EFTA01222594.pdf

0 CORRECTED if checked PAYER'S name. street address. city or town. state or province, country. ZIP to Total ordinary dividends OMB No. 1505-0110 or foreign postal code. and telephone no. $ Dividends and lb Qualified dividends 2018 Distributions $ Form 1099-DIV 2a Total capital gain distr. 2b Unrecap. Sec. 1250 gain Copy B For Recipient PAYERS TIN RECIPIENT'S TIN 2c Section 1202 gain 2d Collectibles (28%) gain $ $ RECIPIENTS name 3 Nondividend distributions 0 Federal ncorne tax vnthheld This is important tax $ $ information and is 5 Section 199A dividends 6 Investment expenses being furnished to the IRS. If you are Street address (including apt. no.) $ $ required to file a 7 Foreign tax paid 8 Roan country ar U.S. possesses return. a negligence penalty or other sanction may be City or town. state or province. country. and ZIP or foreign postal code $ imposed on you if this income is taxable 9 Cash liquidation distributions 10 Noncash liquid: non chanty:an and the IRS $ $ determines that it has not been reported. FATCA film 11 Exempt-interest dividends 12 Specified private activity requirement bond interest dividends 0 $ $ Account number (see instructions) 13 State USOPOOMMenna 15 State tax withheld $ Form 1099-DIV (keep for your records) wwwits.goviform1099DIV Department of the Treasury - Internal Revenue Service EFTA01222594