Form 1099-DIV Dividends and Distributions 2003. Summary: This is an example of Form 1099-DIV (2002). The line items to be completed are as follows:

“Payer's name, street address, city, state, ZIP code, and telephone number’ field
“Payer's Federal identification number’ field
“Recipient's identification number’ field
“Recipient's name’ field
“Street address (including apartment number)’ field
“City, state, and ZIP code’ field
“Account number (optional)’ field
“1a. Ordinary dividends’ field
“1b. qualified dividends’ field
“2a. Total capital gain distribution’ field
“2c. Post-May 5 capital gain distribution’ field
“2d. 28% rate gain’ field
“2e. Qualified 5-year gain’ field
“2f. Unrecaptured section 1250 gain’ field
“2e. Section 1202 gain’ field
“3. Nondividend distributions’ field
“4. Federal income tax withheld’ field
“5. Investment expenses’ field
“6. Foreign tax paid’ field
“7. Foreign country or U.S. possession’ field
“8. Cash liquidation distribution’ field
“9. Noncash liquidation distribution’ field