1099 Sample Forms

 CORRECTED (if checked) 
PAYER'S name, street address, city, state, ZIP code, and telephone no.

  		1a Date of sale or exchange
OMB No. 1545-0715


2006


Form 1099-B		Proceeds From
Broker and
Barter Exchange
Transactions
1b CUSIP no.
2 Stocks, bonds, etc.

$ 		Reported
to IRS		}Gross Proceeds
Gross proceeds less commissions and option premiums
PAYER'S federal identification number

 		RECIPIENT'S identification number

 		3 Bartering

$  		4 Federal income tax withheld

$  		Copy B
For Recipient
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 determines
that it has not been
reported.
RECIPIENT'S name

 


Street address (including apt. no.)

 


City, State, and ZIP code

 		5 No. of shares exchanged


6 Classes of stock
exchanged
7 Description
8 Profit or (loss) realized in
2006

$ 		9 Unrealized profit or (loss) on
open contracts - 12/31/2005

$ 
CORPORATION'S name

 		10 Unrealized profit or (loss) on
open contracts - 12/31/2006

$  		11 Aggregate profit or (loss)


$ 
Account number (see instructions)

 		12 If the box is checked, the recipient cannot take a loss on
thier tax return based on the amount in box 2 . .
Form 1099-B(keep for your records)Department of the Treasury - Internal Revenue Service




 CORRECTED (if checked) 
PAYER'S name, street address, city, state, ZIP code, and telephone no.

  		1a Total ordinary dividends

$  
OMB No. 1545-0110


2006


Form 1099-DIV		Dividends and
Distributions
1b Qualified dividends

$  
2a Total Capital gain distr.


$ 		2b Unrecap. Sec. 1250 gain


$ 		Copy B
For Recipient
PAYER'S federal identification
number

 		RECIPIENT'S identification
number

 		  
RECIPIENT'S name

 


Street address (including apt. no.)

 


City, State, and ZIP code

 		2c Section 1202 gain

$ 		2d Collectibles (28%) gain

$ 		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
saction may be
imposed on you
if this income is
taxable and the
IRS determines
that it has not
been reported.
3 Nondividend distributions

$ 		4 Federal income tax withheld

$ 
 5 Investment expenses

$ 
6 Foreign tax paid


$ 		7 Foreign country or U.S.
possession

 
Account number (see instructions)


 		8 Cash liquidation
distributions

$ 		9 Noncash Liquidation
distributions

$ 


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




 CORRECTED (if checked) 
PAYER'S name, street address, city, state, ZIP code, and telephone no.

  		Payer's RTN (optional)

 
OMB No. 1545-0112



2006



Form 1099-INT		Interest Income
1 Interest income

$ 
2 Early withdrawal penalty

$ 
PAYER'S federal identification number

 		RECIPIENT'S identification number

 		3 Interest on U.S. Savings Bonds and Treas. obligations

$ 		Copy B
For Recipient
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 determines
that it has not been
reported.
RECIPIENT'S name

 


Street address (including apt. no.)

 


City, State, and ZIP code

 		4 Federal income tax withheld


$ 		5 Investment expenses


$ 
6 Foreign tax paid


$ 		7 Foreign country or U.S.
possession
8 Tax exempt interest




$ 		9 Specified private activity
bond interest



$ 
Account number (see instructions)

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




 CORRECTED (if checked) 
PAYER'S name, street address, city, state, ZIP code, and telephone no.

  		1 Rents

$ 
OMB No. 1545-0115


2006


Form 1099-MISC		Miscellaneous
Income
2 Royalties

$ 
3 Other Income

$ 		4 Federal income tax withheld

$ 		Copy B
For Recipient
PAYER'S federal identification
number

 		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

 		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 required to
file a return, a
negligence
penalty or other
saction may be
imposed on you
if this income is
taxable and the
IRS determines
that it has not
been reported.
9 Payer made direct sales of
$5,000 or more of consumer
products to a buyer
(recipient) for resale ›		10 Crop insurance proceeds




$ 
11

 		12

 
Account number (see instructions)


 		13 Excess golden parachute
payments

$ 		14 Gross proceeds paid to
an attorney

$ 
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 for your records)Department of the Treasury - Internal Revenue Service