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Page 1 of 6 of Form 1099-DIV (PAGE 2 IS BLANK) 2
O.K. to print
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reproduction proofs. MUST be removed before printing.
scan organization
Revised proofs
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Separation 1 for page 1 of Form 1099-DIV. Prints in

Red (J-6983) Ink.
Separation 2 for page 1 of Form 1099-DIV. Prints in Black Ink.

9191 VOID CORRECTED

PAYER’S name, street address, city, state, ZIP code, and telephone no. 1a Total ordinary dividends OMB No. 1545-0110

$ Dividends and
1b Qualified dividends 2007 Distributions
$ Form 1099-DIV
2a Total capital gain distr. 2b Unrecap. Sec. 1250 gain
Copy A
$ $ For
PAYER’S federal identification RECIPIENT’S identification Internal Revenue
number number Service Center

File with Form 1096.

RECIPIENT’S name 2c Section 1202 gain 2d Collectibles (28%) gain
$ $ For Privacy Act
3 Nondividend distributions 4 Federal income tax withheld and Paperwork
$ $ Reduction Act
Street address (including apt. no.) 5 Investment expenses Notice, see the
2007 General
$ Instructions for
City, state, and ZIP code 6 Foreign tax paid 7 Foreign country or U.S. possession Forms 1099,
$ 1098, 5498,
Account number (see instructions) 2nd TIN not. 8 Cash liquidation 9 Noncash liquidation and W-2G.
distributions distributions

$ $

Form 1099-DIV Cat. No. 14415N 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
Page 3 of 6 of Form 1099-DIV 2
The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

CORRECTED (if checked)

PAYER’S name, street address, city, state, ZIP code, and telephone no. 1a Total ordinary dividends OMB No. 1545-0110

$ Dividends and
1b Qualified dividends 2007 Distributions
$ Form 1099-DIV
2a Total capital gain distr. 2b Unrecap. Sec. 1250 gain
Copy B
$ $ For Recipient
PAYER’S federal identification RECIPIENT’S identification
number number

RECIPIENT’S name 2c Section 1202 gain 2d Collectibles (28%) gain

This is important
$ $ tax information
3 Nondividend distributions 4 Federal income tax withheld and is being
$ $ furnished to the
Street address (including apt. no.) 5 Investment expenses Internal Revenue
Service. If you
are required to
$ file a return, a
City, state, and ZIP code 6 Foreign tax paid 7 Foreign country or U.S. possession negligence
penalty or other
$ sanction may be
Account number (see instructions) 8 Cash liquidation 9 Noncash liquidation imposed on you
distributions distributions
if this income is
$ $ taxable and the
IRS determines
that it has not
been reported.

Form 1099-DIV (keep for your records) Department of the Treasury - Internal Revenue Service
Page 4 of 6 Form 1099-DIV 2
The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

Instructions for Recipients

Account number. May show an account or other unique number the Box 3. Shows the part of the distribution that is nontaxable because
payer assigned to distinguish your account. it is a return of your cost (or other basis). You must reduce your cost
Box 1a. Shows total ordinary (short-term) dividends that are taxable. (or other basis) by this amount for figuring gain or loss when you sell
Include this amount on line 9a of Form 1040 or 1040A. Also, report it your stock. But if you get back all your cost (or other basis), report
on Schedule B (Form 1040) or Schedule 1 (Form 1040A), if required. future distributions as capital gains. See Pub. 550, Investment
Income and Expenses.
The amount shown may be a distribution from an employee stock
ownership plan (ESOP). Report it as a dividend on your Form Box 4. Shows backup withholding. For example, a payer must
1040/1040A but treat it as a plan distribution, not as investment backup withhold on certain payments at a 28% rate if you did not
income, for any other purpose. give your taxpayer identification number to the payer. See Form W-9,
Request for Taxpayer Identification Number and Certification, for
Box 1b. Shows the portion of the amount in box 1a that may be
information on backup withholding. Include this amount on your
eligible for the 15% or 5% capital gains rates. See the Form
income tax return as tax withheld.
1040/1040A instructions for how to determine this amount. Report
the eligible amount on line 9b, Form 1040 or 1040A. Box 5. Shows your share of expenses of a nonpublicly offered
Box 2a. Shows total capital gain distributions (long-term) from a regulated investment company, generally a nonpublicly offered
regulated investment company or real estate investment trust. Report mutual fund. If you file Form 1040, you may deduct these expenses
the amounts shown in box 2a on Schedule D (Form 1040), line 13. on the “Other expenses” line on Schedule A (Form 1040) subject to
But, if no amount is shown in boxes 2c–2d and your only capital the 2% limit. This amount is included in box 1a.
gains and losses are capital gain distributions, you may be able to Box 6. Shows the foreign tax you may be able to claim as a
report the amounts shown in box 2a on line 13 of Form 1040 (line 10 deduction or a credit on Form 1040. See the Form 1040 instructions.
of Form 1040A) rather than Schedule D. See the Form 1040/1040A Boxes 8 and 9. Shows cash and noncash liquidation distributions.
instructions.
Nominees. If this form includes amounts belonging to another
Box 2b. Shows the portion of the amount in box 2a that is person, you are considered a nominee recipient. You must file Form
unrecaptured section 1250 gain from certain depreciable real 1099-DIV with the IRS for each of the other owners to show their
property. Report this amount on the Unrecaptured Section 1250 share of the income, and you must furnish a Form 1099-DIV to each.
Gain Worksheet–Line 19 in the Schedule D instructions (Form 1040). A husband or wife is not required to file a nominee return to show
Box 2c. Shows the portion of the amount in box 2a that is section amounts owned by the other. See the 2007 General Instructions for
1202 gain from certain small business stock that may be subject to a Forms 1099, 1098, 5498, and W-2G.
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).
Page 5 of 6 of Form 1099-DIV 2
The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

VOID CORRECTED
PAYER’S name, street address, city, state, ZIP code, and telephone no. 1a Total ordinary dividends OMB No. 1545-0110

$ Dividends and
1b Qualified dividends 2007 Distributions
$ Form 1099-DIV
2a Total capital gain distr. 2b Unrecap. Sec. 1250 gain
Copy C
$ $ For Payer
PAYER’S federal identification RECIPIENT’S identification
number number

RECIPIENT’S name 2c Section 1202 gain 2d Collectibles (28%) gain

For Privacy Act
$ $ and Paperwork
3 Nondividend distributions 4 Federal income tax withheld
Reduction Act
$ $ Notice, see the
Street address (including apt. no.) 5 Investment expenses
2007 General
Instructions
$ for Forms
City, state, and ZIP code 6 Foreign tax paid 7 Foreign country or U.S. possession
1099, 1098,
$ 5498,
Account number (see instructions) 2nd TIN not. 8 Cash liquidation 9 Noncash liquidation
distributions distributions and W-2G.
$ $

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

Page 6 of 6 Form 1099-DIV 2
The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

Instructions for Payers

General and specific form instructions are provided as Foreign dividend recipient. If the recipient of the
separate products. The products you should use to dividend is a nonresident alien, you may have to
complete Form 1099-DIV are the 2007 General withhold federal income tax and file Form 1042-S,
Instructions for Forms 1099, 1098, 5498, and W-2G Foreign Person’s U.S. Source Income Subject to
and the 2007 Instructions for Form 1099-DIV. A chart Withholding. See the Instructions for Form 1042-S and
in the general instructions gives a quick guide to which Pub. 515, Withholding of Tax on Nonresident Aliens
form must be filed to report a particular payment. To and Foreign Entities.
order these instructions and additional forms, visit the Need help? If you have questions about reporting on
IRS website at www.irs.gov or call 1-800-TAX-FORM Form 1099-DIV, call the information reporting customer
(1-800-829-3676). service site toll free at 1-866-455-7438 or
Caution: Because paper for ms are scanned dur ing 304-263-8700 (not toll free). For TTY/TDD equipment,
processing, you cannot file with the IRS For ms 1096, call 304-267-3367 (not toll free). The hours of operation
1098, 1099, or 5498 that you pr int from the IRS are Monday through Friday from 8:30 a.m. to 4:30
website. p.m., Eastern time. The service site can also be
reached by email at mccirp@irs.gov.
Due dates. Furnish Copy B of this form to the
recipient by January 31, 2008.
File Copy A of this form with the IRS by
February 28, 2008. If you file electronically, the due
date is March 31, 2008. 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 or
Magnetically. IRS does not provide a fill-in form option.