Form 1099-DIV, Dividends and Distributions Completed Form Examples and Samples

Explore a detailed example of a filled 1099-DIV form for mutual fund dividends. This sample demonstrates how to accurately complete the form for individuals receiving dividends, including crucial fields like payer's and recipient's information, total ordinary dividends, qualified dividends, and capital gains distributions for the tax year 2025.
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Filled 1099-DIV Form for Mutual Fund Dividends

1099-DIV Example – Mutual Fund Dividends

How this form was filled:

This example shows how a 1099-DIV form is completed for an individual receiving dividends from a mutual fund investment. The form includes fields such as payer's information, recipient's details, total and qualified dividends, and capital gains distribution.

Information used to fill out the document:

  • Payer’s Name: Mutual Funds Corp.
  • Payer’s TIN: 98-7654321
  • Recipient’s Name: Jane Smith
  • Recipient’s TIN: 123-45-6789
  • Address: 456 Elm Street, Centerville, USA
  • Account Number: 1234567890
  • Total Ordinary Dividends: 1500.00
  • Qualified Dividends: 1200.00
  • Capital Gains Distribution: 300.00
  • Tax Year: 2025

What this filled form sample shows:

  • Accurate payer and recipient information with names and TINs filled in correctly
  • Details on ordinary dividends and qualified dividends with respective amounts
  • Reporting of capital gains distribution for tax purposes
  • Form completed for tax year 2025 to reflect recent transactions

Form specifications and details:

Use Case: Receiving dividends from mutual fund investments in 2025
Form Type: 1099-DIV
Purpose: To report dividend income and capital gains for tax filing
Categories: distribution forms, dividend distribution forms, 1099 forms
Filled 1099-DIV Form for Mutual Fund Dividends