9191 VOID CORRECTED

4 Federal income tax withheld

PAYER’S name, street address, city, state, ZIP code, and telephone no. OMB No. 1545-0110

Dividends and

Distributions

$

2a Total capital gain distr.

PAYER’S Federal identification number RECIPIENT’S identification number 2c Unrecap. sec. 1250 gain Copy A $ $ For

Internal Revenue

Service Center

28% rate gain

3

2b

RECIPIENT’S name Nontaxable distributions

$ $ File with Form 1096.

For Paperwork

Reduction Act Notice

and instructions for

completing this

form, see the

1998 Instructions for

Forms 1099, 1098,

5498, and W-2G.

Section 1202 gain

Street address (including apt. no.) 5 Investment expenses

2d

$

City, state, and ZIP code

Account number (optional) 2nd TIN Not. Noncash liquidation distr. 8 Cash liquidation distr. 9

$ $

Form 1099-DIV Department of the Treasury - Internal Revenue Service

Do NOT Cut or Separate Forms on This Page

Cat. No. 14415N

Form 1099-DIV

98

$

6 Foreign tax paid 7 Foreign country or U.S. possession

$

$

1 Ordinary dividends
CORRECTED (if checked)

PAYER’S name, street address, city, state, ZIP code, and telephone no. OMB No. 1545-0110

Dividends and

Distributions

PAYER’S Federal identification number RECIPIENT’S identification number

RECIPIENT’S name

Street address (including apt. no.)

City, state, and ZIP code

Account number (optional)

Form 1099-DIV Department of the Treasury - Internal Revenue Service

Copy B

For Recipient

This is important tax

information and is

being furnished to the

Internal Revenue

Service. If you are

required to file a return,

a negligence penalty or

other sanction may be

imposed on you if this

income is taxable and

the IRS determines that

it has not been

reported.

(Keep for your records.)

Form 1099-DIV

98

4 Federal income tax withheld

$

2a Total capital gain distr.

$

2b 28% rate gain

$

2d Section 1202 gain

$

8 Cash liquidation distr.

$

$

6 Foreign tax paid

$

1 Ordinary dividends

2c Unrecap. sec. 1250 gain

$

3 Nontaxable distributions

$

5 Investment expenses

9 Noncash liquidation distr.

$

7 Foreign country or U.S. possession

$
Instructions for Recipient

Box 1. Ordinary dividends, which include any net short-term capital gains

from a mutual fund, are fully taxable. Include this amount on the

“Dividends” line of Form 1040 or 1040A. Also report it on Schedule B

(Form 1040) or Schedule 1 (Form 1040A), as appropriate. This amount

includes any amount shown in box 5.

Box 4. Shows backup withholding. For example, persons not furnishing

their taxpayer identification number to the payer become subject to

backup withholding at a 31% rate on certain payments. See Form W-9,

Request for Taxpayer Identification Number and Certification, for

information on backup withholding. Include this amount on your

income tax return as tax withheld.

The amount shown may be a distribution from an employee stock

ownership plan (ESOP). Report it as a dividend on your income tax

return, but treat it as a plan distribution, not as investment income, for

any other purpose.

Box 5. Any amount shown is your share of expenses of a nonpublicly

offered regulated investment company, generally a nonpublicly offered

mutual fund. If you file Form 1040, you may deduct these expenses on

the “Other expenses” line on Schedule A (Form 1040) subject to the 2%

limit. This amount is included in box 1.

Box 2a. Total capital gain distributions (long-term) from a regulated

investment company or real estate investment trust. Box 2a includes

amounts shown in boxes 2b, 2c, and 2d. Report the amount in box 2a in

Part II, Schedule D (Form 1040). If an amount appears in boxes 2b–2d,

you must report them on the proper lines of Schedule D (Form 1040).

Box 2b. 28% rate gain from sales or exchanges of assets (including

installment payments received) held over 1 year but not over 18 months

and all collectibles gains and losses. Report this amount on Schedule D

(Form 1040), Part II.

Box 2c. Unrecaptured section 1250 gain from certain depreciable real

property. Report this amount on Schedule D (Form 1040), Part IV.

Box 3. This part of the distribution is nontaxable because it is a return of

your cost (or other basis). You must reduce your cost (or other basis) by

this amount for figuring gain or loss when you sell your stock. But if you

get back all your cost (or other basis), you must report future nontaxable

distributions as capital gains, even though this form shows them as

nontaxable. For more information, see Pub. 550, Investment Income and

Expenses.

Box 2d. Section 1202 gain from certain small business stock is subject

to a 50% exclusion. See Schedule D (Form 1040) instructions.

Box 6. You may be able to claim this foreign tax as a deduction or a

credit on Form 1040. See your Form 1040 instructions.

Boxes 8 and 9. Show cash and noncash liquidating distributions.

Nominees. If your Federal identification number is shown on this form

and the form includes amounts belonging to another person, you are

considered a nominee recipient. You must file Form 1099-DIV for each of

the other owners to show their share of the income, and you must furnish

a Form 1099-DIV to each. A husband or wife is not required to file a

nominee return to show amounts owned by the other. See the 1998

Instructions for Forms 1099, 1098, 5498, and W-2G.

Caution: If an amount appears in box 2a, you must report it on

Schedule D (Form 1040). You may not file Form 1040A.
VOID CORRECTED

PAYER’S name, street address, city, state, ZIP code, and telephone no. OMB No. 1545-0110

Dividends and

Distributions

PAYER’S Federal identification number RECIPIENT’S identification number

RECIPIENT’S name

Street address (including apt. no.)

City, state, and ZIP code

Account number (optional) 2nd TIN Not.

Form 1099-DIV Department of the Treasury - Internal Revenue Service

Copy C

For Payer

For Paperwork

Reduction Act

Notice and

instructions for

completing this

form, see the

1998 Instructions

for Forms 1099,

1098, 5498,

and W-2G.

Form 1099-DIV

98

4 Federal income tax withheld

$

2a Total capital gain distr.

$

2b 28% rate gain

$

2d Section 1202 gain

$

8 Cash liquidation distr.

$

$

6 Foreign tax paid

$

1 Ordinary dividends

2c Unrecap. sec. 1250 gain

$

3 Nontaxable distributions

$

5 Investment expenses

9 Noncash liquidation distr.

$

7 Foreign country or U.S. possession

$
Payers, Please Note—

Specific information needed to complete this form

and other forms in the 1099 series is given in the

1998 Instructions for Forms 1099, 1098, 5498,

and W-2G. A chart in those instructions gives a

quick guide to which form must be filed to report

a particular payment. You can order those

instructions and additional forms by calling

1-800-TAX-FORM (1-800-829-3676).

Due dates. Furnish Copy B of this form to the

recipient by February 1, 1999.

File Copy A of this form with the IRS by March

1, 1999.

Foreign dividend recipient. If the recipient of the

dividend is a nonresident alien, you may have to

withhold Federal income tax and file Form

1042-S, Foreign Person’s U.S. Source Income

Subject to Withholding. See the Instructions for

Form 1042-S and Pub. 515, Withholding of Tax

on Nonresident Aliens and Foreign Corporations.