BROKER'S name, address, ZIP code and Federal identifying number.

1a Date of Sale 1b CUSIP No.

Stocks, bonds, ete. SBartering

Recipient's identifying number [4 Federal income tax withheld

5 Description

RECIPIENT'S name,address, and ZIP code.

Regulated Futures Contracts

6 Profit or (loss) realized in 1984 ff 7 Unrealized profit or (loss) on open

contracts-end of prior year

OMB No.1545-0715

1984

Statement for
Recipients of
Proceeds from
Broker and
Barter Exchange
Transactions

For Paperwork
Reduction Act Notice
and instructions for
completing this form,
see Instructions for

Form 1096.
'8 Unrealized profit or (loss) on ‘9 Aggregate profit or (loss)
‘open contracts-12/31/84 Copy C
For Payer

Form 1099-B

Department of the Treasury - Internal Revenue Service

BROKER'S name, address, ZIP code and Federal identifying number.

1a Date of Sale 1b CUSIP No.

2 Stocks, bonds, etc. ‘3 Bartering

Recipient's identifying number [J 4 Federal income tax withheld

5 Description

RECIPIENT'S name,address, and ZIP code.

Regulated Futures Contracts

6 Profit or (loss) realized in 1984 [J 7 Unrealized profit or (loss) on open

OMB No.1545-0715

1984

Statement for
Recipients of
Proceeds from
Broker and
Barter Exchange

Transactions

For Paperwork
Reduction Act Notice
and instructions for
completing this form,

Contratsend of prior year see Instructions for
Form 1096.
8 Unrealized profit or (loss) on ‘9 Aggregate profit or (loss)
‘open contracts-12/31/84 Copy C
For Payer

Form 1099-B

Department of the Treasury - Internal Revenue Service

BROKER'S name, address, ZIP code and Federal identifying number.

1b CUSIP No.

‘3 Bartering

4 Federal income tax withheld

Ta Date of Sale

Stocks, bonds, etc.
Recipient's identifying number
5 Description

RECIPIENT'S name,address, and ZIP code.

Regulated Futures Contracts

6 Profit or (loss) realized in 1984 ff 7 Unrealized profit or (loss) on open

contracts-end of prior year

OMB No.1545-0715

1984

Statement for
Recipients of
Proceeds from
Broker and
Barter Exchange
Transactions

For Paperwork
Reduction Act Notice
and instructions for
completing this form,
see Instructions for

Form 1096.
'8 Unrealized profit or (loss) on ‘9 Aggregate profit or (loss)
‘open contracts-12/31/84 Copy C
For Payer

Form 1099-B

Department of the Treasury - Internal Revenue Service


Instructions for Recipient

Brokers and barter exchanges must report proceeds from all
transactions to the Internal Revenue Service. This form is used to
report these proceeds.

Box 1a—Ordinarily, this date will be the trade date of the
transaction. However, if there is an ‘‘S’’ shown immediately
before the date, it means that the payer is using the actual
settlement date and not the trade date.

Box 1b—Where applicable, shows the CUSIP (Committee for
Uniform Security Identification Procedure) number of items
reported.

Box 2—Shows the proceeds from transactions involving stocks,
bonds, other debt obligations, commodities, or forward contracts.
Losses on forward contracts are shown in brackets. This box does
not include proceeds from regulated futures contracts.

Box 3—Shows the fair market value of any trade credits or scrip
credited to your account for exchanges of property or services.
See the instructions for your 1984 tax return on how to report this
amount for tax purposes.

Box 4—Any amount listed in this box represents backup
withholding. For example, persons not furnishing their taxpayer
identifying number to the payer become subject to backup

Instructions for Recipient

Brokers and barter exchanges must report proceeds from all
transactions to the Internal Revenue Service. This form is used to
report these proceeds.

Box 1a—Ordinarily, this date will be the trade date of the
transaction. However, if there is an ‘‘S’’ shown immediately
before the date, it means that the payer is using the actual
settlement date and not the trade date.

Box 1b—Where applicable, shows the CUSIP (Committee for
Uniform Security Identification Procedure) number of items
reported.

Box 2—Shows the proceeds from transactions involving stocks,
bonds, other debt obligations, commodities, or forward contracts.
Losses on forward contracts are shown in brackets. This box does
not include proceeds from regulated futures contracts.

Box 3—Shows the fair market value of any trade credits or scrip
credited to your account for exchanges of property or services.
See the instructions for your 1984 tax return on how to report this
amount for tax purposes.

Box 4—Any amount listed in this box represents backup
withholding. For example, persons not furnishing their taxpayer
identifying number to the payer become subject to backup

Instructions for Recipient

Brokers and barter exchanges must report proceeds from all
transactions to the Internal Revenue Service. This form is used to
report these proceeds.

Box 1a—Ordinarily, this date will be the trade date of the
transaction. However, if there is an ‘‘S’’ shown immediately
before the date, it means that the payer is using the actual
settlement date and not the trade date.

Box 1b—Where applicable, shows the CUSIP (Committee for
Uniform Security Identification Procedure) number of items
reported.

Box 2—Shows the proceeds from transactions involving stocks,
bonds, other debt obligations, commodities, or forward contracts.
Losses on forward contracts are shown in brackets. This box does
not include proceeds from regulated futures contracts.

Box 3—Shows the fair market value of any trade credits or scrip
credited to your account for exchanges of property or services.
See the instructions for your 1984 tax return on how to report this
amount for tax purposes.

Box 4—Any amount listed in this box represents backup
withholding. For example, persons not furnishing their taxpayer
identifying number to the payer become subject to backup

withholding at a 20% rate on certain payments shown on the
form. See Form W-9, Payer’s Request for Taxpayer Identification
Number, for information on backup withholding and the
furnishing of your taxpayer identifying number to the payer. You
may take a credit on your income tax return for the tax withheld.

Box 5—Shows a brief description of the item or service for which
the proceeds are being reported. For regulated futures contracts,
the customer's account number may be shown.

Box 6—Shows the profit or (loss) realized on regulated futures
contracts closed during 1984.

Box 7—Shows any year-end adjustment to the profit or (Joss)
shown in box 6 due to open contracts at the end of the prior year.

Box 8—Shows the profit or (loss) on open contracts held in your
account on December 31, 1984. These are considered sold as of
that date. This will become an adjustment reported in box 7 in
5.

Box 9—Is used in 1984 to report the adjusted aggregate profit or
(loss) for the year. Include this figure on your 1984 Form 6781,
gains and Losses From Regulated Futures Contracts and

traddles.

withholding at a 20% rate on certain payments shown on the
form. See Form W-9, Payer’s Request for Taxpayer Identification
Number, for information on backup withholding and the
furnishing of your taxpayer identifying number to the payer. You
may take a credit on your income tax return for the tax withheld.

Box 5—Shows a brief description of the item or service for which
the proceeds are being reported. For regulated futures contracts,
the customer's account number may be shown.

Box 6—Shows the profit or (loss) realized on regulated futures
contracts closed during 1984.

Box 7—Shows any year-end adjustment to the profit or (Joss)
shown in box 6 due to open contracts at the end of the prior year.

Box 8—Shows the profit or (loss) on open contracts held in your
account on December 31, 1984. These are considered sold as of
that date. This will become an adjustment reported in box 7 in

5.
Box 9—Is used in 1984 to report the adjusted aggregate profit or
(loss) for the year. Include this figure on your 1984 Form 6781,
Gains and Losses From Regulated Futures Contracts and
Straddles.

withholding at a 20% rate on certain payments shown on the
form. See Form W-9, Payer’s Request for Taxpayer Identification
Number, for information on backup withholding and the
furnishing of your taxpayer identifying number to the payer. You
may take a credit on your income tax return for the tax withheld.

Box 5—Shows a brief description of the item or service for which
the proceeds are being reported. For regulated futures contracts,
the customer's account number may be shown.

Box 6—Shows the profit or (loss) realized on regulated futures
contracts closed during 1984.

Box 7—Shows any year-end adjustment to the profit or (Joss)
shown in box 6 due to open contracts at the end of the prior year.

Box 8—Shows the profit or (loss) on open contracts held in your
account on December 31, 1984. These are considered sold as of
that date. This will become an adjustment reported in box 7 in

5.
Box 9—Is used in 1984 to report the adjusted aggregate profit or
(loss) for the year. Include this figure on your 1984 Form 6781,
Gains and Losses From Regulated Futures Contracts and
Straddles.


O wa vow

For Official Use Only

Type or machine print BROKER'S name

Street address

City, State, and ZIP code

Federal identifying number

Ja Date of Sale 1b CUSIP No.

2 Stocks, bonds, etc. ‘3 Bartering

Type or machine print RECIPIENT'S name (first, middle, last)

Recipient's identifying number | 4 Federal income tax withheld

5 Description

Regulated Futures Contracts

6 Profit or (loss) realized in 1984 J 7 Unrealized profit or (loss) on open

OMB No.1545:0715

1984

Statement for
Recipients of
Proceeds from
Broker and
Barter Exchange
Transactions

For Paperwork
Reduction Act Notice
and instructions for
completing this form,

Street address sontract-end of rior year see Instructions for
Form 1096.

City, State, and ZIP code 8 Unrealized profit or (loss) on ‘9 Aggregate profit or (loss) Co A

open contracts-12/31/84 Py
For Internal Revenue
Service Center
Form 1099-B Department of the Treasury - Internal Revenue Service
Do NOT Cut or Separate Forms on This Page
oO 7a 0 vow For Official Use Only

‘Type or machine print BROKER'S name

Street address

City, State, and ZIP code

Federal identifying number

1a Date of Sale 1b CUSIP No.

2 Stocks, bonds, etc. ‘3 Bartering

Recipient's identifying number J 4 Federal income tax withheld

Type or machine print RECIPIENT'S name (first, middle, last)

5 Description

Regulated Futures Contracts

6 Profit or (loss) realized in 1984 [J 7 Unrealized profit or (loss) on open

OMB No.1545-0715

1984

Statement for
Recipients of
Proceeds from
Broker and
Barter Exchange
Transactions

For Paperwork
Reduction Act Notice
and instructions for
completing this form,

Street address ontracts-end of prior year see Instructions for
Form 1096.

City, State, and ZIP code 8 Unrealized profit or (loss) on | 9 Aggregate profit or (loss)

open contracts-12/31/64 eereea Copy A
For Internal Revenue
Service Center
Form 1099-B Department of the Treasury - Internal Revenue Service
Do NOT Cut or Separate Forms on This Page
O79 0 voi For Official Use Only

Type or machine print BROKER'S name

Street address

City, State, and ZIP code

Federal identifying number

Ja Date of Sale 1b CUSIP No.

2 Stocks, bonds, etc. ‘3 Bartering

Recipient's identifying number | 4 Federal income tax withheld

Type or machine print RECIPIENT'S name (first, middle, last)

Street address

City, State, and ZIP code

5 Description

Regulated Futures Contracts

6 Profit or (loss) realized in 1984 J 7 Unrealized profit or (loss) on open

OMB No.1545:0715

1984

Statement for
Recipients of
Proceeds from
Broker and
Barter Exchange
Transactions

For Paperwork
Reduction Act Notice
and instructions for
completing this form,

sonhracsend of prior year see Instructions for
Form 1096.
'B Unrealized profit or (loss) on | 9 Aggregate profit or (loss)
open contacts: 12/31/84 Fanernal Revenue
Service Center

Form 1099-B

Department of the Treasury - Internal Revenue Service

Do NOT Cut or Separate Forms on This Page




OMB No.1545-0715,

1984

2 Stocks, bonds, etc. 3 Bartering Statement for
Recipients of
Proceeds from
Broker and
Barter Exchange
Transactions

BROKER'S name, address, ZIP code and Federal identifying number. [J 1a Date of Sale ‘Ib CUSIP No.

Recipient's identifying number [J 4 Federal income tax withheld

5 Description

RECIPIENT'S name,address, and ZIP code.

This information is
being furnished to the
Internal Revenue
Service.

Regulated Futures Contracts

6 Profit or (loss) realized in 1984 [| 7 Unrealized proit or (loss) on open
contracts-end of prior year

8 Unrealized profit or (loss) on ‘9 Aggregate profit or (loss)
open contracts-12/31/84 Copy B

For Recipient

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

OMB No.1545-0715

1984

2 Stocks, bonds, etc. ‘3 Bartering Statement for
Recipients of
Proceeds from
Broker and
Barter Exchange
Transactions

BROKER'S name, address, ZIP code and Federal identifying number. J 1a Date of Sale 1b CUSIP No.

Recipient's identifying number [J 4 Federal income tax withheld

'5 Description

RECIPIENT'S name,address, and ZIP code.

This information is
being furnished to the
Internal Revenue
Service.

Regulated Futures Contracts

6 Profit or (loss) realized in 1984 ff 7 Unrealized profit or (loss) on open
‘contracts-end of prior year

8 Unrealized profit or (loss) on ‘9 Aggregate profit or (loss)
open contracts-12/31/84 Copy B

For Recipient

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

OMB No.1545-0715,

1984

2 Stocks, bonds, etc. 3 Bartering Statement for
Recipients of
Proceeds from
Broker and
Barter Exchange
Transactions

BROKER'S name, address, ZIP code and Federal identifying number. [J 1a Date of Sale ‘Ib CUSIP No.

Recipient's identifying number [J 4 Federal income tax withheld

5 Description

RECIPIENT'S name,address, and ZIP code.

This information is
being furnished to the
Internal Revenue
Service.

Regulated Futures Contracts

6 Profit or (loss) realized in 1984 [| 7 Unrealized proit or (loss) on open
contracts-end of prior year

8 Unrealized profit or (loss) on ‘9 Aggregate profit or (loss)
open contracts-12/31/84 Copy B

For Recipient

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