(J voip (_] CORRECTED
PAYER'S name, street address, city, state, and ZIP code 1 Rents (OMB No. 1545-0115
$ 1987 Miscellaneous
2 Royalties Income
Statement for
$ Recipients of
PAYER’S Federal identification number | RECIPIENT'S identification number | 3 Prizes and awards 4 Federal income tax withheld
$ $ Copy C
RECIPIENT'S name (first, middle, last) : Fishing boat proceeds é ‘Medical and health care payments ForPayer
For Paperwork
7 Nonemployee compensation | 8 Substitute payments in lieu of Reduction Act
Street address dividends or interest Notice and
$ $ instructions for
completing this
City, state, and ZIP code 9 Payer made direct sales of $5,000 or more of consumer form, see
Instructions for
ts toa bi It) f Se
products to a buyer (recipient) for resale > Forms 1099,
‘Account number (optional) 1098, 5498, 1096,
10 The amount in Box 7 is crop insurance proceeds -_- p |_| and W-2G.

Form 1099-MISC

(vow

(] CORRECTED

Department of the Treasury - Internal Revenue Service

PAYER’S name, street address, city, state, and ZIP code 1 Rents OMB No. 1545-0115
$ 1987 Miscellaneous
2 Royalties Income
Statement for
$ Recipients of
PAYER’S Federal identification number | RECIPIENT'S identification number 3 Prizes and awards 4 Federal income tax withheld
$ Copy C
RECIPIENT'S name (first, middle, last) 5 Fishing boat proceeds 6 Medical and health care payments ForPayer
$ $
For Paperwork
7 Nonemployee compensation | 8 Substitute payments in lieu of Reduction Act
Street address lividends or interest Notice and
$ $ instructions for
completing this
City, state, and ZIP code 9 Payer made direct sales of $5,000 or more of consumer form, see
products to a buyer (recipient) for resale +O nears 1099,
‘Account number (optional) 1098, 5498, 1096,
10 The amount in Box 7 is crop insurance proceeds -- » [_] and W-2G.

Form 1099-MISC.

Department of the Treasury - Internal Revenue Service

[]voin [J CORRECTED
PAYER’S name, street address, city, state, and ZIP code 1 Rents ‘OMB No. 1545-0115
$ 1987 Miscellaneous
2 Royalties Income
Statement for
$ Recipients of
PAYER'S Federal identification number | RECIPIENT'S identification number | 3 Prizes and awards 4 Federal income tax withheld
$ $ Copy C
RECIPIENT'S name (first, middie, last) : Fishing boat proceeds R Medical and health care payments ForPayer
For Paperwork
7 Nonemployee compensation | 8 Substitute payments in lieu of Reduction Act
Street address dividends or interest | Notice and
$ $ instructions for
completing this.
City, state, and ZIP code ‘9 Payer made direct sales of $5,000 or more of consumer form, see
products toa buyer (recipient) forresale. . . . py rts.
Account number (optional) 1098, 5498, 1096,
10 The amount in Box 7 is crop insurance proceeds -- » [_] and W-2G.

Form 1099-MISC.

Department of the Treasury - Internal Revenue Service


Instructions for Recipient

The amount(s) shown on this form may or may not be taxable to you. If the
amount(s) is taxable and you are an individual, report it on your tax return
as explained below. (Other taxpayers, such as fiduciaries, report the
amount(s) on corresponding lines of your tax return.)

Boxes 1 and 2.—On Schedule E (Form 1040); or Schedule C if you
provide services that are primarily for your customer's convenience, such
as regular cleaning, changing linen, or maid service.

Box 3.—On the line for "Other income" on Form 1040. If it is trade or
business income, report this amount on Schedule C or F (Form 1040).
Box 4.—Any amount listed in this box represents backup withholding. For
example, persons not furnishing their taxpayer identification number to
the payer become subject to backup withholding at a 20% rate on certain
payments. See Form W-9, Payer's Request for Taxpayer Identification
Number and Certification, for information on backup withholding. Include
this on your income tax return as tax withheld.

Box 5.—An amount in this box means the fishing boat operator considers
you self-employed. Report this amount on Schedule C (Form 1040). See
Publication 595, Tax Guide for Commercial Fishermen.

Box 6.—On Schedule C (Form 1040).

Box 7.—Generally, these amounts are considered income from self-
employment. Report them as part of your trade or business income on
Schedule C or F (Form 1040). If you are not self-employed, amounts paid

Instructions for Recipient

The amount(s) shown on this form may or may not be taxable to you. If the
amount(s) is taxable and you are an individual, report it on your tax return
as explained below. (Other taxpayers, such as fiduciaries, report the
amount(s) on corresponding lines of your tax return.)

Boxes 1 and 2.—On Schedule E (Form 1040); or Schedule C if you
provide services that are primarily for your customer's convenience, such
as regular cleaning, changing linen, or maid service.

Box 3.—On the line for ‘Other income” on Form 1040. If itis trade or
business income, report this amount on Schedule C or F (Form 1040).
Box 4.—Any amount listed in this box represents backup withholding, For
example, persons not furnishing their taxpayer identification number to
the payer become subject to backup withholding at a 20% rate on certain
payments. See Form W-9, Payer’s Request for Taxpayer Identification
Number and Certification, for information on backup withholding. Include
this on your income tax return as tax withheld.

Box 5.—An amount in this box means the fishing boat operator considers
you self-employed. Report this amount on Schedule C (Form 1040). See
Publication 595, Tax Guide for Commercial Fishermen.

Box 6.—On Schedule C (Form 1040).

Box 7.—Generally, these amounts are considered income from self-
employment. Report them as part of your trade or business income on
Schedule C or F (Form 1040). If you are not self-employed, amounts paid

Instructions for Recipient

The amount(s) shown on this form may or may not be taxable to you. If the
amount(s) is taxable and you are an individual, report it on your tax return
as explained below. (Other taxpayers, such as fiduciaries, report the
amount(s) on corresponding lines of your tax return.)

Boxes 1 and 2.—On Schedule E (Form 1040); or Schedule C if you
provide services that are primarily for your customer's convenience, such
as regular cleaning, changing linen, or maid service.

Box 3.—On the line for “Other income" on Form 1040. If itis trade or
business income, report this amount on Schedule C or F (Form 1040).
Box 4.—Any amount listed in this box represents backup withholding. For
example, persons not furnishing their taxpayer identification number to
the payer become subject to backup withholding at a 20% rate on certain
payments. See Form W-9, Payer's Request for Taxpayer Identification
Number and Certification, for information on backup withholding. Include
this on your income tax return as tax withheld

Box 5.—An amount in this box means the fishing boat operator considers
you self-employed. Report this amount on Schedule C (Form 1040). See
Publication 595, Tax Guide for Commercial Fishermen.

Box 6.—On Schedule C (Form 1040).

Box 7.—Generally, these amounts are considered income from self-
employment. Report them as part of your trade or business income on
Schedule C or F (Form 1040). If you are not self-employed, amounts paid

to you for services rendered are generally reported on Form 1040 on the
line for "Wages, salaries, tips, etc.”

If there are two amounts shown in this box, one may be labeled “EPP.”
This represents excess golden parachute payments. You must pay a 20%
excise tax on this amount. See your Form 1040 instructions under “‘Other
Taxes.” The unlabeled amount is your total compensation.

Box 8.—As ‘Other income" on your tax return. The amount shown is
substitute payments in lieu of dividends or tax-exempt interest received by
your broker on your behalf after transfer of your securities for use ina short
sale.

Box 9.—An entry in the checkbox means sales to you of consumer
products on a buy-sell, deposit-commission, or any other basis for resale,
have amounted to $5,000 or more. The person filing this return does not
have to show a dollar amount in this box. Any income from your sale of
these products should generally be reported on Schedule C (Form 1040).

Box 10.—An entry in this checkbox means the amount reported in Box 7
is crop insurance proceeds.

The amounts shown on this form (except Boxes 4 and 8) may be subject to
self-employment (social security) tax computed on Schedule SE (Form
1040). See Publication 533, Self-Employment Tax, for more information
on amounts considered self-employment income. Since no income or social
security taxes will be withheld by the payer, you may be required to make
estimated tax payments. See Form 1040-ES, Estimated Tax for Individuals.

to you for services rendered are generally reported on Form 1040 on the
line for "Wages, salaries, tips, etc.’

If there are two amounts shown in this box, one may be labeled "EPP."”
This represents excess golden parachute payments. You must pay a 20%
excise tax on this amount. See your Form 1040 instructions under ‘Other
Taxes." The unlabeled amount is your total compensation.

Box 8.—As “Other income” on your tax return. The amount shown is
substitute payments in lieu of dividends or tax-exempt interest received by
your broker on your behalf after transfer of your securities for use in a short
sale.

Box 9.—An entry in the checkbox means sales to you of consumer
products on a buy-sell, deposit-commission, or any other basis for resale,
have amounted to $5,000 or more. The person filing this return does not
have to show a dollar amount in this box. Any income from your sale of
these products should generally be reported on Schedule C (Form 1040).
Box 10.—An entry in this checkbox means the amount reported in Box 7

is crop insurance proceeds.

The amounts shown on this form (except Boxes 4 and 8) may be subject to
self-employment (social security) tax computed on Schedule SE (Form
1040). See Publication 533, Self-Employment Tax, for more information
on amounts considered self-employment income. Since no income or social
security taxes will be withheld by the payer, you may be required to make
estimated tax payments. See Form 1040-ES, Estimated Tax for Individuals.

to you for services rendered are generally reported on Form 1040 on the
line for "Wages, salaries, tips, etc.’

If there are two amounts shown in this box, one may be labeled “EPP.”
This represents excess golden parachute payments. You must pay a 20%
excise tax on this amount. See your Form 1040 instructions under “'Other
Taxes.”’ The unlabeled amount is your total compensation.

Box 8.—As ‘‘Other income” on your tax return, The amount shown is
substitute payments in lieu of dividends or tax-exempt interest received by
your broker on your behalf after transfer of your securities for use in a short
sale.

Box 9.—An entry in the checkbox means sales to you of consumer
products on a buy-sell, deposit-commission, or any other basis for resale,
have amounted to $5,000 or more. The person filing this return does not
have to show a dollar amount in this box. Any income from your sale of
these products should generally be reported on Schedule C (Form 1040).
Box 10.—An entry in this checkbox means the amount reported in Box 7

is crop insurance proceeds.

The amounts shown on this form (except Boxes 4 and 8) may be subject to
self-employment (social security) tax computed on Schedule SE (Form
1040). See Publication 533, Self-Employment Tax, for more information
on amounts considered self-employment income. Since no income or social
security taxes will be withheld by the payer, you may be required to make
estimated tax payments. See Form 1040-ES, Estimated Tax for Individuals.


9595 C)voiD [] CORRECTED For Oficial Use Only
‘Type or machine print PAYER'S name, street address, city, state, and ZIP code | 1 Rents (OMB No. 1545-0115
$ 1987 Miscellaneous
2 Royalties Income
Statement for
$ Recipients of
PAYER’S Federal identification number | RECIPIENT'S identification number | 3 Prizes and awards 4 Federal income tax withheld Copy A
$ $ For Internal
‘Type or machine print RECIPIENT'S name (first, middle, last) 5 Fishing boat proceeds 6 Medical and health care payments Revenue
$ $ Service Center
- = For Paperwork
7 Nonemployee compensation | 8 Substitute payments in lieu of +
pve come dividends or interest Reduction Act
Street address Notice and
$ $ instructions for
completing this
City, state, and ZIP code 9 Payer made direct sales of $5,000 or more of consumer form, see
products to a buyer (recipient) for resale . >L] Instructions, for
‘orms 1099,
‘Account number (optional) 1098, 5498, 1096,
10 The amount in Box 7 is crop insurance proceeds - - p im and W-2G.

Form 1099-MISC

Do NOT Cut or Separate Forms on This Page

Department of the Treasury - Internal Revenue Service

9595 CIVvoID [J CORRECTED For Official Use Only
‘Type or machine print PAYER'S name, street address, city, state, and ZIP code 1 Rents OMB No, 1545-0115
$ 1987 Miscellaneous
2 Royalties Income
Statement for
$ Recipients of
PAYER'S Federal identification number | RECIPIENT'S identification number —_| 3 Prizes and awards 4 Federal income tax withheld Copy A
$ $ For Internal
Type or machine print RECIPIENT'S name (first, middle, last) 5 Fishing boat proceeds. 6 Medical and health care payments Revenue
$ $ Service Center
. - For Paperwork
7 Nonemployee compensation | & Substitute payments in lieu of ¢
” Gividends or interest Reduction Act
Street address Notice and
$ $ instructions for
- completing this
City, state, and ZIP code 9 Payer made direct sales of $5,000 or more of consumer form, see
products toa buyer (recipient)forresale. . . . -p[ | Instructions for
Forms 1099,
Account number (optional). 1098, 5498, 1096,
10 The amount in Box 7 is crop insurance proceeds - - p[_] and W-2G.

Form 1099-MISC

Do NOT Cut or Separate Forms on This Page

Department of the Treasury - Internal Revenue Service

9595 [CJ VoID = [-]CORRECTED For Oftticiat Use Only
‘Type or machine print PAYER'S name, street address, city, state, and ZIP code | 1 Rents ‘OMB No. 1545-0115
$ 1987 Miscellaneous
2 Royalties Income
Statement for
$ Recipients of
PAYER’S Federal identification number | RECIPIENT'S identi 3 Prizes and awards ‘4 Federal income tax withheld Copy A
$ $ For Internal
Type or machine print RECIPIENT'S name (first, middle, last) 5 Fishing boat proceeds 6 Medical and health care payments Revenue
$ $ Service Center
~ ~ For Paperwork
7 Nonemployee compensation | 8 Substitute payments in lieu of
dividends or interest Reduction Act
Street address Notice and
$ $ instructions for
- . completing this
City, state, and ZIP code ‘9 Payer made direct sales of $5,000 or more of consumer form, see
products to a buyer (recipient) for resale . -» Ll Instructions for
" Forms 1099,
‘Account number (optional) 1098, 5498, 1096)
10 The amount in Box 7 is crop insurance proceeds >C] and W-2G.

Form 1099-MISC

Do NOT Cut or Separate Forms on This Page

Department of the Treasury - Internal Revenue Service




[I CORRECTED (if checked)

PAYER’S name, street address, city, state, and ZIP code 1 Rents OMB No. 1545-0115
$ 1987 Miscellaneous
2 Royalties Income
Statement for
$ Recipients of
PAYER'S Federal identification number | RECIPIENT'S identification number 3 Prizes and awards 4 Federal income tax withheld Copy B
$ $ For Recipient
RECIPIENT'S name (first, middle, last) 5 Fishing boat proceeds 6 Medical and health care payments This is important tax
$ $ information and is

Street address

City, state, and ZIP code

being furnished to the

7 Nonemployee compensation

$

internal Revenue
Service. If you are
required to file a
$ return, a negligence
penalty or other

8 Substitute payments in lieu of
dividends or interest

9 Payer made direct sales of $5,000 or more of consumer
products to a buyer (recipient) for resale

‘sanction will be
imposed on you if this
income is taxable and

‘Account number (optional)

10 The amount in Box 7 is crop insurance proceeds

the IRS determines
that ithas not been
im reported.

Form 1099-MISC

Department of the Treasury - Internal Revenue Service

[J CORRECTED (if checked)

PAYER’S name, street address, city, state, and ZIP code 1 Rents OMB No. 1545-0115
$ 1987 Miscellaneous
2 Royalties Income
Statement for
$ Recipients of
PAYER’S Federal identification number RECIPIENT'S identification number | 3 Prizes and awards 4 Federal income tax withheld Copy B
$ $ For Recipient
RECIPIENT'S name (first, middle, last) 5 Fishing boat proceeds 6 Medical and health care payments This is important tax
$ $ information and is

Street address

City, state, and ZIP code

being furnished to the

7 Nonemployee compensation

$

internal Revenue
Service. If you are
required to file a
$ return, a negligence
penalty or other

8 Substitute payments in lieu of
dividends or interest

9 Payer made direct sales of $5,000 or more of consumer
products toa buyer (recipient) for resale... sp

sanction will be
posed on you if this,
income is taxable and

‘Account number (optional)

10 The amount in Box 7 is crop insurance proceeds -

the IRS determines
that it has not been
reported.

a

Form 1099-MISC

Department of the Treasury - Internal Revenue Service

LJ CORRECTED (if checked)

Street address

City, state, and ZIP code

PAYER'S name, street address, city, state, and ZIP code 1 Rents OMB No. 1545-0115
$ 1987 Miscellaneous
2 Royalties Income
Statement for
$ Recipients of
PAYER’S Federal identification number | RECIPIENT'S identification number 3 Prizes and awards 4 Federal income tax withheld Copy B
$ $ For Recipient
RECIPIENT'S name (first, middle, last) 5 Fishing boat proceeds ‘6 Medical and health care payments This is important tax
$ $ information and is

being furnished to the

7 Nonemployee compensation

$

Internal Revenue
Service. If you are
required to file a
$ return, a negligence
penalty or other

8 Substitute payments in lieu of
dividends or interest

9 Payer made direct sales of $5,000 or more of consumer

sanction will be
imposed on you if this,

products to a buyer (recipient) for resale > income is taxable and

‘Account number (optional) thetithas not been
10 The amount in Box 7 is crop insurance proceeds >O] reported

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