Form 1099-MISC Miscillaneous Income

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Page 1 of 10 of Form 1099-MISC (PAGE 2 IS BLANK)

Date

4

Action

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reproduction proofs. MUST be removed before printing.

O.K. to print
T:FP:F

Separation 1 for page 1 of Form 1099-MISC. Prints in
Red (J-6983) Ink.
Separation 2 for page 1 of Form 1099-MISC. Prints in Black Ink.

O.K. to print
Responsible
scan organization

Date

Signature

Revised proofs
requested

Ok to print as is 

✔
Ok to print as corrected 

9595

VOID

CORRECTED

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

1

Rents

OMB No. 1545-0115

10

$
2

Royalties

Form

$
3

Other income

$
PAYER’S federal identification
number

RECIPIENT’S identification
number

5

$
RECIPIENT’S name

7

9

City, state, and ZIP code

2nd TIN not. 13

$

12

Excess golden parachute 14 Gross proceeds paid to
payments
an attorney

$
15a Section 409A deferrals

$
Form

16

15b Section 409A income

1099-MISC

For
Internal Revenue
Service Center
File with Form 1096.

For Privacy Act
and Paperwork
Reduction Act
Notice, see the
2010 General
Instructions for
Certain
Information
Returns.

17 State/Payer’s state no.

18 State income

$
$

Cat. No. 14425J

Do Not Cut or Separate Forms on This Page

Copy A

$
State tax withheld

$
$

$

8 Substitute payments in lieu of
dividends or interest

Payer made direct sales of
10 Crop insurance proceeds
$5,000 or more of consumer
products to a buyer
(recipient) for resale 䊳
$

11

Account number (see instructions)

6 Medical and health care payments

$
Nonemployee compensation

$
Street address (including apt. no.)

1099-MISC

4 Federal income tax withheld

$
Fishing boat proceeds

Miscellaneous
Income

—

Department of the Treasury - Internal Revenue Service

Do Not Cut or Separate Forms on This Page

D

Page 3 of 10 Form 1099-MISC

(Page 4 is blank)

4

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

VOID

CORRECTED

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

1

Rents

OMB No. 1545-0115

10

$
2

Royalties

Form

$
3

Other income

$
PAYER’S federal identification
number

RECIPIENT’S identification
number

5

7

9

$
Payer made direct sales of
10 Crop insurance proceeds
$5,000 or more of consumer
products to a buyer
(recipient) for resale 䊳
$

11

12

Account number (see instructions)

13

Excess golden parachute 14 Gross proceeds paid to
payments
an attorney

$

$
Form

15b Section 409A income

$
1099-MISC

16

$
$

For State Tax
Department

8 Substitute payments in lieu of
dividends or interest

City, state, and ZIP code

15a Section 409A deferrals

Copy 1

6 Medical and health care payments

$
Nonemployee compensation

$
Street address (including apt. no.)

1099-MISC

4 Federal income tax withheld

$
Fishing boat proceeds

$
RECIPIENT’S name

Miscellaneous
Income

$
State tax withheld

17 State/Payer’s state no.

18 State income

$
$
Department of the Treasury - Internal Revenue Service

4

Page 5 of 10 Form 1099-MISC

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

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

1

Rents

OMB No. 1545-0115

10

$
2

Royalties

Form

$
3

Other income

RECIPIENT’S identification
number

5

Fishing boat proceeds

$
RECIPIENT’S name

7

9

6 Medical and health care payments

8 Substitute payments in lieu of
dividends or interest

$
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 (see instructions)

13

Excess golden parachute 14 Gross proceeds paid to
payments
an attorney

$
15a Section 409A deferrals

$
Form

15b Section 409A income

$
1099-MISC

16

Copy B
For Recipient

$
Nonemployee compensation

$
Street address (including apt. no.)

1099-MISC

4 Federal income tax withheld

$

$
PAYER’S federal identification
number

Miscellaneous
Income

$
State tax withheld

$
$
(keep for your records)

17 State/Payer’s state no.

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.
18 State income

$
$
Department of the Treasury - Internal Revenue Service

4

Page 6 of 10 of Form 1099-MISC

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

Form 1099-MISC incorrect? If this form is incorrect or has been issued in
error, contact the payer. If you cannot get this form corrected, attach an
explanation to your tax return and report your income correctly.

and attach it to your
return
get the payer to
correct this form,

must report the amounts on the proper line of their tax returns.

Instructions for Recipients

D

Account number. May show an account or other unique number the
payer assigned to distinguish your account.
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
y and
Pub. 334 for more information. If no income or social security
Medicare taxes were withheld and you are still receiving these
payments, see Form 1040-ES, Estimated Tax for Individuals.
p
these amounts as explained in the box 7
Individuals must report
instructions on this page. Corporations, fiduciaries, or partnerships
report the amounts on the proper line of your tax return.
p
Boxes 1 and 2. Report
rents from real estate on Schedule E ((Form
1040). However, report rents on Schedule C or C-EZ (Form 1040) if
you provided significant services to the tenant, sold real estate as a
y
business, rented personal property as a business, or you and your
p
p
spouse
elected to be treated as a q
qualified jjoint venture. Report
royalties
y
from oil, g
gas, or mineral properties
p p
(excluding
(
operating
interests) on Schedule E (Form 1040). However, for royalties on timber,
coal, and iron ore, see Pub. 544.
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, payments from a
former employer because you are serving in the Armed Forces or the
National Guard for a period of 30 or fewer days, or other taxable
income. See Pub. 525. 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, and
Pub. 505, for more information. Report this amount on your income
tax return as tax withheld.
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. 334.

Delete comma

report
payments for a
working
interest as
explained in
the box 7
instructions.
For

Box 6. For individuals, 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 tax.
Contact the payer if you believe this form is incorrect or has been issued in
error. If you believe you are an employee and cannot get this form corrected,
report the amount from box 7 on Form 1040, line 7 (or Form 1040NR, line 8).
You must also complete and attach to your return Form 8919, Uncollected
Social Security and Medicare Tax on Wages.
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” line of Form 1040.
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 where to report.
Box 14. Shows gross proceeds paid to an attorney in connection with
legal services. Report only the taxable part as income on your return.
Box 15a. May show current year deferrals as a nonemployee under a
nonqualified deferred compensation (NQDC) plan that is subject to the
requirements of section 409A, plus any earnings on current and prior
year deferrals.
Box 15b. Shows income as a nonemployee under an NQDC plan that
does not meet the requirements of section 409A. This amount is also
included in box 7 as nonemployee compensation. Any amount
included in box 15a that is currently taxable is also included in this
box. This income is also subject to a substantial additional tax to be
reported on Form 1040. See “Total Tax” in the Form 1040 instructions.
Boxes 16–18. Shows state or local income tax withheld from the
payments.

Delete "(excluding operating
interests)"

Page 7 of 10 Form 1099-MISC

(Page 8 is blank)

4

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

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

1

Rents

OMB No. 1545-0115

10

$
2

Royalties

Form

$
3

Other income

$
PAYER’S federal identification
number

RECIPIENT’S identification
number

5

7

9

6 Medical and health care payments

8 Substitute payments in lieu of
dividends or interest

$
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 (see instructions)

13

Excess golden parachute 14 Gross proceeds paid to
payments
an attorney

$
15a Section 409A deferrals

$
Form

15b Section 409A income

$
1099-MISC

16

$
$

Copy 2
To be filed
with
recipient’s
state income
tax return,
when
required.

$
Nonemployee compensation

$
Street address (including apt. no.)

1099-MISC

4 Federal income tax withheld

$
Fishing boat proceeds

$
RECIPIENT’S name

Miscellaneous
Income

$
State tax withheld

17 State/Payer’s state no.

18 State income

$
$
Department of the Treasury - Internal Revenue Service

Page 9 of 10 Form 1099-MISC

4

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

VOID

CORRECTED

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

1

Rents

OMB No. 1545-0115

10

$
2

Royalties

Form

$
3

Other income

$
PAYER’S federal identification
number

RECIPIENT’S identification
number

5

7

9

City, state, and ZIP code

2nd TIN not. 13

$
Form

15b Section 409A income

$
1099-MISC

16

$
$

8 Substitute payments in lieu of
dividends or interest

$

12

Excess golden parachute 14 Gross proceeds paid to
payments
an attorney

$
15a Section 409A deferrals

For Payer

Payer made direct sales of
10 Crop insurance proceeds
$5,000 or more of consumer
products to a buyer
(recipient) for resale 䊳
$

11

Account number (see instructions)

Copy C

6 Medical and health care payments

$
Nonemployee compensation

$
Street address (including apt. no.)

1099-MISC

4 Federal income tax withheld

$
Fishing boat proceeds

$
RECIPIENT’S name

Miscellaneous
Income

For Privacy Act
and Paperwork
Reduction Act
Notice, see the
2010 General
Instructions for
Certain
Information
Returns.

$
State tax withheld

17 State/Payer’s state no.

18 State income

$
$
Department of the Treasury - Internal Revenue Service

D

4

Page 10 of 10 of Form 1099-MISC

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

Instructions for Payers

D

General and specific form instructions are
provided as separate products. The products you
should use to complete Form 1099-MISC are the
2010 General Instructions for Certain Information
Returns and the 2010 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, visit the IRS
website at www.irs.gov or 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, 3921, 3922, or 5498 that
you print from the IRS website.

py A of this form with the IRS by
File Copy
February 28, 2011. If yyou file electronically, the
due date is March 31, 2011. To file electronically,
you must have software that generates a file
according to the specifications in Pub. 1220,
Specifications for Filing Forms 1098, 1099, 3921,
3922, 5498, and W-2G Electronically. IRS does 8935,/
not provide a fill-in form option.
Need help? If you have questions about reporting
on Form 1099-MISC, call the information reporting
customer service site toll free at 1-866-455-7438
or 304-263-8700 ((not toll free).) For TTY/TDD
equipment,
q p
, call 304-579-4827 ((not toll free).) The
hours of operation
p
are Mondayy through Friday
8:30 a.m. to 4:30 p.m., Eastern time.

Due dates. Furnish Copy
py B of this form to the
recipient by January 31,, 2011. The due date is
extended to February 15, 2011, if you are
reporting payments in boxes 8 or 14.
Printed on recycled paper