Form 1099-Div - Dividends And Distributions - 2007 Page 3
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1
2
3VOID
CORRECTED
1a
Total ordinary dividends
PAYER’S name, street address, city, state, ZIP code, and telephone no.
OMB No. 1545-0110
Dividends and
$
2007
Distributions
1b Qualified dividends
1099-DIV
$
Form
2a
Total capital gain distr.
2b
Unrecap. Sec. 1250 gain
Copy C
$
$
For Payer
PAYER’S federal identification
RECIPIENT’S identification
number
number
RECIPIENT’S name
2c
Section 1202 gain
2d
Collectibles (28%) gain
For Privacy Act
$
$
and Paperwork
3
Nondividend distributions
4 Federal income tax withheld
Reduction Act
$
$
Notice, see the
Street address (including apt. no.)
5 Investment expenses
2007 General
Instructions
$
for Forms
City, state, and ZIP code
6
Foreign tax paid
7
Foreign country or U.S. possession
1099, 1098,
$
5498,
Account number (see instructions)
2nd TIN not.
8
Cash liquidation
9
Noncash liquidation
and W-2G.
distributions
distributions
$
$
1099-DIV
Department of the Treasury - Internal Revenue Service
Form
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