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Revenue 

Procedure 

2022-25

Reprinted from IR Bulletin 2022-27
Dated July 05, 2022

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. 07-2022)
Catalog Number 47022Q
www.irs.gov

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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, 1.6050Y-3.)

Rev. Proc. 2022-25
TABLE OF CONTENTS

Part 1 – GENERAL INFORMATION
             Section 1.1 – Overview of Revenue Procedure 2022-25 /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

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Part 6 – EXHIBITS
             Section 6.1 – Exhibits of Forms in This Revenue Procedure . . . . . . . . . . . . . . . . . . . 34

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                                                  Part 1

                              General Information

Section 1.1 – Overview of Revenue Procedure 2022-25 /What's New

1.1.1        .
             The purpose of this revenue procedure is to set forth the 2022 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 these information returns:
Which Forms 
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
              1099-Q          Payments From Qualified Education Programs (Under Sections 529 and 530)

                                                         1

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Form Title
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 250 or more information returns of any one type during a
calendar year must file those returns electronically.

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 250 returns of any one type 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 2022 General Instructions for Certain Information Returns and the 2022
Instructions for Form 1042-S. In addition, see the current revision of Publication
1220, Specifications for Electronic Filing of Forms 1097, 1098, 1099, 3921,
3922, 5498, and W-2G, for electronic filing through the IRS FIRE system.

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1.1.4 .
The IRS prints and provides the forms on which various payments must be
For More
Information reported. See Section 5.3, later, 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 304-263-8700 (not a toll-free number). Persons with a
hearing or speech disability with access to TTY/TDD equipment can call
304-579-4827 (not a toll-free number).

You may also send questions to the call site via the Internet at
mccirp@irs.gov.

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

For other tax information related to business returns or accounts, call
800-829-4933. Persons with hearing or speech disabilities with access
to TTY/TDD equipment can call 800-829-4059 to ask tax account
questions or to order forms and publications.

Further information impacting Publication 1179, such as issues
TIP arising after 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, enacted July 1,
2019, authorized the Department of the Treasury and the IRS to issue
regulations that reduce the 250-return requirement for 2022 tax returns. If final
regulations are issued and effective for 2022 tax returns required to be filed in
2023, we will post an article at IRS.gov explaining the change. Until final
regulations are issued, however, the number remains at 250, as reflected in these
instructions.

Electronic filing of Forms 1099. Under Section 2102 of the Taxpayer First
Act, the IRS is developing an Internet portal that will allow taxpayers to
electronically file Forms 1099 after December 31, 2022 , as an alternative to
using the Filing Information Returns Electronically (FIRE) system. See Part F
in the General Instructions for Certain Information Returns for 2022 or go to
IRS.gov for additional information and updates.

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

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New Form 1098-F filing requirement. File Form 1098-F, Fines, Penalties and
Other Amounts, to report payments made under suits and agreements which are
binding on or after January 1, 2022. See T.D. 9946, available at IRS.gov/
TD9946. For the latest filing information, see IRS.gov/Form1098F.

Continuous use conversion. Forms 1098, 1099-A, 1099-C, 1099-DIV,
1099-G, 1099-INT, 1099-K, 1099-MISC, 1099-NEC, and 1099-S and their
instructions have been converted from annual updates to continuous use. The
form and its instructions will be updated as needed.

Form 1099-DIV new box 11. The “FATCA filing requirement” checkbox has
been assigned box number 11. Subsequently, box numbers 11 through 15 have
been renumbered 12 through 16, respectively.

Form 1099-MISC new box 13. The “FATCA filing requirement” checkbox
has been assigned box number 13. Subsequently, box numbers 13 through 17
have been renumbered 14 through 18, respectively.

Exhibits. All of the exhibits in this publication were updated to include all of
the 2022 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.

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• 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.
• 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 with the IRS. A filer may be a payer, creditor,
payment settlement entity, recipient of mortgage or student loan interest
payments, educational institution, broker, barter exchange, 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.

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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 statement
(recipient must be furnished to a person (form recipient), as defined under the applicable
statement) 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.

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
1111 Constitution Ave. NW
Room 6554
Washington, DC 20224

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.
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

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               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
               • 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.
               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
                 1111 Constitution Ave. NW
                 Room 6554
                 Washington, DC 20224

               or email them to substituteforms@irs.gov.

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 in Part O, Penalties in the 2022 General Instructions for Certain 
               Information Returns.

                                          7

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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, form number, 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.

                           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

                                                     8

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Form Recipient
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

Note. On Copy C, 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 a fillable online format,
are found separately in Part 5.

These forms in their fillable format 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 inches by 11 inches 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

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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, no scaling.

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 Printing 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
Quality as specified by JCP Code 0-25, dated November 29, 1978, must be white 100%
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

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For information only, the Sheffield equivalent-units 170-100
Dirt: Average, each side, not to exceed-parts per million 8

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, 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.

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Density readings on the solid 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 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:

Commissioner of Internal Revenue
Attn: SE:W:CAR:MP:P:TP
Business Publishing – Tax Products
1111 Constitution Ave. NW
Room 6554
Washington, DC 20224

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.

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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, earlier)
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 (Copies B and
C, and Copies 1 and 2 of Forms 1099-B, 1099-DIV, 1099-G, 1099-INT,
1099-K, 1099-MISC, 1099-NEC, 1099-OID, 1099-R, and Copy D for 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, later, for information on electronically furnishing statements
to recipients.

2.1.10 .
You must include the OMB Number on Copies A and Form 1096 in the same
Required
Inclusions/ 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.

• “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 2022 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 2022
General Instructions for Certain Information Returns” must be
printed on all other forms listed in Section 1.1.2.

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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 employer identification number (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).

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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 employer identification number (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 identification number on payee statements. Where
permitted, filers may truncate a payee's identification number (social security
number (SSN), individual taxpayer identification number (ITIN), adoption
taxpayer identification number (ATIN), or employer identification number
(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
Box W-2G for an account number designation when required by the official IRS
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

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are filed with the IRS. The size specified does not include pin feed
holes. Pin feed holes must not be present on forms filed with the IRS.
• 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 2022 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 2022
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.

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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). 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 Government Printing Office (GPO) symbol must not be printed on
substitute Forms W-2G. Instead, the employer identification number
Printer’s Symbol (EIN) of the form’s printer must be printed in the bottom 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 Catalog Number (Cat. No.) shown on Form W-2G is used for IRS
Catalog Number
distribution purposes and should not be printed on any substitute forms.

Part 4

Substitute Statements to Form Recipients and
Form Recipient Copies

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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
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 his or her
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 date acquired

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is known. For 2022 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 it would be shown for short-term dispositions where basis
was reported to the IRS.
For 2022 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 Forms 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.

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• 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 Office of Management and
Budget (OMB) number as shown on the official IRS form. See Section
5.2.
• The recipient statement must contain the tax year (for example, 2022),
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, later). 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.

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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 an acceptable substitute.
                  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 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.

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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 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.

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• 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, 1099-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,
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, and4.4, 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

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                       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, 
                       are 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 

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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.”

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               • 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 negligence 

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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.

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                   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, 
              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.”

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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, earlier.
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, earlier) 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 he or she 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, 2022 (February 15 for Forms 1099-B, 1099-S, and

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1099-MISC with payments reported in box 8 or 10) 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, 2023: (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).

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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, Foreign Person’s U.S. Source Income Subject to Withholding, and may
be privately printed without prior approval from the Internal Revenue Service.

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 (2022).

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, 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 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

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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, later.
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 Government Printing
Printing Office (GPO) symbol must 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 inches) or 3 point (0.045 inches). 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.

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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 that:
OMB
Requirements • 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,
• 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), or

2. OMB # 1545-xxxx (acceptable).

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

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, earlier.
Users

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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, earlier.

Section 5.4 – Effect on Other Revenue Procedures

5.4.1 .
Revenue Procedure 2021-27, 2021-26, I.R.B. 1,252, dated June 28, 2021, is
Other Revenue
Procedures superseded 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 .85 inches 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.
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.

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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 2022
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.

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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 2022
Internal Revenue Service
FILER’S name

2.14 in
Street address (including room or suite number) 1.33 in
7.30 in
City or town, state or province, country, and ZIP or foreign postal code
Name of person to contact Telephone number For Ofﬁcial Use Only
4.50 in
Email address Fax number
1 Employer identication number 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 Enter an “X” in only one box below to indicate the type of form being led.
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 1099-LS .25 in
32 50 81 78 84 03 74 83 80 79 85 73 91 86 92 10 16

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 5498-SA
93 95 71 96 97 31 1A 98 75 94 43 25 26 28 72 2A 27

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. 11.0 in
Signature 8.00 in Title Date
Instructions Enter the ler’s name, address (including room, suite, or other unit
Future developments. For the latest information about developments number), and taxpayer identication number (TIN) in the spaces
related to Form 1096, such as legislation enacted after it was provided on the form. The name, address, and TIN of the ler on this
published, go to www.irs.gov/Form1096. form must be the same as those you enter in the upper left area of
Forms 1097, 1098, 1099, 3921, 3922, 5498, or W-2G.
Reminder. The only acceptable method of electronically ling When to ﬁle.File Form 1096 as follows.
information returns listed on this form in box 6 with the IRS is through • With Forms 1097, 1098, 1099, 3921, 3922, or W-2G, le by
the FIRE System. See Pub. 1220. February 28, 2023.
Purpose of form. Use this form to transmit paper Forms 1097, 1098, • With Forms 1099-NEC, le by January 31, 2023.
1099, 3921, 3922, 5498, and W-2G to the IRS.
Caution: If you are required to le 250 or more information returns of • With Forms 5498, le by May 31, 2023.
any one type (excluding Form 1098-F), you must le electronically. If Where To File
you are required to le electronically but fail to do so, and you do not
have an approved waiver, you may be subject to a penalty. The Send all information returns led on paper with Form 1096 to the
Taxpayer First Act of 2019, enacted July 1, 2019, authorized the following.
Department of the Treasury and the IRS to issue regulations that If your principal business, ofﬁce
reduce the 250-return requirement for 2021 tax returns. If those or agency, or legal residence in Use the following
regulations are issued and effective for 2022 tax returns required to be the case of an individual, is address
led in 2023, we will post an article at www.irs.gov/Form1099 located in
explaining the change. Until regulations are issued, however, the
number remains at 250, as reected in these instructions. For more
information, see part F in the 2022 General Instructions for Certain Alabama, Arizona, Arkansas, Delaware,
Information Returns. Florida, Georgia, Kentucky, Maine, Internal Revenue Service
Massachusetts, Mississippi, New
Forms 1099-QA and 5498-QA can be led on paper only, regardless Hampshire, New Jersey, New Mexico, P.O. Box 149213
of the number of returns. New York, North Carolina, Ohio, Texas, Austin, TX 78714-9213
Who must ﬁle. Any person or entity who les any of the forms shown Vermont, Virginia
in line 6 above must le Form 1096 to transmit those forms to the IRS.
Caution: Your name and TIN must match the name and TIN used on
your 94X series tax return(s) or you may be subject to information
return penalties. Do not use the name and/or TIN of your paying agent
or service bureau.
For more information and the Privacy Act and Paperwork Reduction Act Notice, Cat. No. 14400O Form 1096 (2022)
see the 2022 General Instructions for Certain Information Returns.

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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

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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

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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

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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                                2022                      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 
                                                                                                                                               2022 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 
                                                                                                              2022                      Loan Interest 
                            11.0 in
                                                                                                                                               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 
                                                                                                                                               2022 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 
                                                                                                              2022                      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 
                                                                                                                                               2022 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

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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

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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

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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

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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                              2022                           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–           2022 General 
                                                                               $                                March 2023                   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                              2022                           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–           2022 General 
                                                                               $                                March 2023                   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                              2022                           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–           2022 General 
                                                                               $                                March 2023                   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

                                                                                 44

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Page 48 of 67 Fileid: … ns/p1179/202206/a/xml/cycle02/source 10:47 - 17-Jun-2022

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

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Page 49 of 67  Fileid: … ns/p1179/202206/a/xml/cycle02/source                                                                                  10:47 - 17-Jun-2022

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 
                                                                                                                         2022                  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.           2022 on closed contracts         open contracts—12/31/2021     2022 General 
                                                                                                                                               Instructions for 
                                                                            $                                 $                                Certain 
CUSIP number                                     FATCA ling                10  Unrealized prot or (loss) on 11  Aggregate prot or (loss)    Information 
                                                 requirement                    open contracts—12/31/2022         on contracts                 Returns.
                                                                                                                  4.20 in
14  State name   15  State identication no. 16  State tax withheld         $                                 $
                                         $                                  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 
                                                                                                                          2022                 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.           2022 on closed contracts          open contracts—12/31/2021    2022 General 
                                                                                                                                               Instructions for 
                                                                            $                                 $                                Certain 
CUSIP number                                     FATCA ling                10  Unrealized prot or (loss) on 11  Aggregate prot or (loss)    Information 
                                                 requirement                    open contracts—12/31/2022         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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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, ZIP 1 Patronage dividends         OMB No. 1545-0118
or foreign postal code, and telephone no.                                   $                                                              Taxable 
                                                                            2 Nonpatronage distributions                                   Distributions 
                                                                            $                               2022                     Received From 
                                                                            3 Per-unit retain allocations                                  Cooperatives
                                                                            $                             Form 1099-PATR
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 
                                                                            $                             $                                2022 General 
Account number (see instructions)                   2nd TIN not. 12 Other credits and deductions              13 Specied Coop             Instructions for 
                                                                                                                                           Certain Information 
                                                                            $                                                              Returns.
Form 1099-PATR                      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, ZIP 1 Patronage dividends         OMB No. 1545-0118
or foreign postal code, and telephone no.                                   $                                                              Taxable 
                                                                            2 Nonpatronage distributions                                   Distributions 
                                                                            $                               2022                     Received From 
                                                                            3 Per-unit retain allocations                                  Cooperatives
                                                                            $                             Form 1099-PATR
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 
                                                                            $                             $                                2022 General 
Account number (see instructions)                   2nd TIN not.            12 Other credits and deductions   13 Specied Coop             Instructions for 
                                                                                                                                           Certain Information 
                                                                            $                                                              Returns.
Form 1099-PATR                      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, ZIP 1 Patronage dividends         OMB No. 1545-0118
or foreign postal code, and telephone no.                                   $                                                              Taxable 
                                                                            2 Nonpatronage distributions                                   Distributions 
                                                                            $                               2022                     Received From 
                                                                            3 Per-unit retain allocations                                  Cooperatives
                                                                            $                             Form 1099-PATR
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 
                                                                            $                             $                                2022 General 
Account number (see instructions)                   2nd TIN not.            12 Other credits and deductions   13 Specied Coop             Instructions for 
                                                                                                                                           Certain Information 
                                                                            $                                                              Returns.
Form 1099-PATR                      Cat. No. 14435F                         www.irs.gov/Form1099PATR        Department of the Treasury - Internal Revenue Service

                                                                            56

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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

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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 
                                                                         2a  Taxable amount             2022                   Proﬁt-Sharing Plans, 
                                                                                                                                        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                              2022 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 
                                                                         2a  Taxable amount           2022                     Proﬁt-Sharing Plans, 
                                                                                                                                        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                              2022 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

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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

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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

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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 EIN 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 

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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 
                                                                                                       2022                                Contribution 
                                                                         $
                                                                         2   Rollover contributions                                        Information
                                                                         $                                  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 2023          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                               $                                   2022 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 
                                                                                                       2022                                Contribution 
                                                                         $
                                                                         2   Rollover contributions                                        Information
                                                                         $                                  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 2023          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                               $                                   2022 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

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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

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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.                                2022                         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 (2022)

                                                                                                                  64

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