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

1999

Copy A

File with Form 1096.

For Privacy Act and

Paperwork Reduction

Act Notice and

instructions for

completing this

form, see the

1999 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

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

$

1999
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), as appropriate.

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. 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. If no amount is shown in

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

distributions, see the Form 1040 instructions for the “Capital gain or

(loss)” line. If any amount is shown in boxes 2b–2d, report the amount in

box 2a on Schedule D (Form 1040), Part II.

Box 2b. 28% rate gain. Report this amount on Schedule D (Form 1040),

Part II.

Box 2c. Unrecaptured section 1250 gain from certain depreciable real

property. Report this amount on line 11 of 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), you must report future nontaxable

distributions as capital gains, even though this form shows them as

nontaxable. For more information, 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 your Federal identification number is shown on this form

and the 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 1999 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

$

1999

For Privacy Act and

Paperwork

Reduction Act

Notice and

instructions for

completing this

form, see the

1999 Instructions

for Forms 1099,

1098, 5498, and

W-2G.
Payers, Please Note—

Specific information needed to complete this form

and other forms in the 1099 series is given in the

1999 Instructions for Forms 1099, 1098, 5498,

and W-2G. A chart in those 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.ustreas.gov.

Due dates. Furnish Copy B of this form to the

recipient by January 31, 2000.

File Copy A of this form with the IRS by

February 28, 2000. If you file electronically, the

due date is March 31, 2000.

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 machines (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.