Form 1099-PATR Taxable Distributions Received From Cooperatives

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
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Instructions for Certain Information Returns, available at www.irs.gov/form1099, for more
information about penalties.
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forms.

9797

VOID

CORRECTED

PAYER'S name, street address, city or town, state or province, country, ZIP
or foreign postal code, and telephone no.

OMB No. 1545-0118

1 Patronage dividends

$

2019

2 Nonpatronage distributions

$
3 Per-unit retain allocations

$
PAYER’S TIN

Form

1099-PATR
Copy A

4 Federal income tax withheld

RECIPIENT’S TIN

$
5 Redemption of nonqualified
notices and retain allocations

RECIPIENT’S name

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

$

9 Work opportunity credit

$

8 Investment credit

$
10 Patron’s AMT adjustment

$

2nd TIN not. 11 Other credits and deductions

Account number (see instructions)

$
Form 1099-PATR

6 Domestic production
activities deduction

7 Qualified payments

Street address (including apt. no.)

Cat. No. 14435F

www.irs.gov/Form1099PATR

Taxable
Distributions
Received From
Cooperatives
For
Internal Revenue
Service Center
File with Form 1096.
For Privacy Act
and Paperwork
Reduction Act
Notice, see the
2019 General
Instructions for
Certain Information
Returns.

Department of the Treasury - Internal Revenue Service

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 or town, state or province, country, ZIP
or foreign postal code, and telephone no.

OMB No. 1545-0118

1 Patronage dividends

$

2019

2 Nonpatronage distributions

$
3 Per-unit retain allocations

$
PAYER’S TIN

RECIPIENT’S TIN

Form

1099-PATR
Copy B

4 Federal income tax withheld

$
$

6 Domestic production
activities deduction

$

7 Qualified payments

Street address (including apt. no.)

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

9 Work opportunity credit

$

8 Investment credit

$
10 Patron’s AMT adjustment

$

11 Other credits and deductions

Account number (see instructions)

$
Form 1099-PATR

For Recipient

5 Redemption of nonqualified
notices and retain allocations

RECIPIENT’S name

(keep for your records)

Taxable
Distributions
Received From
Cooperatives

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.

www.irs.gov/Form1099PATR Department of the Treasury - Internal Revenue Service

Instructions for Recipient
Distributions you received from a cooperative may be includible in your income.
Generally, if you are an individual, report any amounts shown in boxes 1, 2, 3,
and 5 as income, unless nontaxable, on Schedule F (Form 1040), Schedule C
(Form 1040), or Form 4835. See the Instructions for Schedule F (Form 1040) and
Pub. 225 for more information.
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.
Account number. May show an account or other unique number the payer
assigned to distinguish your account.
Box 1. Shows patronage dividends paid to you during the year in cash, qualified
written notices of allocation (at stated dollar value), or other property (not including
nonqualified allocations). Any dividends paid on (1) property bought for personal
use or (2) capital assets or depreciable property used in your business are not
taxable. However, if (2) applies, reduce the basis of the assets by this amount.
Box 2. Shows nonpatronage distributions paid to you during the year in cash,
qualified written notices of allocation, or other property (not including
nonqualified written notices of allocation).
Box 3. Shows per-unit retain allocations paid to you during the year in cash,
qualified per-unit retain certificates, or other property.
Box 4. Shows backup withholding. Generally, a payer must backup withhold if
you didn't furnish your taxpayer identification number to the payer. See Form
W-9 for information on backup withholding. Include this amount on your income
tax return as tax withheld.

Box 5. Shows amounts you received when you redeemed nonqualified written
notices of allocation and nonqualified per-unit retain allocations. Because these
were not taxable when issued to you, you must report the redemption as
ordinary income to the extent of the stated dollar value.
Box 6. Shows your share of the cooperative's domestic production activities
deduction. The amount must have been identified on this or another written
notice sent to you from the cooperative during the payment period described in
section 1382(d). To claim the deduction, you must not be a C corporation.
Box 7. Shows the amount of the qualified payments on which the cooperative
computed its 199A(g) deduction.
Box 8. Shows unused investment credits passed through to you by the
cooperative. Use Form 3468, and its instructions, to figure the amount of credit
to which you are entitled.
Box 9. Shows unused work opportunity credits passed through to you by the
cooperative. Use Form 5884 to figure the amount of credit to which you are
entitled. If your only source of the credit is the cooperative, use Form 3800
instead.
Box 10. Shows the alternative minimum tax (AMT) adjustment passed through
to you by the cooperative. Report this amount on Form 6251 on the appropriate
line in Part I.
Box 11. Shows other unused credits and deductions (including depreciation)
passed through to you by the cooperative. For information on how to report
credits, see the instructions for the specific credit form. For information on how
to report deductions, see the instructions for Schedules C and F (Form 1040)
and Pub. 946.
Future developments. For the latest information about developments related to
Form 1099-PATR and its instructions, such as legislation enacted after they were
published, go to www.irs.gov/Form1099PATR.

VOID

CORRECTED

PAYER'S name, street address, city or town, state or province, country, ZIP
or foreign postal code, and telephone no.

OMB No. 1545-0118

1 Patronage dividends

$

2019

2 Nonpatronage distributions

$
3 Per-unit retain allocations

$
PAYER’S TIN

Form

1099-PATR

4 Federal income tax withheld

RECIPIENT’S TIN

Copy C

$
5 Redemption of nonqualified
notices and retain allocations

RECIPIENT’S name

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

9 Work opportunity credit

$
Account number (see instructions)

6 Domestic production
activities deduction

$

7 Qualified payments

Street address (including apt. no.)

Taxable
Distributions
Received From
Cooperatives

8 Investment credit

$
10 Patron’s AMT adjustment

$

2nd TIN not. 11 Other credits and deductions

For Payer
For Privacy Act
and Paperwork
Reduction Act
Notice, see the
2019 General
Instructions for
Certain Information
Returns.

$
Form 1099-PATR

www.irs.gov/Form1099PATR

Department of the Treasury - Internal Revenue Service

Instructions for Payer
To complete Form 1099-PATR, use:
• The 2019 General Instructions for Certain Information
Returns, and
• The 2019 Instructions for Form 1099-PATR.
To order these instructions and additional forms, go to
www.irs.gov/OrderForms.
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 recipient. If the recipient 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-PATR, 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).