Professional Documents
Culture Documents
93-6001789
RECEIPENT'S name and Street address
MATTHEW M BROWN
778 POLK STREET
***-**-0040
1. Unemployment compensation
$ 1,284.00
2. State or local Income tax
refunds, credits or offsets
2014
Form 1099-G
Copy B For
Recipient
3. Box 2 amount is for tax year
Account number
$ 132.00
$
5. ATAA/RTAA payments
9. Market gain
OR
$
10a. State
6. Taxable grants
7. Agriculture payments
$
EUGENE, OR 97402
Certain
Government
Payments
$ 0.00
10b. State ID no.
0972779
$ 81.00
Form 1 0 9 9 - G
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.