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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
NE GROFF & Taxpayer Identification Number: Account Executive No: ET1 CORRECTED: 03/19/2014 2013 FORMS 1099 & DETAILS LESLEY KATHERINE GROFF & DANIEL GROFF JTWROS YEAR-END MESSAGES CERTAIN EVENTS SUCH AS COST BASIS ADJUSTMENTS OR RECLASSIFICATIONS OF AN INCOME PAYMENT RECEIVED FROM A MUTUAL FUND, ETF, REIT,
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
utive No: ORIGINAL: LESLEY KATHERINE GROFF & ETI 12/31/12 RECIPIENT'S Name, Street Address, City, State, and Zip Code LESLEY KATHERINE GROFF & DANIEL GROFF JTWROS Copy B for recipient 7 2nd TIN Notice 2012 Consolidated 1099 Form Payers Federal Identification Number: 32-0012683 Payer's Name, Street, City,
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
utive No: ORIGINAL: LESLEY KATHERINE GROFF & ETI 12/31/12 RECIPIENT'S Name, Street Address, City, State, and Zip Code LESLEY KATHERINE GROFF & DANIEL GROFF JTWROS Copy B for recipient 7 2nd TIN Notice 2012 Consolidated 1099 Form Payers Federal Identification Number: 32-0012683 Payer's Name, Street, City,
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