Nonemployee compensation

$

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 Sta

$

$

$ $

4

$ $

Payer made direct sales of

$5,000 or more of consumer

products to a buyer

(recipient) for resale 

Form 1099-MISC

$

2nd TIN not.

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

File wit

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20

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Intern

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

11 12

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

$ $
11 12

Nonemployee compensation

$

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 R

18 Sta

$

$

$ $

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

F

$

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

$ $
11 12

(keep for your records)

Nonemployee compensation

$

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 R

18 Sta

$

$

$ $

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

$

Fo

This is 

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Federal income tax withheld

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

$ $
Box 15a. May show current year deferrals as a nonemployee u

nonqualified deferred compensation (NQDC) plan that is subjec

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

deferrals.

Boxes 1 and 2. Report rents from real estate on Schedule E (Form 1040).

However, report rents on Schedule C (Form 1040) if you provided significant

services to the tenant, sold real estate as a business, or rented personal

property as a business. Report royalties from oil, gas, or mineral properties,

copyrights, and patents on Schedule E (Form 1040). However, report

payments for a working interest as explained in the box 7 instructions. For

royalties on timber, coal, and iron ore, see Pub. 544.

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

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

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, or other taxable income. See Pub. 525. If it is trade or

business income, report this amount on Schedule C or F (Form 1040).

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

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

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

products on Schedule C (Form 1040).

Box 4. Shows backup withholding or withholding on Indian gaming profits.

Generally, a payer must backup withhold if you did not furnish your taxpayer

identification number. See Form W-9 and Pub. 505 for more information.

Report this amount on your income tax return as tax withheld.

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

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 Pub. 334.

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

sporadic activity or a hobby), report it on Form 1040, line 21 (o

line 21).

Box 13. Shows your total compensation of excess golden para

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

report.

Box 14. Shows gross proceeds paid to an attorney in connectio

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

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

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

box 7 as nonemployee compensation. Any amount included in 

currently taxable is also included in this box. This income is als

substantial additional tax to be reported on Form 1040. See “To

Form 1040 instructions.

and you are still receiving these payments, see Form 1040ES. Individuals

must report these amounts as explained in the box 7 instructions on this page.

Corporations, fiduciaries, or partnerships must report the amounts on the

proper line of their tax returns.

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

Form 1099-MISC incorrect? If this form is incorrect or has been issued in

error, contact the payer. If you cannot get this form corrected, attach an

explanation to your tax return and report your income correctly.

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 the

amount in this box is SE income, report it on Schedule C or F (Form 1040),
11 12

Nonemployee compensation

$

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 R

18 Sta

$

$

$ $

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

s

$

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

$ $
11 12

Nonemployee compensation

$

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 R

18 Sta

$

$

$ $

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

2nd TIN not.

$

For 

and 

Re

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20

Instr

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

$ $
Due dates. Furnish Copy B of this form to the

recipient by January 31, 2012. The due date is

extended to February 15, 2012, if you are

reporting payments in boxes 8 or 14.

you must have software that generates a 

according to the specifications in Pub. 1

Specifications for Filing Forms 1097, 109

3921, 3922, 5498, 8935, and W-2G Elec

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.

2011 General Instructions for Certain Information

Returns and the 2011 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 IRS.gov or

call 1-800-TAX-FORM (1-800-829-3676). Need help? If you have questions about 

on Form 1099-MISC, call the information 

customer service site toll free at 1-866-4

or 304-263-8700 (not toll free). For TTY/T

equipment, call 304-579-4827 (not toll fr

hours of operation are Monday through 

from 8:30 a.m. to 4:30 p.m., Eastern tim