9 5 9 5 VOID CORRECTED

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

$ Miscellaneous

2 Royalties Income

$

3 Prizes, awards, etc.

$

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

For

Internal Revenue

Service Center

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.

VOID CORRECTED

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

$ Miscellaneous

2 Royalties Income

$

3 Prizes, awards, etc.

$

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

CORRECTED (if checked)

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

$ Miscellaneous

2 Royalties Income

$

3 Prizes, awards, etc.

$

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

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.

(keep for your records)
Instructions for Recipient

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

on your tax return, as explained below. (Other taxpayers, such as

fiduciaries or partnerships, report the amounts on the corresponding

lines of your tax return.) If there are two amounts shown in this box, one may be labeled

“EPP.” This represents excess golden parachute payments. You must

pay a 20% excise tax on this amount. See your Form 1040 instructions

under “Other Taxes.” The unlabeled amount is your total

compensation.

Boxes 1 and 2.—Report on Schedule E (Form 1040). However, if you

provided services that were primarily for your customer’s convenience,

such as regular cleaning, changing linen, or maid service, report on

Schedule C (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. The amount

shown 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 or F (Form 1040). 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 (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 20% 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).

Certain 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 more information on amounts

considered self-employment income. Since 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 (Form

1040). See Pub. 595, Tax Guide for Commercial Fishermen.

Box 6.—Report on Schedule C (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 considered you self-employed and did not

withhold social security or Medicare taxes. Report the self-employment

income on Schedule C or F (Form 1040), and compute the selfemployment tax on Schedule SE (Form 1040). However, if you are not

self-employed, amounts paid to you for services rendered are generally

reported on Form 1040 on the line for “Wages, salaries, tips, etc.”
CORRECTED (if checked)

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

$ Miscellaneous

2 Royalties Income

$

3 Prizes, awards, etc.

$

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.

VOID CORRECTED

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

$ Miscellaneous

2 Royalties Income

$

3 Prizes, awards, etc.

$

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 C

For Payer

For Paperwork

Reduction Act

Notice and

instructions for

completing this

form, see

Instructions for

Forms 1099,

1098, 5498,

and W-2G.

2nd TIN Not.