Attention: 

Copy A of this form is provided for informational purposes only. Copy A appears in red, 

similar to the official IRS form. The official printed version of Copy A of this IRS form is 

scannable, but the online version of it, printed from this website, is not. Do not print and file 

copy A downloaded from this website; a penalty may be imposed for filing with the IRS 

information return forms that can’t be scanned. See part O in the current General 

Instructions for Certain Information Returns, available at www.irs.gov/form1099, for more 

information about penalties.

Please note that Copy B and other copies of this form, which appear in black, may be 

downloaded and printed and used to satisfy the requirement to provide the information to 

the recipient.

To order official IRS information returns, which include a scannable Copy A for filing with 

the IRS and all other applicable copies of the form, visit www.IRS.gov/orderforms. Click on 

Employer and Information Returns, and we’ll mail you the forms you request and their 

instructions, as well as any publications you may order.

Information returns may also be filed electronically using the IRS Filing Information Returns 

Electronically (FIRE) system (visit www.IRS.gov/FIRE) or the IRS Affordable Care Act 

Information Returns (AIR) program (visit www.IRS.gov/AIR).

See IRS Publications 1141, 1167, and 1179 for more information about printing these tax 

forms.
 

Form 1099-DIV 

2019

Cat. No. 14415N 

Dividends and 

Distributions 

Copy A

For 

Internal Revenue 

Service Center 

Department of the Treasury - Internal Revenue Service

File with Form 1096.

OMB No. 1545-0110 

For Privacy Act 

and Paperwork 

Reduction Act 

Notice, see the 

2019 General 

Instructions for 

Certain 

Information 

Returns. 

9191 VOID CORRECTED

PAYER’S name, street address, city or town, state or province, country, ZIP 

or foreign postal code, and telephone no. 

PAYER’S TIN RECIPIENT’S TIN

RECIPIENT’S name 

Street address (including apt. no.) 

City or town, state or province, country, and ZIP or foreign postal code

FATCA filing 

requirement

Account number (see instructions) 2nd TIN not. 

1a Total ordinary dividends 

$ 

1b Qualified dividends

$ 

2a Total capital gain distr.

$ 

2b Unrecap. Sec. 1250 gain 

$ 

2c Section 1202 gain 

$ 

2d Collectibles (28%) gain 

$ 

3 Nondividend distributions 

$ 

4 Federal income tax withheld

$ 

5 Section 199A dividends

$ 

6 Investment expenses 

$ 

7 Foreign tax paid 

$ 

8 Foreign country or U.S. possession

9 Cash liquidation distributions

$ 

10 Noncash liquidation distributions

$ 

11 Exempt-interest dividends

$ 

12 Specified private activity 

bond interest dividends

$ 

13 State 14 State identification no. 15 State tax withheld

$ 

$ 

Form 1099-DIV www.irs.gov/Form1099DIV

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

Form 1099-DIV 

2019 Dividends and 

Distributions 

Copy 1

For State Tax 

Department 

Department of the Treasury - Internal Revenue Service

OMB No. 1545-0110 

VOID CORRECTED

PAYER’S name, street address, city or town, state or province, country, ZIP 

or foreign postal code, and telephone no. 

PAYER’S TIN RECIPIENT’S TIN 

RECIPIENT’S name 

Street address (including apt. no.) 

City or town, state or province, country, and ZIP or foreign postal code

FATCA filing 

requirement

Account number (see instructions) 

1a Total ordinary dividends 

$ 

1b Qualified dividends

$ 

2a Total capital gain distr.

$ 

2b Unrecap. Sec. 1250 gain 

$ 

2c Section 1202 gain 

$ 

2d Collectibles (28%) gain 

$ 

3 Nondividend distributions 

$ 

4 Federal income tax withheld

$ 

5 Section 199A dividends

$ 

6 Investment expenses 

$ 

7 Foreign tax paid 

$ 

8 Foreign country or U.S. possession

9 Cash liquidation distributions

$ 

10 Noncash liquidation distributions

$ 

11 Exempt-interest dividends

$ 

12 Specified private activity 

bond interest dividends

$ 

13 State 14 State identification no. 15 State tax withheld

$ 

$ 

Form 1099-DIV www.irs.gov/Form1099DIV
 

Form 1099-DIV 

2019 Dividends and 

Distributions 

Copy B 

For Recipient 

Department of the Treasury - Internal Revenue Service

This is important tax 

information and is 

being furnished to 

the IRS. 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. 

OMB No. 1545-0110 

CORRECTED (if checked)

PAYER’S name, street address, city or town, state or province, country, ZIP 

or foreign postal code, and telephone no. 

PAYER’S TIN RECIPIENT’S TIN

RECIPIENT’S name 

Street address (including apt. no.) 

City or town, state or province, country, and ZIP or foreign postal code

FATCA filing 

requirement

Account number (see instructions) 

1a Total ordinary dividends 

$ 

1b Qualified dividends

$ 

2a Total capital gain distr.

$ 

2b Unrecap. Sec. 1250 gain 

$ 

2c Section 1202 gain 

$ 

2d Collectibles (28%) gain 

$ 

3 Nondividend distributions 

$ 

4 Federal income tax withheld 

$ 

5 Section 199A dividends

$ 

6 Investment expenses 

$ 

7 Foreign tax paid 

$ 

8 Foreign country or U.S. possession

9 Cash liquidation distributions

$ 

10 Noncash liquidation distributions

$ 

11 Exempt-interest dividends

$ 

12 Specified private activity 

bond interest dividends

$ 

13 State 14 State identification no. 15 State tax withheld

$ 

$ 

Form 1099-DIV (keep for your records) www.irs.gov/Form1099DIV
Instructions for Recipient 

Recipient’s taxpayer identification number (TIN). For your protection, 

this form may show only the last four digits of your TIN (social security 

number (SSN), individual taxpayer identification number (ITIN), adoption 

taxpayer identification number (ATIN), or employer identification number 

(EIN)). However, the issuer has reported your complete TIN to the IRS.

FATCA filing requirement. If the FATCA filing requirement box is checked, 

the payer is reporting on this Form 1099 to satisfy its chapter 4 account 

reporting requirement. You also may have a filing requirement. See the 

Instructions for Form 8938.

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

assigned to distinguish your account. 

Box 1a. Shows total ordinary dividends that are taxable. Include this 

amount on the “Ordinary dividends” line of Form 1040. Also, report it on 

Schedule B (Form 1040), if required. 

Box 1b. Shows the portion of the amount in box 1a that may be eligible for 

reduced capital gains rates. See the Form 1040 instructions for how to 

determine this amount and where to report. 

The amount shown may be dividends a corporation paid directly to you 

as a participant (or beneficiary of a participant) in an employee stock 

ownership plan (ESOP). Report it as a dividend on your Form 1040 but 

treat it as a plan distribution, not as investment income, for any other 

purpose. 

Box 2a. Shows total capital gain distributions from a regulated investment

company (RIC) or real estate investment trust (REIT). See How To Report in 

the Instructions for Schedule D (Form 1040). But, if no amount is shown in 

boxes 2c–2d and your only capital gains and losses are capital gain 

distributions, you may be able to report the amounts shown in box 2a on 

your Form 1040 rather than Schedule D. See the Form 1040 instructions. 

Box 2b. Shows the portion of the amount in box 2a that is unrecaptured 

section 1250 gain from certain depreciable real property. See the 

Unrecaptured Section 1250 Gain Worksheet in the Instructions for 

Schedule D (Form 1040). 

Box 2c. Shows the portion of the amount in box 2a that is section 1202 

gain from certain small business stock that may be subject to an exclusion. 

See the Schedule D (Form 1040) instructions. 

Box 2d. Shows 28% rate gain from sales or exchanges of collectibles. If 

required, use this amount when completing the 28% Rate Gain Worksheet 

in the Instructions for Schedule D (Form 1040). 

Box 3. Shows a return of capital. To the extent of your cost (or other basis) 

in the stock, the distribution reduces your basis and is not taxable. Any 

amount received in excess of your basis is taxable to you as capital gain. 

See Pub. 550.

Box 4. Shows backup withholding. A payer must backup withhold on 

certain payments if you did not give your 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 5. Shows the portion of the amount in box 1a that may be eligible for 

the 20% qualified business income deduction under section 199A. See the 

Instructions for Form 1040.

Box 6. Shows your share of expenses of a nonpublicly offered RIC, 

generally a nonpublicly offered mutual fund. This amount is included in 

box 1a. 

Box 7. Shows the foreign tax that you may be able to claim as a deduction 

or a credit on Form 1040. See the Form 1040 instructions. 

Box 8. This box should be left blank if a RIC reported the foreign tax 

shown in box 7. 

Boxes 9 and 10. Show cash and noncash liquidation distributions. 

Box 11. Shows exempt-interest dividends from a mutual fund or other RIC 

paid to you during the calendar year. See the Instructions for Form 1040 

for where to report. This amount may be subject to backup withholding. 

See Box 4 above.

Box 12. Shows exempt-interest dividends subject to the alternative minimum 

tax. This amount is included in box 11. See the Instructions for Form 6251.

Boxes 13–15. State income tax withheld reporting boxes.

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

are considered a nominee recipient. You must file Form 1099-DIV (with a 

Form 1096) 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 spouse is 

not required to file a nominee return to show amounts owned by the other 

spouse. See the 2019 General Instructions for Certain Information Returns. 

Future developments. For the latest information about developments 

related to Form 1099-DIV and its instructions, such as legislation enacted 

after they were published, go to www.irs.gov/Form1099DIV.
 

Form 1099-DIV 

2019 Dividends and 

Distributions 

Copy 2

To be filed with 

recipient’s state 

income tax return, 

when required.

Department of the Treasury - Internal Revenue Service

OMB No. 1545-0110 

VOID CORRECTED

PAYER’S name, street address, city or town, state or province, country, ZIP 

or foreign postal code, and telephone no. 

PAYER’S TIN RECIPIENT’S TIN

RECIPIENT’S name 

Street address (including apt. no.) 

City or town, state or province, country, and ZIP or foreign postal code

FATCA filing 

requirement

Account number (see instructions) 

1a Total ordinary dividends 

$ 

1b Qualified dividends

$ 

2a Total capital gain distr.

$ 

2b Unrecap. Sec. 1250 gain 

$ 

2c Section 1202 gain 

$ 

2d Collectibles (28%) gain 

$ 

3 Nondividend distributions 

$ 

4 Federal income tax withheld

$ 

5 Section 199A dividends

$ 

6 Investment expenses 

$ 

7 Foreign tax paid 

$ 

8 Foreign country or U.S. possession

9 Cash liquidation distributions

$ 

10 Noncash liquidation distributions

$ 

11 Exempt-interest dividends

$ 

12 Specified private activity 

bond interest dividends

$ 

13 State 14 State identification no. 15 State tax withheld

$ 

$ 

Form 1099-DIV www.irs.gov/Form1099DIV
 

Form 1099-DIV 

2019 Dividends and 

Distributions 

Copy C

For Payer

Department of the Treasury - Internal Revenue Service

OMB No. 1545-0110 

For Privacy Act 

and Paperwork 

Reduction Act 

Notice, see the 

2019 General 

Instructions for 

Certain 

Information 

Returns.

VOID CORRECTED

PAYER’S name, street address, city or town, state or province, country, ZIP 

or foreign postal code, and telephone no. 

PAYER’S TIN RECIPIENT’S TIN

RECIPIENT’S name 

Street address (including apt. no.) 

City or town, state or province, country, and ZIP or foreign postal code

FATCA filing 

requirement

Account number (see instructions) 2nd TIN not. 

1a Total ordinary dividends 

$ 

1b Qualified dividends

$ 

2a Total capital gain distr.

$ 

2b Unrecap. Sec. 1250 gain 

$ 

2c Section 1202 gain 

$ 

2d Collectibles (28%) gain 

$ 

3 Nondividend distributions 

$ 

4 Federal income tax withheld

$ 

5 Section 199A dividends

$ 

6 Investment expenses 

$ 

7 Foreign tax paid 

$ 

8 Foreign country or U.S. possession

9 Cash liquidation distributions

$ 

10 Noncash liquidation distributions

$ 

11 Exempt-interest dividends

$ 

12 Specified private activity 

bond interest dividends

$ 

13 State 14 State identification no. 15 State tax withheld

$ 

$ 

Form 1099-DIV www.irs.gov/Form1099DIV
Instructions for Payer 

To complete Form 1099-DIV, use:

• The 2019 General Instructions for Certain Information 

Returns, and

• The 2019 Instructions for Form 1099-DIV.

To order these instructions and additional forms, go 

to www.irs.gov/Form1099DIV. 

Caution: Because paper forms are scanned during 

processing, you cannot file Forms 1096, 1097, 1098, 

1099, 3921, or 5498 that you print from the IRS website. 

Due dates. Furnish Copy B of this form to the recipient 

by January 31, 2020. 

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

2020. If you file electronically, the due date is 

March 31, 2020. To file electronically, you must have 

software that generates a file according to the 

specifications in Pub. 1220. The IRS does not provide a 

fill-in form option for Copy A. 

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. See 

the Instructions for Form 1042-S and Pub. 515. 

Need help? If you have questions about reporting on 

Form 1099-DIV, call the information reporting customer 

service site toll free at 866-455-7438 or 304-263-8700 

(not toll free). Persons with a hearing or speech 

disability with access to TTY/TDD equipment can call 

304-579-4827 (not toll free).