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Form 1099-DIV Dividends and Distributions 2005. Summary: This is an example of Form 1099-DIV (2005). 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. Total ordinary dividends” field
1b. Qualified dividends” field
2a. Total capital gain distribution” field
2b. Unrecaptured Section 1250 gain” field
2c. Section 1202 gain” field
2d. 28% rate 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