Attention:

This form is provided for informational purposes and should not be reproduced on personal computer printers by individual

printed using special paper, special inks, and within precise specifications.

taxpayers for filing. The printed version of this form is "machine readable" form. As such, it must be designed as a

Additional information about the printing of these specialized tax forms can be found in IRS Publications 1141, 1167, 1179, and other IRS resources.

The printed version of the form may be obtained by calling 1-800-TAX-FORM (1-800-829-3676). Be sure to order using the IRS form or publication number.

9595

VOID

CORRECTED

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

OMB No. 1545-0115

004

Form 1099-MISC

$

Miscellaneous

Income

$

3	Other income	4Federal income tax withheld	
5	Fishing boat proceeds	6	Medical and health care payments	

Copy A

$

$

For

Internal Revenue

Service Center

$

$

File with Form 1096.

RECIPIENT’S name

7Nonemployee compensation

Forms 1099,

1098, 5498,

and W-2G.

For Privacy Act

and Paperwork

$

Reduction Act

Notice, see the

2004 General

Instructions for

2nd TIN not.

 13 Excess golden parachute

payments

14 Gross proceeds paid to

an attorney

$

$

15

16 State tax withheld

$

$

$

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

—

□
□

1	Rents		
2	Royalties		

Street address (including apt. no.)				
	products to a buyer	□		
	(recipient) for resale			
City, state, and ZIP code			

□

17	State/Payer’s state no.	18	State income	

VOID

CORRECTED

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

OMB No. 1545-0115

004

Form 1099-MISC

$

Miscellaneous

Income

$

3 Other income

4 Federal income tax withheld

Copy 1

$

$

number

PAYER’S Federal identification

RECIPIENT’S identification

number

5 Fishing boat proceeds

6 Medical and health care payments

For State Tax

Department

$

$

RECIPIENT’S name

Street address (including apt. no.)

City, state, and ZIP code

$

$

Account number (optional)

13 Excess golden parachute

payments

14 Gross proceeds paid to

an attorney

$

$

15

16 State tax withheld

$

$

Form 1099-MI SC

Department of the Treasury - Internal Revenue Service

□
□

1	Rents		
2	Royalties		

7Nonemployee compensation	8	Substitute payments in lieu of
dividends or interest	
			
products to a buyer	□		
(recipient) for resale			

17	State/Payer’s state no.	18	State income	

CORRECTED (if checked)

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

OMB No. 1545-0115

004

Form 1099-MISC

$

Miscellaneous

Income

$

3 Other income

4 Federal income tax withheld

Copy B

$

For Recipient

number

PAYER’S Federal identification

RECIPIENT’S identification

number

5 Fishing boat proceeds

6 Medical and health care payments

$

$

RECIPIENT’S name

Street address (including apt. no.)

City, state, and ZIP code

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

Account number (optional)

13 Excess golden parachute

payments

14 Gross proceeds paid to

an attorney

determines that it

has not been

reported.

$

$

15

16 State tax withheld

$

$

Form 1099-MISC

(keep for your records)

Department of the Treasury - Internal Revenue Service

□

1	Rents		
2	Royalties	

7Nonemployee compensation	8	Substitute payments in lieu of
dividends or interest	
			
products to a buyer	□		
(recipient) for resale			

17	State/Payer’s state no.	18	State income	

Instructions to Recipients

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.

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.

Individuals must report as explained below. Corporations, fiduciaries, or partnerships report the amounts on the proper line

of your tax return.

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

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”

Other Dispositions of Assets.

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 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

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 10. Report this amount on line 8 of Schedule F (Form 1040). 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 tax return as tax withheld.

income on your return.

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 15. Other information may be provided to you in box 15. Boxes 16–18. Shows state or local income tax withheld from the payments.

CORRECTED (if checked)

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

OMB No. 1545-0115

004

Form 1099-MISC

$

Miscellaneous

Income

$

3 Other income

4 Federal income tax withheld

$

$

number

PAYER’S Federal identification

RECIPIENT’S identification

number

5 Fishing boat proceeds

6 Medical and health care payments

Copy 2

To be filed

$

$

with

RECIPIENT’S name

Street address (including apt. no.)

City, state, and ZIP code

recipient’s

state income

tax return,

when

$

$

required.

Account number (optional)

13 Excess golden parachute

payments

14 Gross proceeds paid to

an attorney

$

$

15

16 State tax withheld

$

$

Form 1099-MI SC

Department of the Treasury - Internal Revenue Service

□

1	Rents		
2	Royalties		

7Nonemployee compensation	8	Substitute payments in lieu of
dividends or interest	
			
products to a buyer	□		
(recipient) for resale			

17	State/Payer’s state no.	18	State income	

VOID

CORRECTED

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

OMB No. 1545-0115

004

Form 1099-MISC

$

Miscellaneous

Income

$

3 Other income

4 Federal income tax withheld

$

$

Copy C

number

PAYER’S Federal identification

RECIPIENT’S identification

number

5 Fishing boat proceeds

6 Medical and health care payments

For Payer

$

$

RECIPIENT’S name

Street address (including apt. no.)

City, state, and ZIP code

For Privacy Act

and Paperwork

$

$

Reduction Act

Notice, see the

2004 General

Instructions for

Forms 1099,

1098, 5498,

Account number (optional)

2nd TIN not.

 13 Excess golden parachute

payments

14 Gross proceeds paid to

an attorney

and W-2G.

$

$

15

16 State tax withheld

$

$

Form 1099-MISC

Department of the Treasury - Internal Revenue Service

□
□

1	Rents		
2	Royalties		

7Nonemployee compensation	8	Substitute payments in lieu of
dividends or interest	
			
products to a buyer	□		
(recipient) for resale			

□

17	State/Payer’s state no.	18	State income	

Instructions for Payers

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).

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.

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.