Type or print
PAYER'S
name, address,
ZIP code, and
Federal
Identifying
number.

Statement for
Recipients of

1977

Miscellaneous
Income

Copy C
For Payer

Recipient's identifying number | 1 Rents 2 Royalties

3 Commissions and fees to non-
‘employees (No Form W~2 items)

‘ Prizes and awards to nonem-
ployees (No Form W-2 items)

‘Type or print RECIPIENT'S name, address, and ZIP code below.

5 Other fixed or determinable income

a. Amount

b. Source

Form 1099-MISC

Ye GPO + 187—-0-218-096

ENO. 22.1832268 Department of

‘Type or print
PAYER’S
name, address,
ZIP code, and
Federal
identifying
number.

the Treasury—Internal Revenue Service

1977

Miscellaneous
Income

Copy C
For Payer

Statement for
Recipients of

Recipient's identifying number {1 Rents 2 Royalties,

‘3 Commissions and fees to non-
‘employees (No Form W-2 items)

@ Prizes and awards to nonem-
ployees (No Form W-2 items)

‘Type or print RECIPIENT'S name, address, and ZIP code below.

5 Other fixed or determinable in
a. Amount

come
b. Source

‘$e GPO s 197% —O-218-098

Form 1099—MISC

EINO. 22-1832268 Department of

Type or print
PAYER’S
name, address,
ZIP code, and
Federal
identifying
number.

the Treasury—Internal Revenue Service

1977

Miscellaneous
Income

Copy C
For Payer

Statement for
Recipients of

jent's identifying number | 1 Rents 2 Royalties

‘3 Commissions and fees to non-
employees (No Form W-2 items)

4 Prizes and awards to nonem.
ployees (No Form W-2 items)

‘Type or print RECIPIENT'S name, address, and ZIP code below.

5 Other fixed or determinable income

a. Amount

b. Source

‘$e GPO + 1976—0-218-096

Form 1099-MISC

ENO. 22.1832268 Department of

the Treasury—Internal Revenue Service




For Official Use Only |

Statement for

1977

Recipients of
Ty ‘int .
Pures’ | Miscellaneous
, address,
dese na’ | Income
Federal Copy A
identifying For Internal Revenue
number: Service Center

1 Rents. 2 Royalties

$0

'3 Commissions and fees to non-
‘employees (No Form W-2 items)

4 Prizes and awards to nonem-
ployees (No Form W-2 items)

Type ‘a print RECIPIENT'S name, address, and ZIP code below (Name must aline with
arrow).

Name >|

a. Amount

5 Other fixed or determinable income

| b. Source

For instructions on completing this form,
1096."

"instructions for Form

ENO, 22.1832268,

Form 1099-MISC

‘Ye GPO + 19%—0-218-098

Department of the Treasury—internal Revenue Service

| Statement for
For Official Use Only Recipients of 1977
Type or print H
Burrs | Miscellaneous
name, address, | InCOMe
ZIP code, and
Federal Copy A
identifying For Internal Revenue
number. Service Center

Recipient's Identifying number | 1 Rents 2 Royalties

—

‘3 Commissions and fees to non-
employees (No Form W-2 items)

4 Prizes and awards to_nonem-
ployees (No Form W-2 items)

Type or print RECIPIENT'S name, address, and ZIP code below (Name must aline with

arrow). . Amount

Name >|

5 Other fixed or determinable income

| b, Source

ropa structions on completing this form, see “Instructions fer Form

‘¥r GPO 1 18%—0-218-008 EINO. 22.1832268

Form 1099—MISC

For Official Use Only |

Type or print
PAYER'S
name, address,
ZIP code, and
Federal
identifying
number,

Department of the Treasury—Intemal Revenue Service

Statement for
Recipients of

1977

Miscellaneous
Income

Copy A

For Internal Revenue
Service Center

Recipient's Identifying number J 1 Rents 2 Royalties

$3

‘3 Commissions and fees to non-
employees (No Form W-2 items)

4 Prizes and awards to_nonem-
ployees (No Form W-2 items)

Type or print RECIPIENT'S name, address, and ZIP code below (Name must aline with

arrow). a, Amount

5 Other fixed or determinable income

| b. Source

For instructions on completing this form,
1096."

30 “Instructions for Form

‘Hr GPO 1 1%—-0-218-096

Form 1099—MISC

EINO. 22-1832268,

Department of the Treasury—Internal Revenue Service




Statement for
Recipients of 1977
Bees’ | Miscellaneous

name, address,
ZIP code, ond Income

Federal Copy B
identifying ha
numb For Recipient

Recipient's Identifying number 1 Rents. 2 Royalties

‘3 Commissions and fees to non- | 4 Prizes and awards to nonem-
‘employees (No Form W-2 items) | —ployees (No Form W-2 items)

‘Type or print RECIPIENT'S name, address, and ZIP code below.

'5 Other fixed or determinable income
a. Amount b. Source

Tf this form shows two or more recipients, the recipient
whose Federal identifying number is shown is urged to file a
Form 1087-MISC with the Internal Revenue Service for each
of the other recipients and provide each with a copy. However,
a husband or wife is not required to file Form 1087-MISC to
show payments for the other.

This information is being furnished to the Internal Revenue Service.

Form 1099-MISC

x GPO 1 197%—0-218-096

ENO. 22-1832268 Department of the Treasury—internal Revenue Service

Statement for
Recipients of
Type or print

PAYER’S Miscellaneous

name, address, | Income

ZIP code, and
Federal
identifying
number.

Copy B
For Recipient

Recipient's

1 Rents.

2 Royalties

'3 Commissions and fees to non-
employees (No Form W-2 items)

4?

‘and awards to nonem-
ploy

(No Form W-2 items)

‘Type or print RECIPIENT'S nam

}, address, and ZIP code below.

5 Other fixed or determinable income

a, Amount

b. Source

Tf this form shows two or more recipients, the recipient
whose Federal identifying number is shown is urged to file 2
Form 1087-MISC with the Internal Revenue Service for each
of the other recipients and provide each with a copy. However,
a husband or wife fs not required to file @ Form 1087-MISC to
show payments for the other.

This information is being furnished to the Internal Revenue Service.

‘te GPO 1 197%—-O-218-096

Form 1099-MISC

INO. 22-1832268 Department of the Treasury—Internal Revenue Service

sm 1077

pares’ | Miscellaneous
» address,

Zico ant’ | Income

Federal Copy B

number * For Recipient

Recipient's Identifying number 1 Rents 2 Royalties

‘3 Commissions and fees to non- | 4 Prizes and awards to none.
‘employees (No Form W-2 items) | ployee (No Form W-2 items)

‘Type or print RECIPIENT'S name, address, and ZIP code below.

'5 Other fixed or determinable income
a. Amount b. Source

If this form shows two or more recipients, the recipient
whose Federal identifying number is shown is urged to file a
Form 1087-MISC with the Internal Revenue Service for each
of the other recipients and provide each with a copy. However,
a husband or wife is not required to file a Form 1087-MISC to
show payments for the other.

This information is being furnished to the Internal Revenue Service.

‘He GPO 1 107-0-216-008,

Form 1099-MISC

EINO. 22-1832268 Department of the Treasury—Internal Revenue Service