Form 1099-Div - Dividends And Distributions - 2018 Page 4
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8CORRECTED (if checked)
1a Total ordinary dividends
OMB No. 1545-0110
PAYER’S name, street address, city or town, state or province, country, ZIP
or foreign postal code, and telephone no.
Dividends and
2018
$
Distributions
1b Qualified dividends
$
1099-DIV
Form
2a Total capital gain distr.
2b Unrecap. Sec. 1250 gain
Copy B
$
$
For Recipient
PAYER’S TIN
RECIPIENT’S TIN
2c Section 1202 gain
2d Collectibles (28%) gain
$
$
RECIPIENT’S name
3
Nondividend distributions
4
Federal income tax withheld
This is important tax
$
$
information and is
being furnished to
5
Investment expenses
the IRS. If you are
$
Street address (including apt. no.)
required to file a
return, a negligence
6
Foreign tax paid
7
Foreign country or U.S. possession
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
8
Cash liquidation distributions
9
Noncash liquidation distributions
and the IRS
$
$
determines that it has
not been reported.
10 Exempt-interest dividends
11 Specified private activity
FATCA filing
requirement
bond interest dividends
$
$
Account number (see instructions)
12 State
13
14 State tax withheld
State identification no.
$
$
1099-DIV
(keep for your records)
Form
Department of the Treasury - Internal Revenue Service
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