7373VOID CORRECTED

CORPORATION’S name, street address, city, state, ZIP code, and telephone no. OMB No. 1545-1814

2

1

CORPORATION’S federal identification no. SHAREHOLDER’S identification no.

SHAREHOLDER’S name

Street address (including apt. no.)

City, state, and ZIP code

Form 1099-CAP Department of the Treasury - Internal Revenue ServiceCat. No. 35115M

Form 1099-CAP

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

Copy A

For

Internal Revenue

Service Center

File with Form 1096.

For Paperwork

Reduction Act

Notice, see the

2008 General

Instructions for

Forms 1099, 1098,

5498, and W-2G.

Changes in

Corporate

Control and

Capital Structure

5

Date of sale or exchange

Aggregate amount rec’d*

Account number (see instructions)

3 No. of shares exchanged

* The shareholder cannot claim a loss based on the

amount in box 2.

$

4 Classes of stock exchanged

2008
CORRECTED (if checked)

Copy B

For Shareholder

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

taxable income results

from this transaction

and the IRS determines

that it has not been

reported.

Form 1099-CAP (keep for your records) Department of the Treasury - Internal Revenue Service

Changes in

Corporate

Control and

Capital Structure

CORPORATION’S name, street address, city, state, ZIP code, and telephone no. OMB No. 1545-1814

2

1

CORPORATION’S federal identification no. SHAREHOLDER’S identification no.

SHAREHOLDER’S name

Street address (including apt. no.)

City, state, and ZIP code

Form 1099-CAP

5

Date of sale or exchange

Aggregate amount rec’d*

Account number (see instructions)

3 No. of shares exchanged

* You cannot claim a loss based on the amount in box 2.

$

4 Classes of stock exchanged

2008
Instructions for Shareholder

A corporation in which you own stock that has had a

change in control or a substantial change in capital

structure must send you this statement by January 31

of the year following the calendar year of the change.

You have received this statement because the

corporation has reasonably determined that you may

be required to recognize gain from the receipt of cash,

stock, or other property that was exchanged for the

corporation’s stock. Report any gain from the

exchange on Schedule D (Form 1040), Capital Gains

and Losses. However, you cannot claim a (loss) on

Schedule D (Form 1040) as a result of this exchange.

Box 3. Shows the number of shares of the

corporation’s stock that you held which were

exchanged in the transaction.

Box 1. Shows the date the stock was exchanged for

cash, stock, or other property.

Box 4. Shows the class or classes of stock that were

exchanged.

Box 2. Shows the aggregate amount of any cash and

the fair market value of any stock or other property

received by you in the exchange for the stock you

held.

Account number. May show an account or other

unique number the payer corporation assigned to

distinguish your account.
VOID CORRECTED

For Corporation

For Paperwork

Reduction Act

Notice, see the

2008 General

Instructions for

Forms 1099,

1098, 5498,

and W-2G.

Copy C

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

Changes in

Corporate

Control and

Capital Structure

CORPORATION’S name, street address, city, state, ZIP code, and telephone no. OMB No. 1545-1814

2

1

CORPORATION’S federal identification no. SHAREHOLDER’S identification no.

SHAREHOLDER’S name

Street address (including apt. no.)

City, state, and ZIP code

Form 1099-CAP

5

Date of sale or exchange

Aggregate amount rec’d*

Account number (see instructions)

3 No. of shares exchanged

* The shareholder cannot claim a loss based on the

amount in box 2.

$

4 Classes of stock exchanged

2008
Instructions for Corporations

General and specific form instructions are provided as

separate products. The products you should use for

2008 are the General Instructions for Forms 1099,

1098, 5498, and W-2G and the 2008 Instructions for

Form 1099-CAP. 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, visit the IRS website at

www.irs.gov or call 1-800-TAX-FORM

(1-800-829-3676).

Due dates. Generally, furnish Copy B of this form to

the shareholder by February 2, 2009. However, if the

recipient is a clearing organization, furnish Copy B by

January 5, 2009.

File Copy A of this form with the IRS by March 2,

2009. If you file electronically, the due date is March

31, 2009. To file electronically, you must have software

that generates a file according to the specifications in

Pub. 1220, Specifications for Filing Forms 1098, 1099,

5498, and W-2G Electronically. IRS does not provide a

fill-in form option.

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.

Need help? If you have questions about reporting on

Form 1099-CAP, call the information reporting

customer service site toll free at 1-866-455-7438 or

304-263-8700 (not toll free). For TTY/TDD equipment,

call 304-267-3367 (not toll free). The hours of operation

are Monday through Friday from 8:30 a.m. to 4:30

p.m., Eastern time.