Statement for
Recipients of

‘Type or print .

Bares’ | Miscellaneous
name, address,

ZIP eode, and Income

Federal Copy ¢

identifying
number. For Payer

Recipient's identifying number | 1 Rents 2 Royalties ‘3 Commissions and fees to non- | 4 Prizes and awards to nonem~
employees (No Form W-2 items) | — ployees (No Form W-2 items)

‘Type or print RECIPIENT'S name, address, and ZIP code below. 5 Other fixed or determinable income
a. Amount b. Source

Form 1099—MISC ¥ Gro: 1978 — 263-100 25-1116272 Department of the Treasury—internal Revenue Service

Statement for
Recipients of

Type or print i

peers Miscellaneous
name, address, | InCcOMe

ZIP code, and
Federal Copy C
identifying a 4
number. or Payer
Recipient's Identifying number | 1 Rents 2 Royalties 3 Commissions and fees to non. | 4 Prizes and awards to nonem.

employees (No Form WZ items) | — ployees (No Form W-2 items)

Type or print RECIPIENT'S name, address, and ZIP code below. 5 Other fixed or determinable income
a. Amount . Source

263-100 25-1118272 Department of the Treasury—Internal Revenue Service

Statement for

Recipients of 1978
Ty ‘int .

eee =| Miscellaneous

name, address,
ZIP code, and Income

Form 1099-MISC Yr Gro: 19:

Federal Copy C
identifying
number. For Payer
Recipient’s identifying number 1 Rents 2 Royalties 3 Commissions and fees to non- | 4 Prizes and awards to nonem-

‘employees (No Form W-2 items) | ployees (No Form W-2 items)

Type or print RECIPIENT'S name, address, and ZIP code below. 5 Other fixed or determinable income
a, Amount b. Source

Form 1099—MISC YW GPO: 1978 — 263-100 25-1118272 Department of the Treasury—Internal Revenue Service




For Official Use Only

‘Statement for
Recipients of

1978

Type or print i

Type or ot Miscellaneous
», address,

renee | Hcome

Federal Copy A

identifying For Internal Revenue

number. Service Center

Recipient's identifying number ff 1 Rents

2 Royalties

‘3 Commissions and fees to non-
employees (No Form W-2 items)

@ Prizes and awards to nonem.
ployees (No Form W-2 items)

sO
———.
Type or print RECIPIENT'S name, address, and ZIP code below (Name must aline with J] 5 Other fixed or determinable income
arrow). a, Amount b. Source
Name >|
For instructions on completing this form, see “Instructions for Form
1096.""
Form 1099-MISC WF Gpot 1o7e—zes-100  25-1110272 Department of the Treasury—Internal Revenue Service
| Statement for
For Official Use Only Recipients of
Type or print H
| Bates Miscellaneous
name, address, ncome
ZIP code, and 0
Federal Copy A
1 ‘identifyi
identifying For Internal Revenue
- pumber- Service Center
Recipient's identifying number 1 Rents 2 Royalties 3 Commissions and fees to non- | 4 Prizes and awards to nonem~
employees (No Form W-2 items) ployees (No Form W-2 items)
sO
Type or print RECIPIENT'S name, address, and ZIP code below (Name must aline with [| 5 Other fixed or determinable income
arrow). a. Amount b. Source
Name p>]

I Toe Fnstructions on completing Wis form, see “Tnstruetions for Form

Form 1099-—MISC

For Official Use Only

Yr GPO: 1978 — 263-100 25-1118272

Department of the Treasury—Internal Revenue Service

1978

Statement for
Recipients of

Type or print ii

Type or Miscellaneous
, address,

Zircae os | come

Federal Copy A

identifying For Internal Revenue

number. Service Center

$O

1 Rents.

jent’s identifying number

2 Royalties

‘3 Commissions and fees to non-
employees (No Form W-2 items)

“4 Prizes and awards to nonem.
ployees (No Form W-2 items)

Name |

Type or print RECIPIENT'S name, address, and ZIP code below (Name must aline with

arrow).

5 Other fixed or determinable income
a. Amount | b. Source

Teer TasTucions on completing Tis form, Gee “Instructions for Form
er

Form 1099-MISC

We GPO! 1978 — 263-100 25-1118272

Department of the Treasury—Internal Revenue Service




Statement for
Recipients of

1978

Ty ‘it .

Peers | Miscellaneous
name, address,

ZIP code, and Income

Federal Copy B

women For Recipient

1 Rents 2 Royalties

4 Prizes and awards to nonem-

3 Commissions and fees to non-
ployees (No Form W-2 items)

employees (No Form W-2 items)

‘Type or print RECIPIENT'S name, address, and ZIP code below.

5 Other fixed or determinable income
a. Amount b. Source

If this form shows two or more recipients, the recipient
whose Federal identifying number is shown is urged to file @
Form 1087-MISC with the Internal Revenue Service for each
of the other recipients and provide each with a copy. However,
a husband or wife is not required to file a Form 1087-MISC to
show payments for the other.

This information is being furnished to the Internal Revenue Service,

Gro! 1978 — 263-100 25-1118272,

Form 1099-MISC

Department of the Treasury—Internal Revenue Service

1978

Statement for
Recipients of

Type or print
PAYER’S
name, address,
ZIP code, and
Federal
identifying
number.

Miscellaneous
Income

Copy B
For Recipient

1 Rents 2 Royalties

number

4 Prizes and awards to nonem-

'3 Commissions and fees to non-
ployees (No Form W-2 items)

employees (No Form W-2 items)

‘Type or print RECIPIENT'S name, address, and ZIP code below.

5 Other fixed or determinable income
a. Amount b. Source

If this form shows two or more recipients, the recipient
whose Federal identifying number is shown is urged to file a
Form 1087-MISC with the Internal Revenue Service for each
of the other recipients and provide each with a copy. However,
a husband or wife is not required to file a Form 1087-MISC to
show payments for the other.

This information is being furnished to the Internal Revenue Service

We po: 1978 — 263-100 28-1118272

Form 1099—-MISC

Department of the Treasury—internal Revenue Service

1978

Statement for
Recipients of

Type or print
PAYER'S
name, address,
ZIP code, and
Federal
identifying
number.

Miscellaneous
Income

Copy B
For Recipient

Recipient’s identifying number 1 Rents 2 Royalties

‘3 Commissions and fees to non-

4 Prizes and awards to nonem-
‘employees (No Form W-2 items) )

ployees (No Form W-2 items)

‘Type or print RECIPIENT'S name, address, and ZIP code below.

5 Other fixed or determinable income
a. Amount b, Source

lf this form shows two or more recipients, the recipient
whose Federal identifying number is shown is urged to file a
Form 1087-MISC with the Internal Revenue Service for each
of the other recipients and provide each with a copy. However,
a husband or wife is not required to file a Form 1087-MISC to
show payments for the other.

"This information is being furnished to the Internal Revenue Service,

Y GPo: 1978 — 263-100 25-1118272

Form 1099—MISC

Department of the Treasury—internal Revenue Service