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Form 1099-G

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PAYER’S name, street address, city, state, and ZIP code 1 Unemployment compensation] OMB No. 1545-0120
$ Certain
Tmaeee | 1991 Government
fe or local income tax
refunds, credits, or offsets Payments
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PAYER’S Federal identification number | RECIPIENT'S identification number | 3 Box 2 amounts for tax year | 4 Federal income tax withheld Copy C
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RECIPIENT'S name 5 Dischargeof indebtedness | 6 Taxable grants
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Department of the Treasury - Internal Revenue Service

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PAYER’S name, street address, city, state, and ZIP code 1 Unemployment compensation] OMB No, 1545-0120
$ Certain
Tmaeen | 1991 Government
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PAYER’S Federal identification number | RECIPIENT'S identification number | 3 Box 2amount s for tax year | 4 Federal income tax withheld Copy C
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City, state, and ZIP code Instructions for

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Form 1099-G

Forms 1099, 1098,
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Department of the Treasury - Internal Revenue Service

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Form 1099-G

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PAYER'S name, street address, city, state, and ZIP code 1 Unemployment compensation] OMB No. 1545-0120
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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 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 maybe
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 1990 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 maybe
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 1990 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 maybe
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 1990 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 Publication 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 Publication 225, Farmer's Tax Guide, and
the instructions for Schedule F (Form 1040), Farm Income and
Expenses, 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 one 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 example, if you are insolvent or have declared
bankruptcy. See Publication 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 Publication 225, Farmer's Tax Guide, and
the instructions for Schedule F (Form 1040), Farm Income and
Expenses, 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 one 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 example, if you are insolvent or have declared
bankruptcy. See Publication 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 Publication 225, Farmer's Tax Guide, and
the instructions for Schedule F (Form 1040), Farm Income and
Expenses, 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 one of Form 1040, but should be reported on Schedule C

or F (Form 1040), as appropriate.


Qb8b (J voip

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Clty, state, and ZIP code

‘Account number (optional)

Form 1099-G

Do NOT Cut or Separate Forms on This Page

‘Type or machine print PAYER’S name, street address, city, state, and ZIP code | 1 Unemployment compensation] OMB No. 1545-0120

Certain

$
2 State or local income tax Government
refunds, credits, or offsets Payments

$
PAYER’S Federal identification number | RECIPIENT'S identification number | 3 Box2amount ls ortex year | 4 Federal income tax withheld Copy A
$ ‘or
Internal Revenue

7 Ne

Type or machine print RECIPIENT'S name 8 Discharge of indebtedness | 6 Taxable grants Service Center
File with Form 1096.
$ $ For Paperwork
Street address (Including apt. no.) 7 Agriculture payments 8 The amount in Box 2 apples Reduction Act
to income fom a rad Notice and

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

Department of the Treasury - Internal Revenue Service

Do NOT Cut or Separate Forms on This Page

4bab Civoip [| CORRECTED

Type or machine print PAYER'S name, street address, city, state, and ZIP code | 1 Unemployment compensation] OMB No. 1545-0120
$ Certain
2 State or local income tax 1991 Government
refunds, credits, or offsets Payments

$

PAYER’ Federal identification number | RECIPIENT'S identification number | 3 Box2amountis fortax year | 4 Federal income tax withheld Copy A
$ ‘or
Type or machine print RECIPIENT'S name 1 Discharge of indebtedness | 6 Taxable grants Internal Rey antar
File with Form 1096,
$ $ For Paperwork
Street address (Including apt. no.) 7 Agriculture payments 8 The amount InBox Reduction Act
$ falncor ye from a trade Notioe and
instructions for
completing this
form, see
‘Account number (optional) Fon a teaetions fer for
Hl HU A 5498, and W-2G.
Form 1099-G Department of the Treasury - Internal Revenue Service

City, state, and ZIP code

Account number (optional)

Form 1099-G

&b4b (voip  [] CORRECTED
‘Type or machine print PAYER’S name, street address, city, state, and ZIP code | 1 Unemployment compensation] OMB No. 1845-0120
$ Certain
2 State or local income tax 1991 Government
refunds, credits, or offsets Payments
$
PAYER’S Federal identification number | RECIPIENT'S identification number | 3 Box2amountis for tax year | 4 Federal income tax withheld Copy A
$ ‘or
7 Internal Revenue
Type or machine print RECIPIENT'S name 5 Discharge of indebtedness | 6 Taxable grants Service Center
File with Form 1096.
$ $ For Paperwork
‘Street address (including apt. no.) 7 Agriculture payments 8 The amount in Box 2 applies Reduction Act
to income from a trad ir Notice and
business

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

Department of the Treasury - internal Revenue Service




(J CORRECTED (if checked)

PAYER’S name, street address, city, state, and ZIP code 1 Unemployment compensation] OMB No. 1545-0120
$ Certain
2 State or local income tax 1991 Government
refunds, credits, or offsets Payments
$
PAYER'S Federal identification number | RECIPIENT'S identification number 3 Box 2 amountis fortax year | 4 Federal income tax withheld Copy B

EY 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
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$ internal Revenue
Service. If you are

$

7 Agriculture payments 8 The amount in Box? applies
toincome from a trade or

$ business...

required to filea
return, a negligence
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

Department of the Treasury - Internal Revenue Service

(Zl CORRECTED (if checked)
PAYER’S name, street address, city, state, and ZIP code 1 Unemployment compensation] OMB No. 1545-0120
Certain
$
2 State or local income tax Government
refunds, credits, or offsets Payments
$
PAYER'S Federal identification number | RECIPIENT'S identification number 3 Box 2 amountis fortax 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
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$ Internal Revenue

$

7 Agriculture payments 8 The amount in Box 2 applies
toincome from a trade or

$ business... > L)

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

[CI CORRECTED (if

Department of the Treasury - Internal Revenue Service

hecked)

PAYER’S name, street address, city, state, and ZIP code 1 Unemployment compensation} OMB No. 1545-0120
s 1991 Government
2 ee eee Payments
$

PAYER'S Federal identification number | RECIPIENT'S identification number 3 Box 2 amount is fortax 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 tothe
internal Revenue
Service. If you are

$ $

7 Agriculture payments ‘8 The amount in Box 2 applies
to income from a trade or

$ business... > LI

required to filea
return, a negligence
penalty or other

sanction may be
imposed on you if this,
income is taxable and

Foobunt number (optional the IRS determines
count number (optional) that it has not been
reported,

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