Type or print

Statement for
Recipients of

1981

PAYER'S Dividends and
name, address,} poe gs gs
ZIP code, ana’ | Distributions
Federal
identifying Copy C
number. For Payer

Recipient’s identifying number 1 Gross dividends and other dis- 2 Dividends qualifying for | 3 Dividends not qualifying for 4 Capital gain distributions

tributions on stock exclusion exclusion

5 Nontaxable distributions

is ENT" . . I.
Type or print RECIPIENT'S name, address, and ZIP code below. Nantazabie ois

6 Foreign tax paid (If eligi-
ble for foreign tax credit)

7 Foreign country or
U.S. possession

Yr GPO: 1880—0-313-10725-4118272

Form 1099-DIV

Type or print
PAYER'S
name, address,
ZIP code, and
Federal
identifying
number.

Department of the Treasury—Internal Revenue Service

Statement for
Recipients of

1981

Dividends and
Distributions

Copy C
For Payer

Recipient's identifying number 1 Gross dividends and other dis- | 2 Dividends qualifying for
tributions on stock exclusion exclusion

3 Dividends not qualifying for

4 Capital gain distributions

Type or print RECIPIENT'S name, address, and ZIP code below. 5 Nontaxable distributions

(If determinable)

6 Foreign tax paid (If eligi
ble for foreign tax credit)

7 Foreign country or
U.S. possession

Form 1099—DIV x GPO: 1980—0-313-107 251118272 Department of the Treasury—Internal Revenue Service
Statement for
Recipients of
Type or print ae
PAYER'S Dividends and
name, address, . . .
zip code, ana | Distributions
Federal
identifying Copy C
number. For Payer
Recipient's identifying number 2 Dividends qualifying for 3 Dividends not qualifying for 4 Capital gain distributions

2 Gross dividends and other dis-

tributions on stock exclusion exclusion

5 Nontaxable distributions

‘Type or print RECIPIENT'S name, address, and ZIP code below.
(if determinable)

6 Foreign tax paid (If eligi
ble for toreign tax credit)

7 Foreign country or
U.S. possession

‘Yr GPO: 1980—0-319-107 25-1118272

Form 1099-DIV

Department of the Treasury—Internal Revenue Service


Instructions For Recipient:

The amount listed in box 2 is the amount of dividends
that qualifies for the partial exclusion of dividends and
interest. You are allowed an exclusion of $200 ($400 in
the case of a joint return) of the total of the amounts
received during the tax year as qualifying domestic divi-
dends or interest.

Report the amount shown in box 1 on the Dividend
Income line of your income tax return. Then use the
amount in box 2, together with qualifying interest in-
come, to arrive at the proper amount of the exclusion for

Instructions For Recipient:

The amount listed in box 2 is the amount of dividends
that qualifies for the partial exclusion of dividends and
interest. You are allowed an exclusion of $200 ($400 in
the case of a joint return) of the total of the amounts
received during the tax year as qualifying domestic divi-
dends or interest.

Report the amount shown in box 1 on the Dividend
Income line of your income tax return. Then use the
amount in box 2, together with qualifying interest in-
come, to arrive at the proper amount of the exclusion for

Instructions For Recipient:

The amount listed in box 2 is the amount of dividends
that qualifies for the partial exclusion of dividends and
interest. You are allowed an exclusion of $200 ($400 in
the case of a joint return) of the total of the amounts
received during the tax year as qualifying domestic divi-
dends or interest.

Report the amount shown in box 1 on the Dividend
Income line of your income tax return. Then use the
amount in box 2, together with qualifying interest in-
come, to arrive at the proper amount of the exclusion for

the year. See the instructions for your income tax return
for more information on how to report the income and
take the exclusion.

If you receive dividends from a regulated investment
company (including money market funds), the company
will tell you what portion qualifies for the exclusion.

Amounts listed in box 5 as nontaxable distributions
are usually a return of capital. Once you have received
an amount equal to your basis, these distributions are
taxable to you as capital gain distributions even if the
payer lists them as nontaxable.

the year. See the instructions for your income tax return
for more information on how to report the income and
take the exclusion.

If you receive dividends from a regulated investment
company (including money market funds), the company
will tell you what portion qualifies for the exclusion.

Amounts listed in box 5 as nontaxable distributions
are usually a return of capital. Once you have received
an amount equal to your basis, these distributions are
taxable to you as capital gain distributions even if the
payer lists them as nontaxable.

the year. See the instructions for your income tax return
for more information on how to report the income and
take the exclusion.

If you receive dividends from a regulated investment
company (including money market funds), the company
will tell you what portion qualifies for the exclusion.

Amounts listed in box 5 as nontaxable distributions
are usually a return of capital. Once you have received
an amount equal to your basis, these distributions are
taxable to you as capital gain distributions even if the
payer lists them as nontaxable.


Statement for
For Official Use Only | Recipients of 1981
Ty int ivi
pares” | Dividends and
name, address, Distributions

ZIP code, and
Federal Copy A
identifying For Internal Revenue
number. Service Center
ient’s identifying number 1 Gross dividends and other dis. 2 Dividends qualifying for [J 3 Dividends not qualifying for 4 Capital gain distributions
tributions on stock exclusion exclusion
19
7 " i 5 Nontaxable distributi 6 Foreign tax paid (If eligi. | 7 Forei tt
Type or ai at RECIPIENT'S name, address, and ZIP code below (Name must aline J 5 Nontaxable distributions | 6 Foreign fax paid (If eli, | 7 foreine county or
Name >
For instructions on completing this form, see ‘'In-
structions for Form 1096.”
Form 1099—DIV GPO: 1980—-0-313-107_25-4118272 Department of the Treasury—internal Revenue Service
Statement for
For Official Use Only Recipients of
Ty it ivi
pre rt | Dividends and
name, address, Distributions
ZIP code, and
Federal Copy A
identifying For Internal Revenue
number. Service Center
Recipient's identifying number 1 Gross dividends and other dis- 2 Dividends qualifying for J 3 Dividends not qualifying for 4 Capital gain distributions
tributions on stock exclusion exclusion
19

Ty i z i 5 Nontaxable distributions | 6 Foreign tax paid (If eligi- | 7 Foreign country or
we aon RECIPIENT'S name, address, and ZIP code below (Name must aline Uf determinable) faceign tax paid t eligi freien county

Name >

For instructions on completing this form, see ‘‘In-
structions for Form 1096.”

__! |

Form 1099—DIV Fr GPO: 1980-O-S13-107_26-1118272, Department of the Treasury—Internal Revenue Service

Statement for
For Official Use Only | Recipients of 1981
Ty int ai,
pars" | Dividends and
name, address, Distributions

ZIP code, and
Federal Copy A
identifying For Internal Revenue
number. Service Center
Recipient's identifying number 1 Gross dividends and other dis- 2 Dividends qualifying for [J 3 Dividends not qualifying for 4 Capital gain distributions
tributions on stock: exclusion exclusion
10
it IPIENT’S nam: , f i 5 Nontaxable distributions | 6 Foreign tax paid (If eligi- | 7 Foreign country or
Tape or int RECIPIENT'S name, address, and ZIP code below (Name must aline J > (iGeterminabi) ble for foreign tax credit) | | U.S. possession
Name >

For instructions on completing this form, see “‘In-
structions for Form 1096.”

Form 1099—DIV GPO: 198—O-313-107 as-1118272 Department of the Treasury—Internal Revenue Service




Statement for
Recipients of
Type or print

PAYER'S Dividends and
name, address,

zip code, and | Distributions

Federal
identifying Copy B
number. For Recipient
Recipient's identifying number 1 Gross dividends and other dis- | 2 Dividends qualifying for | 3 Dividends not qualifying for 4 Capital gain distributions
tributions on stock exclusion exclusion
Type or print RECIPIENT’S name, address, and ZIP code below. 5 Nontaxable distributions 6 Foreign tax paid (If eligi. 7 Foreign country or
(If determinable) ble for foreign tax credit) U.S. possession

If this form shows two or more recipients, the recipient whose Federal identifying
number is shown should file a Form 1087-DiV with the Internal Revenue Service for
each of the other recipients and provide each with a copy. However, a husband or wife
is not required to file a Form 1087-DIV to show paymenis for the’ other.

This information is being furnished to the Internal Revenue Service.

Form 1099-DIV $e GPO: 198—O-913-107_as-1416272 Department of the Treasury—Internal Revenue Service
Statement for
Recipients of
Type or print —
PAYER'S Dividends and
name, address,| poe ge gs
Zip code, and | Distributions
Federal
identifying Copy B
number. For Recipient
Recipient's identifying number 1 Gross dividends and other dis- | 2 Dividends qualifying for | 3 Dividends not qualifying for 4 Capital gain distributions
tributions on stock exclusion exclusion
it RECIPIENT'S name, address, and ZIP code below. 5 Nontaxable distributions 6 Foreign tax paid (If eligr 7 Foreign country or
(If determinable) ble for foreign tax credit) U.S. possession
If this form shows two or more recipients, the recipient whose Federal identifying

number is shown should file a Form 1087-DiV with the Internal Revenue Service for
each of the other recipients and provide each with a copy, However, a husband or wife
is not required to file a Form 1087-DIV to show payments for the’ other.

This information is being furnished to the Internal Revenue Service.

Form 1099-DIV $e GPO: 1980—O-319-107_a2o-1410272 Department of the Treasury—Internal Revenue Service
Statement for
Recipients of
Type or print ws
PAYER'S Dividends and
name, address,| pyeig
zip code, and | Distributions
Federal
identifying Copy B
number. For Recipient
Recipient's identifying number 1 Gross dividends and other dis- 2 Dividends qualifying for | 3 Dividends not qualifying for 4 Capital gain distributions
tributions on stock exclusion exclusion
Type or print RECIPIENT'S name, address, and ZIP code below. ‘5 Nontaxable distributions 6 Foreign tax paid (if eligr. 7 Foreign country or
(If determinable) ble for foreign tax credit) U.S. possession

If this form shows two or more recipients, the recipient whose Federal identifying
number is shown should file a Form 1087-DiV with the Internal Revenue Service for
each of the other recipients and provide each with a copy. However, a husband or wife
is not required to file a Form 1087-DIV to show payments for the other.

This information is being furnished to the Internal Revenue Service.

Form 1099-DIV GPO: 188—O-B19-10725-1118272 Department of the Treasury—Internal Revenue Service