PAYER’S name, street address, city, state, ZIP code, and telephone no. Date of sale or exchange 1a OMB No. 1545-0715 Proceeds From

Broker and

Barter Exchange

1b Date of acquisition Transactions

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 Cost or other basis 3 4 Federal income tax withheld

$

RECIPIENT’S name 5 Wash sale loss disallowed

Street address (including apt. no.)

City, state, and ZIP code

2nd TIN not.

CUSIP number

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



Cat. No. 14411V

7979 VOID CORRECTED

Form 1099-B

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

2011 General

Instructions for

Certain Information

Returns.

10

$

Profit or (loss) realized in

2011 on closed contracts

11 Unrealized profit or (loss) on

open contracts—12/31/2010

12 Unrealized profit or (loss) on

open contracts—12/31/2011

13 Aggregate profit or (loss) on

contracts

$

$ $

6

9 Description

2011

8 Type of gain or loss

Short-term

Long-term

Check if loss not

allowed based on

amount in box 2

15

14 Bartering

$

$

Check if a noncovered

security

$

Account number (see instructions)

5

7
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.

PAYER’S name, street address, city, state, ZIP code, and telephone no. Date of sale or exchange 1a OMB No. 1545-0715 Proceeds From

Broker and

Barter Exchange

1b Date of acquisition Transactions

2 Reported

to IRS

Sales price

$ Sales price less commissions and option premiums

RECIPIENT’S name Wash sale loss disallowed 5

Street address (including apt. no.)

City, state, and ZIP code

CUSIP number

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



(keep for your records)

CORRECTED (if checked)

Form 1099-B

6

2011

PAYER’S federal identification number RECIPIENT’S identification number Cost or other basis 3 4 Federal income tax withheld

$

10

$

Profit or (loss) realized in

2011 on closed contracts

11 Unrealized profit or (loss) on

open contracts—12/31/2010

12 Unrealized profit or (loss) on

open contracts—12/31/2011

13 Aggregate profit or (loss) on

contracts

$

$ $

8 Type of gain or loss

Short-term

Long-term

If box checked, loss

based on amount in

box 2 is not allowed

15

14 Bartering

$

$

9 Description

If this box is checked, 

boxes 1b, 3, 5, and 8 

may be blank

$

Sales price of stocks,

bonds, etc.

Account number (see instructions)

7
Instructions for Recipient

Brokers and barter exchanges must report proceeds from transactions to you

and the IRS on Form 1099-B. Reporting is also required when your broker

knows or has reason to know that a corporation in which you own stock has

had a reportable change in control or capital structure. You may be required to

recognize gain from the receipt of cash, stock, or other property that was

exchanged for the corporation’s stock. If your broker reported this type of

transaction to you, the corporation is identified in box 9.

Box 1a. Shows the trade date of the sale or exchange. For short sales, the

date shown is the date the security was delivered to close the short sale. For

aggregate reporting in boxes 10 through 13, no entry will be present.

CUSIP number. For broker transactions, may show the CUSIP (Committee on

Uniform Security Identification Procedures) number of the item reported.

Box 2. Shows the aggregate cash proceeds from transactions involving stocks,

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

the proceeds from the disposition of your interest(s) in a widely held fixed

investment trust. May also show the aggregate amount of cash and the fair

market value of any stock or other property received in a reportable change in

control or capital structure arising from the corporate transfer of property to a

foreign corporation. Losses on forward contracts are shown in parentheses.

This box does not include proceeds from regulated futures contracts. The

broker must indicate whether the sales price or the sales price less

commissions (including transfer taxes) and option premiums was reported to

the IRS. Report this amount as explained in the instructions for Schedule D

(Form 1040).

Box 10. Shows the profit or (loss) realized on regulated futures or foreign

currency contracts closed during 2011.

Box 11. Shows any year-end adjustment to the profit or (loss) shown in box 10

due to open contracts on December 31, 2010.

Box 14. Shows the cash you received, the fair market value of any property or

services you received, and the fair market value of any trade credits or scrip

credited to your account by a barter exchange. See Pub. 525.

Box 12. Shows the unrealized profit or (loss) on open contracts held in your

account on December 31, 2011. These are considered sold as of that date.

This will become an adjustment reported in box 11 in 2012.

Box 4. Shows backup withholding. Generally, a payer must backup withhold if

you did not furnish your taxpayer identification number to the payer. See Form

W-9 for information on backup withholding. Include this amount on your

income tax return as tax withheld.

Regulated Futures Contracts (Boxes 10 Through 13):

Box 5. Shows the amount of nondeductible loss in a wash sale transaction.

For details on wash sales, see the Schedule D (Form 1040) instructions and

Pub. 550.

Account number. May show an account or other unique number the payer

assigned to distinguish your account.

Box 15. If checked, you cannot take a loss on your tax return based on gross

proceeds from a reportable change in control or capital structure reported in

box 2. Do not report this loss on Schedule D (Form 1040). The broker should

advise you of any losses on a separate statement.

Box 13. Boxes 10, 11, and 12 are all used to figure the aggregate profit or

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

this amount on your 2011 Form 6781.

Box 9. 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 may be shown. For

a corporation that had a reportable change in control or capital structure, this

box may show the class of stock as C (common), P (preferred), or O (other).

Box 6. If this box is checked, the securities sold were noncovered securities

and boxes 1b, 3, 5, and 8 may be blank. Generally, a noncovered security is a

security other than stock; stock purchased before 2011; stock in most mutual

funds and other regulated investment companies; and stock held in a dividend

reinvestment plan in 2011.

Box 3. Shows the cost or other basis of securities sold. If box 6 is checked,

box 3 may be blank. See the Schedule D (Form 1040) instructions or Pub. 550

for details about basis.

Box 8. Shows type of gain or loss.

Box 1b. This box may be blank if box 6 is checked or if the securities sold

were acquired on a variety of dates. For short sales, the date shown is the

date you acquired the security delivered to close the short sale.
Copy C

For Payer

For Privacy Act

and Paperwork

Reduction Act

Notice, see the

2011 General

Instructions for

Certain Information

Returns.

PAYER’S name, street address, city, state, ZIP code, and telephone no. Date of sale or exchange 1a OMB No. 1545-0715 Proceeds From

Broker and

Barter Exchange

1b Date of acquisition Transactions

2 Reported

to IRS

Gross proceeds

$ Gross proceeds less commissions and option premiums

3

RECIPIENT’S name

Street address (including apt. no.)

City, state, and ZIP code

2nd TIN not.

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



Form 1099-B

CUSIP number

VOID CORRECTED

2011

PAYER’S federal identification number RECIPIENT’S identification number Cost or other basis 3 4 Federal income tax withheld

$

5 Wash sale loss disallowed 6

8 Type of gain or loss

Short-term

Long-term

Check if loss not

allowed based on

amount in box 2

15

14 Bartering

$

$

Check if a noncovered

security

$

Stocks, bonds, etc.

10

$

Profit or (loss) realized in

2011 on closed contracts

11 Unrealized profit or (loss) on

open contracts—12/31/2010

12 Unrealized profit or (loss) on

open contracts—12/31/2011

13 Aggregate profit or (loss) on

contracts

$

$ $

9 Description

Account number (see instructions)

7
Instructions for Payer

General and specific form instructions are provided as

separate products. The products you should use to

complete Form 1099-B are the 2011 General

Instructions for Certain Information Returns and the

2011 Instructions for Form 1099-B. 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, visit IRS.gov or

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

Due dates. Furnish Copy B of this form to the

recipient by February 15, 2012.

have software that generates a file according to the

specifications in Pub. 1220, Specifications for Filing

Forms 1097, 1098, 1099, 3921, 3922, 5498, 8935, and

W-2G Electronically. The IRS does not provide a fill-in

form option.

Caution: Because paper forms are scanned during

processing, you cannot file with the IRS Forms 1096,

1097, 1098, 1099, 3921, 3922, or 5498 that you print

from the IRS website.

Foreign recipient. If the recipient of the proceeds is a

nonresident alien, you may have to withhold federal

income tax and file Form 1042-S, Foreign Person’s

U.S. Source Income Subject to Withholding. See the

Instructions for Form 1042-S and Pub. 515,

Withholding of Tax on Nonresident Aliens and Foreign

Entities.

Need help? If you have questions about reporting on

Form 1099-B, call the information reporting customer

service site toll free at 1-866-455-7438 or

304-263-8700 (not toll free). For TTY/TDD equipment,

call 304-579-4827 (not toll free). The hours of operation

are Monday through Friday from 8:30 a.m. to

4:30 p.m., Eastern time.

File Copy A of this form with the IRS by 

February 28, 2012. If you file electronically, the due

date is April 2, 2012. To file electronically, you must