Form 1099-Patr - Taxable Distributions Received From Cooperatives - 2018 Page 5
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2
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4
5
6VOID
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
$
2018
Distributions
2 Nonpatronage distributions
Received From
$
Cooperatives
3 Per-unit retain allocations
1099-PATR
$
Form
PAYER’S TIN
RECIPIENT’S TIN
4 Federal income tax withheld
Copy C
$
For Payer
RECIPIENT’S name
5 Redemption of nonqualified
6 Domestic production
notices and retain allocations
activities deduction
For Privacy Act
$
$
and Paperwork
Street address (including apt. no.)
7 Investment credit
Reduction Act
$
Notice, see the
2018 General
8 Work opportunity credit
9 Patron’s AMT adjustment
City or town, state or province, country, and ZIP or foreign postal code
Instructions for
$
$
Certain Information
Returns.
Account number (see instructions)
2nd TIN not.
10 Other credits and deductions
$
1099-PATR
Form
Department of the Treasury - Internal Revenue Service
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