P.O.

Box 9046, Olympia, WA 98507

54000003-000345-01-00000000

Date: Jan 12 2022

Letter ID: L0044371107
CHAO GUO Claimant ID: SGZHQG
15730 116TH AVE NE
BOTHELL WA 98011-4184

PAYER’S name, street address, city or town, province or state, 1 Unemployment compensation OMB No. 1545-0120
ZIP, or foreign postal code, and telephone no.
Certain
State of Washington $ 10,350.00 Government
Employment Security Department
212 Maple Park Ave SE
Olympia, WA 98501-2347
2 State or local income tax
refunds, credits, or offsets
2021 Payments
1-800-318-6022
Form 1099-G
UI1099@[Link]
PAYER’S federal identification number RECIPIENT’S identification number 3 Box 2 amount is for tax year 4 Federal income tax withheld Copy B
91-1762161 704-71-0175 $ 1,044.00 For Recipient
RECIPIENT'S name 5 RTAA payments 6 Taxable grants This is important tax
information and is
CHAO GUO $ 0.00 being furnished to the
Internal Revenue
Street address (including apt. no.) 7 Agriculture payments 8 If checked, box 2 is Service. If you are
trade or business required to file a
15730 116TH AVE NE return, a negligence
income
penalty or other
City or town, province or state, ZIP, or foreign postal code 9 Market gain sanction may be
BOTHELL, WA 98011-4184 imposed on you if this
income is taxable and
Account number (see instructions) 10a State 10b State identification no. 11 State income tax withheld the IRS determines
that it has not been
Unemployment Insurance (UI) --------------------------------------- reported.
Form 1099-G (keep for your records) [Link]/form1099g Department of the Treasury – Internal Revenue Service
 54000003-000345-02-00000000

Instructions for Recipient interest is reported to you, report it as interest income on your tax return. See
Recipient's taxpayer identification number. For your protection, this form may your tax return instructions.
show only the last four digits of your social security number (SSN), individual Box 3. Identifies the tax year for which the box 2 refunds, credits, or offsets
taxpayer identification number (ITIN), adoption taxpayer identification number shown were made. If there is no entry in this box, the refund is for 2016 taxes.
(ATIN), or employer identification number (EIN). However, the issuer has Box 4. Shows backup withholding or withholding you requested on
reported your complete identification number to the IRS. unemployment compensation, Commodity Credit Corporation (CCC) loans, or
Account number. May show an account or other unique number the payer has certain crop disaster payments. Generally, a payer must backup withhold on
assigned to distinguish your account. certain payments if you did not give your taxpayer identification number to the
Box 1. Shows the total unemployment compensation paid to you this year. payer. See Form W-9 for information on backup withholding. Include this
Combine the box 1 amounts from all Forms 1099-G and report the total as amount on your income tax return as tax withheld.
income on the unemployment compensation line of your tax return. Except as Box 5. Shows reemployment trade adjustment assistance (RTAA) payments you
explained below, this is your taxable amount. If you are married filing jointly, received. Include on Form 1040 on the “Other income” line. See the Form 1040
each spouse must figure his or her taxable amount separately. If you expect to instructions.
receive these benefits in the future, you can ask the payer to withhold federal Box 6. Shows taxable grants you received from a federal, state, or local
income tax from each payment. Or, you can make estimated tax payments. For government.
details, see Form 1040-ES. If you made contributions to a governmental Box 7. Shows your taxable Department of Agriculture payments. If the payer
unemployment compensation program or to a governmental paid family leave shown is anyone other than the Department of Agriculture, it means the payer
program and received a payment from that program, the payer must issue a has received a payment, as a nominee, that is taxable to you. This may
separate Form 1099-G to report this amount to you. If you itemize deductions, represent the entire agricultural subsidy payment received on your behalf by the
you may deduct your contributions on Schedule A (Form 1040) as taxes paid. If nominee, or it may be your pro rata share of the original payment. See Pub. 225
you do not itemize, you only need to include in income the amount that is in and the Instructions for Schedule F (Form 1040) for information about where to
excess of your contributions. report this income. Partnerships, see Form 8825 for how to report.
Box 2. Shows refunds, credits, or offsets of state or local income tax you Box 8. If this box is checked, the amount in box 2 is attributable to an income tax
received. It may be taxable to you if you deducted the state or local income tax that applies exclusively to income from a trade or business and is not a tax
paid on Schedule A (Form 1040). Even if you did not receive the amount shown, of general application. If taxable, report the amount in box 2 on Schedule C or F
for example, because: (a) it was credited to your state or local estimated tax, (b) (Form 1040), as appropriate.
it was offset against federal or state debts, (c) it was offset against other offsets, Box 9. Shows market gain on CCC loans whether repaid using cash or CCC
or (d) you made a charitable contribution from your refund, it is still taxable if it certificates. See the Instructions for Schedule F (Form 1040).
was deducted. If you received interest on this amount, you may receive Form Boxes 10a–11. State income tax withheld reporting boxes.
1099-INT for the interest. However, the payer may include interest of less than Future developments. For the latest information about developments related to
$600 in the blank box next to box 9 on Form 1099-G. Regardless of whether the Form 1099-G and its instructions, such as legislation enacted after they were
published, go to [Link]/form1099g.
Important! This letter contains information about your benefits and may include deadlines to respond. If you
speak a language other than English, call 1-800-318-6022 for free language assistance services. Relay 711.

አስፈላጊ! ይህ ደብዳቤ ስለ ጥቅማጥቅሞችዎ መረጃን ይይዛል እናም ምላሽ ለመስጠት ቀነ-ገደቦችን ሊያካትት ይችላል፡፡
ከእንግሊዝኛ ሌላ ቋንቋ የሚናገሩ ከሆነ ለነፃ ቋንቋ እገዛ አገልግሎቶች 1-800-318-6022 ይደውሉ። ቅብብል 711

အရေးကြီးသည် ဤစာတွင် သင်၏အကျိုးခံစားခွင့်များအကြောင်း အချက်အလက်များ ပါဝင်ပြီး စာပြန်ရန်

နောက်ဆုံးနေ့ကို ထည့်သွင်းပေးထားနိုင်ပါသည်။ အကယ်၍ သင်သည် အင်္ဂလိပ်ဘာသာစကားမဟုတ်ပဲ
အခြားဘာသာစကားတစ်ခုပြောပါက အခမဲ့ ဘာသာစကားဝန်ဆောင်မှုများ ရရှိရန်အတွက် 1-800-318-6022 ကို
ဖုန်းခေါ်ဆိုပါ။ လွှဲပြောင်းရန် နံပါတ် 711။

重要说明！本函包含您的福利相关信息, 并可能附有回复截止日期。如果您说英语以外的其他语言,
请致电 1-800-318-6022 以获取免费的语言协助服务。转接711。

重要說明！本函包含您的福利相關資訊, 並可能附有回覆截止日期。如果您說英語以外的其他語言,
請致電 1-800-318-6022 以獲取免費的語言協助服務。轉接711。

Nomot! Ei taropwe mi awora poraus usun eom we aninis me pwal pachenong nasenon ranin eom kopwe
ponueni. Ika pwe ke kapas ew kapas esapw kapasen Merika, kokori 1-800-318-6022 ren aninisin kapas ese
wor momon. Nainen koko 711.

Mahalaga! Ang liham na ito ay naglalaman ng impormasyon tungkol sa iyong mga benepisyo at posibleng
may mga deadline para sa pagtugon. Kung gumagamit ka ng wikang iba pa sa Ingles, tumawag sa
1-800-318-6022 para sa mga libreng serbisyo para sa tulong sa wika. Relay 711.

Important ! Cette lettre comporte des informations sur vos avantages et peut prévoir des délais à respecter. Si
vous parlez une autre langue que l'anglais, appelez au 1-800-318-6022 pour des services d'assistance
linguistique gratuits. Relais 711.

Wichtig! Dieser Brief enthält Informationen zu Ihren Vergünstigungen und möglicherweise auch
Antwortfristen. Wenn Sie kein Englisch sprechen, wählen Sie 1-800-318-6022 für kostenlose
Sprachunterstützung. Durchwahl 711.

Importante! Questa lettera contiene informazioni sui benefici che Le spettano e può includere delle scadenze
per rispondere. Se non parla inglese, chiami il recapito 1-800-318-6022 per avere dei servizi gratuiti di
assistenza linguistica. Numero con servizio di ritrasmissione 711.

重要！この手紙には、 お客様の給付金に関する情報が含まれていて、
お客様にご回答いただく期限が書かれている可能性があります。
英語以外の言語をお使いの場合は、 1-800-318-6022 にご連絡いただき、
無料の通訳サービスをご利用ください。 再び聞く711。

សំខាន់៖ លិខិតនេះមានព័ត៌មានអំពីអត្ថប្រយោជន៍របស់អ្នក
ហើយអាចនឹងរួមបញ្ចូលពេលកំណត់ដើម្បីឆ្លើយតប។
ប្រសិនបើអ្នកនិយាយភាសាផ្សេងក្រៅពីភាសាអង់គ្លេស សូមទូរស័ព្ទមកលេខ 1-800-318-6022
សម្រាប់សេវាកម្មជំនួយភាសាឥតគិតថ្លៃ។ បញ្ជូនត 711 ។

중요! 본 서신에는 귀하의 혜택에 관한 내용이 들어 있으며 회신 마감일을 포함할 수 있습니다.

사용하시는 언어가 영어와 다른 경우 1-800-318-6022 번으로 전화하여 무료 언어 지원 서비스를
요청하십시오. 청각 언어 장애인은 711로전화하십시오.

ສ ິ່ງສ ຳຄັນ! ໜັງສືສະບັບນີີ້ມີຂ ີ້ມູນກິ່ຽວກັບຜົນປະໂຫຍດຂອງທິ່ຳນ ແລະ ອຳດຈະມີກຳນກ ຳນົດເວລຳທີິ່ຈະຕອບກັບ.

ຖີ້ຳທິ່ຳນເວົີ້ຳພຳສຳອືິ່ນ ທີິ່ບ ິ່ແມິ່ນພຳສຳອັງກ ດ, ໃຫີ້ໂທຫຳ 1-800-318-6022 ລັບກຳນບ ລ ກຳນຊິ່ວຍເຫ
ືອດີ້ຳນພຳສຳໂດຍບ ິ່ເສຍຄິ່ຳ. ບ ລ ກຳນ ຣ ເລ 711.

Barbaachisa! Xalayaan kun oddeffaanoo fayyiida kee kan qabate akkaasumas sa'aatti dhumaati debii ittiin
keniitu kan qabaate dha. Yoo ingiliffaa irraa afaan biroo dubbaatta kan ta'e, tajajila degaarsa afaan biliisan
argachuuf 1-800-318-6022 irraatti bilbili. Sarara 711.

ਜ਼ਰੂਰੀ ਸੂਚਨਾ! ਇਸ ਪੱਤਰ ਵ ੱਚ ਤੁਹਾਡੇ ਲਾਭਾਾਂ ਬਾਰੇ ਜਾਣਕਾਰੀ ਸ਼ਾਮਲ ਹੈ ਅਤੇ ਇਸ ਵ ੱਚ ਜ ਾਬ ਦੇਣ ਲਈ ਸਮਾਾਂ-ਸੀਮਾ ਸ਼ਾਮਲ ਹੋ
ਸਕਦੀ ਹੈ। ਜੇਕਰ ਤੁਸੀਾਂ ਅੰਗਰੇਜ਼ੀ ਭਾਸ਼ਾ ਤੋਂ ਇਲਾ ਾ ਕੋਈ ਹੋਰ ਭਾਸ਼ਾ ਬੋਲਦੇ ਹੋ, ਤਾਾਂ ਮੁਫ਼ਤ ਭਾਸ਼ਾ ਸਹਾਇਤਾ ਸੇ ਾ ਾਾਂ ਲਈ
1-800-318-6022 'ਤੇ ਕਾਲ ਕਰੋ। 711 'ਤੇ ਅੱਗੇ ਪਰਸਾਵਰਤ ਕਰੋ।

ਜ਼ਰੂਰੀ ਸੂਚਨਾ! ਇਸ ਪੱਤਰ ਵਿੱਚ ਤੁਹਾਡੇ ਲਾਭਾਂ ਬਾਰੇ ਜਾਣਕਾਰੀ ਸ਼ਾਮਲ ਹੈ ਅਤੇ ਇਸ ਵਿੱਚ ਜਵਾਬ ਦੇਣ ਲਈ ਸਮਾਂ-ਸੀਮਾ ਸ਼ਾਮਲ ਹੋ
ਸਕਦੀ ਹੈ। ਜੇਕਰ ਤੁਸੀਂ ਅੰਗਰੇਜ਼ੀ ਭਾਸ਼ਾ ਤੋਂ ਇਲਾਵਾ ਕੋਈ ਹੋਰ ਭਾਸ਼ਾ ਬੋਲਦੇ ਹੋ, ਤਾਂ ਮੁਫ਼ਤ ਭਾਸ਼ਾ ਸਹਾਇਤਾ ਸੇਵਾਵਾਂ ਲਈ
1-800-318-6022 'ਤੇ ਕਾਲ ਕਰੋ। 711 'ਤੇ ਅੱਗੇ ਪ੍ਰਸਾਰਿਤ ਕਰੋ।

Важно! В этом письме представлена информация о Ваших льготах и могут быть указаны сроки, в
которые необходимо дать ответ. Если Вы не разговариваете на английском языке, обратитесь по
телефону 1-800-318-6022, чтобы получить бесплатную языковую помощь. Телетайп: 711.

Taua! O lenei tusi o loo iai faamatalaga e uiga i au penefiti ma e ono aofia ai aso e faagata ai lau tali. Afai e te
tautala i se gagana e ese mai le Igilisi, valaau le 1-800-318-6022 mo auaunaga fesoasoai fai fua. Faaoo i le
711

Muhiim! Waraaqdaan waxaa ku jira xog ku saabsan gunnooyinkaaga waxaana kamid noqon kara waqtiga loo
cayimay in looga jawaabo. Haddii aad ku hadasho luuqad aan ahayn Ingiriis, wac 1-800-318-6022 si aad u
hesho adeegyada caawimaada luuqada oo bilaash ah. Adeegga Taleefanka Dadka Naafada ah 711.

ኣገዳሲ! እዚ ደብዳበ ሓበሬታ ብዛዕባ ናትካ ረብሓታት ከምኡ`ውን ደረት ግዜ ናይ እትምልሰሎም ከጠቓልል ይኽእል።
እንድሕር እንግልዝኛ ዘይኮነ ካልእ ቋንቋ ትዛረብ እንተኾይንካ፡ ደውል ናብ 1-800-318-6022 ክትረክብ ኣገልግሎታት
ደገፍ ቋንቋ ብነጻ። ንሪለይ ድማ 711።

Mahalaga! Ang liham na ito ay naglalaman ng impormasyon tungkol sa iyong mga benepisyo at posibleng
may mga deadline para sa pagtugon. Kung gumagamit ka ng wikang iba pa sa Ingles, tumawag sa
1-800-318-6022 para sa mga libreng serbisyo para sa tulong sa wika. Relay 711.

Зверніть увагу! Цей лист містить інформацію про Ваші пільги й може мати вказівки щодо терміну
надання відповіді. Якщо Ви не розмовляєте англійською мовою, зателефонуйте за номером
1-800-318-6022, щоб отримати безкоштовну мовну допомогу. Телетайп: 711.

Thông Tin Quan Trọng! Thư này chứa thông tin về các quyền lợi của quý vị và có thể bao gồm thời hạn phản
hồi. Nếu quý vị nói một ngôn ngữ khác ngoài Tiếng Anh, hãy gọi 1-800-318-6022 để nhận các dịch vụ hỗ trợ
ngôn ngữ miễn phí. Dịch vụ tiếp âm 711.