CORRECTED (if checked)

1Unemployment compensation  OMB No. 1545-0120

Certain$

Government2State or local income tax

2013Payments

City

refunds, credits, or offsets

Telephone no.$Form 1099-G

PAYER’S federal identification numberRECIPIENT’S identification number3Box 2 amount is for tax year4Federal income tax withheldCopy B$

For Recipient

RECIPIENT’S name5ATAA payments6Taxable energy grants

This is important tax

information and is$$

being furnished to the

Street address (including apt. no.)7Agricultural payments8

trade or businessrequired to file a return.

Apartment no.$incomeGa negligence penalty or

City9Market gainother sanction may be

imposed on you if this

$income is taxable and

Account number (see instructions)10aState10bState identification no.11State income tax withheldthe IRS determines that

it has not been

reported.

Form 1099-G(keep for your records)Department of the Treasury - Internal Revenue Service

State       ZIP Code

State        ZIP Code

Payer’s Name

PAYER’S INFORMATION

Street address (including apt. no.)

Street address line 2

Check if box 2 isService. If you are

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