9595 VOID CORRECTED

PAYER’S name, street address, city, state, and ZIP code 1 Rents OMB No. 1545-0115
$
2 Royalties
Miscellaneous
$
3 Prizes, awards, etc.
Income
$
PAYER’S Federal identification number RECIPIENT’S identification number 4 Federal income tax withheld 5 Fishing boat proceeds
Copy A
$ $ For
RECIPIENT’S name 6 Medical and health care payments 7 Nonemployee compensation Internal Revenue
$ $ Service Center
8 Substitute payments in lieu of 9 Payer made direct sales of File with Form 1096.
dividends or interest $5,000 or more of consumer
Street address (including apt. no.) For Paperwork
products to a buyer
$ (recipient) for resale © Reduction Act
Notice and
City, state, and ZIP code 10 Crop insurance proceeds 11 State income tax withheld instructions for
$ $ completing this form,
see Instructions for
Account number (optional) 2nd TIN Not. 12 State/Payer’s state number
Forms 1099, 1098,
5498, and W-2G.
Form 1099-MISC Cat. No. 14425J Department of the Treasury - Internal Revenue Service

Do NOT Cut or Separate Forms on This Page

Payers, Please Note—
Specific information needed to complete this form and other Furnish Copy B of this form to the recipient by January 31,
forms in the 1099 series is given in the Instructions for 1994.
Forms 1099, 1098, 5498, and W-2G. A chart in those File Copy A of this form with the IRS by February 28,
instructions gives a quick guide to which form must be filed 1994.
to report a particular payment. You can order those
instructions and additional forms by calling 1-800-TAX-FORM
(1-800-829-3676).
 VOID CORRECTED
PAYER’S name, street address, city, state, and ZIP code 1 Rents OMB No. 1545-0115
$
2 Royalties
Miscellaneous
$
3 Prizes, awards, etc.
Income
$
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
$ $
8 Substitute payments in lieu of 9 Payer made direct sales of Copy 1
dividends or interest $5,000 or more of consumer
Street address (including apt. no.) For State Tax
products to a buyer
$ (recipient) for resale © Department
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

 CORRECTED (if checked)
PAYER’S name, street address, city, state, and ZIP code 1 Rents OMB No. 1545-0115
$
2 Royalties
Miscellaneous
$
3 Prizes, awards, etc.
Income
$
PAYER’S Federal identification number RECIPIENT’S identification number 4 Federal income tax withheld 5 Fishing boat proceeds
Copy B
$ $ For Recipient
RECIPIENT’S name 6 Medical and health care payments 7 Nonemployee compensation
This is important tax
$ $ information and is
being furnished to the
8 Substitute payments in lieu of 9 Payer made direct sales of Internal Revenue
dividends or interest $5,000 or more of consumer Service. If you are
Street address (including apt. no.)
products to a buyer required to file a return,
$ (recipient) for resale © a negligence penalty or
City, state, and ZIP code 10 Crop insurance proceeds 11 State income tax withheld other sanction may be
imposed on you if this
$ $ income is taxable and
the IRS determines that
Account number (optional) 12 State/Payer’s state number it has not been
reported.

Form 1099-MISC (Keep for your records.) Department of the Treasury - Internal Revenue Service
 Box 5.—An amount in this box means the fishing boat operator considers you
Instructions for Recipient self-employed. Report this amount on Schedule C or C-EZ (Form 1040). See
Certain amounts shown on this form may be subject to self-employment Pub. 595, Tax Guide for Commercial Fishermen.
tax computed on Schedule SE (Form 1040). See Pub. 533, Self-Employment Box 6.—Report on Schedule C or C-EZ (Form 1040).
Tax, for more information on amounts considered self-employment income.
Since no income or social security and Medicare taxes were withheld by the Box 7.—Generally, payments for services reported in this box are income from
payer, you may have to make estimated tax payments if you are still receiving self-employment. Since you received this form, rather than Form W-2, the
these payments. See Form 1040-ES, Estimated Tax for Individuals. payer considered you self-employed and did not withhold social security or
Medicare taxes. Report the self-employment income on Schedule C, C-EZ, or
If you are an individual, report the taxable amounts shown on this form on F (Form 1040), and compute the self-employment tax on Schedule SE
your tax return, as explained below. (Other taxpayers, such as fiduciaries or (Form 1040). However, if you are not self-employed, amounts paid to you for
partnerships, report the amounts on the corresponding lines of your tax services rendered are generally reported on Form 1040 on the line for “Wages,
return.) salaries, tips, etc.”
Boxes 1 and 2.—Report on Schedule E (Form 1040). However, if you provided If there are two amounts shown in this box, one may be labeled “EPP.” This
services that were primarily for your customer’s convenience, such as regular represents excess golden parachute payments. You must pay a 20% excise
cleaning, changing linen, or maid service, report on Schedule C or C-EZ (Form tax on this amount. See your Form 1040 instructions under “Other Taxes.” The
1040). For royalties on timber, coal, and iron ore, see Pub. 544, Sales and unlabeled amount is your total compensation.
Other Dispositions of Assets.
Box 8.—Report as “Other income” on your tax return. The amount shown is
Box 3.—Report on the line for “Other income” on Form 1040 and identify the substitute payments in lieu of dividends or tax-exempt interest received by
payment. If it is trade or business income, report this amount on Schedule C, your broker on your behalf after transfer of your securities for use in a short
C-EZ, or F (Form 1040). sale.
Box 4.—Shows backup withholding. For example, persons not furnishing their Box 9.—An entry in the checkbox means sales to you of consumer products
taxpayer identification number to the payer become subject to backup on a buy-sell, deposit-commission, or any other basis for resale have
withholding at a 31% rate on certain payments. See Form W-9, Request for amounted to $5,000 or more. The person filing this return does not have to
Taxpayer Identification Number and Certification, for information on backup show a dollar amount in this box. Any income from your sale of these
withholding. Include this on your income tax return as tax withheld. products should generally be reported on Schedule C or C-EZ (Form 1040).
Box 10.—Report on the line for “Crop insurance proceeds. . .” on Schedule F
(Form 1040).
 CORRECTED (if checked)
PAYER’S name, street address, city, state, and ZIP code 1 Rents OMB No. 1545-0115
$
2 Royalties
Miscellaneous
$
3 Prizes, awards, etc.
Income
$
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 Copy 2
$ $ To be filed
8 Substitute payments in lieu of 9 Payer made direct sales of with
dividends or interest $5,000 or more of consumer recipient’s
Street address (including apt. no.)
products to a buyer
(recipient) for resale © state income
$ tax return,
City, state, and ZIP code 10 Crop insurance proceeds 11 State income tax withheld when
$ $ required.
Account number (optional) 12 State/Payer’s state number

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

 VOID CORRECTED
PAYER’S name, street address, city, state, and ZIP code 1 Rents OMB No. 1545-0115
$
2 Royalties
Miscellaneous
$
3 Prizes, awards, etc.
Income
$
PAYER’S Federal identification number RECIPIENT’S identification number 4 Federal income tax withheld 5 Fishing boat proceeds Copy C
$ $ For Payer
RECIPIENT’S name 6 Medical and health care payments 7 Nonemployee compensation
For Paperwork
$ $ Reduction Act
8 Substitute payments in lieu of 9 Payer made direct sales of Notice and
dividends or interest $5,000 or more of consumer
Street address (including apt. no.)
products to a buyer
instructions for
$ (recipient) for resale © completing this
City, state, and ZIP code 10 Crop insurance proceeds 11 State income tax withheld
form, see
Instructions for
$ $ Forms 1099,
Account number (optional) 2nd TIN Not. 12 State/Payer’s state number 1098, 5498,
and W-2G.
Form 1099-MISC Department of the Treasury - Internal Revenue Service