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

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

credits, or offsets

$5,252.00

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

JUDY NGUYEN

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 $0.00

$

$

$

$

$

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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