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Tax Year

Payer's Information

Payer's Address

Recipient's Information

Recipient’s Address

Dividends and Distributions

2nd TIN not.

FATCA Filing Requirement

1a. Total ordinary dividends

1b. Qualified Dividends

2b. Unrecap. Sec. 1250 Gain

2c. Section 1202 Gain

2d. Collectibles (28%) Gain

2e. Section 897 Ordinary Dividends

2f. Section 897 Capital Gain

3. Nondividend Distributions

4. Federal income tax withheld

5. Section 199A Dividends

6. Investment Expenses

7. Foreign Tax Paid

8. Foreign Country or U.S. Possession

9. Cash Liquidation Distributions

10. Noncash Liquidation Distributions

12. Exempt-Interest Dividends

13. Specified Private Activity Bond Interest Dividends

14.1 State (Line 1)

15.1 State Identification Number (Line 1)

16.1 State Income Tax Withheld (Line 1)

Do you wish to enter a tax income withheld for a second state?

Email Information

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Your Email Address *

Your 1099-DIV Form Preview

The official PDF updates as you complete the form.

Tax Year 2025