9595 VOID CORRECTED

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

$

Miscellaneous

Income

2 Royalties

$

3 Other income

$

PAYER’S Federal identification number RECIPIENT’S identification number 4 Federal income tax withheld 5 Fishing boat proceeds

$ $

RECIPIENT’S name 6 Medical and health care payments 7 Nonemployee compensation

$ $

Payer made direct sales of

$5,000 or more of consumer

products to a buyer

(recipient) for resale ©

Substitute payments in lieu of 9

dividends or interest

8

Street address (including apt. no.)

$

City, state, and ZIP code 10 Crop insurance proceeds 11 State income tax withheld

$ $

Account number (optional) 2nd TIN Not. 12 State/Payer’s state number

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

Do NOT Cut or Separate Forms on This Page

Cat. No. 14425J

Copy A

File with Form 1096.

For Paperwork

Reduction Act

Notice and

instructions for

completing this form,

see Instructions for

Forms 1099, 1098,

5498, and W-2G.

For

Internal Revenue

Service Center

VOID CORRECTED

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

$

Miscellaneous

Income

2 Royalties

$

3

$

PAYER’S Federal identification number RECIPIENT’S identification number 4 Federal income tax withheld 5 Fishing boat proceeds

$ $

RECIPIENT’S name 6 Medical and health care payments 7 Nonemployee compensation

$ $

Payer made direct sales of

$5,000 or more of consumer

products to a buyer

(recipient) for resale ©

Substitute payments in lieu of 9

dividends or interest

8

Street address (including apt. no.)

$

City, state, and ZIP code 10 Crop insurance proceeds 11 State income tax withheld

$ $

Account number (optional) 12 State/Payer’s state number

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

Copy 1

For State Tax

Department

Other income

CORRECTED (if checked)

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

$

Miscellaneous

Income

2 Royalties

$

3

$

PAYER’S Federal identification number RECIPIENT’S identification number 4 Federal income tax withheld 5 Fishing boat proceeds

$ $

RECIPIENT’S name 6 Medical and health care payments 7 Nonemployee compensation

$ $

Payer made direct sales of

$5,000 or more of consumer

products to a buyer

(recipient) for resale ©

Substitute payments in lieu of 9

dividends or interest

8

Street address (including apt. no.)

$

City, state, and ZIP code 10 Crop insurance proceeds 11 State income tax withheld

$ $

Account number (optional) 12 State/Payer’s state number

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

Copy B

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.

(Keep for your records.)

For Recipient

Other income
Instructions for Recipient

If you are an individual, report the taxable amounts shown on this form on

your tax return, as explained below. (Others, such as fiduciaries or

partnerships, report the amounts on the corresponding lines of your tax

return.)

If “EPP” is shown, this is excess golden parachute payments subject to a

20% excise tax. See your Form 1040 instructions under “Other Taxes.” The

unlabeled amount is your total compensation.

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,

or rented personal property as a business, report on Schedule C or C-EZ

(Form 1040). For royalties on timber, coal, and iron ore, see Pub. 544, Sales

and Other Dispositions of Assets. Box 8.—Report as “Other income” on your tax return. This amount is

substitute payments in lieu of dividends or tax-exempt interest received by

your broker on your behalf after transfer of your securities for use in a short

sale.

Box 3.—Report on the line for “Other income” on Form 1040 and identify the

payment. If it is trade or business income, report this amount on Schedule C,

C-EZ, or F (Form 1040). The amount shown may be payments you received as

the beneficiary of a deceased employee, prizes, awards, taxable damages, or

other taxable income.

Box 9.—An entry in the checkbox means sales to you of consumer products

on a buy-sell, deposit-commission, or any other basis for resale have

amounted to $5,000 or more. The person filing this return does not have to

show a dollar amount in this box. Any income from your sale of these

products should generally be reported on Schedule C or C-EZ (Form 1040).

Box 4.—Shows backup withholding. For example, persons not furnishing their

taxpayer identification number to the payer become subject to backup

withholding at a 31% rate on certain payments. See Form W-9, Request for

Taxpayer Identification Number and Certification, for information on backup

withholding. Include this on your income tax return as tax withheld.

Box 10.—Report on the line for “Crop insurance proceeds. . .” on Schedule F

(Form 1040).

Amounts shown on this form may be subject to self-employment tax

computed on Schedule SE (Form 1040). See Pub. 533, Self-Employment Tax,

for information on self-employment income. If no income or social security and

Medicare taxes were withheld by the payer, you may have to make estimated

tax payments if you are still receiving these payments. See Form 1040-ES,

Estimated Tax for Individuals.

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. 595, Tax Guide for Commercial Fishermen.

Box 6.—Report on Schedule C or C-EZ (Form 1040).

Box 7.—Generally, payments for services reported in this box are income from

self-employment. Since you received this form, rather than Form W-2, the

payer may have considered you self-employed and did not withhold social

security or Medicare taxes. Report self-employment income on Schedule C,

C-EZ, or F (Form 1040), and compute the self-employment tax on Schedule

SE (Form 1040). However, if you are not self-employed, report this amount on

Form 1040 on the line for “Wages, salaries, tips, etc.” Call the IRS for

information about how to report any social security and Medicare taxes.
CORRECTED (if checked)

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

$

Miscellaneous

Income

2 Royalties

$

3

$

PAYER’S Federal identification number RECIPIENT’S identification number 4 Federal income tax withheld 5 Fishing boat proceeds

$ $

RECIPIENT’S name 6 Medical and health care payments 7 Nonemployee compensation

$ $

Payer made direct sales of

$5,000 or more of consumer

products to a buyer

(recipient) for resale ©

Substitute payments in lieu of 9

dividends or interest

8

Street address (including apt. no.)

$

City, state, and ZIP code 10 Crop insurance proceeds 11 State income tax withheld

$ $

Account number (optional) 12 State/Payer’s state number

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

Copy 2

To be filed

with

recipient’s

state income

tax return,

when

required.

Other income

VOID CORRECTED

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

$

Miscellaneous

Income

2 Royalties

$

3

$

PAYER’S Federal identification number RECIPIENT’S identification number 4 Federal income tax withheld 5 Fishing boat proceeds

$ $

RECIPIENT’S name 6 Medical and health care payments 7 Nonemployee compensation

$ $

Payer made direct sales of

$5,000 or more of consumer

products to a buyer

(recipient) for resale ©

Substitute payments in lieu of 9

dividends or interest

8

Street address (including apt. no.)

$

City, state, and ZIP code 10 Crop insurance proceeds 11 State income tax withheld

$ $

Account number (optional) 2nd TIN Not. 12 State/Payer’s state number

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

Copy C

For Paperwork

Reduction Act

Notice and

instructions for

completing this

form, see

Instructions for

Forms 1099,

1098, 5498,

and W-2G.

For Payer

Other income
Payers, Please Note—

Specific information needed to complete this form and other

forms in the 1099 series is given in the Instructions for

Forms 1099, 1098, 5498, and W-2G. A chart in those

instructions gives a quick guide to which form must be filed

to report a particular payment. You can order those

instructions and additional forms by calling 1-800-TAX-FORM

(1-800-829-3676).

Furnish Copy B of this form to the recipient by January 31,

1995.

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

1995.

Printed on recycled paper