Exhibit I
Internal Revenue Bulletin 2003-16 · 2026-10-03 edition · updated 2026-10-04 · United States
Dividends and
Distributions
Copy A
For Internal Revenue
Service Center File with Form 1096.
For Privacy Act
and Paperwork
Reduction Act Notice, see the
2003 General Instructions for Forms 1099, 1098,
5498, and W-2G.
| PAYER’S name, street address, city, state, ZIP code, and telephone no. | 1 Ordinary dividends $ |
OMB No. 1545-0110 2003 Form 1099-DIV |
||
|---|---|---|---|---|
| PAYER’S name, street address, city, state, ZIP code, and telephone no. | PAYER’S name, street address, city, state, ZIP code, and telephone no. | PAYER’S name, street address, city, state, ZIP code, and telephone no. | 1.40" Total capital gain distr. 2a $ |
1.40" Total capital gain distr. 2a $ |
| PAYER’S name, street address, city, state, ZIP code, and telephone no. | PAYER’S name, street address, city, state, ZIP code, and telephone no. | PAYER’S name, street address, city, state, ZIP code, and telephone no. | $ 28% rate gain 2b |
$ 28% rate gain 2b |
| PAYER’S Federal identification number | RECIPIENT’S identification number | RECIPIENT’S identification number | $ Qualified 5-year gain 2c |
2d Unrecap. sec. 1250 gain $ |
| RECIPIENT’S name | RECIPIENT’S name | RECIPIENT’S name | $ Section 1202 gain 2e |
3 Nontaxable distributions $ |
| Street address (including apt. no.) | Street address (including apt. no.) | Street address (including apt. no.) | Federal income tax withheld 4 $ |
5 Investment expenses $ |
| City, state, and ZIP code | City, state, and ZIP code | City, state, and ZIP code | Foreign tax paid 6 $ |
7 Foreign country or U.S. possession |
2.80" Account number (optional) |
2.80" Account number (optional) |
2nd TIN not. | Cash liquidation distr. 8 $ |
Noncash liquidation distr. 9 $ |
Form 1099-DIV - Cat. No. 14415N� Department of the Treasury - Internal Revenue Service
.60"
Form 1099-DIV - Cat. No. 14415N� Department of the Treasury - Internal Revenue Service
.60"
Do Not Cut or Separate Forms on This Page - Do Not Cut or Separate Forms on This Page
Dividends and
Distributions
Copy A
For Internal Revenue
Service Center File with Form 1096.
For Privacy Act
and Paperwork
Reduction Act Notice, see the
2003 General Instructions for Forms 1099, 1098,
5498, and W-2G.
| PAYER’S name, street address, city, state, ZIP code, and telephone no. | 1 Ordinary dividends $ |
OMB No. 1545-0110 2003 Form 1099-DIV |
||
|---|---|---|---|---|
| PAYER’S name, street address, city, state, ZIP code, and telephone no. | PAYER’S name, street address, city, state, ZIP code, and telephone no. | PAYER’S name, street address, city, state, ZIP code, and telephone no. | Total capital gain distr. 2a $ |
Total capital gain distr. 2a $ |
| PAYER’S name, street address, city, state, ZIP code, and telephone no. | PAYER’S name, street address, city, state, ZIP code, and telephone no. | PAYER’S name, street address, city, state, ZIP code, and telephone no. | $ 28% rate gain 2b |
$ 28% rate gain 2b |
| PAYER’S Federal identification number | RECIPIENT’S identification number | RECIPIENT’S identification number | $ Qualified 5-year gain 2c |
2d Unrecap. sec. 1250 gain $ |
| RECIPIENT’S name | RECIPIENT’S name | RECIPIENT’S name | $ Section 1202 gain 2e |
3 Nontaxable distributions $ |
| Street address (including apt. no.) | Street address (including apt. no.) | Street address (including apt. no.) | Federal income tax withheld 4 $ |
5 Investment expenses $ |
| City, state, and ZIP code | City, state, and ZIP code | City, state, and ZIP code | Foreign tax paid 6 $ |
7 Foreign country or U.S. possession |
| Account number (optional) | Account number (optional) | 2nd TIN not. | Cash liquidation distr. 8 $ |
Noncash liquidation distr. 9 $ |
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
Dividends and
Distributions
Copy A
For Internal Revenue
Service Center File with Form 1096.
For Privacy Act
and Paperwork
Reduction Act Notice, see the
2003 General Instructions for Forms 1099, 1098,
5498, and W-2G.
| PAYER’S name, street address, city, state, ZIP code, and telephone no. | 1 Ordinary dividends $ |
OMB No. 1545-0110 2003 Form 1099-DIV |
||
|---|---|---|---|---|
| PAYER’S name, street address, city, state, ZIP code, and telephone no. | PAYER’S name, street address, city, state, ZIP code, and telephone no. | PAYER’S name, street address, city, state, ZIP code, and telephone no. | Total capital gain distr. 2a $ |
Total capital gain distr. 2a $ |
| PAYER’S name, street address, city, state, ZIP code, and telephone no. | PAYER’S name, street address, city, state, ZIP code, and telephone no. | PAYER’S name, street address, city, state, ZIP code, and telephone no. | $ 28% rate gain 2b |
$ 28% rate gain 2b |
| PAYER’S Federal identification number | RECIPIENT’S identification number | RECIPIENT’S identification number | $ Qualified 5-year gain 2c |
2d Unrecap. sec. 1250 gain $ |
| RECIPIENT’S name | RECIPIENT’S name | RECIPIENT’S name | $ Section 1202 gain 2e |
3 Nontaxable distributions $ |
| Street address (including apt. no.) | Street address (including apt. no.) | Street address (including apt. no.) | Federal income tax withheld 4 $ |
5 Investment expenses $ |
| City, state, and ZIP code | City, state, and ZIP code | City, state, and ZIP code | Foreign tax paid 6 $ |
7 Foreign country or U.S. possession |
| Account number (optional) | Account number (optional) | 2nd TIN not. | Cash liquidation distr. 8 $ |
Noncash liquidation distr. 9 $ |
Form 1099-DIV Cat. No. 14415N Department of the Treasury - Internal Revenue Service
2003–16 I.R.B. 786 April 21, 2003
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