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