Form 1099-DIV Dividends and Distributions 2012
Summary: This is an example of Form 1099-DIV (2012). The line items to be completed are as
follows:
Payer's name, street address, city, state, ZIP code, and telephone
number
fieldPayer's Federal identification number
fieldRecipient's identification number
fieldRecipient's name
fieldStreet address (including apartment number)
fieldCity, state, and ZIP code
field
Account number (see instructions)
field1a. Total ordinary dividends
field1b. Qualified dividends
field2a. Total capital gain distribution
field2b. Unrecaptured Section 1250 gain
field2c. Section 1202 gain
field2d. Collectibles (28%) rate gain
field3. Nondividend distributions
field4. Federal income tax withheld
field5. Investment expenses
field6. Foreign tax paid
field7. Foreign country or U.S. possession
field8. Cash liquidation distributions
field9. Noncash liquidation distributions
field10. Exempt-interest dividends
field11. Specified private activity bond interest dividends
field12. State
field13. State identification number
field14. State tax withheld
field
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