CORRECTED if check
PAYERS name. street address. city ce town. state ce province. country. ZIP 1 Unemployment compensation OMB No. 1545-0120
or foreign postal code. and telephone no.
Certain
2 State or local income tax
2018 Government
refunds. credits. or offsets Payments
Form 1099-G
PAYER S TIN RECIPIENT'S TIN 3 Box 2 amount is for tax year 4 Federal income tax withheld Copy B
$ For Recipient
RECIPIENT'S name S RTAA payments 6 Taxable grants
This is important tax
$ $ information and is
being furnished to the
7 Agriculture payments 8 If checked. box 2 is
trade or business IRS. If you are required
Street address (including apt. no.) $ income to file a retton. a
negligence penalty or
0 Market g in
other sanction may be
City or town. state or province. country. and ZIP or foreign postal code $ imposed on you if this
income is taxable and
10a State 10b State idenbfication no 11 Sate income tax *Maid the IRS determines that
Account number (see instructions) $ it has not been
reported.
$
Form 1099-G (keep for your records) wvm.irs.gov/Form10996 Department of the Treasury - Internal Revenue Service
EFTA01222596