CORRECTED

PAYER’S name, street address, city, state, ZIP code, and telephone no. OMB No. 1545-0120 1 Unemployment compensation

$

State or local income tax

refunds, credits, or offsets

2

$

PAYER’S Federal identification number RECIPIENT’S identification number 3 Box 2 amount is for tax year 4 Federal income tax withheld

$

RECIPIENT’S name 6 Taxable grants

$

8 Check if box 2 is

trade or business

income 

Street address (including apt. no.) 7 Agriculture payments

$

City, state, and ZIP code

Account number (see instructions)

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

8686 VOID

Do Not Cut or Separate Forms on This Page — Do Not Cut or Separate Forms on This Page

Cat. No. 14438M

Form 1099-G

Certain

Government

Payments

5

Copy A

For

Internal Revenue

Service Center

File with Form 1096.

For Privacy Act

and Paperwork

Reduction Act

Notice, see the

2005 General

Instructions for

Forms 1099, 1098,

5498, and W-2G.

2005

ATAA payments

$
CORRECTED (if checked)

PAYER’S name, street address, city, state, ZIP code, and telephone no. OMB No. 1545-0120 1 Unemployment compensation

Certain

Government

Payments

$

State or local income tax

refunds, credits, or offsets

2

$

PAYER’S Federal identification number RECIPIENT’S identification number 3 Box 2 amount is for tax year 4 Federal income tax withheld

$

RECIPIENT’S name 6 Taxable grants

$

Street address (including apt. no.) 7 Agriculture payments

$

City, state, and ZIP code

Account number (see instructions)

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

Copy B

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)

For Recipient

Form 1099-G

5

8 Box 2 is trade or

business income 

2005

ATAA payments

$
Instructions for Recipient

Account number. May show an account or other unique number the

payer has assigned to distinguish your account.

Box 2. Shows refunds, credits, or offsets of state or local income tax

you received. It may be taxable to you if you deducted the state or

local income 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 state or local estimated

tax, it is still taxable if it was deducted. If you received interest on

this amount, report it as interest income on your tax return. See the

instructions for your tax return.

Box 6. Shows taxable grants you received from a federal, state, or

local government.

Box 7. Shows 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, Profit or Loss From Farming, for information about where to report

this income. Box 3. Identifies the tax year for which the refunds, credits, or

offsets shown in box 2 were made. If there is no entry in this box,

the refund is for 2004 taxes.

Box 4. Shows backup withholding or withholding you requested on

unemployment compensation, Commodity Credit Corporation loans,

or certain crop disaster payments. Generally, a payer must backup

withhold on certain payments at a 28% rate if you did not give your

Box 8. If this box is checked, the refunds, credits, or offsets in box 2

are attributable to an income tax that applies exclusively to income

from a trade or business and is not a tax of general application. If

taxable, report the amount in box 2 on Schedule C, C-EZ, or F (Form

1040), as appropriate.

Box 5. Shows alternative trade adjustment assistance (ATAA)

payments you received. Include on Form 1040 on the “Other

income” line. See the Form 1040 instructions.

taxpayer identification number (TIN) or did not furnish the correct TIN

to the payer. 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. Box 1. Shows the total unemployment compensation paid to you

this year. Report this amount as income on the unemployment

compensation line of your income tax return. If you expect to receive

these benefits in the future, you can ask the payer to withhold

federal income tax from each payment. Or, you can make estimated

tax payments using Form 1040-ES, Estimated Tax for Individuals.
CORRECTED

PAYER’S name, street address, city, state, ZIP code, and telephone no. OMB No. 1545-0120 1 Unemployment compensation

Certain

Government

Payments

$

State or local income tax

refunds, credits, or offsets

2

$

PAYER’S Federal identification number RECIPIENT’S identification number 3 Box 2 amount is for tax year 4 Federal income tax withheld

$

RECIPIENT’S name 6 Taxable grants

$

Street address (including apt. no.) 7 Agriculture payments

$

City, state, and ZIP code

Account number (see instructions)

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

VOID

Copy C

For Payer

Form 1099-G

5

For Privacy Act

and Paperwork

Reduction Act

Notice, see the

2005 General

Instructions for

Forms 1099,

1098, 5498,

and W-2G.

8 Check if box 2 is

trade or business

income 

2005

ATAA payments

$
Instructions for Payers

General and specific form instructions are provided as

separate products. The products you should use to

complete Form 1099-G are the 2005 General

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

and the 2005 Instructions for Form 1099-G. A chart in

the general instructions gives a quick guide to which

form must be filed to report a particular payment. To

order these instructions and additional forms, call

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

Due dates. Furnish Copy B of this form to the

recipient by January 31, 2006.

File Copy A of this form with the IRS by February 28,

2006. If you file electronically, the due date is March

31, 2006.

Caution: Because paper forms are scanned during

processing, you cannot file Forms 1096, 1098, 1099, or

5498 that you download and print from the IRS

website.