Cj voip

[_] CORRECTED

PAYER'S name, street address, city, state, and ZIP code

1 Unemployment compensation

$

2 State or local income tax
refunds, credits, or offsets

$

‘OMB No. 1545-0120

1992

Certain
Government
Payments

PAYER'S Federal identification number] RECIPIENT'S identification number

‘3 Box 2 amount is for tax year

4 Federal income tax withheld

$ Copy C

RECIPIENT'S name

Street address (including apt. no.)

City, state, and ZIP code

'§ Discharge of indebtedness

$

6 Taxable grants For Payer

For Paperwork
$ - Reduction Act

7 Agriculture payments

$

8 The amount in Box 2 Notice and
applies to income from a instructions for

‘Account number (optional)

trade or business completing this
form, see
Instructions for
Forms 1099, 1098,
5498, and W-2G.

Form 1099-G

[J voip

(.] CORRECTED

Department of the Treasury - Internal Revenue Service

PAYER'S name, street address, city, state, and ZIP code

1 Unemployment compensation

OMB No. 1545-0120

Street address (including apt. no.)

City, state, and ZIP code

$

Cert
$ Government
2 State or local income tax 1992
refunds, credits, or offsets Payments
$
PAYER'S Federal identification number RECIPIENT'S identification number | 3 Box 2 amount is for tax year 4 Federal income tax withheld
$ Copy C
RECIPIENT'S name 5 Discharge of indebtedness | 6 Taxable grants For Payer

For Paperwork
$ Reduction Act

7 Agriculture payments

$

8 The amount in Box 2 Notice and
applies to income from a instructions for

‘Account number (optional)

trade or business completing this
form, see
Instructions for
Forms 1099, 1098,
5498, and W-2G.

Form 1099-G

[J voip

(] CORRECTED

Department of the Treasury - Internal Revenue Service

PAYER'S name, street address, city, state, and ZIP code

1 Unemployment compensation

OMB No. 1545-0120

Street address (including apt. no.)

City, state, and ZIP code

$

Cert
$ Government
2 State or local income tax 1992
refunds, credits, or offsets Payments
$
PAYER'S Federal identification number | RECIPIENT'S identification number | 3 Box 2 amount is for tax year | 4 Federal income tax withheld
$ Copy C
RECIPIENT'S name 5 Discharge of indebtedness | 6 Taxable grants For Payer

For Paperwork
$ Reduction Act

7 Agriculture payments

$

8 The amount in Box 2 Notice and
applies to income from a instructions for
trade or business completing this

‘Account number (optional)

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

Form 1099-G

Department of the Treasury - Internal Revenue Service


Instructions for Recipient

Box 1.—Shows the total unemployment compensation paid to
you this year by the payer. This amount is taxable income to
you. For ore information, see the instructions for your
Federal income tax return.

Box 2.—Shows refunds, credits, or offsets of state or local
income tax you received. If there is an entry in this box, it may
be taxable to you if you deducted the tax paid as an itemized
deduction on your Federal income tax return. Even if you did
not receive the amount shown, for example, because it was
credited to your estimated tax, it is still taxable to you if it was
deducted. See the instructions for Form 1040 or 1040A for
more information

Box 3.—Identifies the tax year for which the refund, credit, or
offset shown in Box 2 was made. If there is no entry in this,
box, the refund is for 1991 taxes.

Box 4,—Shows backup withholding. For example, persons not
furnishing their taxpayer identification number to the payer
become subject to backup withholding at a 20% rate on
certain payments, See Form W-9, Request for Taxpayer
identification Number and Certification, for information on
backup withholding. Include this on your income tax return
as tax withheld,

Instructions for Recipient

Box 1.—Shows the total unemployment compensation paid to
you this year by the payer. This amount is taxable income to
you. For more information, see the instructions for your
Federal income tax return.

Box 2.—Shows refunds, credits, or offsets of state or local
income tax you received. If there is an entry in this box, it may
be taxable to you if you deducted the tax paid as an itemized
deduction on your Federal income tax return. Even if you dic
not receive the amount shown, for example, because it was
credited to your estimated tax, it is still taxable to you if it was
deducted. See the instructions for Form 1040 or 1040A for
more information.

Box 3.—Identifies the tax year for which the refund, credit, or
offset shown in Box 2 was made. If there is no entry in this
box, the refund is for 1991 taxes.

Box 4.—Shows backup withholding, For example, persons not
furnishing their taxpayer identification number to the payer
become subject to backup withholding at a 20% rate on
certain payments. See Form W-8, Request for Taxpayer
identification Number and Certification, for information on
backup withholding. Include this on your income tax return
as tax withheld.

Instructions for Recipient

Box 1.—Shows the total unemployment compensation paid to
you this year by the payer. This amount is taxable income to
you. For more information, see the instructions for your
Federal income tax return.

Box 2.—Shows refunds, credits, or offsets of state or local
income tax you received. If there is an entry in this box, it may
be taxable to you if you deducted the tax paid as an itemized
deduction on your Federal income tax return. Even if you did
not receive the amount shown, for example, because it was
credited to your estimated tax, it is still taxable to you if it was
deducted. See the instructions for Form 1040 or 1040A for
more information.

Box 3.—Identifies the tax year for which the refund, credit, or
offset shown in Box 2 was made. If there is no entry in this
box, the refund is for 1991 taxes.

Box 4.—Shows backup withholding. For example, persons not
furnishing their taxpayer identification number to the payer
become subject to backup withholding at a 20% rate on
certain payments. See Form W-9, Request for Taxpayer
Identification Number and Certification, for information on
backup withholding. Include this on your income tax return
as tax withheld.

Box 5.—Shows your indebtedness to a Federal government
agency that was discharged this year as no longer collectible.
This debt generally becomes taxable income to you at the
time the debt is discharged. However, there are exceptions to
this rule—for example, if you are insolvent or have declared
bankruptcy, See Pub. 908, Bankruptcy and Other Debt
Cancellation, for additional information

Box 6.--Shows the amount of taxable grants you received
from the Federal, state, or local government.

Box 7.—Shows the amount of Department of Agriculture
payments that are taxable to you. If the payer shown is
anyone other than the Department of Agriculture, it means the
payer has received a payment, as a nominee, that is taxable
to you. This may represent the entire agricultural subsidy

payment received on your behalf by the nominee, or it may be
your pro rata share of the original payment. See Pub. 225,
Farmer's Tax Guide, and the instructions for Schedute F
(Form 1040), Profit or Loss From Farming, for information
about where to report this income.

Box 8,—If this box is checked, the refund, credit, or offset in
Box 2 is attributable to an income tax that applies exclusively
to income from a trade or business and is not a tax of general
application. The amount, if taxable, should not be reported on
page 1 of Form 1040, but sheuld be reported on Schedule C
or F (Form 1040), as appropriate

Box 5.—Shows your indebtedness to a Federal government
agency that was discharged this year as no longer collectible.
This debt generally becomes taxable income to you at the
time the debt is discharged. However, there are exceptions to
this rule—for example, if you are insolvent or have declared
bankrupicy. See Pub. 908, Bankruptcy and Other Debt
Canceliation, for additional information.

Box 6.-~Shows the amount of taxable grants you received
from the Federal, state, or local government.

Box 7-—Shows the amount of Department of Agriculture
payments that are taxable to you. If the payer shown is
anyone other than the Department of Agriculture, it means the
payer has received a payment, as a nominee, that 1s taxable
to you. This may represent the entire agricultural subsidy
payment received on your behalf by the nominee, or it may be
your pro rata share of the original payment. See Pub. 225,
Farmer's Tax Guide, and the instructions for Schedule F
(Form 1040), Profit or Loss From Farming, for information
about where to report this income

Box 8.—If this box is checked, the refund, credit, or offset in
Box 2 is attributable to an income tax that applies exclusively
to income from a trade or business and is not a tax of general
application. The amount, if taxable, should not be reported on
page 1 of Form 1040, but should be reported on Schedule C
or F (Form 1040), as appropriate.

Box 5.—Shows your indebtedness to a Federal government
agency that was discharged this year as no longer collectible.
This debt generally becomes taxable income to you at the
time the debt is discharged. However, there are exceptions to
this rule—for exarnple, if you are insolvent or have declared
bankiuptcy. See Pub. 908, Bankruptcy and Other Debt
Cancellation, for additional information

Box 6.—Shows the amount of taxable grants you received
from the Federal, state, or local government.

Box 7.—Shows the amount of Department of Agriculture
payments that are taxable to you. If the payer shown is
anyone other than the Department of Agriculture, it means the
payer has received a payment, as a nominee, that is taxable
to you. This may represent the entire agricultural subsidy
payment received on your behalf by the nominee, or it may be
your pro rata share of the original payment. See Pub. 225,
Farmer's Tax Guide, and the instructions for Schedule F
(Form 1040), Profit or Loss From Farming, for information
about where to report this income.

Box 8.—if this box 1s checked, the refund, credit, or offset in
Box 2 is attributable to an income tax that applies exclusively
to income from a trade or business and is not a tax of general
application. The amount, if taxable, should not be reported on
page 1 of Form 1040, but should be reported on Schedule C
or F (Fora 1040), as appropriate.


&6864 [J] VOI [| CORRECTED
'PAYER’S name, street address, city, state, and ZIP code 1 Unemployment compensation | OMB No. 1545-0120
Certain
$ Government
2 State or local income tax 1992
refunds, credits, or offsets Payments
$
PAYER'S Federal identification number RECIPIENT'S identification number | 3 Box 2 amount is for tax year | 4 Federal income tax withheld Copy A

$ For

RECIPIENT'S name

5 Discharge of indebtedness

$

Internal Revenue
6 Taxable grant
maple grants Service Center

File with Form 1096,
For Paperwork

$

Street address (Including apt. no.)

7 Agriculture payments

$

8 The amount in Box 2
apples to income from 2 [~]
trade or business >

Reduction Act
Notice and
instructions for

City, state, and ZIP code

‘Account number (optional)

completing this
form, see
Instructions for
Forms 1099, 1098,
5498, and W-2G.

Form 1099-G

Cat. No. 14438M

Department of the Treasury - Internal Revenue Service

Do NOT Cut or Separate Forms on This Page

&b48b [J] VOID [] CORRECTED
PAYER'S name, street address, city, state, and ZIP code 1 Unemployment compensation | OMB No. 1545-0120
Certain
$ Government
2 State or local income tax 1992
refunds, credits, or offsets Payments
$
PAYER'S Federal identification number RECIPIENT'S identification number | 3 Box 2 amount is for tax year | 4 Federal income tax withheld Copy A
$ For

RECIPIENT'S name

§ Discharge of indebtedness

$

Internal Revenue
Service Center

File with Form 1096.

6 Taxable grants

$

‘Street address (including apt. no.)

7 Agriculture payments

$

For Paperwork
Reduction Act

Notice and
instructions for

8 The amount in Box2
applies to income from a
tase or business LJ

City, state, and ZIP code

Account number (optional)

completing this
form, see
Instructions for
Forms 1099, 1098,
8498, and W-2G.

Form 1099-G

Cat. No. 14438M

Department of the Treasury - Internal Revenue Service

Do NOT Cut or Separate Forms on This Page

&BL8bL © voi _(.] CORRECTED
PAYER'S name, street address, city, state, and ZIP code T Unemployment compensation | OMB No, 1845-0120
Certain
$ Government
2 State or local income tax 1992 met
refunds, credits, or offsets Payments
$
PAYER'S Federal Identification number | RECIPIENT'S identification number | 8 Box 2 amount is for tax year | 4 Federal income tax withheld Copy A
$ For
RECIPIENT'S name % Discharge of indebtedness | 6 Taxable grants Internal Revenue
$ $ File with Form 1096.
For Paperwork
Street address (including apt. no) 7 Agriculture payments @ The amount in Box 2 Reduction Act
applies to income from a Notice and
$ trade or business inet eeeen
City, state, and ZIP code completing this
instructions for
Account number (optional) Forms 1099, 1098,
5498, and W-2G,

Form 1099-G

Cat. No. 14438M

Department of the Treasury - Internal Revenue Service




(1 CORRECTED (if checked)

PAVER'S flame, street address, city, state, and ZIP code 7 Unemployment compensation | OMB No. 1545-0120
$ Certain
2 State or local income tax 1992 Government
refunds, credits, or offsets Payments
$
PAVERS Federal identification number | RECIPIENT'S identification number | 3 Box 2 amount is for tax year | 4 Federal income tax withheld Copy B

$ For Recipient

RECIPIENT'S name

Street address (including apt. no.)

City, state, and ZIP code

5 Discharge of indebtedness

$

6 Taxable grants This is important tax

information and is
being furnished to the
$ Internal Revenue

7 Agriculture payments

$

8 The amount in Box 2
applies to income from a
trade or business

required fo file a
return, a negligence

Service. If you are
O penalty or other

‘Account number (optional)

sanction may be
imposed on you if this
income is taxable and
the IRS determines
that it has not been
reported.

Form 1099-G

(keep for your records)

Department of the Treasury - Internal Revenue Service

(1 CORRECTED (if checked)

PAYER’S name, street address, city, state, and ZIP code 7 Unemployment compensation | OMB No. 1545-0120
$ Certain
2 State or local income tax 1992 Government
refunds, credits, or offsets Payments
$
PAVER’S Federal identification number | RECIPIENT'S identification number | 3 Box 2 amount is for tax year | 4 Federal income tax withheld Copy B

$ For Recipient

RECIPIENT'S name

Street address (including apt. no.)

City, sta.s, and ZIP code

5 Discharge of indebtedness

$

This is important tax

information and is
being furnished to the
$ Internal Revenue

6 Taxable grants

7 Agriculture payments

$

Service. If you are
required to file a
return, a negligence
penalty or other

8 The amount in Box 2
applies to income from a
trade or business >

‘Account number (optional)

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)

Department of the Treasury - Interal Revenue Service

(_] CORRECTED (if checked)

PAYER’S name, street address, city, state, and ZIP code 1 Unemployment compensation | OMB No. 1545-0120
$ Certain
Government
2 State or local income tax
refunds, credits, or offsets Payments
$
PAYER'S Federal identific: ‘ion number RECIPIENT'S identification number | 3 Box 2 amount is for tax year | 4 Federal income tax withheld Copy B

$ For Recipient

RECIPIENT'S name

Street address (including apt. no.)

City, state, and ZIP code

'5 Discharge of indebtedness

$

Taxable grants This is important tax

information and is,
being furnished to the
$ Internal Revenue

7 Agriculture payments

$

8 The amount in Box 2

amoun required to file a
applies to income from a

return, a negligence

Service. If you are

trade or business penalty or other

‘Account number (optional)

sanction may be
imposed on you if this
income is taxable and
the IRS determines,
that it has not been
reported,

Form 1099-

(keep for your records)

Department of the Treasury - Internal Revenue Service