Important Information About Form 1099-G: D D Flaumenbaum 2481 Haff Ave North Bellmore Ny 11710-2735

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Do You Qualify For An Earned Income

NEW YORK STATE DEPARTMENT OF LABOR Credit?


PAYMENT UNIT, BUILDING 12 1099-G You may be entitled to a Federal tax credit. The amount
PO BOX 621 of the credit is based on your earned income such as
ALBANY, NY 12201-0621 wages and self-employment. This credit may be allowed
even if you do not owe any Federal income tax.
However, you must file a Federal income tax return to
obtain the credit. See the instructions on your Federal
income tax forms to determine if the amount of your
income allows you to claim this credit.

D D FLAUMENBAUM
2481 HAFF AVE
NORTH BELLMORE NY 11710-2735

Important Information About Form 1099-G


Because you received unemployment compensation payments of $10 or more If this 1099-G is for a year other than 2019, see the instructions on the
in 2019, New York State is required to report those payments to the Internal appropriate tax return, or contact the Internal Revenue Service, the
Revenue Service, and give you Form 1099-G by January 31, 2020. NYS Department of Taxation and Finance or your local taxing authority
Unemployment compensation includes: to determine the amount of taxable unemployment insurance.
Unemployment Insurance payments BOX 2 Shows adjustments credited to you this year. INCLUDES: Your
Federal Extended Benefits payments cash payments and income tax refunds used to pay back overpaid
TAA (Trade Adjustment Act) basic, retroactive, and additional training benefits. DOES NOT INCLUDE: Your payments to cover penalties, and
payments your unemployment insurance benefits used to pay back overpaid
DUA (Disaster Unemployment Assistance) payments benefits. Adjustment information may be helpful to you in filing your
return.
Please keep Form 1099-G for your records. You will need this information to
BOX 4 Shows total Federal income tax withheld from unemployment
complete your Federal, State and local income tax returns. If you did not
compensation paid to you this year. If you voluntarily authorized
receive any unemployment compensation this year, but repaid an
withholding, tax has been withheld at a 10% rate. Include this amount on
overpayment, this form is being sent in case it will be of help to you.
your income tax return as tax withheld.
Note: Unless you have voluntarily authorized Federal or State withholding, BOX 5 Shows Reemployment Trade Adjustment Assistance (RTAA)
Federal, State and local income taxes are not withheld on unemployment payments you received. The amounts are not included in the Box 1 total.
compensation. If you expect to receive these benefits in the future, you can Include on Form 1040 on the "Other income" line. See the Form 1040
ask the Department to withhold Federal and State income tax from each instructions.
payment. Or, you can make estimated tax payments during the year. For more
BOX 10a Shows the payer's state.
information regarding how to make estimated tax payments, see instructions
on the appropriate tax return, or, contact the Internal Revenue Service or the BOX 10b Shows the payer's Federal Identification Number.
NYS Department of Taxation and Finance. BOX 11 Shows total State income tax withheld from unemployment
BOX 1 Shows the total unemployment compensation paid to you this year. compensation paid to you this year. If you voluntarily authorized
For tax year 2019, combine the box 1 amounts from all Forms 1099-G, and withholding, tax has been withheld at a 2.5% rate. Include tax withheld, if
report the amount as income on the unemployment compensation line on your any, on your income tax return.
return. Except as explained in the following instructions for the remaining Future developments. For the latest information about developments
boxes, this is your taxable amount. If you are married filing jointly, each related to Form 1099-G and its instructions, such as legislation enacted
spouse must figure his or her taxable amount separately. after they were published, go to www.irs.gov/form1099g.

PAYER'S name, street address, city, state, ZIP code, Federal identification number, and telephone number OMB No. 1545-0120
Statement for
Recipients of
NEW YORK STATE
Certain
DEPARTMENT OF LABOR-UNEMPLOYMENT INSURANCE Government
Payments
ALBANY, N.Y. 12240-0001
2019
PAYER'S Fed. Id. No. 27-0293117 Phone 518 485-7071
Form 1099-G (12/19)
RECIPIENT'S identification number 1. Unemployment compensation 2. Adjustments 3. 4. Federal income tax withheld

090-68-6619 $8,437.50 $0.00 $843.75


RECIPIENT'S name, street address, city, state and ZIP code 5. RTAA Payments 6.

$0.00
7. 8. 9.
D D FLAUMENBAUM
2481 HAFF AVE 10 a. 10 b. State 11. State income tax withheld
NORTH BELLMORE NY 11710-2735 State Identification No.
NY 27-0293117 $210.93
This is important tax information and is being furnished to the Internal Revenue Service.If you are required to file a return, 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.

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