3
Shared Docs
3
Same-Page
3 / 3
Mentions
ETRADE CLEARING LLC PO BOX 484 JERSEY CITY, NJ 07303.0484 Account No: Account Name: LESLEY KATHERINE GROFF & Taxpayer Identification Number: Account Executive No: ET1 CORRECTED: 03/19/
IV: DIVIDENDS AND DISTRIBUTIONS (OMB NO. 1545-0110) la Total Ordinary Dividends 1b Qualified Dividends 2a Total Capital Gains Distribution 2b Unrecap Sec. 1250 gain 2c Section 1202 gain 2d Collectibles (28%) gain 3 Non dividend distributions 4 Federal income tax withheld 5 Investment Expenses
olidated 1099 Form Payers Federal Identification Number: 32-0012683 Payer's Name, Street, City, State, Zip Code: E*TRADE CLEARING LLC PO BOX 484 JERSEY CITY, NJ 07303-0484 Telephone NuMber. (800) 387-2331 2012 FORM 1099-DN: DIVIDENDS AND DISTRIBUTIONS (OMB NO. 1645-0110) 2012 FORM 10994NT: INTEREST INC
est Income not included in box 3 5763.74 1b Qualified Dividends $4,130.88 2 Early vAthdrawal penalty 2a 2b Total Capital Gain Distributions Unrecap Sec. 1250 gain 3 Interest on U.S. Savings Bonds & Treasury obligations 2c Section 1202 gain 4 Federal income tax withheld 2d Collectibles (28%)g
olidated 1099 Form Payers Federal Identification Number: 32-0012683 Payer's Name, Street, City, State, Zip Code: E*TRADE CLEARING LLC PO BOX 484 JERSEY CITY, NJ 07303-0484 Telephone NuMber. (800) 387-2331 2012 FORM 1099-DN: DIVIDENDS AND DISTRIBUTIONS (OMB NO. 1645-0110) 2012 FORM 10994NT: INTEREST INC
est Income not included in box 3 5763.74 1b Qualified Dividends $4,130.88 2 Early vAthdrawal penalty 2a 2b Total Capital Gain Distributions Unrecap Sec. 1250 gain 3 Interest on U.S. Savings Bonds & Treasury obligations 2c Section 1202 gain 4 Federal income tax withheld 2d Collectibles (28%)g
Entities connected to both JERSEY CITY and Unrecap Sec

Samantha Power
PERSONREGIS
ORGANIZATION
Lesley Groff
PERSONBROKER & BARTER EXCHANGE
ORGANIZATIONBox la
LOCATION1099 Dividend & Distribution Details
ORGANIZATIONCLEARING LLC
ORGANIZATIONFIRST MARBLEHEAD CORP
ORGANIZATIONCONVERGYS CORP
ORGANIZATIONDANIEL GROFF JTWROS
PERSONvAthdrawal
ORGANIZATIONU.S. Savings Bonds & Treasury
ORGANIZATIONThisisimportanttax
ORGANIZATIONRompient's
ORGANIZATIONminter ISSN
ORGANIZATIONIRS Ind
ORGANIZATIONGiikr,34
ORGANIZATIONMet Rear
ORGANIZATIONPipet
ORGANIZATIONBox N Morn Mtge ern
ORGANIZATION