Form 1099-DIV (Rev. December 2027)

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TREASURY/IRS AND OMB USE ONLY DRAFT

9191

VOID

CORRECTED

1a Total ordinary dividends

PAYER’S name

Form

$
Street address

Room/suite no.

OMB No. 1545-0110

1b Qualified dividends

1099-DIV

(Rev. December 2027)

Dividends and
Distributions

For calendar year

$
City/town

Telephone number

State/province

Country

ZIP/foreign code

PAYER’S TIN

RECIPIENT’S TIN

2a Total capital gain distr.

2b Unrecap. Sec. 1250 gain

$

$

2c Section 1202 gain

2d Collectibles (28%) gain

$

$

2e Section 897 ordinary dividends 2f Section 897 capital gain

$
3

RECIPIENT’S name

$
Nondividend distr.

$
Apt. no.

$
Section 199A dividends

$
7

City/town

Federal income tax
withheld

6

Investment expenses

$
Foreign tax paid

8

Cash liquidation distr.

10 Noncash liquidation distr.

Foreign country or U.S.
territory

$
State/province

Country

ZIP/foreign code
11 FATCA filing
requirement

Account number (see instructions)

2nd TIN not.

9

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

$

$

12 Exempt-interest dividends

13 Specified private activity
bond interest dividends

$

$

www.irs.gov/Form1099

14 State

15 State identification no.

16 State tax withheld

$
$
Form 1099-DIV (Rev. 12-2027) Created 9/4/26

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

DRAFT — DO NOT FILE

DRAFT — DO NOT FILE

Street address

5

4

Copy A
For
Internal Revenue
Service Center

TREASURY/IRS AND OMB USE ONLY DRAFT
VOID

CORRECTED

1a Total ordinary dividends

PAYER’S name

Form

$
Street address

Room/suite no.

OMB No. 1545-0110

1b Qualified dividends

1099-DIV

(Rev. December 2027)

Dividends and
Distributions

For calendar year

$
City/town

Telephone number

State/province

Country

ZIP/foreign code

PAYER’S TIN

RECIPIENT’S TIN

2a Total capital gain distr.

2b Unrecap. Sec. 1250 gain

$

$

2c Section 1202 gain

2d Collectibles (28%) gain

$

$

2e Section 897 ordinary dividends 2f Section 897 capital gain

$
3

RECIPIENT’S name

$
Nondividend distr.

$
Apt. no.

5

Federal income tax
withheld

$
Section 199A dividends

$
7

City/town

4

6

Investment expenses

$
Foreign tax paid

8

Cash liquidation distr.

10 Noncash liquidation distr.

Foreign country or U.S.
territory

$
State/province

Country

ZIP/foreign code
11 FATCA filing
requirement

Account number (see instructions)

9

$

$

12 Exempt-interest dividends

13 Specified private activity
bond interest dividends

$

$

14 State

15 State identification no.

16 State tax withheld

$
$
Form 1099-DIV (Rev. 12-2027)

www.irs.gov/Form1099DIV

Department of the Treasury - Internal Revenue Service

DRAFT — DO NOT FILE

DRAFT — DO NOT FILE

Street address

Copy 1
For State Tax
Department

TREASURY/IRS AND OMB USE ONLY DRAFT
CORRECTED (if checked)

1a Total ordinary dividends

PAYER’S name

Form

$
Street address

Room/suite no.

OMB No. 1545-0110

1b Qualified dividends

1099-DIV

(Rev. December 2027)

Dividends and
Distributions

For calendar year

$
City/town

Telephone number

State/province

Country

ZIP/foreign code

PAYER’S TIN

RECIPIENT’S TIN

2a Total capital gain distr.

2b Unrecap. Sec. 1250 gain

$

$

2c Section 1202 gain

2d Collectibles (28%) gain

$

$

2e Section 897 ordinary dividends 2f Section 897 capital gain

$
3

RECIPIENT’S name

$
Nondividend distr.

$
Apt. no.

5

Federal income tax
withheld

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.
Explore options to
file for free at
www.irs.gov/FFForm.

$
Section 199A dividends

$
7

City/town

4

6

Investment expenses

$
Foreign tax paid

8

Cash liquidation distr.

10 Noncash liquidation distr.

Foreign country or U.S.
territory

$
State/province

Country

ZIP/foreign code
11 FATCA filing
requirement

Account number (see instructions)

9

$

$

12 Exempt-interest dividends

13 Specified private activity
bond interest dividends

$

$

14 State

15 State identification no.

16 State tax withheld

$
$
Form 1099-DIV (Rev. 12-2027)

(keep for your records)

www.irs.gov/Form1099DIV

Department of the Treasury - Internal Revenue Service

DRAFT — DO NOT FILE

DRAFT — DO NOT FILE

Street address

Copy B
For Recipient

TREASURY/IRS AND OMB USE ONLY DRAFT
Free File Program. Go to www.irs.gov/FFForm to see if you qualify for no-cost
online federal tax preparation, e-filing, and direct deposit or payment options.
Recipient’s taxpayer identification number (TIN). For your protection, this
form may show only the last 4 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 1a. Shows total ordinary dividends that are taxable. Include this amount on
the “Ordinary dividends” line of Form 1040 or 1040-SR. 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 Instructions for Form 1040 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 or 1040-SR 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 2b,
2c, 2d, and 2f 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 or
1040-SR rather than Schedule D. See the Instructions for Form 1040.
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 the portion of the amount in box 2a that is 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 2e. Shows the portion of the amount in box 1a that is section 897 gain
attributable to disposition of U.S. real property interests (USRPI).
Box 2f. Shows the portion of the amount in box 2a that is section 897 gain
attributable to disposition of USRPI.
Note: Boxes 2e and 2f apply only to foreign persons and entities whose income
maintains its character when passed through or distributed to its direct or

indirect foreign owners or beneficiaries. It is generally treated as effectively
connected to a trade or business within the United States. See the instructions
for your tax return.
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 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 8995 and Form 8995-A.
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 or 1040-SR. See the Instructions for Form 1040.
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. If the Foreign Account Tax Compliance Act (FATCA) filing requirement
box is checked, the payer is reporting on this Form 1099 to satisfy its account
reporting requirement under chapter 4 of the Internal Revenue Code. You may
also have a filing requirement. See the Instructions for Form 8938.
Box 12. 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 13. Shows exempt-interest dividends subject to the alternative minimum
tax. This amount is included in box 12. See the Instructions for Form 6251.
Boxes 14–16. 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 Pub. 1099.

DRAFT — DO NOT FILE

DRAFT — DO NOT FILE

Instructions for Recipient

TREASURY/IRS AND OMB USE ONLY DRAFT
VOID

CORRECTED

1a Total ordinary dividends

PAYER’S name

Form

$
Street address

Room/suite no.

OMB No. 1545-0110

1b Qualified dividends

1099-DIV

(Rev. December 2027)

Dividends and
Distributions

For calendar year

$
City/town

Telephone number

State/province

Country

ZIP/foreign code

PAYER’S TIN

RECIPIENT’S TIN

2a Total capital gain distr.

2b Unrecap. Sec. 1250 gain

$

$

2c Section 1202 gain

2d Collectibles (28%) gain

$

$

$
3

$
Nondividend distr.

$
Apt. no.

5

Federal income tax
withheld

$
Section 199A dividends

$
7

City/town

4

6

Investment expenses

$
Foreign tax paid

8

Cash liquidation distr.

10 Noncash liquidation distr.

Foreign country or U.S.
territory

$
State/province

Country

ZIP/foreign code
11 FATCA filing
requirement

Account number (see instructions)

9

$

$

12 Exempt-interest dividends

13 Specified private activity
bond interest dividends

$

$

14 State

15 State identification no.

16 State tax withheld

$
$
Form 1099-DIV (Rev. 12-2027)

www.irs.gov/Form1099DIV

Department of the Treasury - Internal Revenue Service

DRAFT — DO NOT FILE

DRAFT — DO NOT FILE

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

2e Section 897 ordinary dividends 2f Section 897 capital gain

RECIPIENT’S name

Street address

Copy 2