EFTA01222601.pdf

■ CORRECTED ifcheck PAYERS name. street address. city or town, state or province, country. ZIP 1 Rents OMB No. 1545-O115 or foreign postal code. and telephone no. Miscellaneous 2 Royalties 2017 Income Form 1099-MISC 3 Other income 4 Federal income tax withheld Copy B $ $ For Recipient PAYERS federal identification number RECIPIENTS identification number S Fishing boat proceeds 6 Medical and health care partisan $ $ RECIPIENTS name 7 Nonemployee compensation 8 Substitute payments n lieu of This is important tax dividends or interest information and Is being furnished to the Internal Revenue Street address (including apt. no.) Service. If you are 8 Payer made direct sales of 10 Crop entrance proceeds required to file a 55.000 or more of consumer return, a negligence products to a buyer penalty Or other City or town. state or province. country. and ZIP or foreign postal code reci for resale .• ❑ $ sanction may be 11 t2 imposed on you if this Income is taxable and the IRS Account number (see instructions) FATCA filing 13 Excess golden parachute 14 Gross proceeds paid to an determines that It requirement payments attomey has not been reported. $ $ 15a Section 409A deferrals 15b Section 409A income 16 State tax withheld 17 State/Payer's state no. 18 State income $ $ $ $ Form 1099-MISC (keep fo your records) vnAv.irs.gov/fom11088miac Department of the Treasury - Internal Revenue &tyke EFTA01222601