7373 VOID CORRECTED

CORPORATION’S/BROKER’S name, street address, city, state, ZIP code, and OMB No. 1545-1814

telephone no.

Classes of stock exchanged

2

1

CORPORATION’S/BROKER’S SHAREHOLDER’S identification no. No. of shares exchanged

Federal identification no.

5

SHAREHOLDER’S name

Street address (including apt. no.)

City, state, and ZIP code

Form 1099-CAP Cat. No. 35115M Department of the Treasury - Internal Revenue Service

4

Form 1099-CAP

Do Not Cut or Separate Forms on This Page — Do Not Cut or Separate Forms on This Page

Copy A

For

Internal Revenue

Service Center

File with Form 1096.

For Privacy Act

and Paperwork

Reduction Act

Notice, see the

2003 General

Instructions for

Forms 1099, 1098,

5498, and W-2G.

7

Federal income tax withheld

$

Changes in

Corporate

Control and

Capital Structure

8

$

10 Description

9

$

FMV of other property received

Date of sale or exchange

CUSIP No.

FMV of stock received

Account number (optional) Check if filed

by broker

2nd TIN not.

3 Cash received Reported

to IRS

Gross proceeds

$ Gross proceeds less commissions and option premiums 

Check the box if shareholder cannot take a loss on their

tax return

2003

6
CORRECTED (if checked)

Copy B

For Shareholder

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

taxable income results

from this transaction

and the IRS determines

that it has not been

reported.

(keep for your records)

CORPORATION’S/BROKER’S name, street address, city, state, ZIP code, and

telephone no.

CORPORATION’S/BROKER’S SHAREHOLDER’S identification no.

Federal identification no.

SHAREHOLDER’S name

Street address (including apt. no.)

City, state, and ZIP code

Form 1099-CAP Department of the Treasury - Internal Revenue Service

Federal income tax withheld

Account number (optional) Filed by broker

(if checked)

OMB No. 1545-1814

Classes of stock exchanged

2

1

4 5 No. of shares exchanged

Form 1099-CAP

7

$

Changes in

Corporate

Control and

Capital Structure

8

$

10 Description

9

$

FMV of other property received

Date of sale or exchange

CUSIP No.

FMV of stock received

3 Cash received Reported

to IRS

Gross proceeds

$ Gross proceeds less commissions and option premiums 

If this box is checked, you cannot take a loss on your

tax return

2003

6
Instructions for Shareholder

A corporation in which you own stock that has had a change in

control or a substantial change in capital structure must send you

this statement by January 31 (February 28 if sent by your broker) of

the year following the calendar year of the change. You have

received this statement because the corporation has reasonably

determined that you may be required to recognize gain from the

receipt of cash, stock, or other property that was exchanged for the

corporation’s stock. Report any gain from the exchange on

Schedule D (Form 1040), Capital Gains and Losses. However, if the

box below Box 10 is checked, you cannot take a loss on your tax

return. Do not report this loss on Schedule D (Form 1040).

Box 4. If filed by a broker, shows backup withholding. Generally, a

payer must backup withhold at a 30% rate if you did not furnish

your taxpayer identification number to the payer. See Form W-9,

Request for Taxpayer Identification Number and Certification, for

information on backup withholding. Include this amount on your

income tax return as tax withheld.

Box 5. Shows the number of shares of the corporation’s stock that

you held which were exchanged in the transaction.

Box 1. Shows the date the stock was exchanged for cash, stock, or

other property.

Box 2. If filed by a broker, may show the CUSIP (Committee on

Uniform Security Identification Procedures) number of the item

reported.

Box 7. Shows the class or classes of stock that were exchanged.

Box 8. Shows the fair market value (FMV) of any stock you received

in exchange for the stock you held.

Box 9. Shows the FMV of any property (other than cash or stock)

you received in exchange for the stock you held.

Box 10. If filed by a broker, shows the corporation’s name and EIN

(Employer Identification Number).

Note: If you received this form from your broker, the broker may use

this form to report all proceeds from this transaction. The broker is

not required to also send you Form 1099-B, Proceeds From Broker

and Barter Exchange Transactions, to report cash proceeds from this

transaction. However, you may receive Form 1099-B from the broker

for other transactions with this corporation.

Box 3. Shows the amount of any cash received in the exchange for

the stock you held. The broker must indicate whether gross

proceeds or gross proceeds less commissions and option premiums

were reported to the IRS.
6

VOID CORRECTED

For Corporation

or Broker

For Privacy Act

and Paperwork

Reduction Act

Notice, see the

2003 General

Instructions for

Forms 1099,

1098, 5498,

and W-2G.

Copy C

CORPORATION’S/BROKER’S name, street address, city, state, ZIP code, and

telephone no.

CORPORATION’S/BROKER’S SHAREHOLDER’S identification no.

Federal identification no.

SHAREHOLDER’S name

Street address (including apt. no.)

City, state, and ZIP code

Form 1099-CAP Department of the Treasury - Internal Revenue Service

Account number (optional) 2nd TIN not. Check if filed

by broker

OMB No. 1545-1814

Classes of stock exchanged

2

1

4 5 No. of shares exchanged

Form 1099-CAP

7

Federal income tax withheld

$

Changes in

Corporate

Control and

Capital Structure

8

$

10 Description

9

$

FMV of other property received

Date of sale or exchange

CUSIP No.

FMV of stock received

3 Cash received Reported

to IRS

Gross proceeds

$ Gross proceeds less commissions and option premiums 

Check the box if shareholder cannot take a loss on their

tax return

2003
Instructions for Corporations

General and specific form instructions are provided as

separate products. The products you should use for 2003 are

the General Instructions for Forms 1099, 1098, 5498, and

W-2G and the separate specific instructions for each

information return you file. Specific information needed to

complete this form is given in the 2003 Instructions for

Form 1099-CAP. A chart in the general instructions gives a

quick guide to which form must be filed to report a particular

payment. To order these instructions and additional forms,

call 1-800-TAX-FORM (1-800-829-3676).

Due dates. Furnish Copy B of this form to the shareholder

by February 2, 2004 (March 1, 2004, if filed by a broker).

File Copy A of this form with the IRS by March 1, 2004. If

you file electronically, the due date is March 31, 2004.

Caution: Because the IRS processes paper forms by

machine (optical character recognition equipment), you

cannot file with the IRS Forms 1096, 1098, 1099, or 5498

that you print from the IRS Web Site.