Form 1099-Patr - Taxable Distributions Received From Cooperatives - 2012 Page 5
ADVERTISEMENT
1
2
3
4
5
6VOID
CORRECTED
PAYER’S name, street address, city, state, ZIP code, and telephone no.
1 Patronage dividends
OMB No. 1545-0118
Taxable
$
2012
Distributions
2 Nonpatronage distributions
Received From
$
Cooperatives
3 Per-unit retain allocations
1099-PATR
$
Form
PAYER’S federal identification number RECIPIENT’S identification number
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
2012 General
8 Work opportunity credit
9 Patron’s AMT adjustment
City, state, and ZIP 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
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Financial