Nonemployee compensation

VOID CORRECTED

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

$

2 Royalties

$

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 (optional) 13

$

16 State tax withheld 17 State/Payer’s state no.

$

18 State income

$

$

$ $

4

$ $

Payer made direct sales of

$5,000 or more of consumer

products to a buyer

(recipient) for resale 

Form 1099-MISC

Miscellaneous

Income

15

$

9595

2nd TIN not.

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

Copy A

File with Form 1096.

For Privacy Act

and Paperwork

Reduction Act

Notice, see the

2001 General

Instructions for

Forms 1099,

1098, 5498,

and W-2G.

For

Internal Revenue

Service Center

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

2001

11 12

11 12

Nonemployee compensation

VOID CORRECTED

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

$

2 Royalties

$

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 (optional) 13

$

16 State tax withheld 17 State/Payer’s state no.

$

Department of the Treasury - Internal Revenue Service

18 State income

$

$

$ $

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

Miscellaneous

Income

15

Copy 1

For State Tax

Department

$

2001

11 12

(Keep for your records.)

Nonemployee compensation

CORRECTED (if checked)

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

$

2 Royalties

$

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 (optional) 13

$

16 State tax withheld 17 State/Payer’s state no.

$

Department of the Treasury - Internal Revenue Service

18 State income

$

$

$ $

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

Miscellaneous

Income

15

$

2001

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.

Federal income tax withheld
If you are an individual, report the taxable amounts shown on

Form 1040, as explained below. For corporations, fiduciaries, or

partnerships, report the amounts on the proper line of your tax

return.

Box 15. Other information may be provided to you in box 15.

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. Shows 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. 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. 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, Indian gaming profits, or other taxable income.

Box 9. If marked, 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. Generally, report

any income from your sale of these products on Schedule C or

C-EZ (Form 1040).

Box 4. Shows backup withholding or withholding on Indian

gaming profits. Generally, a payer must backup withhold at a 31%

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.

Box 10. Report on the “Crop insurance proceeds. . .” line on

Schedule F (Form 1040).

Amounts shown on this form may be subject to

self-employment tax. If your net income from self-employment

is $400 or more, you must file a return and compute your

self-employment tax on Schedule SE (Form 1040). See Pub.

533, Self-Employment Tax, for more information. If no income or

social security and Medicare taxes were withheld, 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 Highlights for

Commercial Fishermen.

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

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 payments that are reported in this

box are income from self-employment, report this amount on

Schedule C, C-EZ, or F (Form 1040), and complete Schedule SE

(Form 1040). Because 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. Contact the

payer if you believe this form is incorrect or has been issued in

error. If you are not self-employed, report this amount on the

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

information about how to report any social security and

Medicare taxes.

Box 13. Shows excess golden parachute payments subject to a

20% excise tax. See your Form 1040 instructions for the “Total

Tax” line. The amount in box 7 is your total compensation.

Box 14. Shows gross proceeds paid to an attorney in

connection with legal services. Report only the taxable part as

income on your return.

Instructions to Recipients

Boxes 16–18. If state or local income tax was withheld from the

payment, these boxes may be completed.
11 12

Nonemployee compensation

CORRECTED (if checked)

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

$

2 Royalties

$

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 (optional) 13

$

16 State tax withheld 17 State/Payer’s state no.

$

Department of the Treasury - Internal Revenue Service

18 State income

$

$

$ $

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

Miscellaneous

Income

15

Copy 2

To be filed

with

recipient’s

state income

tax return,

when

required.

$

2001

11 12

Nonemployee compensation

VOID CORRECTED

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

$

2 Royalties

$

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 (optional) 13

$

16 State tax withheld 17 State/Payer’s state no.

$

Department of the Treasury - Internal Revenue Service

18 State income

$

$

$ $

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

Miscellaneous

Income

15

Copy C

For Payer

2nd TIN not.

$

2001

For Privacy Act

and Paperwork

Reduction Act

Notice, see the

2001 General

Instructions for

Forms 1099,

1098, 5498,

and W-2G.
Payers, Please Note—

Due dates. Furnish Copy B of this

form to the recipient by January 31,

2002.

File Copy A of this form with the IRS

by February 28, 2002. If you file

electronically, the due date is April 1,

2002.

Caution: Because the IRS processes

paper forms by machine (optical

character recognition equipment), you

cannot file with the IRS Forms 1096,

1098, 1099, or 5498 that you print

from the IRS’s Internet Web Site.

To help make it easier for you to get

only the information you need to

complete the Forms 1099, 1098, 5498,

and W-2G you file, we provide general

and specific form instructions as

separate products. The products you

should use for 2001 are the General

Instructions for Forms 1099, 1098,

5498, and W-2G, which contain

general information concerning Form

1099-MISC and other forms in the

1099 series, and the separate specific

instructions for each information return

you file. Specific information needed to

complete this form is given in the 2001

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.

You can order those instructions and

additional forms by calling

1-800-TAX-FORM (1-800-829-3676).

You can also get forms and

instructions from the IRS’s Internet

Web Site at www.irs.gov.