Form 1099-CAP (Rev. April 2025)

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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

OMB No. 1545-1814
Form

2 Aggregate amount rec’d*

1099-CAP

(Rev. April 2025)
For calendar year

Changes in
Corporate
Control and
Capital Structure

$
CORPORATION’S TIN

SHAREHOLDER’S TIN

3 No. of shares exchanged

4 Classes of stock exchanged

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)
Form 1099-CAP (Rev. 4-2025)

Copy A

* The shareholder cannot claim a loss based on the
amount in box 2.
Cat. No. 35115M

www.irs.gov/Form1099CAP

For filing information,
Privacy Act, and
Paperwork Reduction
Act Notice, see the
General Instructions
for Certain
Information Returns.
www.irs.gov/Form1099

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

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

OMB No. 1545-1814
Form

2 Aggregate amount rec’d*

1099-CAP

(Rev. April 2025)
For calendar year

Changes in
Corporate
Control and
Capital Structure

$
CORPORATION’S TIN

SHAREHOLDER’S TIN

3 No. of shares exchanged

4 Classes of stock exchanged

Copy B
For Shareholder

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 (Rev. 4-2025)

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

(keep for your records)

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 chapter 4 of Pub. 550 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.
Free File Program. Go to www.irs.gov/FreeFile to see if
you qualify for no-cost online federal tax preparation,
e-filing, and direct deposit or payment options.