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O. 800 *See Reverse Side for Easy Opening Instructions* COPY B FOR RECIPIENT A FORM 1099G CERTAIN GOVERNMENT PAYMENTS REPORT OF TAXABLE UNEMPLOYMENT COMPENSATION PAYMENTS FROM THE STATE OF CALIFORNIA Employment Development Department Recipient's Name Payer's Federal ID No. 94-2650401 2. State or Local Income Tax Refunds, Credits, or Offsets Unemployment Insurance Integrity and Accounting Division - MIC 16A P.O. Box 2408 Rancho Cordova, CA 95741-2408 1. Unemployment Compensation (UC).

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