Form 1099-B Proceeds from Broker and Barter Exchange Transactions

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This form is provided for informational purposes only. Copy A appears in red, similar
to the official IRS form. Do not file copy A downloaded from this website. The official
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about printing these tax forms.

7979

VOID

CORRECTED

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

1a Date of sale or exchange

OMB No. 1545-0715

2010

1b CUSIP no.

Form
2 Stocks, bonds, etc.

$
PAYER’S federal identification number

RECIPIENT’S identification number

Reported
to IRS

Proceeds From
Broker and
Barter Exchange
Transactions

1099-B

其

Gross proceeds
Gross proceeds less commissions and option premiums

3 Bartering

4 Federal income tax withheld

$

$

RECIPIENT’S name

5 No. of shares exchanged

6 Classes of stock
exchanged

Street address (including apt. no.)

7 Description

Copy A
For
Internal Revenue
Service Center
File with Form 1096.

City, state, and ZIP code

8 Profit or (loss) realized in
2010

9 Unrealized profit or (loss) on
open contracts—12/31/2009

$

$

10 Unrealized profit or (loss) on 11 Aggregate profit or (loss)
open contracts–12/31/2010

CORPORATION’S name

$
Account number (see instructions)

Form

1099-B

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

$

2nd TIN not. 12 Check the box if recipient cannot take a loss on their tax
return based on the amount in box 2

Cat. No. 14411V

Do Not Cut or Separate Forms on This Page

—

Department of the Treasury - Internal Revenue Service

Do Not Cut or Separate Forms on This Page

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

2010

1b CUSIP no.

Form
2 Stocks, bonds, etc.

$
PAYER’S federal identification number

RECIPIENT’S name

RECIPIENT’S identification number

Reported
to IRS

Proceeds From
Broker and
Barter Exchange
Transactions

1099-B

其

Gross proceeds
Gross proceeds less commissions and option premiums

3 Bartering

4 Federal income tax withheld

$

$

5 No. of shares exchanged

6 Classes of stock
exchanged

Street address (including apt. no.)

7 Description

City, state, and ZIP code

8 Profit or (loss) realized in
2010

9 Unrealized profit or (loss) on
open contracts—12/31/2009

$

$

CORPORATION’S name

10 Unrealized profit or (loss) on 11 Aggregate profit or (loss)
open contracts–12/31/2010

$
Account number (see instructions)

Form

1099-B

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.

$

12 If the box is checked, the recipient cannot take a loss on
their tax return based on the amount in box 2

(keep for your records)

Department of the Treasury - Internal Revenue Service

Instructions for Recipient
Brokers and barter exchanges must report proceeds from
transactions to you and the IRS on Form 1099-B. Reporting is also
required when your broker knows or has reason to know that a
corporation in which you own stock has had a change in control or a
substantial change in capital structure. You may be required to
recognize gain from the receipt of cash, stock, or other property that
was exchanged for the corporation’s stock. If your broker reported
this type of transaction to you, the corporation is identified in the
box below your name and address on Form 1099-B.
Recipient’s identification number. For your protection, this form
may show only the last four digits of your social security number
(SSN), individual taxpayer identification number (ITIN), or adoption
taxpayer identification number (ATIN). However, the issuer has
reported your complete identification number to the IRS and, where
applicable, to state and/or local governments.
Account number. May show an account or other unique number the
payer assigned to distinguish your account.
Box 1a. Shows the trade date of the transaction. For aggregate
reporting, no entry will be present.
Box 1b. For broker transactions, may show the CUSIP (Committee
on Uniform Security Identification Procedures) number of the item
reported.
Box 2. Shows the aggregate cash proceeds from transactions
involving stocks, bonds, other debt obligations, commodities, or
forward contracts. May show the proceeds from the disposition of
your interest(s) in a widely held fixed investment trust. May also
show the aggregate amount of cash and the fair market value of any
stock or other property received in a change in control or substantial
change in capital structure arising from the corporate transfer of
property to a foreign corporation. Losses on forward contracts are
shown in parentheses. This box does not include proceeds from
regulated futures contracts. The broker must indicate whether gross
proceeds or gross proceeds less commissions and option premiums
were reported to the IRS. Report this amount on Schedule D (Form
1040), Capital Gains and Losses. But, for changes in control or
substantial changes in capital structure, see box 12.

Box 3. Shows the cash you received, the fair market value of any
property or services you received, and/or the fair market value of any
trade credits or scrip credited to your account by a barter exchange.
See Pub. 525, Taxable and Nontaxable Income, for information on
how to report this income.
Box 4. Shows backup withholding. Generally, a payer must backup
withhold at a 28% rate if you did not furnish your taxpayer
identification number to the payer. See Form W-9, Request for
Taxpayer Identification Number and Certification, for information on
backup withholding. Include this amount on your income tax return
as tax withheld.
Box 5. Shows the number of shares of the corporation’s stock that
you held which were exchanged in the change in control or
substantial change in capital structure.
Box 6. Shows the class or classes of the corporation’s stock that
were exchanged in the change in control or substantial change in
capital structure.
Box 7. Shows a brief description of the item or service for which the
proceeds or bartering income is being reported. For regulated
futures contracts and forward contracts, “RFC” or other appropriate
description may be shown.
Regulated Futures Contracts:
Box 8. Shows the profit or (loss) realized on regulated futures or
foreign currency contracts closed during 2010.
Box 9. Shows any year-end adjustment to the profit or (loss) shown
in box 8 due to open contracts on December 31, 2009.
Box 10. Shows the unrealized profit or (loss) on open contracts held
in your account on December 31, 2010. These are considered sold
as of that date. This will become an adjustment reported in box 9 in
2011.
Box 11. Boxes 8, 9, and 10 are all used to figure the aggregate
profit or (loss) on regulated futures or foreign currency contracts for
the year. Include this amount on your 2010 Form 6781.
Box 12. If checked, you cannot take a loss on your tax return based
on gross proceeds from an acquisition of control or substantial
change in capital structure reported in box 2. Do not report this loss
on Schedule D (Form 1040). The broker should advise you of any
losses on a separate statement.

VOID

CORRECTED

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

1a Date of sale or exchange

OMB No. 1545-0715

2010

1b CUSIP no.

Form
2 Stocks, bonds, etc.

$
PAYER’S federal identification number

RECIPIENT’S name

RECIPIENT’S identification number

Reported
to IRS

Proceeds From
Broker and
Barter Exchange
Transactions

1099-B

其

Gross proceeds
Gross proceeds less commissions and option premiums

3 Bartering

4 Federal income tax withheld

$

$

5 No. of shares exchanged

6 Classes of stock
exchanged

Street address (including apt. no.)

7 Description

City, state, and ZIP code

8 Profit or (loss) realized in
2010

9 Unrealized profit or (loss) on
open contracts—12/31/2009

$

$

CORPORATION’S name

Form

1099-B

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

10 Unrealized profit or (loss) on 11 Aggregate profit or (loss)
open contracts–12/31/2010

$
Account number (see instructions)

Copy C
For Payer

$

2nd TIN not. 12 Check the box if recipient cannot take a loss on their tax
return based on the amount in box 2

Department of the Treasury - Internal Revenue Service

Instructions for Payer
General and specific form instructions are provided as
separate products. The products you should use for
2010 are the General Instructions for Certain
Information Returns and the 2010 Instructions for Form
1099-B. 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.
Due dates. Furnish Copy B of this form to the
recipient by February 15, 2011.
File Copy A of this form with the IRS by
February 28, 2011. If you 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, 8935, and W-2G
Electronically. IRS does not provide a fill-in form
option.
Foreign recipient. If the recipient of the proceeds is a
nonresident alien, you may have to withhold federal
income tax and file Form 1042-S, Foreign Person’s
U.S. Source Income Subject to Withholding. See the
Instructions for Form 1042-S and Pub. 515,
Withholding of Tax on Nonresident Aliens and Foreign
Entities.
Need help? If you have questions about reporting on
Form 1099-B, 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,
call 304-579-4827 (not toll free). The hours of operation
are Monday through Friday from 8:30 a.m. to
4:30 p.m., Eastern time.