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9595 VOID CORRECTED

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

$ Miscellaneous
2 Royalties 2001 Income
$ Form 1099-MISC
3 Other income 4 Federal income tax withheld
Copy A
$ $ For
PAYER’S Federal identification RECIPIENT’S identification 5 Fishing boat proceeds 6 Medical and health care payments Internal Revenue
number number Service Center

File with Form 1096.


$ $
RECIPIENT’S name 7 Nonemployee compensation 8 Substitute payments in lieu of
dividends or interest For Privacy Act
and Paperwork
$ $ Reduction Act
Street address (including apt. no.) 9 Payer made direct sales of 10 Crop insurance proceeds Notice, see the
$5,000 or more of consumer 2001 General
products to a buyer
(recipient) for resale 䊳 $ Instructions for
City, state, and ZIP code 11 12 Forms 1099,
1098, 5498,
Account number (optional) 2nd TIN not. 13 Excess golden parachute 14 Gross proceeds paid to and W-2G.
payments an attorney

$ $
15 16 State tax withheld 17 State/Payer’s state no. 18 State income

$ $
$ $
Form 1099-MISC Cat. No. 14425J Department of the Treasury - Internal Revenue Service
Do Not Cut or Separate Forms on This Page — Do Not Cut or Separate Forms on This Page
VOID CORRECTED
PAYER’S name, street address, city, state, and ZIP code 1 Rents OMB No. 1545-0115

$ Miscellaneous
2 Royalties 2001 Income
$ Form 1099-MISC
3 Other income 4 Federal income tax withheld

$ $ Copy 1
PAYER’S Federal identification RECIPIENT’S identification 5 Fishing boat proceeds 6 Medical and health care payments For State Tax
number number
Department

$ $
RECIPIENT’S name 7 Nonemployee compensation 8 Substitute payments in lieu of
dividends or interest

$ $
Street address (including apt. no.) 9 Payer made direct sales of 10 Crop insurance proceeds
$5,000 or more of consumer
products to a buyer
(recipient) for resale 䊳 $
City, state, and ZIP code 11 12

Account number (optional) 13 Excess golden parachute 14 Gross proceeds paid to


payments an attorney

$ $
15 16 State tax withheld 17 State/Payer’s state no. 18 State income

$ $
$ $
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

$ Miscellaneous
2 Royalties 2001 Income
$ Form 1099-MISC
3 Other income 4 Federal income tax withheld Copy B
$ For Recipient
$
PAYER’S Federal identification RECIPIENT’S identification 5 Fishing boat proceeds 6 Medical and health care payments
number number

$ $
RECIPIENT’S name 7 Nonemployee compensation 8 Substitute payments in lieu of
dividends or interest This is important tax
information and is
being furnished to
the Internal Revenue
$ $ Service. If you are
Street address (including apt. no.) 9 Payer made direct sales of 10 Crop insurance proceeds required to file a
$5,000 or more of consumer return, a negligence
products to a buyer penalty or other
(recipient) for resale 䊳 $ sanction may be
City, state, and ZIP code 11 12 imposed on you if
this income is
taxable and the IRS
Account number (optional) 13 Excess golden parachute 14 Gross proceeds paid to determines that it
payments an attorney has not been
reported.
$ $
15 16 State tax withheld 17 State/Payer’s state no. 18 State income

$ $
$ $
Form 1099-MISC (Keep for your records.) Department of the Treasury - Internal Revenue Service
Instructions to Recipients Box 6. Report on Schedule C or C-EZ (Form 1040).
Amounts shown on this form may be subject to Box 7. Shows nonemployee compensation. If you are in the
self-employment tax. If your net income from self-employment trade or business of catching fish, box 7 may show cash you
is $400 or more, you must file a return and compute your received for the sale of fish. If payments that are reported in this
self-employment tax on Schedule SE (Form 1040). See Pub. box are income from self-employment, report this amount on
533, Self-Employment Tax, for more information. If no income or Schedule C, C-EZ, or F (Form 1040), and complete Schedule SE
social security and Medicare taxes were withheld, you may have (Form 1040). Because you received this form rather than Form
to make estimated tax payments if you are still receiving these W-2, the payer may have considered you self-employed and did
payments. See Form 1040-ES, Estimated Tax for Individuals. not withhold social security or Medicare taxes. Contact the
payer if you believe this form is incorrect or has been issued in
If you are an individual, report the taxable amounts shown on
error. If you are not self-employed, report this amount on the
Form 1040, as explained below. For corporations, fiduciaries, or
“Wages, salaries, tips, etc.” line of Form 1040. Call the IRS for
partnerships, report the amounts on the proper line of your tax
information about how to report any social security and
return.
Medicare taxes.
Boxes 1 and 2. Report rents from real estate on Schedule E
Box 8. Shows substitute payments in lieu of dividends or
(Form 1040). If you provided significant services to the tenant,
tax-exempt interest received by your broker on your behalf after
sold real estate as a business, or rented personal property as a
transfer of your securities for use in a short sale. Report on the
business, report on Schedule C or C-EZ (Form 1040). For
“Other income” line of Form 1040.
royalties on timber, coal, and iron ore, see Pub. 544, Sales and
Other Dispositions of Assets. Box 9. If marked, sales to you of consumer products on a
buy-sell, deposit-commission, or any other basis for resale have
Box 3. Generally, report this amount on the “Other income” line
amounted to $5,000 or more. The person filing this return does
of Form 1040 and identify the payment. If it is trade or business
not have to show a dollar amount in this box. Generally, report
income, report this amount on Schedule C, C-EZ, or F (Form
any income from your sale of these products on Schedule C or
1040). The amount shown may be payments you received as the
C-EZ (Form 1040).
beneficiary of a deceased employee, prizes, awards, taxable
damages, Indian gaming profits, or other taxable income. Box 10. Report on the “Crop insurance proceeds. . .” line on
Schedule F (Form 1040).
Box 4. Shows backup withholding or withholding on Indian
gaming profits. Generally, a payer must backup withhold at a 31% Box 13. Shows excess golden parachute payments subject to a
rate if you did not furnish your taxpayer identification number to 20% excise tax. See your Form 1040 instructions for the “Total
the payer. See Form W-9, Request for Taxpayer Identification Tax” line. The amount in box 7 is your total compensation.
Number and Certification, for information on backup withholding. Box 14. Shows gross proceeds paid to an attorney in
Include this amount on your income tax return as tax withheld. connection with legal services. Report only the taxable part as
Box 5. An amount in this box means the fishing boat operator income on your return.
considers you self-employed. Report this amount on Schedule C Box 15. Other information may be provided to you in box 15.
or C-EZ (Form 1040). See Pub. 595, Tax Highlights for Boxes 16–18. If state or local income tax was withheld from the
Commercial Fishermen. payment, these boxes may be completed.
CORRECTED (if checked)
PAYER’S name, street address, city, state, and ZIP code 1 Rents OMB No. 1545-0115

$ Miscellaneous
2 Royalties 2001 Income
$ Form 1099-MISC
3 Other income 4 Federal income tax withheld

$ $
PAYER’S Federal identification RECIPIENT’S identification 5 Fishing boat proceeds 6 Medical and health care payments
number number Copy 2
To be filed
$ $ with
RECIPIENT’S name 7 Nonemployee compensation 8 Substitute payments in lieu of recipient’s
dividends or interest state income
tax return,
when
$ $ required.
Street address (including apt. no.) 9 Payer made direct sales of 10 Crop insurance proceeds
$5,000 or more of consumer
products to a buyer
(recipient) for resale 䊳 $
City, state, and ZIP code 11 12

Account number (optional) 13 Excess golden parachute 14 Gross proceeds paid to


payments an attorney

$ $
15 16 State tax withheld 17 State/Payer’s state no. 18 State income

$ $
$ $
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

$ Miscellaneous
2 Royalties 2001 Income
$ Form 1099-MISC
3 Other income 4 Federal income tax withheld

$ $
PAYER’S Federal identification RECIPIENT’S identification 5 Fishing boat proceeds 6 Medical and health care payments
Copy C
number number For Payer

$ $
RECIPIENT’S name 7 Nonemployee compensation 8 Substitute payments in lieu of
dividends or interest For Privacy Act
and Paperwork
$ $ Reduction Act
Street address (including apt. no.) 9 Payer made direct sales of 10 Crop insurance proceeds Notice, see the
$5,000 or more of consumer 2001 General
products to a buyer
(recipient) for resale 䊳 $ Instructions for
City, state, and ZIP code 11 12 Forms 1099,
1098, 5498,
Account number (optional) 2nd TIN not. 13 Excess golden parachute 14 Gross proceeds paid to and W-2G.
payments an attorney

$ $
15 16 State tax withheld 17 State/Payer’s state no. 18 State income

$ $
$ $
Form 1099-MISC Department of the Treasury - Internal Revenue Service
Payers, Please Note—
To help make it easier for you to get additional forms by calling
only the information you need to 1-800-TAX-FORM (1-800-829-3676).
complete the Forms 1099, 1098, 5498, You can also get forms and
and W-2G you file, we provide general instructions from the IRS’s Internet
and specific form instructions as Web Site at www.irs.gov.
separate products. The products you Caution: Because the IRS processes
should use for 2001 are the General paper forms by machine (optical
Instructions for Forms 1099, 1098, character recognition equipment), you
5498, and W-2G, which contain cannot file with the IRS Forms 1096,
general information concerning Form 1098, 1099, or 5498 that you print
1099-MISC and other forms in the from the IRS’s Internet Web Site.
1099 series, and the separate specific
instructions for each information return Due dates. Furnish Copy B of this
you file. Specific information needed to form to the recipient by January 31,
complete this form is given in the 2001 2002.
Instructions for Form 1099-MISC. A File Copy A of this form with the IRS
chart in the general instructions gives a by February 28, 2002. If you file
quick guide to which form must be electronically, the due date is April 1,
filed to report a particular payment. 2002.
You can order those instructions and

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