: C vow

(J corrRECTED

PAYER’S name, street address, city, state, and ZIP code

1 Gross dividends and other
distributions on stock

$

OMB No. 1545-0110

2 Investment expenses
included in Box 1

Dividends and
Distribu

1988

Statement for

$ Recipients of

PAYER’S Federal identification number | RECIPIENT'S identification number | 3 Capital gain distributions Yyf YY Copy C
iY YY

$ WM For Payer

RECIPIENT'S name (first, middle, last)

4 Federal income tax withheld

5 Nontaxable distributions (if

determinable) For Paperwork

Reduction Act

$ $ Notice and

Street address 6 Foreign tax paid 7 Foreign country or U.S. possession instructions for
$ completing this

City, state, and ZIP code 1 form, Sor
; : iquidation Distributi instructions for
Liquidation Distributions Forms 1099,

‘Account number (optional) 8 Cash 9 Noncash (Fair market value) 1098, 5498,
$ $ 1096, and W-2G.

Form 1099-DIV

Department of the Treasury - Internal Revenue Service

Li voi Li correcteo
PAYER'S name, street adcress, city, state, and ZIP code . 1 Gross dividends and other OMB No. 1545-0110
distributions on stock
$ 1988 Dividends and
| Distributions
2 Investment expenses
included in Box 1
Statement for
$ Recipients of
PAYER’S Federal identification number | RECIPIENT'S identification number 3 Capital gain distributions Copy Cc
$ For Payer

RECIPIENT'S name (first, middle, last)

4 Federal income tax withheld

5

Nontaxable distributions (if
determinable) For Paperwork

Reduction Act

$ $ Notice and

Street address 6 Foreign tax paid 7 Foreign country or U.S, possession instructions for
$ completing this

City, state, and ZIP code instruc ee
ity, state, iquidation Distributi instructions for
. Liquidation Distributions Forms 1099,

‘Account number (optional) 8 Cash 9 Noncash (Fair market value) 1098, 5498,
$ $ 1096, and W-2G

Form 1099-DIV

Department of the Treasury - Internal Revenue Service

Evo [) correctep
PAYER'S name, street address, city, state, and ZIP code 1 Gross dividends and other OMB No. 1545-0110
distributions on stock
$ 1988 Dividends and
Distributions
2 Investment expenses
included in Box 1
Statement for
$ Recipients of
PAYER’S Federal identification number | RECIPIENT'S identification number | 3 Capital gain distributions Yy y Copy C
$ I] For Payer

RECIPIENT'S name (first, middle, last)

4 Federal income tax withheld

5

Nontaxable distributions (if
determinable) For Paperwork

Reduction Act

$ $ Notice and

Street address 6 Foreign tax paid 7 Foreign country or U.S. possession instructions for
$ completing this

City, state, and ZIP code Inst form, vod
_— Liquidation Distributions Instructions for

4 Forms 1099,

‘Account number (optional) 8 Cash 9 Noncash (Fair market value) 1098, 5498,
$ $ 1096, and W-2G.

Form 1099-DIV

Department of the Treasury - Internal Revenue Service


Instructions for Recipient

Box 1.—Report the amount shown on the “Dividends” line of your
income tax return or, if required, list your dividends on the separate
schedule of your tax return. See the instructions for your income tax
return for more information on how to report the income.

The amount shown may be a distribution from an emoloyee stock
ownership plan (ESOF>. Although you should report the ESOP
distribution as a dividend on your income tax return. treat it as a
plan distribution, not as investment income, for any other purpose.
Box 2.—-The amount shown is your share ot the expenses of =
regulated investment company, including a mutual fund, which is
included as a dividend in Box i. The full amount shown in Box 1
must be reported as income on your tax return. The expenses
shown in Box 2 are deductible as a “Miscellaneous Deduction” only
if you itemize your deductions. Generally, the actual amount you
should have received or had credited to you ts the amount in Box 1
less the amount in Box 2.

Box 3.—Report the amount shown as a capital gain on your tax
return. This amount is also included in Box 1. See your Form 1040
instructions.

Box 4.—Any amount shown represents backup withhoiding. For
example, persons not furnishing their taxpayer identification
number to the payer become subject to backup withholding at a

Instructions for Recipient

Box 1.—Report the amount shown on the “Dividends” line of your
income tax return or, if required, list your dividends on the separate
schedule of your tax return. See the instructions for your income tax
return for more information on how to report the income.

The amount shown may be a distribution from ar employee stock
ownership plan (ESOP?. Although you should report the ESOP
distribution as a dividend on your income tax return, treat tt asa
plan distribution, not as investment income, for anv other purpose.
Box 2,—The amount shewn 1s your share of the expenses of a
regulated investment company, including 4 mutual fund, which is
incluaed as a dividend in Box 1. The full amount shown in Bex 1
must be reported as income on your tax return. The exoenses
shown in Sox 2 are deductible as a “Miscellaneous Deduction” only
if you itemize vour aeauctions. Generally, the actual amount you
should have received or had credited tc you 1s the amount in Box 1
less the amount tn Box 2.

Box 3.—Report the amount shown as a capital gain on your tax
yeturn. This amount is also included in Box 1. See your Form 3040
instructions. ‘

Box 4,.—Any amount shown represents backup withholding. For
example, versons not furnishing their taxpayer identification
number to the payer Secnme subiect to backup withholding at a

instructions for Kevipient

Box 1.—Repor: the amiount shown on the “Dividends” fine of your
income tax return or. if required, list your dividends on the senarate
schedule of your tax return, See the instructions for your income tax
return for more information on now to report the income.

‘The amount shown may be a distribution from an employee stock
ownership plan (ESQP%. Although you should report the ESOP
distribution as a dividenc on your income tax return, «reat it as a
pian distributies:, mt as investment income, for any other ourpese
Box 2.—The amount shown 1s vour share of the expenses of a
regulated investment company, including 2 mutual fund, which is
included as a dividend in Sox i. The full amount shown in Box 1
must be reported as income on your tax return. The expenses
shown in Box 2 are deductible as a “Miscellaneous Deduction” only
if you itemize your deductions. Generally, the actual amount you
should have received or had credited to you ts the amount in Box 1
less the amount in Box 2.

Box 3.—Report the amount shown as a capital gain on your tax
return. This amount is also included in Box 1. See your Form 1040
instructions.

Box 4.—Any amount shown represents 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 wW-9, Request for
Taxpayer !dentification Number and Certification, for information
on backup withholding. Include this amount on your income tax
return as tax withneld

Box 5.—-Amounts shown are usually a return of capital. Once you
fave received an arnount equal to your cost or other basis, these
distributioris are taxable to you as a capital gain even it the payer
lists them as nontaxable. For more information, see Publication
550, Investment income and Expenses.

Nomiziees.—!t your Federal identification number ts shown on
this form and two or more recioients are shown cr the form
includes amounts belonging to another person, you are
considered a nominee recipient. You must orm 1099-DIV for
each of the other owners showing the income allocable to each.
File Form(s) :999-DIV with Form 1096, Annual Summary and
Transmittal of U.S. Information Returns, at the Internal Revenue
Service Center for your area. On Forms 1099-D!V and 1096, you
should be listed as the “paver.” On Form 1099-DIV, the other
owner(s) should be listed as the “recipient.” A husband or wife is
net required te file a nominee return to show payments tor the
other,

20% rate on certain payments. See Form W-9, Request for
Taxpayer Identification Number and Certification. tor information
‘on backup withholding. inciude this amount on your income tax
return as tax withheid.

Box 5.—Amounts shown are usually a return of caoital. Once you
have rece:ved an amount equa! to your cost or other basis, these
distributions are taxatie fe you as a capital gain even if t!
lists them as nontaxanle. For more information, see Publication
50, Investment Incerre and Expenses.

Nominees.—f your Federal identification number is shown on
this form and two or more iecipients are shown or the form
includes amcunts belonging to another person, you are
considered a nominee recipient. You must file Form 1099-D:V for
gach of the other owners showing the incorne allocaole to each.
File Forrnfs) 1C99-DIV with Form 1096, Annual Summary and
Transmittal of U.S. Information Returns, at the internal Revenue
Service Center vor your area. On Forms 1099-DIV and 1096, you
should be listed as tne “payer.” On Form 109-DIV, the other
owner(s) should be fisted as the “recipient.” A husband or wife is
nat required ro ji!e a nominee return to show payments for the
other.

Request for
won. tor information

on backuo wiianeldin
return as tax with.
Box 5.—Amounts snown are usually a return of capital. Once you
have receivee an amount equai to your cost or other basis, these
stributioiis are taxabie io you as a capital gain even if the payer
fists them as nontaxable. For more information, see Aublication
550, Investment !ncome and Expenses.

Nominees. —If your Federal identification number 's shown on
this form and two or more recipients are shown or the form
includes amounts belonging to another person, you are
considered a nominee recipient. You must file Form 1099-DIV for
each of the other owners showing the income allocable to each.
File Form(s) 1099-DIV with Form 1096, Annual Summary and
Transmittal of U.S. Information Returns, at the Internal Revenue
Service Center for your area. On Forms 1099-DIV and 1096, you
should be listed as the “payer.” On Form 1099-DIV, the other
owner(s) should be listed as the “recipient.” A husband or wife is
nat required to file a nominee return to show payments for the
other.



9191 FC) voi

LI corrected

For Official Use Only

“Type or machine print PAYER'S name, street address, city, state, and ZIP code

1 Gross dividends and other
distributions on stock

$

OMB No. 1545-0110

2 Investment'expenses
included in Box 1

$

1988

Statement for
Recipients of

Dividends and
Distributi

PAYER’S Federal identification number

RECIPIENT'S identification number

3 Capital gain distributions

$

‘Type or machine print RECIPIENT'S name (first, middle, last)

4 Federal income tax withheld

5 Nontaxable distributions (if
determinable)

$ $
Street address 6 Foreign tax paid 7 Foreign country or U.S. possession
$
state, and ZIP code lei . + cael .
City state, ano ZIP co Liquidation Distributions
Account number (optional) 8 Cash 9 Noncash (Fair market value)
$ $

Copy A

For Internal
Revenue
Service Center

For Paperwork
Reduction Act
Notice and
instructions for
completing this
form, see
Instructions for
Forms 1099, 1098,
5498, 1096, and
W.2G

Form 1099-DIV

Do NOT Cut or Separate Forms on This Page

94191 C] vow

C] corRecTeD

For Official Use Only

Type or machine print PAYER'S name, street address, city, state, and ZIP code

1 Gross dividends and other
distributions on stock

OMB No. 1545-0110

Department of the Treasury - Internal Revenue Service

$ 1988 Dividends and
Distributions
2 Investment expenses:
included in Box 1
Statement for
$ Recipients of
PAYER’S Federal identification number | RECIPIENT'S identification number | 3 Capital gain distributions Y Copy A
$ For Internal
‘Type or machine print RECIPIENT'S name (first, middle, last) 4 Federal income tax withheld | 5 Nontaxable distributions (if Revenue

determinable)

$ $
Street address 6 Foreign tax paid 7 Foreign country or U.S. possession
$
City, state, and ZIP code aauidation Dictributi
¥ Liquidation Distributions
‘Account number (optional) 8 Cash 9 Noncash (Fair market value)
$ $

Service Center

For Paperwork
Reduction Act
Notice and
instructions for
completing this
form, see
Instructions for
Forms 1099, 1098,
5498, 1096, and
W-2G.

Form 1099-DIV

Do NOT Cut or Separate Forms on This Page

4191 L vow

LJ corrected

For Official Use Only

Type or machine print PAYER'S name, street address, city, state, and ZIP code

1 Gross dividends and other
distributions on stock

(OMB No. 1545-0110

Department of the Treasury - Internal Revenue Service

Dividends and

$ 1988 Distributions
2 Investment expenses
included in Box 1
Statement for
$ Recipients of
PAYER’S Federal identification number | RECIPIENT'S identification number 3 Capital gain distributions Y Copy A
$ For Internal
Type or machine print RECIPIENT'S name (First, riddle, last) 4 Federalincome tax withheld | 5 Nontaxable distributions (if Revenue
determinable) Ser e Center
$ $ For Paperwork
Street address, 6 Foreign tax paid 7 Foreign country or US. possession Reauction Act
$ instructions for
completing this
City, state, and ZIP cod eae
iy, state, ang 2ip coc’ Liquidation Distributions form, see
Instructions for
“Recount number (optional) ® Cash ‘9 Noncash (Fair market value) Me te ce ee
$ $ : V-2G,

Form 1099-DIV

Department of the Treasury - Internal Revenue Service




J CORRECTED (if checked)

PAYER’S name, street address, city, state, and ZIP code 1 Gross dividends and other] OMB No. 1545-0110
distributions on stock

s _ __| 1988

2 Investment expenses
included in Box 1

Statement for
$ Recipients of
PAYER’S Federal identification number] RECIPIENT'S identification number | 3 Capital gain distributions Y yy UY Copy B
$ yy Y For Recipient
RECIPIENT'S name (first, middle, last) 4 Federal income tax withheld | 5 Nontaxable distributions (if This 1s important tax
determinable) information and is
: being furnished to the
$ $ Internal Revenue
Street address 6 Foreign tax pad 7 Foreign country or U.S. possession Service. If you are

required to file a return
$ a negligence penalty or
other sanction will be
imposed on you if this,

dividend income is

taxable and the IRS
determines that it has
$ not been reported.

¥ 1P
City. state, andZIP cove Liquidation Distributions

‘Account number (optional) ‘9 Noncash (Fair market value)

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

(J CORRECTED (if checked)

PAYER'S name, street address, city, state, and ZIP code 1 Gross dividends and other | OMB No. 1545-0110
distributions on stock

988 |  sssaten

2 Investment expenses
included in Box 1

Statement for

$ Recipients of

PAYER’S Federal identification number | RECIPIENT'S identification number | 3 Capital gain distributions Yy Y/ Copy B
$ Wf MW 7], For Recipient

RECIPIENT'S name (first, middle, last) 4 Federal income tax withheld | 5 Nontaxable distributions (if This 1s important tax
determinable) information and is

being furnished to the
$ $ Internal Revenue
Street address 6 Foreign tax paid 7 Foreign county oF US. possession request tie onan
$ a negligence penalty or
City, state, and ZIP cod other sanction will be
ity, state, and ZIP code va idation Dictri

" Liquidation Distributions imposed on you if this
: dividend income is
‘Account number (optional) ® Cash 9 Noncash Fair market value) | gi ableard tne IRS
$ $ not been reported.

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

(J CORRECTED (if checked)

PAYER'S name, street address, city, state, and ZIP code 1 Gross dividends andather | OMB No. 1545-0110
distributions on stock

s «| 1988

2 Investment expenses
included in Box 1

Statement for

$ Recipients of
if "S \dentificatic it r Uy

PAYER’S Federal identification number | RECIPIENT'S identification number | 3 Capital gain distributions WY Yy ]/ Yy Yy Copy B
$ OY UY For Recipient
RECIPIENT'S name (first, middle, last) 4 Federal income tax withheld | 5 Nontaxable distributions (if This is important tax
determinable) information and is
being furnished to the
$ $ internal Revenue
Street address 6 Foreign tax paid 7 Foreign country or U.S. possession Service. If you are

required to file a return,
$ a negligence penalty or
other sanction will be
Imposed on you if this

dividend income is
Account nombre 3 Gash "[S Noveash Farmaervaiay | {rable and nel RS

$ Ls not been reported

City,state, and ZIP code Rapeerereurerrane
y Liquidation Distributions

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