       Copy B “For Beneficiary”; Copy C “For Issuer.”
              5498-SA       Copy B “For Participant”; Copy C “For Trustee.”

                                        28

- 31 -

Page 31 of 66 Fileid: … ns/p1179/202309/a/xml/cycle03/source 13:58 - 5-Sep-2023

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

Form Title
Copy 1 “For State, City, or Local Tax Department”; Copy B “Report this
income on your federal tax return. If this form shows federal income tax
W-2G withheld in box 2, attach this copy to your return.”; Copy C “For Winner’s
Records”; Copy 2 “Attach this copy to your state, city, or local income tax
return, if required.”; Copy D “For Payer.”
Copy B “For Recipient”; Copy C “For Recipient” and “Attach to any federal
1042-S tax return you file”; Copy D “For Recipient” and “Attach to any state tax
return you file”; Copy E “For Withholding Agent.”

4.5.3 .
Instructions for perforation of forms can be found in Section 2.1.9.
Perforations

Section 4.6 – Electronic Delivery of Recipient Statements

4.6.1 .
If you are required to furnish a written statement (Copy B or an acceptable
Electronic
Recipient substitute) to a recipient, then you may furnish the statement electronically
Statements instead of on paper. This includes furnishing the statement to recipients of
Forms 1098, 1098-E, 1098-F, 1098-MA, 1098-Q, 1098-T, 1099-A, 1099-B,
1099-C, 1099-CAP, 1099-DIV, 1099-G, 1099-H, 1099-INT, 1099-K, 1099-LS,
1099-LTC, 1099-MISC, 1099-NEC, 1099-OID, 1099-PATR, 1099-Q, 1099-QA,
1099-R, 1099-S, 1099-SA, 1099-SB, 1042-S, 3921, 3922, 5498, 5498-ESA,
5498-QA, and 5498-SA. It also includes Form W-2G (except for horse and dog
racing, jai alai, sweepstakes, wagering pools, and lotteries).
Note. Until further guidance is issued, you cannot furnish Form 1098-C
electronically. Perforation (see Section 2.1.9) does not apply to printouts of
copies of forms that are furnished electronically to recipients. However,
recipients should be cautioned to carefully separate the copies.
If you meet the requirements listed in Sections 4.6.2 and 4.6.3, you are treated as
furnishing the statement timely.

4.6.2 .
The recipient must consent in the affirmative to receiving the statement
Consent
electronically and not have withdrawn the consent before the statement is
furnished. The consent by the recipient must be made electronically in a way
that shows that the recipient can access the statement in the electronic format in
which it will be furnished. You must notify the recipient of any hardware or
software changes prior to furnishing the statement. A new consent to receive the
statement electronically is required after the new hardware or software is put
into service. Prior to furnishing the statements electronically, you must provide
the recipient a statement with the following statements prominently displayed.
• If the recipient does not consent to receive the statement electronically,
a paper copy will be provided.
• The scope and duration of the consent. For example, whether the
consent applies to every year the statement is furnished or only for the
January 31, 2024, (February 15 for Forms 1099-B, 1099-S, and

- 32 -

Page 32 of 66 Fileid: … ns/p1179/202309/a/xml/cycle03/source 13:58 - 5-Sep-2023

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

1099-MISC with payments reported in box 8 or 10) due date
immediately following the date of the consent.
• How to obtain a paper copy after giving consent.
• How to withdraw the consent. The consent may be withdrawn at any
time by furnishing the withdrawal in writing (electronically or on
paper) to the person whose name appears on the statement.
Confirmation of the withdrawal will also be in writing (electronically
or on paper).
• Notice of termination. The notice must state under what conditions the
statements will no longer be furnished to the recipient.
• Procedures to update the recipient's information.
• A description of the hardware and software required to access, print,
and retain a statement, and a date the statement will no longer be
available on the website.

4.6.3 .
Additionally, you must:
Format, Posting,
and Notification • Ensure the electronic format contains all the required information and
complies with the guidelines in this document;
• Post, on or before the January 31, 2024, (February 15 for Forms
1099-B, 1099-S, and 1099-MISC with payments reported in box 8 or
10) due date, the applicable statement on a website accessible to the
recipient through October 17 of that year; and
• Inform the recipient, electronically or by mail, of the posting and how
to access and print the statement.
For more information, see Regulations section 31.6051-1(j).
For electronic furnishing of:

• Forms 1098-E and 1098-T, see Regulations sections 1.6050S-2 and
1.6050S-4;
• Form 1099-K, see Regulations section 1.6050W-2;
• Forms 1099-QA and 5498-QA, see Regulations section 1.529A-7;
• Forms 1099-R, 1099-SA, 1099-Q, 5498, 5498-ESA, and 5498-SA, see
Notice 2004-10, 2004-1 C.B. 433; and
• Form 1042-S, see Regulations section 1.1461-1(c)(1)(i).

- 33 -

Page 33 of 66 Fileid: … ns/p1179/202309/a/xml/cycle03/source 13:58 - 5-Sep-2023

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

Part 5

Additional Instructions for Substitute Forms 1097-
BTC, 1098, 1099, 5498, W-2G, and 1042-S

Section 5.1 – Paper Substitutes for Form 1042-S

5.1.1 .
Paper substitutes of Copies A, B, C, and D must be identical to the Form
Paper
Substitutes 1042-S and may be privately printed without prior approval from the IRS.
Caution. On the bottom of Copy B, left align the following text: (keep for
your records), and right align the following text: Form 1042-S (2023).
Note. Copies A, B, C, and D of Form 1042-S may not contain multiple income
types for the same recipient, that is, multiple rows of the top boxes 1–11 of the
form. Only Copy E, retained by the withholding agent, can contain multiple
income types.

5.1.2 .
Form 1042-S is subject to annual review and possible change. Withholding
Revisions
agents and form suppliers are cautioned against overstocking supplies of the
privately printed substitutes.

5.1.3 .
Copies of the official form for the reporting year may be obtained from most
Obtaining
Copies IRS offices. The IRS provides only cut sheets of these forms. Continuous
fan-fold/pin-fed forms are not provided.

5.1.4 .
Instructions for • Only original forms may be filed with the IRS. Photocopies are not
Withholding acceptable.
Agents
• The term “Recipient’s U.S. TIN” for an individual means the SSN,
ITIN, or ATIN, consisting of nine digits separated by hyphens as
follows: 000-00-0000; for all other recipients, it means the EIN or
qualified intermediary employer identification number (QI-EIN). The
QI-EIN designation includes a withholding foreign partnership
employer identification number (WP-EIN), and a withholding foreign
trust employer identification number (WT-EIN). The EIN, QI-EIN,
WP-EIN, and WT-EIN consist of nine digits separated by a hyphen as
follows: 00-0000000. The TIN must be in one of these formats. Note.
Digits must be separated by hyphens on paper statements in the formats
listed.
• The term “Recipient's GIIN” means the global intermediary
identification number (GIIN) assigned to a recipient that is a
participating foreign financial institution (FFI) (including a reporting
Model 2 FFI), registered deemed-compliant FFI (including a reporting
Model 1 FFI), or other entity for chapter 4 purposes.

Note. A GIIN consists of nineteen characters as follows:
XXXXXX.XXXXX.XX.XXX (6 characters followed by a period, 5

- 34 -

Page 34 of 66 Fileid: … ns/p1179/202309/a/xml/cycle03/source 13:58 - 5-Sep-2023

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

characters followed by a period, 2 characters followed by a period, and 3
final characters).

• Withholding agents are requested to type or machine print whenever
possible, provide quality data entries on the forms (that is, use black
ink and insert data in the middle of blocks well separated from other
printing and guidelines), and take other measures to guarantee a clear,
sharp image. Withholding agents are not required, however, to acquire
special equipment solely for the purpose of preparing these forms.
• The “UNIQUE FORM IDENTIFIER,” “AMENDED,” and
“AMENDMENT NO.” boxes must be printed at the top center of the
form under the title.
• Substitute forms prepared in continuous or strip form must be burst and
stripped to conform to the size specified for a single form before they
are filed with the IRS. The dimensions are found in Section 5.1.5.
Computer cards are acceptable provided they meet all requirements
regarding layout, content, and size.
• The OMB number must be printed in the format “OMB No.
1545-XXXX.” Use the appropriate OMB number from the most recent
revision of the original IRS form.

5.1.5 .
Substitute Form
Property Substitute Form 1042-S Format Requirements
1042-S Format
Requirements Privately printed substitute Forms 1042-S must be exact replicas of the
official forms with respect to layout and content. The GPO symbol must
Printing be deleted. The exact dimensions are found below. The Cat. No. must be
removed and replaced with the form printer’s EIN or the vendor code
(preferred). See Section 2.1.10.
Only one type of income may be represented on Copies A, B, C, and D
submitted to the IRS or furnished to recipients. Multiple income types may
Box Entries be shown on Copy E retained by withholding agents. All boxes on Copy A
filed with the IRS, and Copies B, C, and D furnished to recipients on the
substitute form must conform to the official IRS form.
Color and Quality of
All printing must be in high quality nongloss black ink.
Ink
Type must be substantially identical in size and shape to corresponding
type on the official form. All rules on the document are either 1 point
Typography
(0.015 inch) or 3 point (0.045 inch). Vertical rules must be parallel to the
left edge of the document; horizontal rules must be parallel to the top edge.
If all five parts are present, the parts of the assembly shall be arranged
from top to bottom as follows: Copy A (Original) “for Internal Revenue
Assembly
Service”; Copies B, C, and D “for Recipient”; and Copy E “for
Withholding Agent.”
Paper for Copy A must be white chemical wood bond, or equivalent, 20
pounds (basis 17 x 22-500), plus or minus 5% (0.05); or offset book paper,
Color Quality of 50 pounds (basis 25 x 38-500). No optical brighteners may be added to the
Paper pulp or paper during manufacture. The paper must consist of principally
bleached chemical wood pulp or recycled printed paper. It must also be
suitably sized to accept ink without feathering.

- 35 -

Page 35 of 66 Fileid: … ns/p1179/202309/a/xml/cycle03/source 13:58 - 5-Sep-2023

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

Property Substitute Form 1042-S Format Requirements
• The dimensions for substitute Copies A, B, C, and D must match the
IRS Form 1042-S in size and format.
• The official form is 8 inches wide x 11 inches deep, exclusive of a 1/ 2
Dimensions inch snap stub on the left side of the form. The snap feature is not
required on substitutes.
• Copies A, B, C, and D must conform to the official IRS form. No size
variations are permitted.
Copies B, C, and D must be furnished for the convenience of payees who
Other Copies must send a copy of the form with other federal and state returns they file.
Copy E may be used as a withholding agent’s record/copy.

Section 5.2 – OMB Requirements for All Forms in This Revenue Procedure

5.2.1 .
The Paperwork Reduction Act (the Act) of 1995 (P. L. 104-13) requires the
OMB
Requirements following.
• OMB approves all IRS tax forms that are subject to the Act. Each IRS
form contains (in or near the upper right corner) the OMB approval
number, if any. (The official OMB numbers may be found on the
official IRS printed forms and are also shown on the forms in the
exhibits in Part 6.)
• Each IRS form (or its instructions) states:

1. Why the IRS needs the information,

2. How it will be used, and

3. Whether or not the information is required to be furnished to the
IRS.
This information must be provided to any users of official or substitute IRS
forms or instructions.

5.2.2 .
The OMB requirements for substitute IRS forms are:
Substitute Form
Requirements • Any substitute form or substitute statement to a recipient must show the
OMB number as it appears on the official IRS form; and
• For Copy A, the OMB number must appear exactly as shown on the
official IRS form.
For any copy other than Copy A, the OMB number must use one of the
following formats.

1. OMB No. 1545-xxxx (preferred).

2. OMB # 1545-xxxx (acceptable).

Caution. These requirements do not apply to substitute Forms 1042-S. See
Section 5.1.4.

- 36 -

Page 36 of 66 Fileid: … ns/p1179/202309/a/xml/cycle03/source 13:58 - 5-Sep-2023

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

5.2.3 .
All substitute forms must state the Privacy Act and Paperwork Reduction Act
Required
Explanation to Notice as listed in Section 2.1.10.
Users If no instructions are provided to users of your forms, you must furnish them
with the exact text of the Privacy Act and Paperwork Reduction Act Notice.

Section 5.3 – Ordering Forms and Instructions

You can order official IRS Forms (Forms 1096, 1098, 1099, W-2G, 1042-S, and
most other forms mentioned in this publication), instructions, and information
copies of federal tax material by going to IRS.gov/OrderForms.

Note. Some forms on the Internet are intended as information only and may not
be submitted as an official IRS form (for example, most Forms 1099, W-2, and
W-3). Unless otherwise instructed, Form 1096 and Copy A of 1098 series, 1099
series, 5498 series, and Forms 3921 and 3922 cannot be used for filing with the
IRS when printed from a conventional printer. These forms contain drop-out ink
requirements as described in Part 2 of this publication.

Exception. Forms 1097-BTC, 1098-C, 1098-MA, 1099-CAP, 1099-LTC,
1099-Q, 1099-QA, 1099-SA, 3922, 5498-ESA, 5498-QA, 5498-SA, and 1042-S
can be printed in black ink as specified in Sections 2.1.1 and 5.1.5.

Section 5.4 – Effect on Other Revenue Procedures

5.4.1 .
Revenue Procedure 2022-25, 2022-27 I.R.B. 3, dated July 5, 2022, is superseded
Other Revenue
Procedures by this revenue procedure.

Part 6

Exhibits

Section 6.1 – Exhibits of Forms in This Revenue Procedure

6.1.1 .
Exhibits A through CC illustrate some of the specifications that were discussed
Purpose
earlier in this revenue procedure. The dimensions apply to the actual size forms,
but the exhibits have been reduced in size.
Generally, the illustrated dimensions apply to all like forms. For example,
Exhibit E shows 11.00 inches from the top edge to the bottom edge of Form
1098-E and 0.85 inch between the bottom rule of the top form and the top rule
of the second form on the page. These dimensions apply to all forms that are
printed 3-to-a-page.

- 37 -

Page 37 of 66 Fileid: … ns/p1179/202309/a/xml/cycle03/source 13:58 - 5-Sep-2023

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

Exhibit B contains the general measurements for forms printed 2-to-a-page. All
2-to-a-page forms, except Form 1099-B, are 4.5 inches in height within the
border lines. Form 1099-B is 4.67 inches in height within the border lines.
Exhibit E contains the general measurements for forms printed 3-to-a-page. All
3-to-a-page forms are 2.83 inches in height within the border lines.
The printed area of all forms is 7.3 inches wide.
All of the exhibits in this publication were updated to include all of the 2023
revisions for those forms that have been revised.

6.1.2 .
Keep in mind the following guidelines when printing substitute forms.
Guidelines
• Closely follow the specifications to avoid delays in processing the
forms.
• Always use the specifications as outlined in this revenue procedure and
illustrated in the exhibits.
• Do not add the text line “Do Not Cut or Separate Forms on This Page”
to the bottom form. This will be inconsistent with the specifications.

6.2 .
The following exhibits provide specifications for the forms listed in Section
Exhibits
1.1.2.Exhibits A, B, and Econtain the general measurements for all of the
forms. The remaining exhibits represent the images and may contain unique
measurements as required by the form.

- 38 -

Page 38 of 66     Fileid: … ns/p1179/202309/a/xml/cycle03/source                                                                                                 13:58 - 5-Sep-2023

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

Exhibit A                                                                                                                                                             Form 1096
                                                             .50 in
       Do Not Staple  6969
                                                                                                                                                             OMB No. 1545-0108
       Form 1096                                          Annual Summary and Transmittal of                  
       Department of the Treasury                                    U.S. Information Returns                                                                    2023
       Internal Revenue Service
          FILER’S name

          Street address (including room or suite number)                                                                                                 2.14 in
                                                                                             1.33 in
          City or town, state or province, country, and ZIP or foreign postal code                                                    7.30 in

       Name of person to contact                                     Telephone number                                                 For Ofﬁcial Use Only
4.95 in
       Email address                                                 Fax number
       1                             2 Social security number        3 Total number of forms 4 Federal income tax withheld            5 Total amount reported with this Form 1096
                 1.40 in                     1.40 in                    1.20 in              $        1.40 in                         $                   1.90 in
       6 
       W-2G     1097-BTC    1098       1098-C     1098-E     1098-F  1098-Q     1098-T     1099-A     1099-B     1099-C    1099-CAP             1099-DIV   1099-G     1099-INT   1099-K          .25 in
          32      50        81       78      84           03         74 83          80       79       85   73                                   91        86     92        10

       1099-LS    1099-LTC  1099-MISC 1099-NEC  1099-OID  1099-PATR  1099-Q     1099-QA    1099-R     1099-S     1099-SA    1099-SB   3921      3922      5498      5498-ESA   5498-QA 
          16      93        95       71      96           97         31 1A          98       75       94   43                         25        26        28     72        2A

       5498-SA   
          27
                                                                                       11.0 in

       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 ﬂat 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.
                                             8.00 in
       Signature                                                                                Title                                              Date
       Instructions                                                                    When to ﬁle. If any date shown falls on a Saturday, Sunday, or legal 
       Future developments. For the latest information about developments              the due date is the next business day. File Form 1096 in the calendar 
       related to Form 1096, such as legislation enacted after it was published, go    year following the year for which the information is being reported, as 
       to www.irs.gov/Form1096.                                                        follows.
       Reminder.                                                                       •
       returns. Go to www.irs.gov/inforeturn                                           •
       the 2023 General Instructions for Certain Information Returns.                  • 
       Purpose of form.Use this form to transmit paper Forms 1097,      1098,          * Leap years do not impact the due date. See Announcement 91-179, 
       1099, 3921, 3922, 5498, and W-2G to the IRS.                                    1991-49 I.R.B. 78, for more information. 
       Caution:                                                                        Where To File
       number of returns.
       Who must ﬁle. 
                                                                                       If your principal business, ofﬁce or 
       Caution:                                                                          agency, or legal residence in the                                Use the following               
                  number (EIN) or social security number (SSN)) must match the         case of an individual, is located in:                              address:
       name and TIN used on your 94X series tax return(s) or you may be subject        Alabama, Arizona, Arkansas, Delaware, 
       to information return penalties. Do not use the name and/or TIN of your         Florida, Georgia, Kentucky, Maine,                          Internal Revenue Service  
       paying agent or service bureau.                                                 Massachusetts, Mississippi, New                                    P.O. Box 149213 
                                                                                       Hampshire, New Jersey, New Mexico, 
       number), and TIN in the spaces provided on the form. The name, address,         New York, North Carolina, Ohio, Texas,                      Austin, TX 78714-9213
                                                                                       Vermont, Virginia
       upper left area of Form 1097, 1098, 1099, 3921, 3922, 5498, or W-2G.            Alaska, Colorado, Hawaii, Idaho, 
                                                                                       Illinois, Indiana, Iowa, Kansas, 
                                                                                       Michigan, Minnesota, Missouri,                           Internal Revenue Service Center 
                                                                                       Montana, Nebraska, Nevada, North                                   P.O. Box 219256 
                                                                                       Dakota, Oklahoma, Oregon, South                           Kansas City, MO 64121-9256
                                                                                       Carolina, South Dakota, Tennessee, 
                                                                                       Utah, Washington, Wisconsin, Wyoming
       For more information and the Privacy Act and Paperwork Reduction Act Notice,                        Cat. No. 14400O                                       Form 1096 (2023)
       see the 2023 General Instructions for Certain Information Returns.

                                                                                    36

- 39 -

Page 39 of 66  Fileid: … ns/p1179/202309/a/xml/cycle03/source                                                                          13:58 - 5-Sep-2023

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

Exhibit B                                                                                                                              Form 1097-BTC
                                                                                                     6.25in
              5050                            VOID                     CORRECTED
       FORM 1097-BTC ISSUER’S name, street address, city or town, state or         1    Total                     OMB No. 1545-2197
       province, country, ZIP or foreign postal code, and telephone no.
                                                                                   $                              Form 1097-BTC
              4.50 in                 1.33 in                                      2a  Code                       (Rev. December 2019) Bond 
                                                                                                                  For calendar year    Tax 
                                                                                                                       20
                                                                                   2b  Unique identier                                Credit
       FORM 1097-BTC ISSUER’S TIN            RECIPIENT’S TIN                                               2.80 in
                                                                                   3    Bond type          4
                                                                                              1.40 in
       RECIPIENT’S name                                                                                                                Copy A
                                                                                   5a  January             5b  February                For 
                                      3.40 in                                      $                       $                           Internal Revenue 
       Street address (including apt. no.)                                         5c  March               5d  April                   Service Center
                                                                                   $                       $                           File with Form 1096.
                                                                                   5e  May                 5f   June
       City or town, state or province, country, and ZIP or foreign postal code    $                       $ 
                                      7.30 in                                      5g  July                5h  August                  For Privacy Act 
                                                                                   $                       $                           and Paperwork 
       Form 1097-BTC issuer is (check one):                                        5i   September          5j   October                Reduction Act 
                                                                                   $                       $                           Notice, see the 
              Issuer of bond or its agent ling current year                                                                           Instructions for 
.15 in                                                                             5k  November            5l   December               current General 
.22 in        Form 1097-BTC for credit being reported                      1.17 in $                       $                           Certain Information 
              An entity or a person that received or should have received          6    Comments                                       Returns.
              a current year Form 1097-BTC and is distributing part or all 
              of that credit to others
.35 in
      Form 1097-BTC (Rev. 12-2019)            Cat. No. 54293T                      www.irs.gov/Form1097BTC  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

                                                                                                            1 in

                   5050                       VOID                     CORRECTED
       FORM 1097-BTC ISSUER’S name, street address, city or town, state or         1    Total                     OMB No. 1545-2197
       province, country, ZIP or foreign postal code, and telephone no.
                                                                                   $                              Form 1097-BTC
                                                                                   2a  Code                       (Rev. December 2019) Bond 
                                                                                                                  For calendar year    Tax 
                                                                                                                       20
                                                                                   2b  Unique identier                                Credit
       FORM 1097-BTC ISSUER’S TIN             RECIPIENT’S TIN
                                                                                   3    Bond type          4
       RECIPIENT’S name                                                                                                                Copy A
                                                                                   5a  January             5b  February                For 
                                                                                   $                       $                           Internal Revenue 
       Street address (including apt. no.)                                         5c  March               5d  April                   Service Center
                                                                                   $                       $                           File with Form 1096.
                                                                                   5e  May                 5f   June
       City or town, state or province, country, and ZIP or foreign postal code    $                       $ 
                                                                                   5g  July                5h  August                  For Privacy Act 
                                                                                   $                       $                           and Paperwork 
        Form 1097-BTC issuer is (check one):                                       5i   September          5j   October                Reduction Act 
                                                                                   $                       $                           Notice, see the 
                                                                                   5k  November            5l   December               current General 
              Issuer of bond or its agent ling current year                                                                           Instructions for 
              Form 1097-BTC for credit being reported                              $                       $                           Certain Information 
              An entity or a person that received or should have received          6    Comments                                       Returns.
              a current year Form 1097-BTC and is distributing part or all 
              of that credit to others
      Form 1097-BTC (Rev. 12-2019)            Cat. No. 54293T                      www.irs.gov/Form1097BTC  Department of the Treasury - Internal Revenue Service

                                                                                     37

- 40 -

Page 40 of 66  Fileid: … ns/p1179/202309/a/xml/cycle03/source                                                                                13:58 - 5-Sep-2023

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

Exhibit C                                                                                                                                      Form 1098

              8181                    VOID                      CORRECTED 
RECIPIENT’S/LENDER’S name, street address, city or town, state or                                     OMB No. 1545-1380
province, country, ZIP or foreign postal code, and telephone no.
                                                                                                       Form 1098                               Mortgage 
                                                                                                      (Rev. January 2022)                      Interest 
                                                                                                       For calendar year                       Statement
                                                                                                              20
                                                                         1 Mortgage interest received from payer(s)/borrower(s)                Copy A 
                                                                         $ 
RECIPIENT’S/LENDER’S TIN            PAYER’S/BORROWER’S TIN               2 Outstanding mortgage       3 Mortgage origination date                            For 
                                                                         principal                                                           Internal Revenue 
                                                                                                                                               Service Center 
                                                                         $                                                                                        
                                                                         4 Refund of overpaid         5 Mortgage insurance                   File with Form 1096. 
                                                                         interest                     premiums
PAYER’S/BORROWER’S name                                                  $                            $
                                                                         6 Points paid on purchase of principal residence                      For Privacy Act 
                                                                                                                                               and Paperwork 
                                                                         $                                                                     Reduction Act 
Street address (including apt. no.)                                      7        If address of property securing mortgage is the same         Notice, see the        1.13 in
                                                                         as PAYER’S/BORROWER’S address, check the box, or enter                current General 
                                                                         the address or description in box 8.                                  Instructions for 
                                                                                                                                                         Certain 
City or town, state or province, country, and ZIP or foreign postal code 8 Address or description of property securing mortgage (see           Information 
                                                                         instructions)                                                         Returns.

9 Number of properties securing the 10 Other
mortgage
                                                                                                                                             11 Mortgage 
Account number (see instructions)                                                                                                            acquisition date

Form 1098  (Rev. 1-2022)                    Cat. No. 14402K                      www.irs.gov/Form1098  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

              8181                    VOID                      CORRECTED 
RECIPIENT’S/LENDER’S name, street address, city or town, state or                                     OMB No. 1545-1380
province, country, ZIP or foreign postal code, and telephone no.
                                                                                                       Form 1098                               Mortgage 
                                                                                                      (Rev. January 2022)                      Interest 
                                                                                                       For calendar year                       Statement
                                                                                                              20
                                                                         1 Mortgage interest received from payer(s)/borrower(s)                Copy A 
                                                                         $ 
RECIPIENT’S/LENDER’S TIN            PAYER’S/BORROWER’S TIN               2 Outstanding mortgage       3 Mortgage origination date                            For 
                                                                         principal                                                           Internal Revenue 
                                                                                                                                               Service Center 
                                                                         $                                                                                        
                                                                         4 Refund of overpaid         5 Mortgage insurance                   File with Form 1096. 
                                                                         interest                     premiums
PAYER’S/BORROWER’S name                                                  $                            $
                                                                         6 Points paid on purchase of principal residence                      For Privacy Act 
                                                                                                                                               and Paperwork 
                                                                         $                                                                     Reduction Act 
Street address (including apt. no.)                                      7        If address of property securing mortgage is the same         Notice, see the 
                                                                         as PAYER’S/BORROWER’S address, check the box, or enter                current General 
                                                                         the address or description in box 8.                                  Instructions for 
                                                                                                                                                         Certain 
City or town, state or province, country, and ZIP or foreign postal code 8 Address or description of property securing mortgage (see           Information 
                                                                         instructions)                                                         Returns.

9 Number of properties securing the 10 Other
mortgage
                                                                                                                                             11 Mortgage 
Account number (see instructions)                                                                                                            acquisition date

Form 1098  (Rev. 1-2022)                    Cat. No. 14402K                      www.irs.gov/Form1098  Department of the Treasury - Internal Revenue Service

                                                                          38

- 41 -

Page 41 of 66 Fileid: … ns/p1179/202309/a/xml/cycle03/source 13:58 - 5-Sep-2023

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

Exhibit D Form 1098-C

7878 VOID CORRECTED
DONEE’S name, street address, city or town, state or province, country, ZIP 1 Date of contribution OMB No. 1545-1959 Contributions of
or foreign postal code, and telephone no.
Form 1098-C Motor Vehicles,
2a Odometer mileage (Rev. November 2019) Boats, and
For calendar year Airplanes
20
7.16 in 2b Year 2c Make 2d Model

DONEE’S TIN DONOR’S TIN 3 Vehicle or other identication number
2.80 in

DONOR’S name 4a Donee certies that vehicle was sold in arm’s 2.45 in
3.40 in length transaction to unrelated party
Street address (including apt. no.) 4b Date of sale

City or town, state or province, country, and ZIP or foreign postal code 4c Gross proceeds from sale (see instructions) Copy A
$
5a Donee certies that vehicle will not be transferred for money, other property, or services before completion of material For
improvements or signicant intervening use Internal Revenue
Service Center
5b Donee certies that vehicle is to be transferred to a needy individual for signicantly below fair market value in furtherance of File with Form 1096.
donee’s charitable purpose
For Privacy Act
5c Donee certies the following detailed description of material improvements or signicant intervening use and duration of use and Paperwork
Reduction Act
Notice, see the
current General
Instructions for
Certain
6a Did you provide goods or services in exchange for the vehicle? . . . . . . . . . . . . . Yes No Information
.55 in Returns.
6b Value of goods and services provided in exchange for the vehicle
$
6c Describe the goods and services, if any, that were provided. If this box is checked, donee certies that the goods and services .05 in
consisted solely of intangible religious benets . . . . . . . . . . . . . . . . . . . . .
7.30 in

7 Under the law, the donor may not claim a deduction of more than $500 for this vehicle if this box is checked . . . . .

Form 1098-C (Rev. 11-2019) Cat. No. 39732R www.irs.gov/Form1098C Department of the Treasury - Internal Revenue Service

- 42 -

Page 42 of 66  Fileid: … ns/p1179/202309/a/xml/cycle03/source                                                                           13:58 - 5-Sep-2023

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

Exhibit E                                                                                                                               Form 1098-E
                                                           .33 in
                                                                                    .50 in
                       8484                       VOID     CORRECTED
       RECIPIENT’S/LENDER’S name, street address, city or town, state or                                   OMB No. 1545-1576
       province, country, ZIP or foreign postal code, and telephone number
                                                                                                                                               Student 
              3.33 in                                      1 in                                               2023                      Loan Interest 
.45 in                                                                                                                                         Statement
                                                                                                              Form 1098-E
       RECIPIENT’S TIN                     BORROWER’S TIN                       1 Student loan interest received by lender                     Copy A                     .25 in
              1.70 in                                                           $                          2.80 in                             For 
       BORROWER’S name                                                                                                                  Internal Revenue 
                                                                                    2.83 in                                             Service Center
                            3.40 in                                                                                                     File with Form 1096.
       Street address (including apt. no.)                                                                                              For Privacy Act and 
                                                                                                                     7.30 in            Paperwork Reduction 
       City or town, state or province, country, and ZIP or foreign postal code                                                         Act Notice, see the 
                                                                                                                                               2023 General
                                                                                                                                               Instructions for
       Account number (see instructions)                                        2 Check if box 1 does not include loan origination fees Certain Information        1.17 in
                                                                                  and/or capitalized interest, and the loan was made           Returns.
                                                                                  before September 1, 2004  . .    . .     . .       .
       Form 1098-E                         Cat. No. 25088U                        www.irs.gov/Form1098E       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
                                           .85 in                                                                                       8.00 in
                       8484                       VOID     CORRECTED                                                                    4.75 in
       RECIPIENT’S/LENDER’S name, street address, city or town, state or                                   OMB No. 1545-1576
       province, country, ZIP or foreign postal code, and telephone number
                                                                                                                                               Student 
                            11.0 in                                                                           2023                      Loan Interest 
                                                                                                                                               Statement
                                                                                                              Form 1098-E
       RECIPIENT’S TIN                     BORROWER’S TIN                       1 Student loan interest received by lender                     Copy A
                                                                                $                                                              For 
       BORROWER’S name                                                                                                                  Internal Revenue 
                                                                                                                                        Service Center
                                                                                                                                        File with Form 1096.
       Street address (including apt. no.)                                                                                              For Privacy Act and 
                                                                                                                                        Paperwork Reduction 
       City or town, state or province, country, and ZIP or foreign postal code                                                         Act Notice, see the 
                                                                                                                                               2023 General
                                                                                                                                               Instructions for
       Account number (see instructions)                                        2 Check if box 1 does not include loan origination fees Certain Information
                                                                                  and/or capitalized interest, and the loan was made           Returns.
                                                                                  before September 1, 2004  . .    . .     . .       .
       Form 1098-E                         Cat. No. 25088U                        www.irs.gov/Form1098E       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
                       8484                       VOID     CORRECTED
       RECIPIENT’S/LENDER’S name, street address, city or town, state or                                   OMB No. 1545-1576
       province, country, ZIP or foreign postal code, and telephone number
                                                                                                                                               Student 
                                                                                                              2023                      Loan Interest 
                                                                                                                                               Statement
                                                                                                              Form 1098-E
       RECIPIENT’S TIN                     BORROWER’S TIN                       1 Student loan interest received by lender                     Copy A
                                                                                $                                                              For 
       BORROWER’S name                                                                                                                  Internal Revenue 
                                                                                                                                        Service Center
                                                                                                                                        File with Form 1096.
       Street address (including apt. no.)                                                                                              For Privacy Act and 
                                                                                                                                        Paperwork Reduction 
       City or town, state or province, country, and ZIP or foreign postal code                                                         Act Notice, see the 
                                                                                                                                               2023 General
                                                                                                                                               Instructions for
       Account number (see instructions)                                        2 Check if box 1 does not include loan origination fees Certain Information
                                                                                  and/or capitalized interest, and the loan was made           Returns.
                                                                                  before September 1, 2004 .  .    . .     . .       .
       Form 1098-E                         Cat. No. 25088U                        www.irs.gov/Form1098E       Department of the Treasury - Internal Revenue Service

                                                                                  40

- 43 -

Page 43 of 66  Fileid: … ns/p1179/202309/a/xml/cycle03/source                                                                              13:58 - 5-Sep-2023

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

Exhibit F                                                                                                                                  Form 1098-F

              0303                        VOID      CORRECTED
FILER’S name, street address, city or town, state or province, country, ZIP 1  Total amount required to be paid OMB No. 1545-2284
or foreign postal code, and telephone no.                                   $
                                                                            2  Amount to be paid for            Form 1098-F           Fines, Penalties, and 
                                                                               violation or potential violation (Rev. January 2022)        Other Amounts
                                                                            $                                   For calendar year     
                                                                            3  Restitution/remediation             20
                                                                               amount
FILER’S TIN                         PAYER’S TIN                             $                                   5  Date of order/agreement Copy A
                                                                            4  Compliance amount                                                   For 
PAYER’S name                                                                $                                                              Internal Revenue 
                                                                            6  Court or entity                                             Service Center
Street address (including apt. no.)                                                                                                        File with Form 1096.
                                                                            7  Case number                                                 For Privacy Act and 
City or town, state or province, country, and ZIP or foreign postal code                                                                   Paperwork Reduction 
                                                                            8  Case name or names of parties to suit, order, or agreement  Act Notice, see the 
                                                                                                                                           current General 
                                                                                                                                           Instructions for 
                                                                            9  Code                                                        Certain Information 
                                                                                                                                           Returns.
Form 1098-F (Rev. 1-2022)           Cat. No. 71382B                      www.irs.gov/Form1098F                  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
              0303                        VOID      CORRECTED
FILER’S name, street address, city or town, state or province, country, ZIP 1  Total amount required to be paid OMB No. 1545-2284
or foreign postal code, and telephone no.                                   $
                                                                            2  Amount to be paid for            Form 1098-F           Fines, Penalties, and 
                                                                               violation or potential violation (Rev. January 2022)        Other Amounts
                                                                            $                                   For calendar year     
                                                                            3  Restitution/remediation             20
                                                                               amount
FILER’S TIN                         PAYER’S TIN                             $                                   5  Date of order/agreement Copy A
                                                                            4  Compliance amount                                                   For 
PAYER’S name                                                                $                                                              Internal Revenue 
                                                                            6  Court or entity                                             Service Center
Street address (including apt. no.)                                                                                                        File with Form 1096.
                                                                            7  Case number                                                 For Privacy Act and 
City or town, state or province, country, and ZIP or foreign postal code                                                                   Paperwork Reduction 
                                                                            8  Case name or names of parties to suit, order, or agreement  Act Notice, see the 
                                                                                                                                           current General 
                                                                                                                                           Instructions for 
                                                                            9  Code                                                        Certain Information 
                                                                                                                                           Returns.
Form 1098-F (Rev. 1-2022)           Cat. No. 71382B                      www.irs.gov/Form1098F                  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
              0303                        VOID      CORRECTED
FILER’S name, street address, city or town, state or province, country, ZIP 1  Total amount required to be paid OMB No. 1545-2284
or foreign postal code, and telephone no.                                   $
                                                                            2  Amount to be paid for            Form 1098-F           Fines, Penalties, and 
                                                                               violation or potential violation (Rev. January 2022)        Other Amounts
                                                                            $                                   For calendar year     
                                                                            3  Restitution/remediation             20
                                                                               amount
FILER’S TIN                         PAYER’S TIN                             $                                   5  Date of order/agreement Copy A
                                                                            4  Compliance amount                                                   For 
PAYER’S name                                                                $                                                              Internal Revenue 
                                                                            6  Court or entity                                             Service Center
Street address (including apt. no.)                                                                                                        File with Form 1096.
                                                                            7  Case number                                                 For Privacy Act and 
City or town, state or province, country, and ZIP or foreign postal code                                                                   Paperwork Reduction 
                                                                            8  Case name or names of parties to suit, order, or agreement  Act Notice, see the 
                                                                                                                                           current General 
                                                                                                                                           Instructions for 
                                                                            9  Code                                                        Certain Information 
                                                                                                                                           Returns.
Form 1098-F (Rev. 1-2022)           Cat. No. 71382B                      www.irs.gov/Form1098F                  Department of the Treasury - Internal Revenue Service

                                                                             41

- 44 -

Page 44 of 66  Fileid: … ns/p1179/202309/a/xml/cycle03/source                                                                13:58 - 5-Sep-2023

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

Exhibit G                                                                                                                    Form 1098-MA

                                     VOID      CORRECTED 
FILER’S name, street address, city, state, ZIP code, and telephone no.                               OMB No. 1545-2221
                                                                                               Form 1098-MA                  Mortgage 
                                                                                               (Rev. September 2019)         Assistance 
                                                                                                      For calendar year      Payments
                                                                                                      20
FILER’S TIN                          HOMEOWNER’S TIN                   1. Total State HFA and homeowner mortgage payments        Copy A
                                                                       $                                                                 For 
HOMEOWNER’S name                                                       2. State HFA mortgage assistance payments             Internal Revenue 
                                                                                                                             Service Center
                                                                       $                                                         For Privacy Act 
Street address (including apt. no.) (optional)                         3. Homeowner mortgage payments                            and Paperwork 
                                                                       $                                                         Reduction Act 
City, state, and ZIP code (optional)                                                                                             Notice, see 
                                                                                                                             the current General 
                                                                                                                                 Instructions for 
Account number (optional)                                                                                                    Certain Information 
                                                                                                                                 Returns.
Form 1098-MA (Rev. 9-2019)           Cat. No. 58017D                    www.irs.gov/Form1098MA 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 
FILER’S name, street address, city, state, ZIP code, and telephone no.                               OMB No. 1545-2221
                                                                                               Form 1098-MA                  Mortgage 
                                                                                               (Rev. September 2019)         Assistance 
                                                                                                      For calendar year      Payments
                                                                                                      20
FILER’S TIN                          HOMEOWNER’S TIN                   1. Total State HFA and homeowner mortgage payments        Copy A
                                                                       $                                                                 For 
HOMEOWNER’S name                                                       2. State HFA mortgage assistance payments             Internal Revenue 
                                                                                                                             Service Center
                                                                       $                                                         For Privacy Act 
Street address (including apt. no.) (optional)                         3. Homeowner mortgage payments                            and Paperwork 
                                                                       $                                                         Reduction Act 
City, state, and ZIP code (optional)                                                                                             Notice, see 
                                                                                                                             the current General 
                                                                                                                                 Instructions for 
Account number (optional)                                                                                                    Certain Information 
                                                                                                                                 Returns.
Form 1098-MA (Rev. 9-2019)           Cat. No. 58017D                    www.irs.gov/Form1098MA 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 
FILER’S name, street address, city, state, ZIP code, and telephone no.                               OMB No. 1545-2221
                                                                                               Form 1098-MA                  Mortgage 
                                                                                               (Rev. September 2019)         Assistance 
                                                                                                      For calendar year      Payments
                                                                                                      20
FILER’S TIN                          HOMEOWNER’S TIN                   1. Total State HFA and homeowner mortgage payments        Copy A
                                                                       $                                                                 For 
HOMEOWNER’S name                                                       2. State HFA mortgage assistance payments             Internal Revenue 
                                                                                                                             Service Center
                                                                       $                                                         For Privacy Act 
Street address (including apt. no.) (optional)                         3. Homeowner mortgage payments                            and Paperwork 
                                                                       $                                                         Reduction Act 
City, state, and ZIP code (optional)                                                                                             Notice, see 
                                                                                                                             the current General 
                                                                                                                                 Instructions for 
Account number (optional)                                                                                                    Certain Information 
                                                                                                                                 Returns.
Form 1098-MA (Rev. 9-2019)           Cat. No. 58017D                    www.irs.gov/Form1098MA Department of the Treasury - Internal Revenue Service 

                                                                       42

- 45 -

Page 45 of 66  Fileid: … ns/p1179/202309/a/xml/cycle03/source                                                                               13:58 - 5-Sep-2023

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

Exhibit H                                                                                                                                   Form 1098-Q

              7474                       VOID            CORRECTED 
ISSUER’S name, street address, city or town, state or province, country, ZIP  ISSUER’S TIN                     OMB No. 1545-2234
or foreign postal code, and telephone no.
                                                                                                                                            Qualifying 
                                                                               PARTICIPANT’S TIN
                                                                                                               Form 1098-Q            Longevity Annuity 
                                         1.5 in                                                 .50 in         (Rev. December 2019)         Contract 
                                                                               1a Annuity amount on start date  For calendar year           Information
                                                                               $                                    20
                                                                               1b Annuity start date           2 Check if start date may be         Copy A 
                                                                                                               accelerated0.4 in
                                                                                                                                                    For 
                                                                                                                                            Service Center 
                                                         0.6 in                3 Total premiums 0.4 in         4   FMV of QLAC              Internal Revenue 
                                                                               $                               $                                                 
PARTICIPANT’S name                                                             5a January            dd        5b February            dd    File with Form 1096. 
                                                                                                                           0.34 in
                   0.5 in                                                      $                               $                            For Privacy Act 
                                                                               5c March              dd        5d April               dd    and Paperwork 
Street address (including apt. no.)                                            $                               $                            Reduction Act 
                                                0.6 in                         5e May                dd        5f  June               dd    Notice, see the 
                                                                               $                               $                            current General 
                                                                               5g July               dd        5h August              dd    Instructions for 
                                                                                                                                            Certain Information 
City or town, state or province, country, and ZIP or foreign postal code0.3 in $                               $                                    Returns. 
                                                                               5i  September         dd        5j  October            dd
Account number (see instructions)               Plan number                    $                               $ 
                                    0.5 in                                     5k November           dd        5l  December           dd
                                                                               $       1.0 in        0.4 in    $ 
Name of plan                                    Plan sponsor’s EIN
              0.5 in

Form 1098-Q (Rev. 12-2019)               Cat. No. 67073Z                       www.irs.gov/Form1098Q            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

              7474                       VOID            CORRECTED 
ISSUER’S name, street address, city or town, state or province, country, ZIP  ISSUER’S TIN                     OMB No. 1545-2234
or foreign postal code, and telephone no.
                                                                                                                                            Qualifying 
                                                                               PARTICIPANT’S TIN
                                                                                                               Form 1098-Q            Longevity Annuity 
                                                                                                               (Rev. December 2019)         Contract 
                                                                               1a Annuity amount on start date  For calendar year           Information
                                                                               $                                    20
                                                                               1b Annuity start date           2 Check if start date may be         Copy A 
                                                                                                               accelerated
                                                                                                                                                    For 
                                                                               3 Total premiums                4   FMV of QLAC              Internal Revenue 
                                                                                                                                            Service Center 
                                                                               $                               $                                                      
PARTICIPANT’S name                                                             5a January            dd        5b February            dd    File with Form 1096. 
                                                                               $                               $                            For Privacy Act 
                                                                               5c March              dd        5d April               dd    and Paperwork 
Street address (including apt. no.)                                            $                               $                            Reduction Act 
                                                                               5e May                dd        5f  June               dd    Notice, see the 
                                                                               $                               $                            current General 
                                                                               5g July               dd        5h August              dd    Instructions for 
                                                                                                                                            Certain Information 
City or town, state or province, country, and ZIP or foreign postal code       $                               $                                    Returns. 
                                                                               5i  September         dd        5j  October            dd
Account number (see instructions)               Plan number                    $                               $ 
                                                                               5k November           dd        5l  December           dd
                                                                               $                               $ 
Name of plan                                    Plan sponsor’s EIN

Form 1098-Q (Rev. 12-2019)               Cat. No. 67073Z                       www.irs.gov/Form1098Q            Department of the Treasury - Internal Revenue Service

                                                                                 43

- 46 -

Page 46 of 66  Fileid: … ns/p1179/202309/a/xml/cycle03/source                                                                                13:58 - 5-Sep-2023

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

Exhibit I                                                                                                                                    Form 1098-T

               8383                       VOID          CORRECTED
FILER’S name, street address, city or town, state or province, country, ZIP or 1 Payments received for        OMB No. 1545-1574
foreign postal code, and telephone number                                        qualied tuition and related 
                                                                                 expenses
                                                                               $                                                             Tuition 
                                                                               2                              2023                           Statement
                                                                                                                Form 1098-T
FILER’S employer identication no.      STUDENT’S TIN                          3                                                             Copy A
                                                                                                                                             For 
STUDENT’S name                                                                 4 Adjustments made for a       5 Scholarships or grants       Internal Revenue 
                                                                                 prior year                                                  Service Center
                                                                               $                              $                              File with Form 1096.
Street address (including apt. no.)                                            6 Adjustments to               7 Checked if the amount        For Privacy Act and 
                                                                                 scholarships or grants         in box 1 includes            Paperwork Reduction 
                                                                                 for a prior year               amounts for an 
City or town, state or province, country, and ZIP or foreign postal code                                        academic period              Act Notice, see the 
                                                                                                                beginning January–           2023 General
                                                                               $                                March 2024                   Instructions for
Service Provider/Acct. No. (see instr.)   8 Checked if at least                9 Checked if a graduate        10 Ins. contract reimb./refund Certain Information
                                            half-time student                    student                      $                              Returns.
Form 1098-T                             Cat. No. 25087J                          www.irs.gov/Form1098T          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

               8383                       VOID          CORRECTED
FILER’S name, street address, city or town, state or province, country, ZIP or 1 Payments received for        OMB No. 1545-1574
foreign postal code, and telephone number                                        qualied tuition and related 
                                                                                 expenses
                                                                               $                                                             Tuition 
                                                                               2                              2023                           Statement
                                                                                                                 Form 1098-T
FILER’S employer identication no.      STUDENT’S TIN                          3                                                             Copy A
                                                                                                                                             For 
STUDENT’S name                                                                 4 Adjustments made for a       5 Scholarships or grants       Internal Revenue 
                                                                                 prior year                                                  Service Center
                                                                               $                              $                              File with Form 1096.
Street address (including apt. no.)                                            6 Adjustments to               7 Checked if the amount        For Privacy Act and 
                                                                                 scholarships or grants          in box 1 includes           Paperwork Reduction 
                                                                                 for a prior year                amounts for an 
City or town, state or province, country, and ZIP or foreign postal code                                         academic period             Act Notice, see the 
                                                                                                                 beginning January–          2023 General
                                                                               $                                 March 2024                  Instructions for
Service Provider/Acct. No. (see instr.)   8 Checked if at least                9 Checked if a graduate        10 Ins. contract reimb./refund Certain Information
                                            half-time student                    student                      $                              Returns.
Form 1098-T                             Cat. No. 25087J                          www.irs.gov/Form1098T           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
              8383                        VOID          CORRECTED
FILER’S name, street address, city or town, state or province, country, ZIP or 1 Payments received for        OMB No. 1545-1574
foreign postal code, and telephone number                                        qualied tuition and related 
                                                                                 expenses
                                                                               $                                                             Tuition 
                                                                               2                              2023                           Statement
                                                                                                                 Form 1098-T
FILER’S employer identication no.      STUDENT’S TIN                          3                                                             Copy A
                                                                                                                                             For 
STUDENT’S name                                                                 4 Adjustments made for a       5 Scholarships or grants       Internal Revenue 
                                                                                 prior year                                                  Service Center
                                                                               $                              $                              File with Form 1096.
Street address (including apt. no.)                                            6 Adjustments to               7 Checked if the amount        For Privacy Act and 
                                                                                 scholarships or grants         in box 1 includes            Paperwork Reduction 
                                                                                 for a prior year               amounts for an 
City or town, state or province, country, and ZIP or foreign postal code                                        academic period              Act Notice, see the 
                                                                                                                beginning January–           2023 General
                                                                               $                                March 2024
Service Provider/Acct. No. (see instr.)   8 Checked if at least                9 Checked if a graduate        10 Ins. contract reimb./refund Instructions for
                                                                                                                                             Certain Information
                                            half-time student                    student                      $                              Returns.
Form 1098-T                             Cat. No. 25087J                          www.irs.gov/Form1098T          Department of the Treasury - Internal Revenue Service

                                                                                 44

- 47 -

Page 47 of 66 Fileid: … ns/p1179/202309/a/xml/cycle03/source 13:58 - 5-Sep-2023

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

Exhibit J Form 1099-A

8080 VOID CORRECTED
LENDER’S name, street address, city or town, state or province, country, ZIP or OMB No. 1545-0877
foreign postal code, and telephone no. Form 1099-A Acquisition or
(Rev. January 2022) Abandonment of
For calendar year Secured Property
20
1 Date of lender’s acquisition or 2 Balance of principal Copy A
LENDER’S TIN BORROWER’S TIN knowledge of abandonment outstanding For
$ Internal Revenue
BORROWER’S name 3 4 Fair market value of property Service Center
File with Form 1096.
$ For Privacy Act
Street address (including apt. no.) 5 Check if the borrower was personally liable for repayment of and Paperwork
the debt . . . . . . . . ... . Reduction Act
Notice, see the
City or town, state or province, country, and ZIP or foreign postal code 6 Description of property current General
Instructions for
Account number (see instructions) Certain
Information
Returns.
Form 1099-A (Rev. 1-2022) Cat. No. 14412G www.irs.gov/Form1099A 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
8080 VOID CORRECTED
LENDER’S name, street address, city or town, state or province, country, ZIP or OMB No. 1545-0877
foreign postal code, and telephone no. Form 1099-A Acquisition or
(Rev. January 2022) Abandonment of
For calendar year Secured Property
20
1 Date of lender’s acquisition or 2 Balance of principal Copy A
LENDER’S TIN BORROWER’S TIN knowledge of abandonment outstanding For
$ Internal Revenue
BORROWER’S name 3 4 Fair market value of property Service Center
File with Form 1096.
$ For Privacy Act
Street address (including apt. no.) 5 Check if the borrower was personally liable for repayment of and Paperwork
the debt . . . . . . . . ... . Reduction Act
Notice, see the
City or town, state or province, country, and ZIP or foreign postal code 6 Description of property current General
Instructions for
Account number (see instructions) Certain
Information
Returns.
Form 1099-A (Rev. 1-2022) Cat. No. 14412G www.irs.gov/Form1099A Department of the Treasury - Internal Revenue Service

- 48 -

Page 48 of 66  Fileid: … ns/p1179/202309/a/xml/cycle03/source                                                                                  13:58 - 5-Sep-2023

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

Exhibit K                                                                                                                                      Form 1099-B

               7979                       VOID      CORRECTED
PAYER’S name, street address, city or town, state or province, country, ZIP Applicable checkbox on Form 8949         OMB No. 1545-0715         Proceeds From 
or foreign postal code, and telephone no.                                                                                                      Broker and 
                                                                                                                         2023                  Barter Exchange 
                                                                                                                         Form 1099-B           Transactions
                                                                            1a Description of property (Example: 100 sh. XYZ Co.)
                                                                            1b Date acquired                  1c  Date sold or disposed
PAYER’S TIN                         RECIPIENT’S TIN                         1d Proceeds                       1e  Cost or other basis          Copy A
                                                                            $                                 $
                                                                            1f Accrued market discount        1g Wash sale loss disallowed            For 
                                                                            $                                 $                                Internal Revenue 
RECIPIENT’S name                                                            2   Short-term gain or loss       3  Check if proceeds from:       Service Center 
                                                                                Long-term gain or loss            Collectibles                 File with Form 1096.
                                                                                Ordinary                          QOF                          1.27 in
Street address (including apt. no.)                                         4  Federal income tax withheld    5  Check if noncovered       
                                                                            $                                    security
                                                                            6  Reported to IRS:               7  Check if loss is not allowed  For Privacy Act 
City or town, state or province, country, and ZIP or foreign postal code        Gross proceeds                   based on amount in 1d         and Paperwork 
                                                                                                                      2.60 in
                                                                                Net proceeds                                                   Reduction Act 
                                                    0.60 in                 8  Prot or (loss) realized in    9  Unrealized prot or (loss) on Notice, see the 
Account number (see instructions)                   2nd TIN not.                2023 on closed contracts         open contracts—12/31/2022     2023 General
                                                                                                                                               Instructions for
                                                                            $                                 $                                Certain 
CUSIP number                                     FATCA ling                10  Unrealized prot or (loss) on 11  Aggregate prot or (loss)    Information
                                                 requirement                    open contracts—12/31/2023         on contracts                 Returns.
14  State name   15  State identication no. 16  State tax withheld         $                                 $      4.20 in
                                          $                                 12  Check if basis reported to    13  Bartering
                                                                                IRS
                                          $                                                                   $                1.56 in
Form 1099-B                         Cat. No. 14411V                             www.irs.gov/Form1099B          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

               7979                       VOID      CORRECTED
PAYER’S name, street address, city or town, state or province, country, ZIP Applicable checkbox on Form 8949         OMB No. 1545-0715         Proceeds From 
or foreign postal code, and telephone no.                                                                                                      Broker and 
                                                                                                                         2023                  Barter Exchange 
                                                                                                                         Form 1099-B           Transactions
                                                                            1a Description of property (Example: 100 sh. XYZ Co.)
                                                                            1b Date acquired                  1c  Date sold or disposed
PAYER’S TIN                         RECIPIENT’S TIN                         1d Proceeds                       1e  Cost or other basis          Copy A
                                                                            $                                 $
                                                                            1f Accrued market discount        1g Wash sale loss disallowed            For 
                                                                            $                                 $                                Internal Revenue 
RECIPIENT’S name                                                            2   Short-term gain or loss       3  Check if proceeds from:       Service Center 
                                                                                Long-term gain or loss            Collectibles                 File with Form 1096.
                                                                                Ordinary                          QOF
Street address (including apt. no.)                                         4  Federal income tax withheld    5  Check if noncovered       
                                                                            $                                    security
                                                                            6  Reported to IRS:               7  Check if loss is not allowed  For Privacy Act 
City or town, state or province, country, and ZIP or foreign postal code        Gross proceeds                   based on amount in 1d         and Paperwork 
                                                                                Net proceeds                                                   Reduction Act 
                                                                            8  Prot or (loss) realized in    9  Unrealized prot or (loss) on Notice, see the 
Account number (see instructions)                   2nd TIN not.                2023 on closed contracts         open contracts—12/31/2022     2023 General
                                                                                                                                               Instructions for
                                                                            $                                 $                                Certain 
CUSIP number                                     FATCA ling                10  Unrealized prot or (loss) on 11  Aggregate prot or (loss)    Information
                                                 requirement                    open contracts—12/31/2023         on contracts                 Returns.
14  State name   15  State identication no. 16  State tax withheld         $                                 $
                                          $                                 12  Check if basis reported to    13  Bartering
                                                                                IRS
                                          $                                                                   $
Form 1099-B                         Cat. No. 14411V                             www.irs.gov/Form1099B          Department of the Treasury - Internal Revenue Service

                                                                              46

- 49 -

Page 49 of 66 Fileid: … ns/p1179/202309/a/xml/cycle03/source 13:58 - 5-Sep-2023

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

Exhibit L Form 1099-C

8585 VOID CORRECTED
CREDITOR’S name, street address, city or town, state or province, country, 1 Date of identiable event OMB No. 1545-2281
ZIP or foreign postal code, and telephone no.
2 Amount of debt discharged Form 1099-C Cancellation
$ (Rev. January 2022) of Debt
3 Interest, if included in box 2 For calendar year
$ 20
CREDITOR’S TIN DEBTOR’S TIN 4 Debt description Copy A
For
DEBTOR’S name Internal Revenue
Service Center
File with Form 1096. 1.3 in
Street address (including apt. no.) 5 Check here if the debtor was personally liable for For Privacy Act and
repayment of the debt . . . . . . . . Paperwork Reduction
City or town, state or province, country, and ZIP or foreign postal code Act Notice, see the
current General
Instructions for
Account number (see instructions) 6 Identiable event code 7 Fair market value of property Certain Information
$ Returns.
Form 1099-C (Rev. 1-2022) Cat. No. 26280W www.irs.gov/Form1099C 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
8585 VOID CORRECTED
CREDITOR’S name, street address, city or town, state or province, country, 1 Date of identiable event OMB No. 1545-2281
ZIP or foreign postal code, and telephone no.
2 Amount of debt discharged Form 1099-C Cancellation
$ (Rev. January 2022) of Debt
3 Interest, if included in box 2 For calendar year
$ 20
CREDITOR’S TIN DEBTOR’S TIN 4 Debt description Copy A
For
DEBTOR’S name Internal Revenue
Service Center
File with Form 1096.
Street address (including apt. no.) 5 Check here if the debtor was personally liable for For Privacy Act and
repayment of the debt . . . . . . . . Paperwork Reduction
City or town, state or province, country, and ZIP or foreign postal code Act Notice, see the
current General
Instructions for
Account number (see instructions) 6 Identiable event code 7 Fair market value of property Certain Information
$ Returns.
Form 1099-C (Rev. 1-2022) Cat. No. 26280W www.irs.gov/Form1099C 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
8585 VOID CORRECTED
CREDITOR’S name, street address, city or town, state or province, country, 1 Date of identiable event OMB No. 1545-2281
ZIP or foreign postal code, and telephone no.
2 Amount of debt discharged Form 1099-C Cancellation
$ (Rev. January 2022) of Debt
3 Interest, if included in box 2 For calendar year
$ 20
CREDITOR’S TIN DEBTOR’S TIN 4 Debt description Copy A
For
DEBTOR’S name Internal Revenue
Service Center
File with Form 1096.
Street address (including apt. no.) 5 Check here if the debtor was personally liable for For Privacy Act and
repayment of the debt . . . . . . . . Paperwork Reduction
City or town, state or province, country, and ZIP or foreign postal code Act Notice, see the
current General
Instructions for
Account number (see instructions) 6 Identiable event code 7 Fair market value of property Certain Information
$ Returns.
Form 1099-C (Rev. 1-2022) Cat. No. 26280W www.irs.gov/Form1099C Department of the Treasury - Internal Revenue Service

- 50 -

Page 50 of 66  Fileid: … ns/p1179/202309/a/xml/cycle03/source                                                                                             13:58 - 5-Sep-2023

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

Exhibit M                                                                                                                                       Form 1099-DIV

              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  Qualied 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 
                                                                            7    Foreign tax paid                 8    Foreign country or U.S. possession Notice, see the 
                                                                                                                                                          current General 
City or town, state or province, country, and ZIP or foreign postal code    $                                                                             Instructions for 
                                                                                                                                                          Certain 
                                                                            9    Cash liquidation distributions   10   Noncash liquidation distributions  Information 
                                                                            $                                     $                                       Returns. 
                                                    11  FATCA ling         12  Exempt-interest dividends         13  Specied private activity 
                                                    requirement                                                        bond interest dividends
                                                                            $                                     $ 
Account number (see instructions)                   2nd TIN not.            14  State 15  State identication 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

              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  Qualied 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 
                                                                            7    Foreign tax paid                 8    Foreign country or U.S. possession Notice, see the 
                                                                                                                                                          current General 
City or town, state or province, country, and ZIP or foreign postal code    $                                                                             Instructions for 
                                                                                                                                                          Certain 
                                                                            9    Cash liquidation distributions   10   Noncash liquidation distributions  Information 
                                                                            $                                     $                                       Returns. 
                                                    11  FATCA ling         12  Exempt-interest dividends         13  Specied private activity 
                                                    requirement                                                        bond interest dividends
                                                                            $                                     $ 
Account number (see instructions)                   2nd TIN not.            14  State 15  State identication 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

                                                                            48

- 51 -

Page 51 of 66  Fileid: … ns/p1179/202309/a/xml/cycle03/source                                                                           13:58 - 5-Sep-2023

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

Exhibit N                                                                                                                               Form 1099-G

              8686                          VOID               CORRECTED
PAYER’S name, street address, city or town, state or province, country, ZIP 1 Unemployment compensationOMB No. 1545-0120
or foreign postal code, and telephone no.
                                                                                                           Form 1099-G                        Certain 
                                                                            $                              (Rev. January 2022)          Government 
                                                                            2 State or local income tax 
                                                                              refunds, credits, or offsets For calendar year                  Payments
                                                                            $                                   20
PAYER’S TIN                           RECIPIENT’S TIN                       3 Box 2 amount is for tax year 4Federal income tax withheld          Copy A
                                                                                                           $                                          For 
RECIPIENT’S name                                                            5 RTAA payments                6 Taxable grants             Internal Revenue 
                                                                            $                              $                                  Service Center
                                                                            7 Agriculture payments         8 Check if box 2 is          File with Form 1096.
                                                                                                             trade or business 
Street address (including apt. no.)                                         $                                income                           For Privacy Act 
                                                                            9 Market gain                                                     and Paperwork 
                                                                                                                                              Reduction Act 
City or town, state or province, country, and ZIP or foreign postal code    $                                                                 Notice, see the 
                                                                            10a State 10b State identication no.11 State income tax withheld current General 
Account number (see instructions)                              2nd TIN not.                                     $                             Instructions for 
                                                                                                                                        Certain Information 
                                                                                                                $                                Returns.
Form 1099-G (Rev. 1-2022)                   Cat. No. 14438M                 www.irs.gov/Form1099G          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

              8686                          VOID               CORRECTED
PAYER’S name, street address, city or town, state or province, country, ZIP 1 Unemployment compensationOMB No. 1545-0120
or foreign postal code, and telephone no.
                                                                                                           Form 1099-G                        Certain 
                                                                            $                              (Rev. January 2022)          Government 
                                                                            2 State or local income tax 
                                                                              refunds, credits, or offsets For calendar year                  Payments
                                                                            $                                   20
PAYER’S TIN                           RECIPIENT’S TIN                       3 Box 2 amount is for tax year 4Federal income tax withheld          Copy A
                                                                                                           $                                          For 
RECIPIENT’S name                                                            5 RTAA payments                6 Taxable grants             Internal Revenue 
                                                                            $                              $                                  Service Center
                                                                            7 Agriculture payments         8 Check if box 2 is          File with Form 1096.
                                                                                                             trade or business 
Street address (including apt. no.)                                         $                                income                           For Privacy Act 
                                                                            9 Market gain                                                     and Paperwork 
                                                                                                                                              Reduction Act 
City or town, state or province, country, and ZIP or foreign postal code    $                                                                 Notice, see the 
                                                                            10a State 10b State identication no.11 State income tax withheld current General 
Account number (see instructions)                              2nd TIN not.                                     $                             Instructions for 
                                                                                                                                        Certain Information 
                                                                                                                $                                Returns.
Form 1099-G (Rev. 1-2022)                   Cat. No. 14438M                 www.irs.gov/Form1099G          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

              8686                          VOID               CORRECTED
PAYER’S name, street address, city or town, state or province, country, ZIP 1 Unemployment compensationOMB No. 1545-0120
or foreign postal code, and telephone no.
                                                                                                           Form 1099-G                        Certain 
                                                                            $                              (Rev. January 2022)          Government 
                                                                            2 State or local income tax 
                                                                              refunds, credits, or offsets For calendar year                  Payments
                                                                            $                                   20
PAYER’S TIN                           RECIPIENT’S TIN                       3 Box 2 amount is for tax year 4Federal income tax withheld          Copy A
                                                                                                           $                                          For 
RECIPIENT’S name                                                            5 RTAA payments                6 Taxable grants             Internal Revenue 
                                                                            $                              $                                  Service Center
                                                                            7 Agriculture payments         8 Check if box 2 is          File with Form 1096.
                                                                                                             trade or business 
Street address (including apt. no.)                                         $                                income                           For Privacy Act 
                                                                            9 Market gain                                                     and Paperwork 
                                                                                                                                              Reduction Act 
City or town, state or province, country, and ZIP or foreign postal code    $                                                                 Notice, see the 
                                                                            10a State 10b State identication no.11 State income tax withheld current General 
Account number (see instructions)                              2nd TIN not.                                     $                             Instructions for 
                                                                                                                                        Certain Information 
                                                                                                                $                                Returns.
Form 1099-G (Rev. 1-2022)                   Cat. No. 14438M                 www.irs.gov/Form1099G          Department of the Treasury - Internal Revenue Service

                                                                            49

- 52 -

Page 52 of 66  Fileid: … ns/p1179/202309/a/xml/cycle03/source                                                                                            13:58 - 5-Sep-2023

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

Exhibit O                                                                                                                                             Form 1099-INT

              9292                       VOID            CORRECTED
PAYER’S name, street address, city or town, state or province, country, ZIP Payer’s RTN (optional)                     OMB No. 1545-0112
or foreign postal code, and telephone no.
                                                                                                                       Form 1099-INT                        Interest 
                                                                            1 Interest income                          (Rev. January 2022)                  Income
                                                                                                                       For calendar year
                                                                            $                                                   20
                                                                            2 Early withdrawal penalty
                                                                                                                                                            Copy A
PAYER’S TIN                         RECIPIENT’S TIN                         $
                                                                            3 Interest on U.S. Savings Bonds and Treasury obligations                       For 
                                                                                                                                                         Internal Revenue 
                                                                                                                                                            Service Center
                                                                            $
RECIPIENT’S name                                                            4 Federal income tax withheld 5 Investment expenses                           File with Form 1096.
                                                                            $                         $
                                                                            6 Foreign tax paid                      7 Foreign country or U.S. possession  For Privacy Act 
Street address (including apt. no.)                                         $                                                                             and Paperwork 
                                                                            8 Tax-exempt interest                   9  Specied private activity bond       Reduction Act 
                                                                                                                       interest                           Notice, see the 
City or town, state or province, country, and ZIP or foreign postal code    $                         $                                                  current General 
                                                                            10 Market discount                      11 Bond premium                      Instructions for 
                                                                                                                                                            Certain 
                                                         FATCA ling        $                         $                                                     Information 
                                                         requirement        12 Bond premium on Treasury obligations 13 Bond premium on tax-exempt bond      Returns.
                                                                            $                         $
Account number (see instructions)                        2nd TIN not. 14 Tax-exempt and tax credit                  15 State 16 State identication no.  17 State tax withheld
                                                                               bond CUSIP no.                                                            $
                                                                                                                                                         $
Form 1099-INT (Rev. 1-2022)              Cat. No. 14410K                    www.irs.gov/Form1099INT                   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

              9292                       VOID            CORRECTED
PAYER’S name, street address, city or town, state or province, country, ZIP Payer’s RTN (optional)                     OMB No. 1545-0112
or foreign postal code, and telephone no.
                                                                                                                       Form 1099-INT                        Interest 
                                                                            1 Interest income                          (Rev. January 2022)                  Income
                                                                                                                       For calendar year
                                                                            $                                                   20
                                                                            2 Early withdrawal penalty
                                                                                                                                                            Copy A
PAYER’S TIN                         RECIPIENT’S TIN                         $
                                                                            3 Interest on U.S. Savings Bonds and Treasury obligations                       For 
                                                                                                                                                         Internal Revenue 
                                                                                                                                                            Service Center
                                                                            $
RECIPIENT’S name                                                            4 Federal income tax withheld 5 Investment expenses                           File with Form 1096.
                                                                            $                         $
                                                                            6 Foreign tax paid                      7 Foreign country or U.S. possession  For Privacy Act 
Street address (including apt. no.)                                         $                                                                             and Paperwork 
                                                                            8 Tax-exempt interest                   9  Specied private activity bond       Reduction Act 
                                                                                                                       interest                           Notice, see the 
City or town, state or province, country, and ZIP or foreign postal code    $                         $                                                  current General 
                                                                            10 Market discount                      11 Bond premium                      Instructions for 
                                                                                                                                                            Certain 
                                                         FATCA ling        $                         $                                                     Information 
                                                         requirement        12 Bond premium on Treasury obligations 13 Bond premium on tax-exempt bond      Returns.
                                                                            $                         $
Account number (see instructions)                        2nd TIN not. 14 Tax-exempt and tax credit                  15 State 16 State identication no.  17 State tax withheld
                                                                               bond CUSIP no.                                                            $
                                                                                                                                                         $
Form 1099-INT (Rev. 1-2022)              Cat. No. 14410K                    www.irs.gov/Form1099INT                   Department of the Treasury - Internal Revenue Service

                                                                             50

- 53 -

Page 53 of 66  Fileid: … ns/p1179/202309/a/xml/cycle03/source                                                                         13:58 - 5-Sep-2023

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

Exhibit P                                                                                                                              Form 1099-K

              1010                        VOID            CORRECTED 
FILER’S name, street address, city or town, state or province, country, ZIP  FILER’S TIN                  OMB No. 1545-2205
or foreign postal code, and telephone no.                                               0.33 in
                                                                                                                                 Payment Card and 
                                                                             PAYEE’S TIN
                                                                                                          Form 1099-K                     Third Party 
                                      1.40 in
                                                                             1a Gross amount of payment   (Rev. January 2022)             Network 
                                                                                 card/third party network For calendar year           Transactions
                                                                                 transactions 0.50 in
                                                                             $                                 20
                                                                             1b Card Not Present          2   Merchant category code          Copy A 
                                                                                 transactions                          0.42 in
Check to indicate if FILER is a (an): Check to indicate transactions         $                                                                For 
                                      reported are:
Payment settlement entity (PSE)       Payment card                           3   Number of payment        4   Federal income tax      Internal Revenue 
Electronic Payment Facilitator            1.56 in         0.09 in                transactions 0.42 in         withheld                    Service Center 
(EPF)/Other third party               Third party network                                                 $                                                     
PAYEE’S name                                                                 5a January                   5b February                 File with Form 1096. 
                                                                             $                            $                               For Privacy Act 
                                                                             5c March                     5d April                        and Paperwork 
                                                                                                                       0.33 in
Street address (including apt. no.)                                          $                            $                               Reduction Act 
                                                                             5e May                       5f  June                        Notice, see the 
                                                                             $                            $                               current General 
                                                                             5g July                      5h August                       Instructions for 
                                                                                                                                      Certain Information 
City or town, state or province, country, and ZIP or foreign postal code     $                            $                                   Returns. 
                                                                             5i  September                5j  October
PSE’S name and telephone number                                              $                            $ 
                                                                             5k November                  5l  December
                                                                             $                            $ 
Account number (see instructions)                         2nd TIN not.       6   State                    7   State identication no. 8   State income tax withheld
                                                                                                                                      $
                                                                                                                                      $
Form 1099-K (Rev. 1-2022)             Cat. No. 54118B                        www.irs.gov/Form1099K        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

              1010                        VOID            CORRECTED 
FILER’S name, street address, city or town, state or province, country, ZIP  FILER’S TIN                  OMB No. 1545-2205
or foreign postal code, and telephone no.
                                                                                                                                 Payment Card and 
                                                                             PAYEE’S TIN
                                                                                                          Form 1099-K                     Third Party 
                                                                             1a Gross amount of payment   (Rev. January 2022)             Network 
                                                                                 card/third party network For calendar year           Transactions
                                                                                 transactions 
                                                                             $                                 20
                                                                             1b Card Not Present          2   Merchant category code          Copy A 
                                                                                 transactions 
Check to indicate if FILER is a (an): Check to indicate transactions         $                                                                For 
                                      reported are:
Payment settlement entity (PSE)       Payment card                           3   Number of payment        4   Federal income tax      Internal Revenue 
Electronic Payment Facilitator                                                   transactions                 withheld                    Service Center 
(EPF)/Other third party               Third party network                                                 $                                    
PAYEE’S name                                                                 5a January                   5b February                 File with Form 1096. 
                                                                             $                            $                               For Privacy Act 
                                                                             5c March                     5d April                        and Paperwork 
Street address (including apt. no.)                                          $                            $                               Reduction Act 
                                                                             5e May                       5f  June                        Notice, see the 
                                                                             $                            $                               current General 
                                                                             5g July                      5h August                       Instructions for 
                                                                                                                                      Certain Information 
City or town, state or province, country, and ZIP or foreign postal code     $                            $                                   Returns. 
                                                                             5i  September                5j  October
PSE’S name and telephone number                                              $                            $ 
                                                                             5k November                  5l  December
                                                                             $                            $ 
Account number (see instructions)                         2nd TIN not.       6   State                    7   State identication no. 8   State income tax withheld
                                                                                                                                      $
                                                                                                                                      $
Form 1099-K (Rev. 1-2022)             Cat. No. 54118B                        www.irs.gov/Form1099K        Department of the Treasury - Internal Revenue Service

                                                                             51

- 54 -

Page 54 of 66  Fileid: … ns/p1179/202309/a/xml/cycle03/source                                                                            13:58 - 5-Sep-2023

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

Exhibit Q                                                                                                                                Form 1099-LS

                    1616                      VOID            CORRECTED
ACQUIRER’S name, street address, city or town, state or province, country, 1  Amount paid to payment OMB No. 1545-2281
ZIP or foreign postal code, and telephone no.                                recipient
                                                                           $                         Form 1099-LS                        Reportable Life 
                                                                           2  Date of sale           (Rev. December 2019)                Insurance Sale
                                                                                                     For calendar year     
                                                                                                          20
ACQUIRER’S TIN                      PAYMENT RECIPIENT’S TIN                Issuer’s name                                                 Copy A
                                                                                                                                                 For 
PAYMENT RECIPIENT’S name                                                   Acquirer’s information contact name, street address, city or  Internal Revenue 
                                                                           town, state or province, country, ZIP or foreign postal code, Service Center
                                                                           and telephone no. (if different from ACQUIRER)                File with Form 1096. 
                                                                                                                                         For Privacy Act 
Street address (including apt. no.)                                                                                                      and Paperwork 
                                                                                                                                         Reduction Act 
                                                                                                                                         Notice, see the 
City or town, state or province, country, and ZIP or foreign postal code                                                                 current General 
                                                                                                                                         Instructions for 
Policy number                                                                                                                                    Certain 
                                                                                                                                         Information 
                                                                                                                                         Returns.
Form 1099-LS (Rev. 12-2019)                   Cat. No. 71383M              www.irs.gov/Form1099LS    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
                    1616                      VOID                  CORRECTED
ACQUIRER’S name, street address, city or town, state or province, country, 1  Amount paid to payment OMB No. 1545-2281
ZIP or foreign postal code, and telephone no.                                recipient
                                                                           $                         Form 1099-LS                        Reportable Life 
                                                                           2  Date of sale           (Rev. December 2019)                Insurance Sale
                                                                                                     For calendar year     
                                                                                                          20
ACQUIRER’S TIN                      PAYMENT RECIPIENT’S TIN                Issuer’s name                                                 Copy A
                                                                                                                                                 For 
PAYMENT RECIPIENT’S name                                                   Acquirer’s information contact name, street address, city or  Internal Revenue 
                                                                           town, state or province, country, ZIP or foreign postal code, Service Center
                                                                           and telephone no. (if different from ACQUIRER)                File with Form 1096. 
                                                                                                                                         For Privacy Act 
Street address (including apt. no.)                                                                                                      and Paperwork 
                                                                                                                                         Reduction Act 
                                                                                                                                         Notice, see the 
City or town, state or province, country, and ZIP or foreign postal code                                                                 current General 
                                                                                                                                         Instructions for 
Policy number                                                                                                                                    Certain 
                                                                                                                                         Information 
                                                                                                                                         Returns.
Form 1099-LS (Rev. 12-2019)                   Cat. No. 71383M              www.irs.gov/Form1099LS    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
                    1616                      VOID                  CORRECTED
ACQUIRER’S name, street address, city or town, state or province, country, 1  Amount paid to payment OMB No. 1545-2281
ZIP or foreign postal code, and telephone no.                                recipient
                                                                           $                         Form 1099-LS                        Reportable Life 
                                                                           2  Date of sale           (Rev. December 2019)                Insurance Sale
                                                                                                     For calendar year     
                                                                                                          20
ACQUIRER’S TIN                      PAYMENT RECIPIENT’S TIN                Issuer’s name                                                 Copy A
                                                                                                                                                 For 
PAYMENT RECIPIENT’S name                                                   Acquirer’s information contact name, street address, city or  Internal Revenue 
                                                                           town, state or province, country, ZIP or foreign postal code, Service Center
                                                                           and telephone no. (if different from ACQUIRER)                File with Form 1096. 
                                                                                                                                         For Privacy Act 
Street address (including apt. no.)                                                                                                      and Paperwork 
                                                                                                                                         Reduction Act 
                                                                                                                                         Notice, see the 
City or town, state or province, country, and ZIP or foreign postal code                                                                 current General 
                                                                                                                                         Instructions for 
Policy number                                                                                                                                    Certain 
                                                                                                                                         Information 
                                                                                                                                         Returns.
Form 1099-LS (Rev. 12-2019)                   Cat. No. 71383M              www.irs.gov/Form1099LS    Department of the Treasury - Internal Revenue Service

                                                                           52

- 55 -

Page 55 of 66  Fileid: … ns/p1179/202309/a/xml/cycle03/source                                                                                 13:58 - 5-Sep-2023

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

Exhibit R                                                                                                                               Form 1099-MISC

                   9595                         VOID         CORRECTED
       PAYER’S name, street address, city or town, state or province, country, ZIP 1 Rents                      OMB No. 1545-0115
       or foreign postal code, and telephone no.
                                                                                   $                            Form 1099-MISC               Miscellaneous 
                                                                                   2 Royalties                  (Rev. January 2022)              Information
                                                                                                                For calendar year     
.45 in                                                                             $                                 20
                                                                                   3 Other income               4 Federal income tax withheld    Copy A
                                                                                   $                            $                                            For 
       PAYER’S TIN                         RECIPIENT’S TIN                         5 Fishing boat proceeds      6 Medical and health care     Internal Revenue 
                                                                                                                 payments                        Service Center

                                                                                   $                            $                             File with Form 1096.
       RECIPIENT’S name                                                            7 Payer made direct sales    8 Substitute payments in lieu  For Privacy Act 
                                                                                   totaling $5,000 or more of    of dividends or interest
                                                                                   consumer products to                                        and Paperwork 
                                                                                   recipient for resale         $                                Reduction Act 
       Street address (including apt. no.)                                         9 Crop insurance proceeds    10 Gross proceeds paid to an     Notice, see the 
                                                                                                                   attorney                   current General 
                                                .50 in
                                                                                   $                            $                             Instructions for 
       City or town, state or province, country, and ZIP or foreign postal code    11 Fish purchased for resale 12 Section 409A deferrals        Certain 
                                                                                                                                                 Information 
                                                                                   $                            $                                Returns.
                                                           13 FATCA ling          14 Excess golden parachute   15 Nonqualied deferred 
                                                             requirement              payments                     compensation
                                                                                   $                            $
       Account number (see instructions)                   2nd TIN not.            16 State tax withheld        17 State/Payer’s state no.    18 State income
                                                                                   $                                                          $
                                                                                   $                                                          $
       Form 1099-MISC (Rev. 1-2022)        Cat. No. 14425J   www.irs.gov/Form1099MISC                           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
                                                                                               1.00 in

                   9595                         VOID         CORRECTED
       PAYER’S name, street address, city or town, state or province, country, ZIP 1 Rents                      OMB No. 1545-0115
       or foreign postal code, and telephone no.
                                                                                   $                            Form 1099-MISC               Miscellaneous 
                                                                                   2 Royalties                  (Rev. January 2022)              Information
                                                                                                                For calendar year     
                                                                                   $                                 20
                                                                                   3 Other income               4 Federal income tax withheld    Copy A
                                                                                   $                            $                                            For 
       PAYER’S TIN                         RECIPIENT’S TIN                         5 Fishing boat proceeds      6 Medical and health care     Internal Revenue 
                                                                                                                 payments                        Service Center

                                                                                   $                            $                             File with Form 1096.
       RECIPIENT’S name                                                            7 Payer made direct sales    8 Substitute payments in lieu  For Privacy Act 
                                                                                   totaling $5,000 or more of    of dividends or interest
                                                                                   consumer products to                                        and Paperwork 
                                                                                   recipient for resale         $                                Reduction Act 
       Street address (including apt. no.)                                         9 Crop insurance proceeds    10 Gross proceeds paid to an     Notice, see the 
                                                                                                                   attorney                   current General 
                                                                                   $                            $                             Instructions for 
       City or town, state or province, country, and ZIP or foreign postal code    11 Fish purchased for resale 12 Section 409A deferrals        Certain 
                                                                                                                                                 Information 
                                                                                   $                            $                                Returns.
                                                           13 FATCA ling          14 Excess golden parachute   15 Nonqualied deferred 
                                                             requirement              payments                     compensation
                                                                                   $                            $
       Account number (see instructions)                   2nd TIN not.            16 State tax withheld        17 State/Payer’s state no.    18 State income
                                                                                   $                                                          $
                                                                                   $                                                          $
       Form 1099-MISC (Rev. 1-2022)        Cat. No. 14425J   www.irs.gov/Form1099MISC                            Department of the Treasury - Internal Revenue Service

                                                                                      53

- 56 -

Page 56 of 66  Fileid: … ns/p1179/202309/a/xml/cycle03/source                                                                    13:58 - 5-Sep-2023

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

Exhibit S                                                                                                                        Form 1099-NEC

              7171                          VOID               CORRECTED
PAYER’S name, street address, city or town, state or province, country, ZIP                               OMB No. 1545-0116
or foreign postal code, and telephone no.
                                                                                                          Form 1099-NEC           Nonemployee 
                                                                                                          (Rev. January 2022)    Compensation
                                                                                                          For calendar year
                                                                                                               20
PAYER’S TIN                           RECIPIENT’S TIN                       1 Nonemployee compensation                                   Copy A
                                                                            $                                                    For Internal Revenue 
RECIPIENT’S name                                                            2 Payer made direct sales totaling $5,000 or more of   Service Center
                                                                              consumer products to recipient for resale          File with Form 1096.
                                                                            3                                                      For Privacy Act and 
Street address (including apt. no.)                                                                                              Paperwork Reduction Act 
                                                                                                                                  Notice, see the current 
                                                                            4 Federal income tax withheld                        General Instructions for 
                                                                                                                                   Certain Information 
City or town, state or province, country, and ZIP or foreign postal code    $                                                            Returns.
                                                                            5 State tax withheld 6 State/Payer’s state no.       7 State income
Account number (see instructions)                              2nd TIN not. $                                                    $
                                                                            $                                                    $
Form 1099-NEC (Rev. 1-2022)              Cat. No. 72590N                 www.irs.gov/Form1099NEC          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
              7171                          VOID               CORRECTED
PAYER’S name, street address, city or town, state or province, country, ZIP                               OMB No. 1545-0116
or foreign postal code, and telephone no.
                                                                                                          Form 1099-NEC          Nonemployee 
                                                                                                          (Rev. January 2022)    Compensation
                                                                                                          For calendar year
                                                                                                               20
PAYER’S TIN                           RECIPIENT’S TIN                       1 Nonemployee compensation                                   Copy A
                                                                            $                                                    For Internal Revenue 
RECIPIENT’S name                                                            2 Payer made direct sales totaling $5,000 or more of   Service Center
                                                                              consumer products to recipient for resale          File with Form 1096.
                                                                            3                                                      For Privacy Act and 
Street address (including apt. no.)                                                                                              Paperwork Reduction Act 
                                                                                                                                  Notice, see the current 
                                                                            4 Federal income tax withheld                        General Instructions for 
                                                                                                                                   Certain Information 
City or town, state or province, country, and ZIP or foreign postal code    $                                                            Returns.
                                                                            5 State tax withheld 6 State/Payer’s state no.       7 State income
Account number (see instructions)                              2nd TIN not. $                                                    $
                                                                            $                                                    $
Form 1099-NEC (Rev. 1-2022)              Cat. No. 72590N                 www.irs.gov/Form1099NEC          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
              7171                          VOID               CORRECTED
PAYER’S name, street address, city or town, state or province, country, ZIP                               OMB No. 1545-0116
or foreign postal code, and telephone no.
                                                                                                          Form 1099-NEC          Nonemployee 
                                                                                                          (Rev. January 2022)    Compensation
                                                                                                          For calendar year
                                                                                                               20
PAYER’S TIN                           RECIPIENT’S TIN                       1 Nonemployee compensation                                   Copy A
                                                                            $                                                    For Internal Revenue 
RECIPIENT’S name                                                            2 Payer made direct sales totaling $5,000 or more of   Service Center
                                                                              consumer products to recipient for resale          File with Form 1096.
                                                                            3                                                      For Privacy Act and 
Street address (including apt. no.)                                                                                              Paperwork Reduction Act 
                                                                                                                                  Notice, see the current 
                                                                            4 Federal income tax withheld                        General Instructions for 
                                                                                                                                   Certain Information 
City or town, state or province, country, and ZIP or foreign postal code    $                                                            Returns.
                                                                            5 State tax withheld 6 State/Payer’s state no.       7 State income
Account number (see instructions)                              2nd TIN not. $                                                    $
                                                                            $                                                    $
Form 1099-NEC (Rev. 1-2022)              Cat. No. 72590N                 www.irs.gov/Form1099NEC          Department of the Treasury - Internal Revenue Service

                                                                              54

- 57 -

Page 57 of 66  Fileid: … ns/p1179/202309/a/xml/cycle03/source                                                                       13:58 - 5-Sep-2023

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

Exhibit T                                                                                                                          Form 1099-OID

              9696                             VOID CORRECTED
PAYER’S name, street address, city or town, state or province, country,  1 Original issue discount for OMB No. 1545-0117
ZIP or foreign postal code, and telephone no.                              the year
                                                                         $
                                                                                                       Form 1099-OID                Original Issue 
                                                                                                       (Rev. October 2019)          Discount
                                                                         2 Other periodic interest
                                                                                                        For calendar year     
                                                                         $                                    20
PAYER’S TIN                        RECIPIENT’S TIN                       3 Early withdrawal penalty    4 Federal income tax withheld
                                                                                                                                    Copy A
                                                                         $                             $
                                                                         5 Market discount             6 Acquisition premium
                                                                                                                                    For 
RECIPIENT’S name                                                         $                             $                            Internal Revenue 
                                                                                                                                    Service Center
                                                                         7 Description
                                                                                                                                    File with Form 1096.
Street address (including apt. no.)
                                                                                                                                    For Privacy Act 
City or town, state or province, country, and ZIP or foreign postal code 8 Original issue discount on  9 Investment expenses        and Paperwork 
                                                                           U.S. Treasury obligations                                Reduction Act 
                                                                                                                                    Notice, see the 
                                                                         $                             $
                                                    FATCA ling          10 Bond premium               11 Tax-exempt OID            current General 
                                                    requirement                                                                     Instructions for 
                                                                                                                                    Certain 
                                                                         $                             $
Account number (see instructions)                   2nd TIN not.         12 State 13 State identication no. 14 State tax withheld  Information 
                                                                                                                                    Returns.
                                                                                                             $
                                                                                                             $
Form 1099-OID (Rev. 10-2019)       Cat. No. 14421R                       www.irs.gov/Form1099OID         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

              9696                             VOID CORRECTED
PAYER’S name, street address, city or town, state or province, country,  1 Original issue discount for OMB No. 1545-0117
ZIP or foreign postal code, and telephone no.                              the year
                                                                         $
                                                                                                       Form 1099-OID                Original Issue 
                                                                                                       (Rev. October 2019)          Discount
                                                                         2 Other periodic interest
                                                                                                        For calendar year     
                                                                         $                                    20
PAYER’S TIN                        RECIPIENT’S TIN                       3 Early withdrawal penalty    4 Federal income tax withheld
                                                                                                                                    Copy A
                                                                         $                             $
                                                                         5 Market discount             6 Acquisition premium
                                                                                                                                    For 
RECIPIENT’S name                                                         $                             $                            Internal Revenue 
                                                                                                                                    Service Center
                                                                         7 Description
                                                                                                                                    File with Form 1096.
Street address (including apt. no.)
                                                                                                                                    For Privacy Act 
City or town, state or province, country, and ZIP or foreign postal code 8 Original issue discount on  9 Investment expenses        and Paperwork 
                                                                           U.S. Treasury obligations                                Reduction Act 
                                                                                                                                    Notice, see the 
                                                                         $                             $
                                                    FATCA ling          10 Bond premium               11 Tax-exempt OID            current General 
                                                    requirement                                                                     Instructions for 
                                                                                                                                    Certain 
                                                                         $                             $
Account number (see instructions)                   2nd TIN not.         12 State 13 State identication no. 14 State tax withheld  Information 
                                                                                                                                    Returns.
                                                                                                             $
                                                                                                             $
Form 1099-OID (Rev. 10-2019)       Cat. No. 14421R                       www.irs.gov/Form1099OID         Department of the Treasury - Internal Revenue Service

                                                                           55

- 58 -

Page 58 of 66  Fileid: … ns/p1179/202309/a/xml/cycle03/source                                                                         13:58 - 5-Sep-2023

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

Exhibit U                                                                                                                      Form 1099-PATR

              9797                            VOID  CORRECTED
PAYER’S name, street address, city or town, state or province, country,  1 Patronage dividends         OMB No. 1545-0118
ZIP or foreign postal code, and telephone no.                            $                                                            Taxable 
                                                                         2 Nonpatronage distributions  Form 1099-PATR                 Distributions 
                                                                         $                             (Rev. January 2023)        Received From 
                                                                         3 Per-unit retain allocations For calendar year              Cooperatives
                                                                         $                                 20
PAYER’S TIN                         RECIPIENT’S TIN                      4 Federal income tax withheld 5 Redeemed nonqualied notices Copy A
                                                                         $                             $                              For 
RECIPIENT’S name                                                         6 Section 199A(g) deduction   7 Qualied payments            Internal Revenue 
                                                                                                          (Section 199A(b)(7))        Service Center
                                                                         $                             $                              File with Form 1096.
Street address (including apt. no.)                                      8 Section 199A(a) qual. items 9 Section 199A(a) SSTB items   For Privacy Act 
                                                                                                                                      and Paperwork 
                                                                         $                             $                              Reduction Act 
City or town, state or province, country, and ZIP or foreign postal code 10 Investment credit          11 Work opportunity credit     Notice, see the 
                                                                         $                             $                              current General
Account number (see instructions)                   2nd TIN not. 12 Other credits and deductions             13 Specied Coop         Instructions for
                                                                                                                                      Certain Information
                                                                         $                                                            Returns.
Form 1099-PATR (Rev. 1-2023)        Cat. No. 14435F                      www.irs.gov/Form1099PATR      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

              9797                            VOID  CORRECTED
PAYER’S name, street address, city or town, state or province, country,  1 Patronage dividends         OMB No. 1545-0118
ZIP or foreign postal code, and telephone no.                            $                                                            Taxable 
                                                                         2 Nonpatronage distributions  Form 1099-PATR                 Distributions 
                                                                         $                             (Rev. January 2023)        Received From 
                                                                         3 Per-unit retain allocations For calendar year              Cooperatives
                                                                         $                                 20
PAYER’S TIN                         RECIPIENT’S TIN                      4 Federal income tax withheld 5 Redeemed nonqualied notices Copy A
                                                                         $                             $                              For 
RECIPIENT’S name                                                         6 Section 199A(g) deduction   7 Qualied payments            Internal Revenue 
                                                                                                          (Section 199A(b)(7))        Service Center
                                                                         $                             $                              File with Form 1096.
Street address (including apt. no.)                                      8 Section 199A(a) qual. items 9 Section 199A(a) SSTB items   For Privacy Act 
                                                                                                                                      and Paperwork 
                                                                         $                             $                              Reduction Act 
City or town, state or province, country, and ZIP or foreign postal code 10 Investment credit          11 Work opportunity credit     Notice, see the 
                                                                         $                             $                              current General
Account number (see instructions)                   2nd TIN not. 12 Other credits and deductions             13 Specied Coop         Instructions for
                                                                                                                                      Certain Information
                                                                         $                                                            Returns.
Form 1099-PATR (Rev. 1-2023)        Cat. No. 14435F                      www.irs.gov/Form1099PATR      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

              9797                            VOID  CORRECTED
PAYER’S name, street address, city or town, state or province, country,  1 Patronage dividends         OMB No. 1545-0118
ZIP or foreign postal code, and telephone no.                            $                                                            Taxable 
                                                                         2 Nonpatronage distributions  Form 1099-PATR                 Distributions 
                                                                         $                             (Rev. January 2023)        Received From 
                                                                         3 Per-unit retain allocations For calendar year              Cooperatives
                                                                         $                                 20
PAYER’S TIN                         RECIPIENT’S TIN                      4 Federal income tax withheld 5 Redeemed nonqualied notices Copy A
                                                                         $                             $                              For 
RECIPIENT’S name                                                         6 Section 199A(g) deduction   7 Qualied payments            Internal Revenue 
                                                                                                          (Section 199A(b)(7))        Service Center
                                                                         $                             $                              File with Form 1096.
Street address (including apt. no.)                                      8 Section 199A(a) qual. items 9 Section 199A(a) SSTB items   For Privacy Act 
                                                                         $                             $                              and Paperwork 
                                                                                                                                      Reduction Act 
City or town, state or province, country, and ZIP or foreign postal code 10 Investment credit          11 Work opportunity credit     Notice, see the 
                                                                         $                             $                              current General
Account number (see instructions)                   2nd TIN not. 12 Other credits and deductions             13 Specied Coop         Instructions for
                                                                                                                                      Certain Information
                                                                         $                                                            Returns.
Form 1099-PATR (Rev. 1-2023)        Cat. No. 14435F                      www.irs.gov/Form1099PATR      Department of the Treasury - Internal Revenue Service

                                                                         56

- 59 -

Page 59 of 66  Fileid: … ns/p1179/202309/a/xml/cycle03/source                                                                        13:58 - 5-Sep-2023

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

Exhibit V                                                                                                                            Form 1099-Q

              3131                  VOID              CORRECTED
PAYER’S/TRUSTEE’S name, street address, city or town, state or province, 1 Gross distribution        OMB No. 1545-1760               Payments From 
country, ZIP or foreign postal code, and telephone no.
                                                                                                     Form 1099-Q                     Qualiﬁed 
                                                                         $                                                           Education 
                                                                         2 Earnings                  (Rev. November 2019)            Programs 
                                                                                                     For calendar year               (Under Sections 
                                                                                                          20                         529 and 530)
                                                                         $
PAYER’S/TRUSTEE’S TIN               RECIPIENT’S TIN                      3 Basis                     4 Trustee-to-trustee            1.17 in Copy A
                                                                         $                             transfer                              For 
RECIPIENT’S name                                                         5 Distribution is from:     6 Check if the recipient is     Internal Revenue 
                                                                         • Qualied tuition program—   not the designated            Service Center
                                                                                                       beneciary 3.30 in
                                                                           Private       or State               2.55 in              File with Form 1096.
Street address (including apt. no.)                                      • Coverdell ESA                                             For Privacy Act 
                                                                                                                                     and Paperwork 
                                                                                                                                     Reduction Act 
City or town, state or province, country, and ZIP or foreign postal code                                                             Notice, see the 
                                                                                                                                     current General      
Account number (see instructions)                                                                                                    Instructions for 
                                                                                                                                     Certain Information 
                                                                                                                                             Returns.
Form 1099-Q (Rev. 11-2019)          Cat. No. 32223J                      www.irs.gov/Form1099Q         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

              3131                  VOID              CORRECTED
PAYER’S/TRUSTEE’S name, street address, city or town, state or province, 1 Gross distribution        OMB No. 1545-1760               Payments From 
country, ZIP or foreign postal code, and telephone no.
                                                                                                     Form 1099-Q                             Qualiﬁed 
                                                                         $                                                           Education 
                                                                         2 Earnings                  (Rev. November 2019)            Programs 
                                                                                                     For calendar year               (Under Sections 
                                                                                                          20                         529 and 530)
                                                                         $
PAYER’S/TRUSTEE’S TIN               RECIPIENT’S TIN                      3 Basis                     4 Trustee-to-trustee                    Copy A
                                                                         $                             transfer                              For 
RECIPIENT’S name                                                         5 Distribution is from:     6 Check if the recipient is     Internal Revenue 
                                                                         • Qualied tuition program—   not the designated            Service Center
                                                                                                       beneciary
                                                                           Private       or State                                    File with Form 1096.
Street address (including apt. no.)                                      • Coverdell ESA                                             For Privacy Act 
                                                                                                                                     and Paperwork 
                                                                                                                                     Reduction Act 
City or town, state or province, country, and ZIP or foreign postal code                                                             Notice, see the 
                                                                                                                                     current General         
Account number (see instructions)                                                                                                    Instructions for 
                                                                                                                                     Certain Information 
                                                                                                                                             Returns.
Form 1099-Q (Rev. 11-2019)          Cat. No. 32223J                      www.irs.gov/Form1099Q         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

              3131                  VOID              CORRECTED
PAYER’S/TRUSTEE’S name, street address, city or town, state or province, 1 Gross distribution        OMB No. 1545-1760               Payments From 
country, ZIP or foreign postal code, and telephone no.
                                                                                                     Form 1099-Q                             Qualiﬁed 
                                                                         $                                                           Education 
                                                                         2 Earnings                  (Rev. November 2019)            Programs 
                                                                                                     For calendar year               (Under Sections 
                                                                                                          20                         529 and 530)
                                                                         $
PAYER’S/TRUSTEE’S TIN               RECIPIENT’S TIN                      3 Basis                     4 Trustee-to-trustee                    Copy A
                                                                         $                             transfer                              For 
RECIPIENT’S name                                                         5 Distribution is from:     6 Check if the recipient is     Internal Revenue 
                                                                         • Qualied tuition program—   not the designated            Service Center
                                                                                                       beneciary
                                                                           Private       or State                                    File with Form 1096.
Street address (including apt. no.)                                      • Coverdell ESA                                             For Privacy Act 
                                                                                                                                     and Paperwork 
                                                                                                                                     Reduction Act 
City or town, state or province, country, and ZIP or foreign postal code                                                             Notice, see the 
                                                                                                                                     current General         
Account number (see instructions)                                                                                                    Instructions for 
                                                                                                                                     Certain Information 
                                                                                                                                             Returns.
Form 1099-Q (Rev. 11-2019)          Cat. No. 32223J                      www.irs.gov/Form1099Q         Department of the Treasury - Internal Revenue Service

                                                                           57

- 60 -

Page 60 of 66  Fileid: … ns/p1179/202309/a/xml/cycle03/source                                                                         13:58 - 5-Sep-2023

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

Exhibit W                                                                                                                                 Form 1099-R

              9898                  VOID               CORRECTED
PAYER’S name, street address, city or town, state or province,           1  Gross distribution        OMB No. 1545-0119         Distributions From 
country, ZIP or foreign postal code, and telephone no.                                                                         Pensions, Annuities, 
                                                                                                                                          Retirement or 
                                                                         $                            2023                     Proﬁt-Sharing Plans, 
                                                                         2a  Taxable amount                                           IRAs, Insurance 
                                                                                                                                      Contracts, etc.
                                                                         $                            Form  1099-R
                                                                         2b  Taxable amount               Total                           Copy A 
                                                                             not determined               distribution
                                                                                                                                          For 
PAYER’S TIN                 RECIPIENT’S TIN                              3  Capital gain (included in 4  Federal income tax           Internal Revenue 
                                                                             box 2a)                      withheld                    Service Center 

                                                                         $                            $                               File with Form 1096.
RECIPIENT’S name                                                         5  Employee contributions/   6  Net unrealized
                                                                            Designated Roth              appreciation in                  For Privacy Act 
                                                                            contributions or             employer’s securities            and Paperwork 
                                                                            insurance premiums                                            Reduction Act 
                                                                         $                            $                                   Notice, see the 
Street address (including apt. no.)                                      7  Distribution     IRA/     8  Other                            2023 General 
                                                                            code(s)          SEP/                                     Instructions for 
                                                                                             SIMPLE                                       Certain 
                                                                                                      $                        %
City or town, state or province, country, and ZIP or foreign postal code 9a  Your percentage of total 9b Total employee contributions     Information 
                                                                             distribution       % $                                       Returns.
10  Amount allocable to IRR 11 1st year of desig. 12  FATCA ling        14  State tax withheld       15  State/Payer’s state no.     16  State distribution
    within 5 years                  Roth contrib.      requirement $                                                              $
$                                                                        $                                                        $
Account number (see instructions)                 13  Date of            17  Local tax withheld       18  Name of locality            19  Local distribution
                                                       payment           $                                                        $
                                                                         $                                                        $
Form 1099-R                 Cat. No. 14436Q            www.irs.gov/Form1099R                          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

              9898                  VOID               CORRECTED
PAYER’S name, street address, city or town, state or province,           1  Gross distribution        OMB No. 1545-0119         Distributions From 
country, ZIP or foreign postal code, and telephone no.                                                                         Pensions, Annuities, 
                                                                                                                                          Retirement or 
                                                                         $                            2023                     Proﬁt-Sharing Plans, 
                                                                         2a  Taxable amount                                           IRAs, Insurance 
                                                                                                                                      Contracts, etc.
                                                                         $                            Form  1099-R
                                                                         2b  Taxable amount               Total                           Copy A 
                                                                             not determined               distribution
                                                                                                                                          For 
PAYER’S TIN                 RECIPIENT’S TIN                              3  Capital gain (included in 4  Federal income tax           Internal Revenue 
                                                                             box 2a)                      withheld                    Service Center 

                                                                         $                            $                               File with Form 1096.
RECIPIENT’S name                                                         5  Employee contributions/   6  Net unrealized
                                                                            Designated Roth              appreciation in                  For Privacy Act 
                                                                            contributions or             employer’s securities            and Paperwork 
                                                                            insurance premiums                                            Reduction Act 
                                                                         $                            $                                   Notice, see the 
Street address (including apt. no.)                                      7  Distribution     IRA/     8  Other                            2023 General 
                                                                            code(s)          SEP/                                     Instructions for 
                                                                                             SIMPLE                                       Certain 
                                                                                                      $                        %
City or town, state or province, country, and ZIP or foreign postal code 9a  Your percentage of total 9b Total employee contributions     Information 
                                                                             distribution       % $                                       Returns.
10  Amount allocable to IRR 11 1st year of desig. 12  FATCA ling        14  State tax withheld       15  State/Payer’s state no.     16  State distribution
    within 5 years                  Roth contrib.      requirement $                                                              $
$                                                                        $                                                        $
Account number (see instructions)                 13  Date of            17  Local tax withheld       18  Name of locality            19  Local distribution
                                                       payment           $                                                        $
                                                                         $                                                        $
Form 1099-R                 Cat. No. 14436Q            www.irs.gov/Form1099R                          Department of the Treasury - Internal Revenue Service

                                                                            58

- 61 -

Page 61 of 66  Fileid: … ns/p1179/202309/a/xml/cycle03/source                                                                                  13:58 - 5-Sep-2023

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

Exhibit X                                                                                                                                      Form 1099-S

              7575                  VOID             CORRECTED
FILER’S name, street address, city or town, state or province, country,  1  Date of closing                 OMB No. 1545-0997
ZIP or foreign postal code, and telephone number
                                                                                                            Form 1099-S                   Proceeds From Real 
                                                                         2  Gross proceeds                  (Rev. January 2022)           Estate Transactions
                                                                                                            For calendar year
                                                                         $                                  20
FILER’S TIN                         TRANSFEROR’S TIN                     3  Address (including city, state, and ZIP code) or legal description Copy A
                                                                                                                                               For 
TRANSFEROR’S name                                                                                                                              Internal Revenue 
                                                                                                                                               Service Center
                                                                         4  Check  here  if  the  transferor  received  or  will  receive      File with Form 1096. 
Street address (including apt. no.)                                         property or services as part of the consideration                  For Privacy Act 
                                                                                                                                               and Paperwork 
                                                                         5 Check  here  if  the  transferor  is  a  foreign  person            Reduction Act 
City or town, state or province, country, and ZIP or foreign postal code    (nonresident alien, foreign partnership, foreign estate,           Notice, see the 
                                                                            or foreign trust)  .........                                       current General 
                                                                                                                                               Instructions for 
Account number (see instructions)                                        6  Buyer’s part of real estate tax                                    Certain Information 
                                                                         $                                                                     Returns.
Form 1099-S (Rev. 1-2022)           Cat. No. 64292E                      www.irs.gov/Form1099S              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
              7575                  VOID             CORRECTED
FILER’S name, street address, city or town, state or province, country,  1  Date of closing                 OMB No. 1545-0997
ZIP or foreign postal code, and telephone number
                                                                                                            Form 1099-S                   Proceeds From Real 
                                                                         2  Gross proceeds                  (Rev. January 2022)           Estate Transactions
                                                                                                            For calendar year
                                                                         $                                  20
FILER’S TIN                         TRANSFEROR’S TIN                     3  Address (including city, state, and ZIP code) or legal description Copy A
                                                                                                                                               For 
TRANSFEROR’S name                                                                                                                              Internal Revenue 
                                                                                                                                               Service Center
                                                                         4  Check  here  if  the  transferor  received  or  will  receive      File with Form 1096. 
Street address (including apt. no.)                                         property or services as part of the consideration                  For Privacy Act 
                                                                                                                                               and Paperwork 
                                                                         5  Check  here  if  the  transferor  is  a  foreign  person           Reduction Act 
City or town, state or province, country, and ZIP or foreign postal code    (nonresident alien, foreign partnership, foreign estate,           Notice, see the 
                                                                            or foreign trust)  .........                                       current General 
                                                                                                                                               Instructions for 
Account number (see instructions)                                        6  Buyer’s part of real estate tax                                    Certain Information 
                                                                         $                                                                     Returns.
Form 1099-S (Rev. 1-2022)           Cat. No. 64292E                      www.irs.gov/Form1099S              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
              7575                  VOID             CORRECTED
FILER’S name, street address, city or town, state or province, country,  1  Date of closing                 OMB No. 1545-0997
ZIP or foreign postal code, and telephone number
                                                                                                            Form 1099-S                   Proceeds From Real 
                                                                         2  Gross proceeds                  (Rev. January 2022)           Estate Transactions
                                                                                                            For calendar year
                                                                         $                                  20
FILER’S TIN                         TRANSFEROR’S TIN                     3  Address (including city, state, and ZIP code) or legal description Copy A
                                                                                                                                               For 
TRANSFEROR’S name                                                                                                                              Internal Revenue 
                                                                                                                                               Service Center
                                                                         4  Check  here  if  the  transferor  received  or  will  receive      File with Form 1096. 
Street address (including apt. no.)                                         property or services as part of the consideration                  For Privacy Act 
                                                                                                                                               and Paperwork 
                                                                         5  Check  here  if  the  transferor  is  a  foreign  person           Reduction Act 
City or town, state or province, country, and ZIP or foreign postal code    (nonresident alien, foreign partnership, foreign estate,           Notice, see the 
                                                                            or foreign trust)  .........                                       current General 
                                                                                                                                               Instructions for 
Account number (see instructions)                                        6  Buyer’s part of real estate tax                                    Certain Information 
                                                                         $                                                                     Returns.
Form 1099-S (Rev. 1-2022)           Cat. No. 64292E                      www.irs.gov/Form1099S              Department of the Treasury - Internal Revenue Service

                                                                           59

- 62 -

Page 62 of 66  Fileid: … ns/p1179/202309/a/xml/cycle03/source                                                                              13:58 - 5-Sep-2023

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

Exhibit Y                                                                                                                                  Form 1099-SB

                    4343                      VOID                  CORRECTED
ISSUER’S name, street address, city or town, state or province, country, ZIP 1  Investment in contract OMB No. 1545-2281
or foreign postal code, and telephone no.
                                                                                                       Form 1099-SB          Seller’s Investment in 
                                                                             $                         (Rev. December 2019)                Life Insurance 
                                                                             2  Surrender amount
                                                                                                       For calendar year                   Contract
                                                                             $                              20
ISSUER’S TIN                              SELLER’S TIN                       Issuer’s information contact name, street address, city or    Copy A
                                                                             town, state or province, country, ZIP or foreign postal code,         For 
                                                                             and telephone no. (if different from ISSUER)
SELLER’S name                                                                                                                              Internal Revenue 
                                                                                                                                           Service Center
                                                                                                                                           File with Form 1096. 
                                                                                                                                           For Privacy Act 
Street address (including apt. no.)                                                                                                        and Paperwork 
                                                                                                                                           Reduction Act 
                                                                                                                                           Notice, see the 
City or town, state or province, country, and ZIP or foreign postal code                                                                   current General 
                                                                                                                                           Instructions for 
Policy number                                                                                                                                      Certain 
                                                                                                                                           Information 
                                                                                                                                           Returns.
Form 1099-SB (Rev. 12-2019)                       Cat. No. 71384X            www.irs.gov/Form1099SB    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

                    4343                      VOID                  CORRECTED
ISSUER’S name, street address, city or town, state or province, country, ZIP 1  Investment in contract OMB No. 1545-2281
or foreign postal code, and telephone no.
                                                                                                       Form 1099-SB          Seller’s Investment in 
                                                                             $                         (Rev. December 2019)                Life Insurance 
                                                                             2  Surrender amount
                                                                                                       For calendar year                   Contract
                                                                             $                              20
ISSUER’S TIN                        SELLER’S TIN                             Issuer’s information contact name, street address, city or    Copy A
                                                                             town, state or province, country, ZIP or foreign postal code,         For 
                                                                             and telephone no. (if different from ISSUER)
SELLER’S name                                                                                                                              Internal Revenue 
                                                                                                                                           Service Center
                                                                                                                                           File with Form 1096. 
                                                                                                                                           For Privacy Act 
Street address (including apt. no.)                                                                                                        and Paperwork 
                                                                                                                                           Reduction Act 
                                                                                                                                           Notice, see the 
City or town, state or province, country, and ZIP or foreign postal code                                                                   current General 
                                                                                                                                           Instructions for 
Policy number                                                                                                                                      Certain 
                                                                                                                                           Information 
                                                                                                                                           Returns.
Form 1099-SB (Rev. 12-2019)                       Cat. No. 71384X            www.irs.gov/Form1099SB    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

                    4343                      VOID                  CORRECTED
ISSUER’S name, street address, city or town, state or province, country, ZIP 1  Investment in contract OMB No. 1545-2281
or foreign postal code, and telephone no.
                                                                                                       Form 1099-SB          Seller’s Investment in 
                                                                             $                         (Rev. December 2019)                Life Insurance 
                                                                             2  Surrender amount
                                                                                                       For calendar year                   Contract
                                                                             $                              20
ISSUER’S TIN                        SELLER’S TIN                             Issuer’s information contact name, street address, city or    Copy A
                                                                             town, state or province, country, ZIP or foreign postal code,         For 
                                                                             and telephone no. (if different from ISSUER)
SELLER’S name                                                                                                                              Internal Revenue 
                                                                                                                                           Service Center
                                                                                                                                           File with Form 1096. 
                                                                                                                                           For Privacy Act 
Street address (including apt. no.)                                                                                                        and Paperwork 
                                                                                                                                           Reduction Act 
                                                                                                                                           Notice, see the 
City or town, state or province, country, and ZIP or foreign postal code                                                                   current General 
                                                                                                                                           Instructions for 
Policy number                                                                                                                                      Certain 
                                                                                                                                           Information 
                                                                                                                                           Returns.
Form 1099-SB (Rev. 12-2019)                       Cat. No. 71384X            www.irs.gov/Form1099SB    Department of the Treasury - Internal Revenue Service

                                                                             60

- 63 -

Page 63 of 66  Fileid: … ns/p1179/202309/a/xml/cycle03/source                                                                      13:58 - 5-Sep-2023

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

Exhibit Z                                                                                                                          Form 3921

              2525                      VOID            CORRECTED
TRANSFEROR’S name, street address, city or town, state or province,      1 Date option granted         OMB No. 1545-2129
country, and ZIP or foreign postal code                                                                                            Exercise of an 
                                                                                                     Form 3921                     Incentive Stock 
                                                                         2 Date option exercised                                   Option Under 
                                                                                                     (Rev. October 2017)           Section 422(b)
TRANSFEROR’S TIN                    EMPLOYEE’S TIN                       3 Exercise price per share  4 Fair market value per share Copy A
                                                                                                       on exercise date            For 
EMPLOYEE’S name                                                          $                           $                             Internal Revenue 
                                                                         5 No. of shares transferred                               Service Center
                                                                                                                                   File with Form 1096.
Street address (including apt. no.)                                      6 If other than TRANSFEROR, name, address, and TIN of     For Privacy Act and 
                                                                           corporation whose stock is being transferred            Paperwork 
                                                                                                                                   Reduction Act 
City or town, state or province, country, and ZIP or foreign postal code                                                           Notice, see the 
                                                                                                                                   current version of
                                                                                                                                   the General
Account number (see instructions)                                                                                                  Instructions for
                                                                                                                                   Certain Information
                                                                                                                                   Returns.
Form 3921 (Rev. October 2017)           Cat. No. 41179O                  www.irs.gov/Form3921          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

              2525                      VOID            CORRECTED
TRANSFEROR’S name, street address, city or town, state or province,      1 Date option granted         OMB No. 1545-2129
country, and ZIP or foreign postal code                                                                                            Exercise of an 
                                                                                                     Form 3921                     Incentive Stock 
                                                                         2 Date option exercised                                   Option Under 
                                                                                                     (Rev. October 2017)           Section 422(b)
TRANSFEROR’S TIN                    EMPLOYEE’S TIN                       3 Exercise price per share  4 Fair market value per share Copy A
                                                                                                       on exercise date            For 
EMPLOYEE’S name                                                          $                           $                             Internal Revenue 
                                                                         5 No. of shares transferred                               Service Center
                                                                                                                                   File with Form 1096.
Street address (including apt. no.)                                      6 If other than TRANSFEROR, name, address, and TIN of     For Privacy Act and 
                                                                           corporation whose stock is being transferred            Paperwork 
                                                                                                                                   Reduction Act 
City or town, state or province, country, and ZIP or foreign postal code                                                           Notice, see the 
                                                                                                                                   current version of
                                                                                                                                   the General
Account number (see instructions)                                                                                                  Instructions for
                                                                                                                                   Certain Information
                                                                                                                                   Returns.
Form 3921 (Rev. October 2017)           Cat. No. 41179O                  www.irs.gov/Form3921          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

              2525                      VOID            CORRECTED
TRANSFEROR’S name, street address, city or town, state or province,      1 Date option granted         OMB No. 1545-2129
country, and ZIP or foreign postal code                                                                                            Exercise of an 
                                                                                                     Form 3921                     Incentive Stock 
                                                                         2 Date option exercised                                   Option Under 
                                                                                                     (Rev. October 2017)           Section 422(b)
TRANSFEROR’S TIN                    EMPLOYEE’S TIN                       3 Exercise price per share  4 Fair market value per share Copy A
                                                                                                       on exercise date            For 
EMPLOYEE’S name                                                          $                           $                             Internal Revenue 
                                                                         5 No. of shares transferred                               Service Center
                                                                                                                                   File with Form 1096.
Street address (including apt. no.)                                      6 If other than TRANSFEROR, name, address, and TIN of     For Privacy Act and 
                                                                           corporation whose stock is being transferred            Paperwork 
                                                                                                                                   Reduction Act 
City or town, state or province, country, and ZIP or foreign postal code                                                           Notice, see the 
                                                                                                                                   current version of
                                                                                                                                   the General
Account number (see instructions)                                                                                                  Instructions for
                                                                                                                                   Certain Information
                                                                                                                                   Returns.
Form 3921 (Rev. October 2017)           Cat. No. 41179O                  www.irs.gov/Form3921          Department of the Treasury - Internal Revenue Service

                                                                         61

- 64 -

Page 64 of 66  Fileid: … ns/p1179/202309/a/xml/cycle03/source                                                                              13:58 - 5-Sep-2023

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

Exhibit AA                                                                                                                                 Form 5498

                      2828          VOID                  CORRECTED
TRUSTEE’S or ISSUER’S name, street address, city or town, state or       1   IRA contributions (other  OMB No. 1545-0747
province, country, and ZIP or foreign postal code                             than amounts in boxes 
                                                                              2–4, 8–10, 13a, and 14a)                                     IRA 
                                                                                                       2023                                Contribution 
                                                                         $                                                                 Information
                                                                         2   Rollover contributions
                                                                         $                                  Form 5498
                                                                         3   Roth IRA conversion       4   Recharacterized 
                                                                              amount                        contributions  0.50 in         Copy A
TRUSTEE’S or ISSUER’S TIN           PARTICIPANT’S TIN                    $                             $                                   For 
                                                                         5   FMV of account            6   Life insurance cost included in Internal Revenue 
              0.66 in                             1.70 in                                                   box 1                          Service Center
                                                                         $                             $                                   File with Form 1096.
PARTICIPANT’S name                                                       7    IRA     SEP              SIMPLE     Roth IRA
                                                                         8   SEP contributions         9   SIMPLE contributions
                                                                         $                             $                  0.33 in          For Privacy Act 
Street address (including apt. no.)                                      10   Roth IRA contributions   11   Check if RMD for 2024          and Paperwork 
                                                  0.50 in                $                                                                 Reduction Act 
                                                                         12a RMD date                  12b RMD amount                      Notice, see the 
City or town, state or province, country, and ZIP or foreign postal code                               $                                   2023 General
                                                                                                                                           Instructions for
                                                                         13a Postponed/late contrib.   13b Year   13c Code                 Certain
                                                                         $                                                                 Information
                                                                         14a Repayments                14b Code                            Returns.

                                                                         $
Account number (see instructions)                                        15a FMV of certain specied   15b Code(s)
                                                                              assets
                                                                         $
Form 5498                           Cat. No. 50010C                      www.irs.gov/Form5498          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

                      2828          VOID                  CORRECTED
TRUSTEE’S or ISSUER’S name, street address, city or town, state or       1   IRA contributions (other  OMB No. 1545-0747
province, country, and ZIP or foreign postal code                             than amounts in boxes 
                                                                              2–4, 8–10, 13a, and 14a)                                     IRA 
                                                                                                       2023                                Contribution 
                                                                         $                                                                 Information
                                                                         2   Rollover contributions
                                                                         $                                  Form 5498
                                                                         3   Roth IRA conversion       4   Recharacterized 
                                                                              amount                        contributions                  Copy A
TRUSTEE’S or ISSUER’S TIN           PARTICIPANT’S TIN                    $                             $                                   For 
                                                                         5   FMV of account            6   Life insurance cost included in Internal Revenue 
                                                                                                            box 1                          Service Center
                                                                         $                             $                                   File with Form 1096.
PARTICIPANT’S name                                                       7    IRA     SEP              SIMPLE     Roth IRA
                                                                         8   SEP contributions         9   SIMPLE contributions
                                                                         $                             $                                   For Privacy Act 
Street address (including apt. no.)                                      10   Roth IRA contributions   11   Check if RMD for 2024          and Paperwork 
                                                                         $                                                                 Reduction Act 
                                                                         12a RMD date                  12b RMD amount                      Notice, see the 
City or town, state or province, country, and ZIP or foreign postal code                               $                                   2023 General
                                                                                                                                           Instructions for
                                                                         13a Postponed/late contrib.   13b Year   13c Code                 Certain
                                                                         $                                                                 Information
                                                                         14a Repayments                14b Code                            Returns.

                                                                         $
Account number (see instructions)                                        15a FMV of certain specied   15b Code(s)
                                                                              assets
                                                                         $
Form 5498                           Cat. No. 50010C                      www.irs.gov/Form5498          Department of the Treasury - Internal Revenue Service

                                                                         62

- 65 -

Page 65 of 66  Fileid: … ns/p1179/202309/a/xml/cycle03/source                                                                                      13:58 - 5-Sep-2023

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

Exhibit BB                                                                                                                                         Form W-2G

              3232                   VOID            CORRECTED
PAYER’S name, street address, city or town, province or state, country,  1  Reportable winnings                     2  Date won                    OMB No. 1545-0238
and ZIP or foreign postal code                                                            0.50 in                                                  Form W-2G
                                                                         $                                                                         Certain 
                                                                         3  Type of wager                           4  Federal income tax withheld Gambling 
                                                                                                                    $                              Winnings
                                                                         5  Transaction                             6  Race                        (Rev. January 2021)
                                                                                                                                      0.33 in      For calendar year
                                                                         7   Winnings from identical wagers         8  Cashier                     20
PAYER’S federal identication number PAYER’S telephone number            $
                                                                         9   Winner’s taxpayer identication no.    10  Window
                                                     0.67 in                                                                                       For Privacy Act 
                                                                                                                                                   and Paperwork 
                                                                                                                                                   Reduction Act 
WINNER’S name                                                            11  First identication                    12  Second identication       Notice, see the 
                                                                                          0.50 in                                                  current General 
                                                                                                                                                   Instructions for 
Street address (including apt. no.)                                      13   State/Payer’s state identication no. 14  State winnings             Certain Information 
                                                                                                                                                     Returns.
                                                                                                                    $
City or town, province or state, country, and ZIP or foreign postal code 15  State income tax withheld              16  Local winnings
                                                                                                                                                   File with Form 1096
                                                                         $                                          $
                                                                         17  Local income tax withheld              18  Name of locality             Copy A 
                                                                                                                                                   For Internal Revenue 
                                                                         $                                                                         Service Center
Under penalties of perjury, I declare that, to the best of my knowledge and belief, the name, address, and taxpayer identication number 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 entitled to any part of these payments.
Signature                                                                                              Date  
Form W-2G (Rev. 1-2021)              Cat. No. 10138V                     www.irs.gov/FormW2G                         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

              3232                   VOID            CORRECTED
PAYER’S name, street address, city or town, province or state, country,  1  Reportable winnings                     2  Date won                    OMB No. 1545-0238
and ZIP or foreign postal code                                                                                                                     Form W-2G
                                                                         $                                                                         Certain 
                                                                         3  Type of wager                           4  Federal income tax withheld Gambling 
                                                                                                                    $                              Winnings
                                                                         5  Transaction                             6  Race                        (Rev. January 2021)
                                                                                                                                                   For calendar year
                                                                         7   Winnings from identical wagers         8  Cashier                     20
PAYER’S federal identication number PAYER’S telephone number            $
                                                                         9   Winner’s taxpayer identication no. 10  Window
                                                                                                                                                   For Privacy Act 
                                                                                                                                                   and Paperwork 
                                                                                                                                                   Reduction Act 
WINNER’S name                                                            11  First identication                    12  Second identication       Notice, see the 
                                                                                                                                                   current General 
                                                                                                                                                   Instructions for 
Street address (including apt. no.)                                      13   State/Payer’s state identication no. 14  State winnings             Certain Information 
                                                                                                                                                     Returns.
                                                                                                                    $
City or town, province or state, country, and ZIP or foreign postal code 15  State income tax withheld              16  Local winnings
                                                                                                                                                   File with Form 1096
                                                                         $                                          $
                                                                         17  Local income tax withheld              18  Name of locality           Copy A 
                                                                                                                                                   For Internal Revenue 
                                                                         $                                                                         Service Center
Under penalties of perjury, I declare that, to the best of my knowledge and belief, the name, address, and taxpayer identication number 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 entitled to any part of these payments.
Signature                                                                                              Date  
Form W-2G (Rev. 1-2021)              Cat. No. 10138V                     www.irs.gov/FormW2G                         Department of the Treasury - Internal Revenue Service

                                                                          63

- 66 -

Page 66 of 66      Fileid: … ns/p1179/202309/a/xml/cycle03/source                                                                                                                 13:58 - 5-Sep-2023

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

Exhibit CC                                                                                                                                                                           Form 1042-S

                                    Foreign Person’s U.S. Source Income Subject to Withholding                                                                               OMB No. 1545-0096
        Form 1042-S                  Go to www.irs.gov/Form1042S for instructions and the latest information.                                    2023                        Copy A for
        Department of the Treasury                                                                                                                                       Internal Revenue Service
        Internal Revenue Service                                         UNIQUE FORM IDENTIFIER                        AMENDED             AMENDMENT NO.
        1 Income     2  Gross income 3   Chapter indicator.  Enter “3” or “4”                                     13e  Recipient’s U.S. TIN, if any             13f  Ch. 3 status code
          code                       3a Exemption code             4a Exemption code                                                                            13g Ch. 4 status code
                                     3b Tax rate           .       4b Tax rate                                  . 13h  Recipient’s GIIN          13i Recipient ’sforeign tax identication    13j LOB code 
                                                                                                                                                     number, if any
        5  Withholding allowance
        6  Net income
        7a  Federal tax withheld                                                                                  13k  Recipient’s account number
        7b  Check if federal tax withheld was not deposited with the IRS because 
            escrow procedures were applied (see instructions)  ....               . .                             13l  Recipient’s date of birth (YYYYMMDD)
        7c  Check if withholding occurred in subsequent year with respect to a 
            partnership interest  .....          .     .      .......
        8  Tax withheld by other agents                                                                           14a  Primary Withholding Agent ’sName (if applicable)
        9 Overwithheld tax repaid to recipient pursuant to adjustment procedures (see instructions)
           (                                                                                                    ) 14b  Primary Withholding Agent’s EIN
        10  Total withholding credit (combine boxes 7a, 8, and 9)                                                                                               15  Check if pro-rata basis reporting 
                                                                                                                  15a  Intermediary or ow-through entity’s EIN, if any 15b Ch. 3 status code 15c Ch. 4 status code
0.35 in 11  Tax paid by withholding agent (amounts not withheld) (see instructions)
                                                                                                                  15d  Intermediary or ow-through entity’s name
        12a  Withholding agent’s EIN          12b Ch. 3 status code12c       Ch. 4 status code
                                                                                                                  15e  Intermediary or ow-through entity’s GIIN
        12d  Withholding agent’s name                                                                             15f  Country code        15g  Foreign tax identication number, if any
        12e  Withholding agent’s Global Intermediary Identication Number (GIIN)                                  15h  Address (number and street)
                                              5.30 in
        12f  Country code           12g  Foreign tax identication number, if any                                 15i  City or town, state or province, country, ZIP or foreign postal code                        0.35 in
        12h  Address (number and street)                                                                          16a  Payer’s name                                         16b  Payer’s TIN
        12i  City or town, state or province, country, ZIP or foreign postal code                                 16c  Payer’s GIIN                             16d Ch. 3 status code16e Ch. 4 status code
        13a  Recipient’s name                              13b  Recipient’s country code                          17a  State income tax withheld     17b  Payer’s state tax no.  17c  Name of state
                                                                                                                                           7.30 in
        13c  Address (number and street)
        13d  City or town, state or province, country, ZIP or foreign postal code

        For Privacy Act and Paperwork Reduction Act Notice, see instructions.                                                       Cat. No. 11386R                              Form 1042-S (2023)

                                                                                                                  64

PDF file checksum: 1052128667

(Plugin #1/9.12/13.0)