Attention:: Order Information Returns and Employer Returns Online
Attention:: Order Information Returns and Employer Returns Online
This form is provided for informational purposes only. Copy A appears in red, similar to the official IRS form. Do not file copy A downloaded from this website. The official printed version of this IRS form is scannable, but the online version of it, printed from this website, is not. A penalty may be imposed for filing forms that cant be scanned. See part O in the current General Instructions for Certain Information Returns for more information about penalties. To order official IRS forms, call 1-800-TAX-FORM (1-800-829-3676) or Order Information Returns and Employer Returns Online, and well mail you the scannable forms and other products. See IRS Publications 1141, 1167, 1179 and other IRS resources for information about printing these tax forms.
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1a Total ordinary dividends OMB No. 1545-0110
PAYERS name, street address, city, state, ZIP code, and telephone no.
$
1b Qualified dividends
2011
Form
$
2a Total capital gain distr.
1099-DIV
$
PAYERS federal identification number RECIPIENTS identification number 2c Section 1202 gain
$
2d Collectibles (28%) gain
$
RECIPIENTS name 3 Nondividend distributions
$
4 Federal income tax withheld
$
5 Investment expenses
$
Street address (including apt. no.) 6 Foreign tax paid 7 Foreign country or U.S. possession
$
City, state, and ZIP code Account number (see instructions) 2nd TIN not. 8 Cash liquidation distributions 9 Noncash liquidation distributions
For Privacy Act and Paperwork Reduction Act Notice, see the 2011 General Instructions for Certain Information Returns.
Form 1099-DIV
$
1b Qualified dividends
2011
Form
$
2a Total capital gain distr.
1099-DIV
$
PAYERS federal identification number RECIPIENTS identification number 2c Section 1202 gain
$
2d Collectibles (28%) gain
$
RECIPIENTS name 3 Nondividend distributions
$
4 Federal income tax withheld
$
5 Investment expenses
$
Street address (including apt. no.) 6 Foreign tax paid 7 Foreign country or U.S. possession
$
City, state, and ZIP code Account number (see instructions) 8 Cash liquidation distributions 9 Noncash liquidation distributions
This is important tax information and is being furnished to the Internal Revenue Service. 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-DIV
Box 2d. Shows 28% rate gain from sales or exchanges of collectibles. If required, use this amount when completing the 28% Rate Gain WorksheetLine 18 in the instructions for Schedule D (Form 1040). Box 3. Shows the part of the distribution that is nontaxable because it is a return of your cost (or other basis). You must reduce your cost (or other basis) by this amount for figuring gain or loss when you sell your stock. But if you get back all your cost (or other basis), report future distributions as capital gains. See Pub. 550, Investment Income and Expenses. Box 4. Shows backup withholding. A payer must backup withhold on certain payments if you did not give your taxpayer identification number to the payer. See Form W-9, Request for Taxpayer Identification Number and Certification, for information on backup withholding. Include this amount on your income tax return as tax withheld. Box 5. Shows your share of expenses of a nonpublicly offered regulated investment company, generally a nonpublicly offered mutual fund. If you file Form 1040, you may deduct these expenses on the Other expenses line on Schedule A (Form 1040) subject to the 2% limit. This amount is included in box 1a. Box 6. Shows the foreign tax that you may be able to claim as a deduction or a credit on Form 1040. See the Form 1040 instructions. Box 7. This box should be left blank if a regulated investment company reported the foreign tax shown in box 6. Boxes 8 and 9. Shows cash and noncash liquidation distributions. Nominees. If this form includes amounts belonging to another person, you are considered a nominee recipient. You must file Form 1099-DIV with the IRS for each of the other owners to show their share of the income, and you must furnish a Form 1099-DIV to each. A husband or wife is not required to file a nominee return to show amounts owned by the other. See the 2011 General Instructions for Certain Information Returns.
VOID
CORRECTED
1a Total ordinary dividends OMB No. 1545-0110
PAYERS name, street address, city, state, ZIP code, and telephone no.
$
1b Qualified dividends
2011
Form
$
2a Total capital gain distr.
1099-DIV
$
PAYERS federal identification number RECIPIENTS identification number 2c Section 1202 gain
$
2d Collectibles (28%) gain
$
RECIPIENTS name 3 Nondividend distributions
$
4 Federal income tax withheld
$
5 Investment expenses
$
Street address (including apt. no.) 6 Foreign tax paid 7 Foreign country or U.S. possession
$
City, state, and ZIP code Account number (see instructions) 2nd TIN not. 8 Cash liquidation distributions 9 Noncash liquidation distributions
For Privacy Act and Paperwork Reduction Act Notice, see the 2011 General Instructions for Certain Information Returns.
Form 1099-DIV