EFTA01222596.pdf

CORRECTED if check PAYERS name. street address. city ce town. state ce province. country. ZIP 1 Unemployment compensation OMB No. 1545-0120 or foreign postal code. and telephone no. Certain 2 State or local income tax 2018 Government refunds. credits. or offsets Payments Form 1099-G PAYER S TIN RECIPIENT'S TIN 3 Box 2 amount is for tax year 4 Federal income tax withheld Copy B $ For Recipient RECIPIENT'S name S RTAA payments 6 Taxable grants This is important tax $ $ information and is being furnished to the 7 Agriculture payments 8 If checked. box 2 is trade or business IRS. If you are required Street address (including apt. no.) $ income to file a retton. a negligence penalty or 0 Market g in other sanction may be City or town. state or province. country. and ZIP or foreign postal code $ imposed on you if this income is taxable and 10a State 10b State idenbfication no 11 Sate income tax *Maid the IRS determines that Account number (see instructions) $ it has not been reported. $ Form 1099-G (keep for your records) wvm.irs.gov/Form10996 Department of the Treasury - Internal Revenue Service EFTA01222596