PAYER’S name, street address, city, state, and ZIP code 1a Date of sale (MMDDYY) OMB No. 1545-0715 Proceeds From

Broker and

Barter Exchange

Transactions

1b CUSIP No.

2 Stocks, bonds, etc. Reported

to IRS

Gross proceeds

$ Gross proceeds less commissions and option premiums

PAYER’S Federal identification number RECIPIENT’S identification number 3 Bartering 4 Federal income tax withheld

$ $

RECIPIENT’S name 5 Description

Regulated Futures Contracts

Street address (including apt. no.) Unrealized profit or (loss) on

open contracts—12/31/94

Profit or (loss) realized in 7

1995

6

City, state, and ZIP code $ $

Unrealized profit or (loss) on 9 Aggregate profit or (loss)

open contracts—12/31/95

8

Account number (optional) 2nd TIN Not.

$ $

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

Do NOT Cut or Separate Forms on This Page

%

Cat. No. 14411V

7979 VOID CORRECTED

Copy A

For

Internal Revenue

Service Center

File with Form 1096.

For Paperwork

Reduction Act

Notice and

instructions for

completing this form,

see Instructions for

Forms 1099, 1098,

5498, and W-2G.

Form 1099-B

PAYER’S name, street address, city, state, and ZIP code 1a Date of sale Proceeds From

Broker and

Barter Exchange

Transactions

1b CUSIP No.

2 Stocks, bonds, etc. Reported

to IRS

Gross proceeds

$ Gross proceeds less commissions and option premiums

PAYER’S Federal identification number RECIPIENT’S identification number 3 Bartering 4 Federal income tax withheld

$ $

RECIPIENT’S name 5 Description

Regulated Futures Contracts

Street address (including apt. no.) Unrealized profit or (loss) on

open contracts—12/31/94

Profit or (loss) realized in 7

1995

6

City, state, and ZIP code $ $

Unrealized profit or (loss) on 9 Aggregate profit or (loss)

open contracts—12/31/95

8

Account number (optional)

$ $

Form 1099-B (Keep for your records.) Department of the Treasury - Internal Revenue Service

%

Copy B

For Recipient

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.

CORRECTED (if checked)

OMB No. 1545-0715

Form 1099-B
Instructions for Recipient

Brokers and barter exchanges must report proceeds from

transactions to the Internal Revenue Service. This form is used to

report these proceeds.

Box 5.—Shows a brief description of the item or service for which

the proceeds or bartering income is being reported. For regulated

futures contracts and forward contracts, “RFC” or other appropriate

description, and any amount subject to backup withholding, may be

shown.

Box 1a.—Shows the trade date of the transaction. For aggregate

reporting, no entry will be present.

Box 1b.—For broker transactions, may show the CUSIP (Committee

on Uniform Security Identification Procedures) number of the item

reported.

Box 6.—Shows the profit or (loss) realized on regulated futures or

foreign currency contracts closed during 1995.

Box 2.—Shows the proceeds from transactions involving stocks,

bonds, other debt obligations, commodities, or forward contracts.

Losses on forward contracts are shown in parentheses. This box

does not include proceeds from regulated futures contracts. The

broker must indicate whether gross proceeds or gross proceeds less

commissions and option premiums were reported to the IRS. Report

this amount on Schedule D (Form 1040), Capital Gains and Losses.

Box 7.—Shows any year-end adjustment to the profit or (loss)

shown in box 6 due to open contracts on December 31, 1994.

Box 8.—Shows the unrealized profit or (loss) on open contracts held

in your account on December 31, 1995. These are considered sold

as of that date. This will become an adjustment reported in box 7 in

1996.

Box 3.—Shows the fair market value of any trade credits or scrip

credited to your account for exchanges of property or services as

well as cash received through a barter exchange. Report bartering

income in the proper part of Form 1040. See Pub. 525, Taxable and

Nontaxable Income, for information on how to report this income.

Box 9.—Boxes 6, 7, and 8 are used to figure the aggregate profit or

(loss) on regulated futures or foreign currency contracts for the year.

Include this figure on your 1995 Form 6781, Gains and Losses From

Section 1256 Contracts and Straddles.

subject to backup withholding at a 31% rate on certain payments.

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 4.—Shows backup withholding. For example, persons not

furnishing their taxpayer identification number to the payer become
PAYER’S name, street address, city, state, and ZIP code 1a Date of sale Proceeds From

Broker and

Barter Exchange

Transactions

1b CUSIP No.

2 Stocks, bonds, etc. Reported

to IRS

Gross proceeds

$ Gross proceeds less commissions and option premiums

PAYER’S Federal identification number RECIPIENT’S identification number 3 Bartering 4 Federal income tax withheld

$ $

RECIPIENT’S name 5 Description

Regulated Futures Contracts

Street address (including apt. no.) Unrealized profit or (loss) on

open contracts—12/31/94

Profit or (loss) realized in 7

1995

6

City, state, and ZIP code $ $

Unrealized profit or (loss) on 9 Aggregate profit or (loss)

open contracts—12/31/95

8

Account number (optional) 2nd TIN Not.

$ $

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

%

Copy C

For Payer

For Paperwork

Reduction Act

Notice and

instructions for

completing this

form, see

Instructions for

Forms 1099,

1098, 5498,

and W-2G.

VOID CORRECTED

OMB No. 1545-0715

Form 1099-B
Payers, Please Note—

Specific information needed to complete this form and other

forms in the 1099 series is given in the 1995 Instructions for

Forms 1099, 1098, 5498, and W-2G. A chart in those

instructions gives a quick guide to which form must be filed

to report a particular payment. You can order those

instructions and additional forms by calling 1-800-TAX-FORM

(1-800-829-3676).

Furnish Copy B of this form to the recipient by January 31,

1996.

File Copy A of this form with the IRS by February 28,

1996.

Printed on recycled paper