Nonemployee compensation

VOID CORRECTED

PAYER’S name, street address, city, state, ZIP code, and telephone no. 1 Rents OMB No. 1545-0115

$

2 Royalties

$

3 Other income Federal income tax withheld

RECIPIENT’S identification

number

PAYER’S federal identification

number

5 Fishing boat proceeds 6 Medical and health care payments

$ $

RECIPIENT’S name Substitute payments in lieu of

dividends or interest

7 8

$ $

Street address (including apt. no.) 9 10 Crop insurance proceeds

City, state, and ZIP code

Gross proceeds paid to

an attorney

Excess golden parachute 14

payments

Account number (see instructions) 13

$

16 State tax withheld 17 State/Payer’s state no.

$

18 State income

$

$

$ $

4

$ $

Payer made direct sales of

$5,000 or more of consumer

products to a buyer

(recipient) for resale 

Form 1099-MISC

Miscellaneous

Income

$

9595

2nd TIN not.

Form 1099-MISC Cat. No. 14425J Department of the Treasury - Internal Revenue Service

Copy A

File with Form 1096.

For Privacy Act

and Paperwork

Reduction Act

Notice, see the

2009 General

Instructions for

Forms 1099,

1098, 3921,

3922, 5498, and

W-2G.

For

Internal Revenue

Service Center

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

11 12

15a Section 409A deferrals 15b Section 409A income

$ $

2009
11 12

Nonemployee compensation

VOID CORRECTED

PAYER’S name, street address, city, state, ZIP code, and telephone no. 1 Rents OMB No. 1545-0115

$

2 Royalties

$

3 Other income Federal income tax withheld

RECIPIENT’S identification

number

PAYER’S federal identification

number

5 Fishing boat proceeds 6 Medical and health care payments

$ $

RECIPIENT’S name Substitute payments in lieu of

dividends or interest

7 8

$ $

Street address (including apt. no.) 9 10 Crop insurance proceeds

City, state, and ZIP code

Gross proceeds paid to

an attorney

Excess golden parachute 14

payments

Account number (see instructions) 13

$

16 State tax withheld 17 State/Payer’s state no.

$

Department of the Treasury - Internal Revenue Service

18 State income

$

$

$ $

4

$ $

Payer made direct sales of

$5,000 or more of consumer

products to a buyer

(recipient) for resale 

Form 1099-MISC

Form 1099-MISC

Miscellaneous

Income

Copy 1

For State Tax

Department

$

15a Section 409A deferrals 15b Section 409A income

$ $

2009
11 12

(keep for your records)

Nonemployee compensation

CORRECTED (if checked)

PAYER’S name, street address, city, state, ZIP code, and telephone no. 1 Rents OMB No. 1545-0115

$

2 Royalties

$

3 Other income

RECIPIENT’S identification

number

PAYER’S federal identification

number

5 Fishing boat proceeds 6 Medical and health care payments

$ $

RECIPIENT’S name Substitute payments in lieu of

dividends or interest

7 8

$ $

Street address (including apt. no.) 9 10 Crop insurance proceeds

City, state, and ZIP code

Gross proceeds paid to

an attorney

Excess golden parachute 14

payments

Account number (see instructions) 13

$

16 State tax withheld 17 State/Payer’s state no.

$

Department of the Treasury - Internal Revenue Service

18 State income

$

$

$ $

4

$ $

Payer made direct sales of

$5,000 or more of consumer

products to a buyer

(recipient) for resale 

Form 1099-MISC

Form 1099-MISC

Miscellaneous

Income

$

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.

Federal income tax withheld

15a Section 409A deferrals 15b Section 409A income

$ $

2009
Box 15a. May show current year deferrals as a nonemployee under a

nonqualified deferred compensation (NQDC) plan that is subject to the

requirements of section 409A, plus any earnings on current and prior

year deferrals.

Boxes 1 and 2. Report rents from real estate on Schedule E (Form

1040). If you provided significant services to the tenant, sold real

estate as a business, rented personal property as a business, or you

and your spouse elected to be treated as a qualified joint venture,

report on Schedule C or C-EZ (Form 1040). For royalties on timber,

coal, and iron ore, see Pub. 544.

Box 8. Shows substitute payments in lieu of dividends or tax-exempt

interest received by your broker on your behalf as a result of a loan of

your securities. Report on the “Other income” line of Form 1040.

Box 3. Generally, report this amount on the “Other income” line of

Form 1040 and identify the payment. The amount shown may be

payments received as the beneficiary of a deceased employee, prizes,

awards, taxable damages, Indian gaming profits, payments from a

former employer because you are serving in the Armed Forces or the

National Guard for a period of 30 or fewer days, or other taxable

income. See Pub. 525. If it is trade or business income, report this

amount on Schedule C, C-EZ, or F (Form 1040).

Box 9. If checked, $5,000 or more of sales of consumer products was

paid to you on a buy-sell, deposit-commission, or other basis. A dollar

amount does not have to be shown. Generally, report any income from

your sale of these products on Schedule C or C-EZ (Form 1040).

Box 4. Shows backup withholding or withholding on Indian gaming

profits. Generally, a payer must backup withhold at a 28% rate if you

did not furnish your taxpayer identification number. See Form W-9,

Request for Taxpayer Identification Number and Certification, and

Pub. 505, for more information. Report this amount on your income

tax return as tax withheld.

Box 10. Report this amount on line 8 of Schedule F (Form 1040).

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

payer assigned to distinguish your account.

Box 5. An amount in this box means the fishing boat operator

considers you self-employed. Report this amount on Schedule C or

C-EZ (Form 1040). See Pub. 334.

Box 6. For individuals, report on Schedule C or C-EZ (Form 1040).

Box 7. Shows nonemployee compensation. If you are in the trade or business

of catching fish, box 7 may show cash you received for the sale of fish. If

payments in this box are SE income, report this amount on Schedule C, C-EZ,

or F (Form 1040), and complete Schedule SE (Form 1040). You received this

form instead of Form W-2 because the payer did not consider you an

employee and did not withhold income tax or social security and Medicare tax.

Contact the payer if you believe this form is incorrect or has been issued in

error. If you believe you are an employee and cannot get this form corrected,

report the amount from box 7 on Form 1040, line 7 (or Form 1040NR, line 8).

You must also complete and attach to your return Form 8919, Uncollected

Social Security and Medicare Tax on Wages.

Box 13. Shows your total compensation of excess golden parachute

payments subject to a 20% excise tax. See the Form 1040

instructions for where to report.

Box 14. Shows gross proceeds paid to an attorney in connection with

legal services. Report only the taxable part as income on your return.

Instructions for Recipients

Box 15b. Shows income as a nonemployee under an NQDC plan that

does not meet the requirements of section 409A. This amount is also

included in box 7 as nonemployee compensation. Any amount

included in box 15a that is currently taxable is also included in this

box. This income is also subject to a substantial additional tax to be

reported on Form 1040. See “Total Tax” in the Form 1040 instructions.

Amounts shown may be subject to self-employment (SE) tax. If

your net income from self-employment is $400 or more, you must file

a return and compute your SE tax on Schedule SE (Form 1040). See

Pub. 334 for more information. If no income or social security and

Medicare taxes were withheld and you are still receiving these

payments, see Form 1040-ES, Estimated Tax for Individuals.

Individuals must report as explained for box 7 below. Corporations,

fiduciaries, or partnerships report the amounts on the proper line of

your tax return.

Boxes 16–18. Shows state or local income tax withheld from the

payments.
11 12

Nonemployee compensation

CORRECTED (if checked)

PAYER’S name, street address, city, state, ZIP code, and telephone no. 1 Rents OMB No. 1545-0115

$

2 Royalties

$

3 Other income Federal income tax withheld

RECIPIENT’S identification

number

PAYER’S federal identification

number

5 Fishing boat proceeds 6 Medical and health care payments

$ $

RECIPIENT’S name Substitute payments in lieu of

dividends or interest

7 8

$ $

Street address (including apt. no.) 9 10 Crop insurance proceeds

City, state, and ZIP code

Gross proceeds paid to

an attorney

Excess golden parachute 14

payments

Account number (see instructions) 13

$

16 State tax withheld 17 State/Payer’s state no.

$

Department of the Treasury - Internal Revenue Service

18 State income

$

$

$ $

4

$ $

Payer made direct sales of

$5,000 or more of consumer

products to a buyer

(recipient) for resale 

Form 1099-MISC

Form 1099-MISC

Miscellaneous

Income

Copy 2

To be filed

with

recipient’s

state income

tax return,

when

required.

$

15a Section 409A deferrals 15b Section 409A income

$ $

2009
11 12

Nonemployee compensation

VOID CORRECTED

PAYER’S name, street address, city, state, ZIP code, and telephone no. 1 Rents OMB No. 1545-0115

$

2 Royalties

$

3 Other income Federal income tax withheld

RECIPIENT’S identification

number

PAYER’S federal identification

number

5 Fishing boat proceeds 6 Medical and health care payments

$ $

RECIPIENT’S name Substitute payments in lieu of

dividends or interest

7 8

$ $

Street address (including apt. no.) 9 10 Crop insurance proceeds

City, state, and ZIP code

Gross proceeds paid to

an attorney

Excess golden parachute 14

payments

Account number (see instructions) 13

$

16 State tax withheld 17 State/Payer’s state no.

$

Department of the Treasury - Internal Revenue Service

18 State income

$

$

$ $

4

$ $

Payer made direct sales of

$5,000 or more of consumer

products to a buyer

(recipient) for resale 

Form 1099-MISC

Form 1099-MISC

Miscellaneous

Income

Copy C

For Payer

2nd TIN not.

$

For Privacy Act

and Paperwork

Reduction Act

Notice, see the

2009 General

Instructions for

Forms 1099,

1098, 3921,

3922, 5498,

and W-2G.

15a Section 409A deferrals 15b Section 409A income

$ $

2009
Instructions for Payers

Due dates. Furnish Copy B of this form to the

recipient by February 1, 2010. The due date is

extended to February 16, 2010, if you are

reporting payments in boxes 8 or 14.

File Copy A of this form with the IRS by March

1, 2010. If you file electronically, the due date is

March 31, 2010. To file electronically, you must

have software that generates a file according to

the specifications in Pub. 1220, Specifications for

Filing Forms 1098, 1099, 3921, 3922, 5498, and

W-2G Electronically. 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, 1098, 1099, 3921, 3922, or 5498 that

you print from the IRS website.

General and specific form instructions are

provided as separate products. The products you

should use to complete Form 1099-MISC are the

2009 General Instructions for Forms 1099, 1098,

3921, 3922, 5498, and W-2G and the 2009

Instructions for Form 1099-MISC. 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 the IRS website at www.irs.gov or call

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

Need help? If you have questions about reporting

on Form 1099-MISC, 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 304-267-3367 (not toll free).