Form 1099-CAP Changes in Corporate Control and Capital Structure

7373

VOID

CORRECTED

CORPORATION'S name, street address, city or town, state or province,
country, ZIP or foreign postal code, and telephone no.

1 Date of sale or exchange
2 Aggregate amount rec'd*

OMB No. 1545-1814

2019

Changes in
Corporate
Control and
Capital Structure

$

Form 1099-CAP

3 No. of shares exchanged

4 Classes of stock exchanged

Copy A
CORPORATION'S TIN

SHAREHOLDER'S TIN

For
Internal Revenue
Service Center

SHAREHOLDER'S name

Street address (including apt. no.)
5
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)

* The shareholder cannot claim a loss based on the
amount in box 2.

File with Form 1096.
For Paperwork
Reduction Act
Notice, see the
2019 General
Instructions for
Certain Information
Returns.

1099-CAP
Cat. No. 35115M
www.irs.gov/Form1099CAP
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

Form

CORRECTED (if checked)
CORPORATION'S name, street address, city or town, state or province,
country, ZIP or foreign postal code, and telephone no.

1 Date of sale or exchange
2 Aggregate amount rec'd*

OMB No. 1545-1814

2019

Changes in
Corporate
Control and
Capital Structure

$

Form 1099-CAP

3 No. of shares exchanged

4 Classes of stock exchanged

Copy B
CORPORATION'S TIN

For Shareholder

SHAREHOLDER'S TIN

SHAREHOLDER'S name

Street address (including apt. no.)
5
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)
Form

1099-CAP

(keep for your records)

* You cannot claim a loss based on the amount in box 2.
www.irs.gov/Form1099CAP

This is important tax
information and is being
furnished to the IRS. If
you are required to file a
return, a negligence
penalty or other
sanction may be
imposed on you if
taxable income results
from this transaction
and the IRS determines
that it has not been
reported.

Department of the Treasury - Internal Revenue Service

Instructions for Shareholder
A corporation in which you own stock that has had a
change in control or a substantial change in capital
structure must send you this statement by January 31 of
the year following the calendar year of the change. You
have received this statement because the corporation
has reasonably determined that you may be required to
recognize gain from the receipt of cash, stock, or other
property that was exchanged for the corporation’s
stock. Report any gain from the exchange on Form
8949. However, you cannot claim a (loss) on Form 8949
as a result of this exchange. See Pub. 550, chapter 4,
for additional information.
Shareholder's taxpayer identification number (TIN).
For your protection, this form may show only the last
four digits of your TIN (social security number (SSN),
individual taxpayer identification number (ITIN), adoption
taxpayer identification number (ATIN), or employer
identification number (EIN)). However, the issuer has
reported your complete TIN to the IRS.

Account number. May show an account or other
unique number the payer corporation assigned to
distinguish your account.
Box 1. Shows the date the stock was exchanged for
cash, stock, or other property.
Box 2. Shows the aggregate amount of any cash and
the fair market value of any stock or other property
received by you in the exchange for the stock you held.
Box 3. Shows the number of shares of the corporation’s
stock that you held which were exchanged in the
transaction.
Box 4. Shows the class or classes of stock that were
exchanged.
Future developments. For the latest information about
developments related to Form 1099-CAP and its
instructions, such as legislation enacted after they were
published, go to www.irs.gov/Form1099CAP.

VOID

CORRECTED

CORPORATION'S name, street address, city or town, state or province,
country, ZIP or foreign postal code, and telephone no.

1 Date of sale or exchange
2 Aggregate amount rec'd*

OMB No. 1545-1814

2019

Changes in
Corporate
Control and
Capital Structure

$

Form 1099-CAP

3 No. of shares exchanged

4 Classes of stock exchanged

Copy C
CORPORATION'S TIN

For Corporation

SHAREHOLDER'S TIN

For Paperwork
Reduction Act
Notice, see the
2019 General
Instructions for
Certain Information
Returns.

SHAREHOLDER'S name

Street address (including apt. no.)
5
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)
Form

1099-CAP

* The shareholder cannot claim a loss based on the
amount in box 2.
www.irs.gov/Form1099CAP

Department of the Treasury - Internal Revenue Service

Instructions for Corporation
To complete Form 1099-CAP, use:
• The 2019 General Instructions for Certain Information
Returns, and
• The 2019 Instructions for Form 1099-CAP.
To get or to order these instructions, go to
www.irs.gov/Form1099CAP.
Due dates. Generally, furnish Copy B of this form to the
shareholder by January 31, 2020. However, if the
recipient is a clearing organization, furnish Copy B by
January 7, 2020.

File Copy A of this form with the IRS by
February 28, 2020. If you file electronically, the due date
is March 31, 2020. To file electronically, you must have
software that generates a file according to the
specifications in Pub. 1220.
Need help? If you have questions about reporting on
Form 1099-CAP, call the information reporting customer
service site toll free at 866-455-7438 or 304-263-8700
(not toll free). Persons with a hearing or speech
disability with access to TTY/TDD equipment can call
304-579-4827 (not toll free).