Form 1099-DIV Dividends and Distributions

Attention:
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similar to the official IRS form. Do not file copy A with the IRS. The official printed
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about printing these tax forms.

9191

VOID

CORRECTED
1a Total ordinary dividends

PAYER’S name, street address, city, state, ZIP code, and telephone no.

OMB No. 1545-0110

$

2008

1b Qualified dividends

$

PAYER’S federal identification
number

Form

Dividends and
Distributions

1099-DIV

2a Total capital gain distr.

2b Unrecap. Sec. 1250 gain

$

$

RECIPIENT’S identification
number

Copy A
For
Internal Revenue
Service Center
File with Form 1096.

RECIPIENT’S name

2c Section 1202 gain

2d Collectibles (28%) gain

$

$

3

Nondividend distributions

4 Federal income tax withheld

$

$
Street address (including apt. no.)

5 Investment expenses

$
City, state, and ZIP code

6

Foreign tax paid

7 Foreign country or U.S. possession

Cash liquidation
distributions

9 Noncash liquidation
distributions

$
Account number (see instructions)

2nd TIN not.

8

$

Form

1099-DIV

$

Cat. No. 14415N

Do Not Cut or Separate Forms on This Page

For Privacy Act
and Paperwork
Reduction Act
Notice, see the
2008 General
Instructions for
Forms 1099,
1098, 5498,
and W-2G.

—

Department of the Treasury - Internal Revenue Service

Do Not Cut or Separate Forms on This Page

CORRECTED (if checked)
PAYER’S name, street address, city, state, ZIP code, and telephone no.

1a Total ordinary dividends

OMB No. 1545-0110

2008

$
1b Qualified dividends

$

PAYER’S federal identification
number

RECIPIENT’S name

Form

1099-DIV

2a Total capital gain distr.

2b Unrecap. Sec. 1250 gain

$

$

2c Section 1202 gain

2d Collectibles (28%) gain

$

$
Nondividend distributions

4 Federal income tax withheld

$

$
Street address (including apt. no.)

5 Investment expenses

$
6

Foreign tax paid

7 Foreign country or U.S. possession

Cash liquidation
distributions

9 Noncash liquidation
distributions

$
Account number (see instructions)

8

$

Form

1099-DIV

Copy B
For Recipient

RECIPIENT’S identification
number

3

City, state, and ZIP code

Dividends and
Distributions

(keep for your records)

$

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.

Department of the Treasury - Internal Revenue Service

Instructions for Recipients
What’s New? The 5% capital gains rate is reduced to zero after
December 31, 2007. See box 1b.
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 line 9a of Form 1040 or 1040A. Also, report it on
Schedule B (Form 1040) or Schedule 1 (Form 1040A), if required.
The amount shown may be a distribution from an employee stock
ownership plan (ESOP). Report it as a dividend on your Form
1040/1040A but treat it as a plan distribution, not as investment
income, for any other purpose.
Box 1b. Shows the portion of the amount in box 1a that may be
eligible for the 15% or zero capital gains rates. See the Form
1040/1040A instructions for how to determine this amount. Report
the eligible amount on line 9b, Form 1040 or 1040A.
Box 2a. Shows total capital gain distributions from a regulated
investment company or real estate investment trust. Report the
amounts shown in box 2a on Schedule D (Form 1040), line 13. 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 line 13 of Form 1040 (line 10 of Form
1040A) rather than Schedule D. See the Form 1040/1040A
instructions.
Box 2b. Shows the portion of the amount in box 2a that is
unrecaptured section 1250 gain from certain depreciable real
property. Report this amount on the Unrecaptured Section 1250
Gain Worksheet–Line 19 in the Schedule D instructions (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 a
50% 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–Line 18 in the instructions for Schedule D
(Form 1040).
Box 3. Shows the part of the distribution that 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 distributions as capital gains. See Pub. 550, Investment
Income and Expenses.
Box 4. Shows backup withholding. For example, a payer must
backup withhold on certain payments at a 28% rate if you did not
give your taxpayer identification number 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 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 1a.
Box 6. 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 7. This box should be left blank if a regulated investment
company reported the foreign tax shown in box 6.
Boxes 8 and 9. Shows 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 2008 General Instructions for
Forms 1099, 1098, 5498, and W-2G.

VOID

CORRECTED

PAYER’S name, street address, city, state, ZIP code, and telephone no.

1a Total ordinary dividends

OMB No. 1545-0110

$

2008

1b Qualified dividends

$

PAYER’S federal identification
number

Form

1099-DIV

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

$

Street address (including apt. no.)

5 Investment expenses

$
City, state, and ZIP code

6

Foreign tax paid

7 Foreign country or U.S. possession

Cash liquidation
distributions

9 Noncash liquidation
distributions

$
2nd TIN not.

8

$

Form

1099-DIV

Copy C
For Payer

RECIPIENT’S identification
number

RECIPIENT’S name

Account number (see instructions)

Dividends and
Distributions

For Privacy Act
and Paperwork
Reduction Act
Notice, see the
2008 General
Instructions
for Forms
1099, 1098,
5498,
and W-2G.

$

Department of the Treasury - Internal Revenue Service

Instructions for Payers
General and specific form instructions are provided as
separate products. The products you should use to
complete Form 1099-DIV are the 2008 General
Instructions for Forms 1099, 1098, 5498, and W-2G
and the 2008 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. To
order these instructions and additional forms, visit the
IRS website at www.irs.gov or call 1-800-TAX-FORM
(1-800-829-3676).
Caution: Because paper for ms are scanned dur ing
processing, you cannot file with the IRS For ms 1096,
1098, 1099, or 5498 that you pr int from the IRS
website.
Due dates. Furnish Copy B of this form to the
recipient by February 2, 2009.
File Copy A of this form with the IRS by
March 2, 2009. If you file electronically, the due date is
March 31, 2009. To file electronically, you must have

software that generates a file according to the
specifications in Pub. 1220, Specifications for Filing
Forms 1098, 1099, 5498, and W-2G Electronically. IRS
does not provide a fill-in form option.
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 Entities.
Need help? If you have questions about reporting on
Form 1099-DIV, call the information reporting customer
service site toll free at 1-866-455-7438 or
304-263-8700 (not toll free). For TTY/TDD equipment,
call 304-267-3367 (not toll free). The hours of operation
are Monday through Friday from 8:30 a.m. to 4:30
p.m., Eastern time.