IRS Form 1099-DIV – Earned Dividends

Please fill out all of the information below from your IRS form. If there is nothing in the box on your form, just leave the field blank. Round all amounts to the nearest dollar (no cents).

Please fill out all of the information below from your IRS 1099-div form. If there is nothing in the box on your 1099-div, just leave the field blank. Round all amounts to the nearest dollar (no cents).
Email Address*
Payer's Name
First Last
Payer's Federal ID #
Payer's Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Recipient's Name
Recipient's Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Account #
Box 1a - Total ordinary dividends
Box 1b - Qualified Dividends
Box 2a - Total capital gain distr.
Box 2b - Unrecap. Sec. 1250 gain
Box 2c - Section 1202 gain
Box 2d - Collectibles (28%) gain
Box 3 - Nondividend distributions
Box 4 - Federal income tax withheld
Box 5 - Investment expenses
Box 6 - Foreign tax paid
Box 7 - Foreign country or U.S. possession
Box 8 - Cash liquidation 9 distributions
Box 9 - Noncash liquidation distributions
Special Notes