STOCK PLAN ACCOUNT

FORM 1099 FOR 2021 Page 1 of 4

Plan Number: 56H

Account Number: XXX-XX-5548
Tax ID Number: XXX-XX-5548
Marilee Toppins
933 W EMBERCREST DR Important income tax return document enclosed. For tax
ARLINGTON, TX 76017-5920 advice, please consult your tax advisor.

The enclosed applies to transactions in your company stock

plan account. For a complete Historical Transaction Summary
please refer to the Document Library on
www.stockplanconnect.com.
You may also reference our Tax Planning Guide online.
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 STOCK PLAN ACCOUNT
FORM 1099-DIV FOR 2021 Page 3 of 4

Copy B for Recipient

Account number: 56H-XXX-XX-5548 SS # XXX-XX-5548
Marilee Toppins
Payer
933 W EMBERCREST DR MORGAN STANLEY DOMESTIC HOLDINGS, INC.
ARLINGTON TX 760175920 MORGAN STANLEY SMITH BARNEY, LLC.
1 NEW YORK PLAZA, 40TH FLOOR
NEW YORK, NY 10004

TAX ID NUMBER: 20-8764829

Questions call: 1-877-772-1099

Security Description
OCCIDENTAL PETROLEUM CORP DE

Form 1099-DIV Dividends and Distributions (OMB No. 1545-0110)

Total ordinary dividends Qualified dividends Total capital gain distributions Unrecaptured sect. 1250 gain Section 1202 gain Collectibles (28%) gain

$2.72 $2.72

Box 1a Box 1b Box 2a Box 2b Box 2c Box 2d

Federal Income Tax Foreign country or US

Nondividend distributions Withheld Section 199A dividends Investment Expenses Foreign Tax Paid possession

Box 3 Box 4 Box 5 Box 6 Box 7 Box 8

Non cash liquidation Specified private activity bond

Cash liquidation distributions distributions Exempt-Interest dividends interest dividends State State Identification no. State Tax Withheld

Box 9 Box 10 Box 11 Box 12 Box 13 Box14 Box 15

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.

See instructions on reverse side for further information.

IMPORTANT TAX INFORMATION - PLEASE RETAIN FOR YOUR RECORDS
 Page: 4 of 4

Instructions for Recipient

Form 1099-DIV
Recipient's taxpayer identification number (TIN). For your protection, this form may show only Box 4. Shows backup withholding. A payer must backup withhold on certain payments if you did not
the last four digits of your TIN (SSN, ITIN, ATIN, or EIN). However, the issuer has reported your give your TIN to the payer. See Form W-9 for information on backup withholding. Include this amount
complete TIN to the IRS. on your income tax return as tax withheld.

Account number. May show an account or other unique number the payer assigned to distinguish Box 5. Shows the portion of the amount in box 1a that may be eligible for the 20% qualified business
your account. income deduction under section 199A. See the instructions for Form 8995 and Form 8995-A.

Box 1a. Shows total ordinary dividends that are taxable. Include this amount on the “Ordinary Box 6. Shows your share of expenses of a nonpublicly offered RIC, generally a nonpublicly offered
dividends” line of Form 1040 or 1040-SR. Also report it on Schedule B (Form 1040), if required. mutual fund. This amount is included in box 1a.

Box 1b. Shows the portion of the amount in box 1a that may be eligible for reduced capital gains Box 7 Shows the foreign tax that you may be able to claim as a deduction or a credit on Form 1040
rates. See the Instructions for Forms 1040 and 1040-SR for how to determine this amount and or 1040-SR. See the Instructions for Forms 1040 and 1040-SR.
where to report.
Box 8 This box should be left blank if a RIC reported the foreign tax shown in box 7.
The amount shown may be dividends a corporation paid directly to you as a participant (or
beneficiary of a participant) in an employee stock ownership plan (ESOP). Report it as a dividend on Boxes 9 and 10 Show cash and noncash liquidation distributions.
your Form 1040 or 1040-SR but treat it as a plan distribution, not as investment income, for any
other purpose. Box 11 Shows exempt-interest dividends from a mutual fund or other RIC paid to you during the
calendar year. See the Instructions for Forms 1040 and 1040-SR for where to report. This amount
Box 2a. Shows total capital gain distributionsfrom a regulated investment company (RIC) or real may be subject to backup withholding. See Box 4 above.
estate investment trust (REIT). See How To Report in the Instructions for Schedule D (Form 1040).
But, if no amount is shown in boxes 2b, 2c, 2d, and 2f and your only capital gains and losses are Box 12 Shows exempt-interest dividends subject to the alternative minimum tax. This amount is
capital gain distributions,you may be able to report the amounts shown in box 2a on your Form 1040 included in box 11. See the Instructions for Form 6251.
or 1040-SR rather than Schedule D. See the Instructions for Forms 1040 and 1040-SR.
Boxes 13–15. State income tax withheld reporting boxes.
Box 2b. Shows the portion of the amount in box 2a that is unrecaptured section 1250 gain from
certain depreciable real property. See the Unrecaptured Section 1250 Gain Worksheet in the Nominees. If this form includes amounts belonging to another person, you are considered a nominee
Instructions for Schedule D (Form 1040). recipient. You must file Form 1099-DIV (with a Form 1096) with the IRS for each of the other owners
to show their share of the income, and you must furnish a Form 1099-DIV to each. A spouse is not
Box 2c. Shows the portion of the amount in box 2a that is section 1202 gain from certain small required to file a nominee return to show amounts owned by the other spouse. See the 2021 General
business stock that may be subject to an exclusion. See the Schedule D (Form 1040) instructions. Instructions for Certain Information Returns.

Box 2d. Shows the portion of the amount in box 2a that is 28% rate gain from sales or exchanges of
collectibles. If required, use this amount when completing the 28% Rate Gain Worksheet in the
Instructions for Schedule D (Form 1040).

Box 3. Shows a return of capital. To the extent of your cost (or other basis) in the stock, the
distribution reduces your basis and is not taxable. Any amount received in excess of your basis is
taxable to you as capital gain. See Pub. 550.

IMPORTANT TAX INFORMATION - PLEASE RETAIN FOR YOUR RECORDS