Form 1099-DIV (Dividends and Distributions)
Please complete the form below by entering the information EXACTLY as it appears on your Form 1099-DIV. Use the Tab key to move to the next field. An asterisk ( * ) indicates a required field.
* Your email Address:
* PAYER’S name, street address, city, state, ZIP code, and telephone no.
1 Ordinary dividends
2001
2a Total capital gain distr.
2b 28% rate gain
Form 1099-DIV
* PAYER’S Federal ID number
* RECIPIENT'S ID number
2c Qualified 5-year plan
2d Unrecap. Sec. 1250 gain
* RECIPIENT'S name, street address, city, state, and ZIP code
2e Section 1202 gain
3 Nontaxable distributions
4 Federal income tax withheld
5 Investment expenses
6 Foreign tax paid
7 Foreign country or US poss.
Account number (optional)
8 Cash liquidation distr.
9 Noncash liquidation distr.
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