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

$ $

28% rate gain

3

2b

RECIPIENT’S name Nontaxable distributions

$ $

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 Cat. No. 14415N Department of the Treasury - Internal Revenue Service

$ Form 1099-DIV

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

$

$

1 Ordinary dividends

Copy A

File with Form 1096.

For Privacy Act and

Paperwork

Reduction Act

Notice, see the

2000 General

Instructions for

Forms 1099, 1098,

5498, and W-2G.

For

Internal Revenue

Service Center

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

2000
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

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

$

2000
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 “Ordinary

dividends” line of Form 1040 or 1040A. Also report it on Schedule B (Form

1040) or Schedule 1 (Form 1040A), if required. 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. Shows total capital gain distributions (long-term) from a regulated

investment company or real estate investment trust. Amounts shown in boxes

2b, 2c, and 2d are included in box 2a. Report the amount in box 2a on

Schedule D (Form 1040), Part II. But, if no amount is shown in boxes 2b–2d

and your only capital gains and losses are capital gain distributions, you may

be able to report the amount in box 2a on the “Capital gain or (loss)” line of

Form 1040 rather than on Schedule D (Form 1040). See the Form 1040

instructions.

Box 2b. Shows 28% rate gain from sales or exchange of collectibles. Report

this amount on Schedule D (Form 1040), Part II.

Box 2c. Shows unrecaptured section 1250 gain from certain depreciable real

property. Report this amount on the Unrecaptured Section 1250 Gain

Worksheet in the Instructions for Schedule D (Form 1040).

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), report future nontaxable distributions as capital

gains, even though this form shows them as nontaxable. See Pub. 550,

Investment Income and Expenses.

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

to a 50% exclusion. See the 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 liquidation distributions.

Nominees. If this form includes amounts belonging to another person, you are

considered a nominee recipient. You must file Form 1099-DIV with the IRS 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 2000 General

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

Caution: If an amount appears in box 2a, you must file 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

Form 1099-DIV

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

$

For Privacy Act and

Paperwork

Reduction Act

Notice, see the

2000 General

Instructions for

Forms 1099, 1098,

5498, and W-2G.

2000
Payers, Please Note—

To help make it easier for you to get only the

information you need to complete the Forms 1099,

1098, 5498, and W-2G you file, we are now providing

general and specific form instructions as separate

products. The new products you should use for 2000

are the General Instructions for Forms 1099, 1098,

5498, and W-2G, which contains general information

concerning Form 1099-DIV and other forms in the

1099 series, and the separate specific instructions for

each information return you file. Specific information

needed to complete this form is given in the 2000

Instructions for Form 1099-DIV. A chart in the general

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). You can also get

forms and instructions from the IRS’s Internet Web Site

at www.irs.gov.

Due dates. Furnish Copy B of this form to the

recipient by January 31, 2001.

File Copy A of this form with the IRS by February

28, 2001. If you file electronically, the due date is April

2, 2001.

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.

Caution: Because the IRS processes paper forms by

machine (optical character recognition equipment), you

cannot file with the IRS Forms 1096, 1098, 1099, or

5498 that you print from the IRS’s Internet Web Site.