Exhibit N Form 1099-DIV
Publication 1179 — General Rules and Specifications For Substitute Forms 1096, 1098, 1099, 5498, and Certain Other Information Returns · 2026-10-03 edition · updated 2026-10-04 · United States
9191
Distributions
Copy A
For Internal Revenue
Service Center
File with Form 1096.
For Privacy Act and Paperwork
Reduction Act Notice, see the current General
Instructions for
Certain Information
Returns.
| PAYER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. |
1a Total ordinary dividends $ |
OMB No. 1545-0110 1099-DIV Form (Rev. January 2024) |
|||
|---|---|---|---|---|---|
PAYER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. |
PAYER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. |
PAYER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. |
1bQualified dividends $ |
1bQualified dividends $ |
1bQualified dividends $ |
PAYER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. |
PAYER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. |
PAYER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. |
1bQualified dividends $ |
1bQualified dividends $ |
For calendar year |
PAYER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. |
PAYER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. |
PAYER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. |
2aTotal capital gain distr. $ |
2aTotal capital gain distr. $ |
2bUnrecap. Sec. 1250 gain $ |
| PAYER’S TIN | RECIPIENT’S TIN | RECIPIENT’S TIN | 2cSection 1202 gain $ |
2cSection 1202 gain $ |
2dCollectibles (28%) gain $ |
| PAYER’S TIN | RECIPIENT’S TIN | RECIPIENT’S TIN | 2eSection 897 ordinary dividends $ |
2eSection 897 ordinary dividends $ |
2fSection 897 capital gain $ |
| RECIPIENT’S name | RECIPIENT’S name | RECIPIENT’S name | 3Nondividend distributions $ |
3Nondividend distributions $ |
4 Federal income tax withheld $ |
| RECIPIENT’S name | RECIPIENT’S name | RECIPIENT’S name | 5Section 199A dividends $ |
5Section 199A dividends $ |
6Investment expenses $ |
| Street address (including apt. no.) | Street address (including apt. no.) | Street address (including apt. no.) | Street address (including apt. no.) | Street address (including apt. no.) | Street address (including apt. no.) |
| Street address (including apt. no.) | Street address (including apt. no.) | Street address (including apt. no.) | 7Foreign tax paid $ |
7Foreign tax paid $ |
8Foreign country or U.S. possession |
| City or town, state or province, country, and ZIP or foreign postal code | |||||
| City or town, state or province, country, and ZIP or foreign postal code | City or town, state or province, country, and ZIP or foreign postal code | City or town, state or province, country, and ZIP or foreign postal code | 9Cash liquidation distributions $ |
9Cash liquidation distributions $ |
10Noncash liquidation distributions $ |
| 11FATCA filing requirement |
12Exempt-interest dividends $ |
12Exempt-interest dividends $ |
13Specified private activity bond interest dividends $ |
||
| Account number (see instructions) |
Account number (see instructions) |
2nd TIN not. | 14 State | 15 State identification no. | 16State tax withheld $ |
| Account number (see instructions) |
Account number (see instructions) |
2nd TIN not. | $ |
Do Not Cut or Separate Forms on This Page — Do Not Cut or Separate Forms on This Page
Cat. No. 14415N
Department of the Treasury - Internal Revenue Service
9191
Distributions
Copy A
For Internal Revenue
Service Center
File with Form 1096.
For Privacy Act and Paperwork
Reduction Act Notice, see the current General
Instructions for
Certain Information
Returns.
| PAYER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. |
1a Total ordinary dividends $ |
OMB No. 1545-0110 1099-DIV Form (Rev. January 2024) |
|||
|---|---|---|---|---|---|
PAYER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. |
PAYER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. |
PAYER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. |
1bQualified dividends $ |
1bQualified dividends $ |
1bQualified dividends $ |
PAYER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. |
PAYER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. |
PAYER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. |
1bQualified dividends $ |
1bQualified dividends $ |
For calendar year |
PAYER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. |
PAYER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. |
PAYER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. |
2aTotal capital gain distr. $ |
2aTotal capital gain distr. $ |
2bUnrecap. Sec. 1250 gain $ |
| PAYER’S TIN | RECIPIENT’S TIN | RECIPIENT’S TIN | 2cSection 1202 gain $ |
2cSection 1202 gain $ |
2dCollectibles (28%) gain $ |
| PAYER’S TIN | RECIPIENT’S TIN | RECIPIENT’S TIN | 2eSection 897 ordinary dividends $ |
2eSection 897 ordinary dividends $ |
2fSection 897 capital gain $ |
| RECIPIENT’S name | RECIPIENT’S name | RECIPIENT’S name | 3Nondividend distributions $ |
3Nondividend distributions $ |
4 Federal income tax withheld $ |
| RECIPIENT’S name | RECIPIENT’S name | RECIPIENT’S name | 5Section 199A dividends $ |
5Section 199A dividends $ |
6Investment expenses $ |
| Street address (including apt. no.) | Street address (including apt. no.) | Street address (including apt. no.) | Street address (including apt. no.) | Street address (including apt. no.) | Street address (including apt. no.) |
| Street address (including apt. no.) | Street address (including apt. no.) | Street address (including apt. no.) | 7Foreign tax paid $ |
7Foreign tax paid $ |
8Foreign country or U.S. possession |
| City or town, state or province, country, and ZIP or foreign postal code | |||||
| City or town, state or province, country, and ZIP or foreign postal code | City or town, state or province, country, and ZIP or foreign postal code | City or town, state or province, country, and ZIP or foreign postal code | 9Cash liquidation distributions $ |
9Cash liquidation distributions $ |
10Noncash liquidation distributions $ |
| 11FATCA filing requirement |
12Exempt-interest dividends $ |
12Exempt-interest dividends $ |
13Specified private activity bond interest dividends $ |
||
| Account number (see instructions) |
Account number (see instructions) |
2nd TIN not. | 14 State | 15 State identification no. | 16State tax withheld $ |
| Account number (see instructions) |
Account number (see instructions) |
2nd TIN not. | $ |
49
Department of the Treasury - Internal Revenue Service
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