Operations associate.task team member

* ************ ************

* ***** ** ***** ****** tax refunds,

credits, or offsets

$11,452.00

* *** * ****** ** for tax year

* **** ********

* *********** ********

PAYER'S name, street address, city, state, and ZIP code, and telephone no. PO BOX 916

PAYER'S Federal Identification number

RECIPIENT'S Name

MICHELE L POTTS

NEW JERSEY DEPARTMENT OF LABOR

UNEMPLOYMENT INSURANCE

TRENTON, NJ 08625-0916

UNEMPLOYMENT INSURANCE

OMB No. 1545-0120

Form 1099-G

4 Federal Income tax withheld

6 Taxable grants

8 Box 2 is trade or

business income

Certain

Government

Payments

Copy B

For Recipient

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.

22-2481818 $240.00

$

$

$

$

$

Form 1099-G (Keep for your records.) Department of the Treasury - Internal Revenue Service 2020

TAA Form: TAA-1-08 (R-11-16)

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