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 CUSIP no. 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 3 Bartering 4 Federal income tax withheld

$ $

RECIPIENT’S name 5 No. of shares exchanged

Street address (including apt. no.) 7 Description

City, state, and ZIP code

Account number (optional) 2nd TIN not.

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

2004 General

Instructions for

Forms 1099, 1098,

5498, and W-2G.

8

$

Profit or (loss) realized in

2004

9 Unrealized profit or (loss) on

open contracts—12/31/2003

10 Unrealized profit or (loss) on

open contracts–12/31/2004

11 Aggregate profit or (loss)

$

$ $

Classes of stock

exchanged

6

CORPORATION’S name, street address, city, state, and ZIP code

12 Check the box if recipient cannot take a loss on their tax

return based on the amount in box 2

2004
Proceeds From

Broker and

Barter Exchange

Transactions

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.

CORRECTED (if checked)

Form 1099-B (keep for your records) Department of the Treasury - Internal Revenue Service

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

1b CUSIP no.

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 3 Bartering 4 Federal income tax withheld

$ $

RECIPIENT’S name No. of shares exchanged 5

Street address (including apt. no.) Description 7

City, state, and ZIP code

Account number (optional) 2nd TIN not.



Form 1099-B

8

$

Profit or (loss) realized in

2004

9 Unrealized profit or (loss) on

open contracts—12/31/2003

10 Unrealized profit or (loss) on

open contracts–12/31/2004

11 Aggregate profit or (loss)

$

$ $

Classes of stock

exchanged

6

CORPORATION’S name, street address, city, state, and ZIP code

12 If this box is checked, you cannot take a loss on your

tax return based on the amount in box 2

2004
Instructions for Recipient

Brokers and barter exchanges must report proceeds from transactions to you

and the IRS on Form 1099-B by January 31 of the year following the calendar

year of the transaction. Reporting is also required when your broker knows or

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

change in control or a substantial change in 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 the box below your

name and address on Form 1099-B.

Box 7. 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.

Box 1a. Shows the trade date of the transaction. For aggregate reporting, no

entry will be present.

Box 1b. For broker transactions, may show the CUSIP (Committee on Uniform

Security Identification Procedures) number of the item reported.

Box 8. Shows the profit or (loss) realized on regulated futures or foreign

currency contracts closed during 2004.

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

bonds, other debt obligations, commodities, or forward contracts. Losses on

forward contracts and changes in control or substantial change in capital

structure are shown in parentheses. This box does not include proceeds from

regulated futures contracts. The broker must indicate whether gross proceeds

or gross proceeds less commissions and option premiums were reported to

the IRS. Report this amount on Schedule D (Form 1040), Capital Gains and

Losses. However, if Box 12 is checked, you cannot take a loss on your tax

return based on gross proceeds from an acquisition of control or substantial

change in 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 9. Shows any year-end adjustment to the profit or (loss) shown in box 8

due to open contracts on December 31, 2003.

Box 10. Shows the unrealized profit or (loss) on open contracts held in your

account on December 31, 2004. These are considered sold as of that date.

This will become an adjustment reported in box 9 in 2005.

Box 3. Shows the cash you received, the fair market value of any property or

services you received, and/or the fair market value of any trade credits or scrip Box 11. Boxes 8, 9, and 10 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 2004 Form 6781.

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

a 28% rate if you did not furnish your taxpayer identification number to the

payer. See Form W-9, Request for Taxpayer Identification Number and

Certification, for information on backup withholding. Include this amount on

your income tax return as tax withheld.

Regulated Futures Contracts:

Box 5. Shows the number of shares of the corporation’s stock that you held

which were exchanged in the change in control or substantial change in capital

structure.

Box 6. Shows the class or classes of the corporation’s stock that were

exchanged in the change in control or substantial change in capital structure.

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

Nontaxable Income, for information on how to report this income.
Proceeds From

Broker and

Barter Exchange

Transactions

Copy C

For Payer

For Privacy Act

and Paperwork

Reduction Act

Notice, see the

2004 General

Instructions for

Forms 1099,

1098, 5498,

and W-2G.

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

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

1b CUSIP no.

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 3 Bartering 4 Federal income tax withheld

$ $

RECIPIENT’S name No. of shares exchanged 5

Street address (including apt. no.) Description 7

City, state, and ZIP code

Account number (optional) 2nd TIN not.



Form 1099-B

8

$

Profit or (loss) realized in

2004

9 Unrealized profit or (loss) on

open contracts—12/31/2003

10 Unrealized profit or (loss) on

open contracts–12/31/2004

11 Aggregate profit or (loss)

$

$ $

Classes of stock

exchanged

6

CORPORATION’S name, street address, city, state, and ZIP code

12 Check the box if recipient cannot take a loss on their tax

return based on the amount in box 2

2004

VOID CORRECTED
Instructions for Payers

General and specific form instructions are provided as

separate products. The products you should use for 2004 are

the General Instructions for Forms 1099, 1098, 5498, and

W-2G and the 2004 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, call 1-800-TAX-FORM

(1-800-829-3676).

Due dates. Furnish Copy B of this form to the recipient by

January 31, 2005.

File Copy A of this form with the IRS by February 28, 2005.

If you file electronically, the due date is March 31, 2005.

Printed on recycled paper

Caution: Because paper forms are scanned during

processing, you cannot file with the IRS Forms 1096, 1098,

1099, 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.