Nonemployee compensation

VOID CORRECTED

PAYER’S name, street address, city, state, ZIP code, and telephone no. 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

2004 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

11 12

2004
11 12

Nonemployee compensation

VOID CORRECTED

PAYER’S name, street address, city, state, ZIP code, and telephone no. 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

$

2004
11 12

(keep for your records)

Nonemployee compensation

CORRECTED (if checked)

PAYER’S name, street address, city, state, ZIP code, and telephone no. 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

$

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

2004
Individuals must report as explained below. 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 as a

result of a loan of your securities. 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. The amount shown may

be payments received as the beneficiary of a deceased

employee, prizes, awards, taxable damages, Indian gaming

profits, or other taxable income. If it is trade or business income,

report this amount on Schedule C, C-EZ, or F (Form 1040).

Box 9. If checked, $5,000 or more of sales of consumer

products was paid to you on a buy-sell, deposit-commission, or

other basis. A dollar amount does not have to be shown.

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 28%

rate if you did not furnish your taxpayer identification number. See

Form W-9, Request for Taxpayer Identification Number and

Certification, for more information. Report this amount on your

income tax return as tax withheld.

Box 10. Report this amount on line 8 of Schedule F (Form 1040).

Amounts shown may be subject to self-employment (SE) tax.

If your net income from self-employment is $400 or more, you

must file a return and compute your SE 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 and 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 in this box are SE

income, report this amount on Schedule C, C-EZ, or F (Form

1040), and complete Schedule SE (Form 1040). You received

this form instead of Form W-2 because the payer did not

consider you an employee and did not withhold income tax or

social security and Medicare taxes. Contact the payer if you

believe this form is incorrect or has been issued in error. If you

believe you are an employee, report this amount on line 7 of

Form 1040 and call the IRS for information on how to report any

social security and Medicare taxes.

Box 13. Shows your total compensation of excess golden

parachute payments subject to a 20% excise tax. See the Form

1040 instructions for the “Total Tax” line.

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. Shows state or local income tax withheld from the

payments.
11 12

Nonemployee compensation

CORRECTED (if checked)

PAYER’S name, street address, city, state, ZIP code, and telephone no. 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.

$

2004
11 12

Nonemployee compensation

VOID CORRECTED

PAYER’S name, street address, city, state, ZIP code, and telephone no. 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.

$

For Privacy Act

and Paperwork

Reduction Act

Notice, see the

2004 General

Instructions for

Forms 1099,

1098, 5498,

and W-2G.

2004
Instructions for Payers

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.

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.

General and specific form instructions

are provided as separate products. The

products you should use to complete

Form 1099-MISC are the 2004 General

Instructions for Forms 1099, 1098,

5498, and W-2G and the separate

specific instructions, 2004 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. To order these

instructions and additional forms, call

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