Form 1099-DIV Dividends and Distributions

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.

9191

VOID

CORRECTED

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

1a Total ordinary dividends

OMB No. 1545-0110

2019

$
1b Qualified dividends

$

PAYER’S TIN

RECIPIENT’S TIN

RECIPIENT’S name

Form

2b Unrecap. Sec. 1250 gain

$

$

2c Section 1202 gain

2d Collectibles (28%) gain

$

$
Nondividend distributions

4

Section 199A dividends

6

Foreign tax paid

8

$
5
7
City or town, state or province, country, and ZIP or foreign postal code

Investment expenses

$
Foreign country or U.S. possession

Cash liquidation distributions 10 Noncash liquidation distributions

$

$

FATCA filing 11 Exempt-interest dividends
requirement

$
Account number (see instructions)

Federal income tax withheld

$
9

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

$

$

Street address (including apt. no.)

1099-DIV

2a Total capital gain distr.

3

Dividends and
Distributions

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

12 Specified private activity
bond interest dividends

$

2nd TIN not. 13 State

14 State identification no. 15 State tax withheld

$
$
Form 1099-DIV

Cat. No. 14415N

Do Not Cut or Separate Forms on This Page

www.irs.gov/Form1099DIV

—

Department of the Treasury - Internal Revenue Service

Do Not Cut or Separate Forms on This Page

VOID

CORRECTED

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

1a Total ordinary dividends

OMB No. 1545-0110

2019

$
1b Qualified dividends

$

PAYER’S TIN

RECIPIENT’S TIN

Form

2b Unrecap. Sec. 1250 gain

$

$

2c Section 1202 gain

2d Collectibles (28%) gain

3

4

Section 199A dividends

6

Foreign tax paid

8

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

Investment expenses

$
Foreign country or U.S. possession

$
9

Cash liquidation distributions 10 Noncash liquidation distributions

$

$

FATCA filing 11 Exempt-interest dividends
requirement

$
Account number (see instructions)

Federal income tax withheld

$

$
7

Copy 1
For State Tax
Department

$
Nondividend distributions

$
5
Street address (including apt. no.)

1099-DIV

2a Total capital gain distr.

$
RECIPIENT’S name

Dividends and
Distributions

12 Specified private activity
bond interest dividends

$

13 State

14 State identification no. 15 State tax withheld

$
$
Form 1099-DIV

www.irs.gov/Form1099DIV

Department of the Treasury - Internal Revenue Service

CORRECTED (if checked)
PAYER’S name, street address, city or town, state or province, country, ZIP
or foreign postal code, and telephone no.

1a Total ordinary dividends

OMB No. 1545-0110

2019

$
1b Qualified dividends

$

PAYER’S TIN

RECIPIENT’S TIN

Form

2b Unrecap. Sec. 1250 gain

$

$

2c Section 1202 gain

2d Collectibles (28%) gain

3
5

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

Federal income tax withheld

Section 199A dividends

6

Foreign tax paid

8

Investment expenses

$
Foreign country or U.S. possession

$
9

Cash liquidation distributions 10 Noncash liquidation distributions

$

$

FATCA filing 11 Exempt-interest dividends
requirement

$
Account number (see instructions)

4

$

$
7

Copy B
For Recipient

$
Nondividend distributions

$
Street address (including apt. no.)

1099-DIV

2a Total capital gain distr.

$
RECIPIENT’S name

Dividends and
Distributions

12 Specified private activity
bond interest dividends

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.

$

13 State

14 State identification no. 15 State tax withheld

$
$
Form 1099-DIV

(keep for your records)

www.irs.gov/Form1099DIV

Department of the Treasury - Internal Revenue Service

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.

VOID

CORRECTED

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

1a Total ordinary dividends

OMB No. 1545-0110

2019

$
1b Qualified dividends

$

PAYER’S TIN

RECIPIENT’S TIN

Form

2b Unrecap. Sec. 1250 gain

$

$

2c Section 1202 gain

2d Collectibles (28%) gain

3

$
Nondividend distributions

4

Section 199A dividends

6

Foreign tax paid

8

$
5
7
City or town, state or province, country, and ZIP or foreign postal code

To be filed with
recipient’s state
income tax return,
when required.

Federal income tax withheld
Investment expenses

$
Foreign country or U.S. possession

$
9

Cash liquidation distributions 10 Noncash liquidation distributions

$

$

FATCA filing 11 Exempt-interest dividends
requirement

$
Account number (see instructions)

Copy 2

$

$

Street address (including apt. no.)

1099-DIV

2a Total capital gain distr.

$
RECIPIENT’S name

Dividends and
Distributions

12 Specified private activity
bond interest dividends

$

13 State

14 State identification no. 15 State tax withheld

$
$
Form 1099-DIV

www.irs.gov/Form1099DIV

Department of the Treasury - Internal Revenue Service

VOID

CORRECTED

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

1a Total ordinary dividends

OMB No. 1545-0110

2019

$
1b Qualified dividends

$

PAYER’S TIN

RECIPIENT’S TIN

Form

2b Unrecap. Sec. 1250 gain

$

$

2c Section 1202 gain

2d Collectibles (28%) gain

3

4

Section 199A dividends

6

Foreign tax paid

8

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

Investment expenses

$
Foreign country or U.S. possession

$
9

Cash liquidation distributions 10 Noncash liquidation distributions

$

$

FATCA filing 11 Exempt-interest dividends
requirement

$
Account number (see instructions)

Federal income tax withheld

$

$
7

Copy C
For Payer

$
Nondividend distributions

$
5
Street address (including apt. no.)

1099-DIV

2a Total capital gain distr.

$
RECIPIENT’S name

Dividends and
Distributions

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

12 Specified private activity
bond interest dividends

$

2nd TIN not. 13 State

14 State identification no. 15 State tax withheld

$
$
Form 1099-DIV

www.irs.gov/Form1099DIV

Department of the Treasury - Internal Revenue Service

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).