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1. Tax Year

Tax Year

2. Payer's Information

3. Recipient's Information

FATCA Filing Requirement

2nd TIN not.

4. Filing Information

Rents

Royalties

Other Income

Federal Income Tax Withheld

Fishing Boat Proceeds

Medical and Health Care Payments

Payer made direct sales totaling $5,000 or more of consumer products to recipients for resale

Substitute Payments in Lieu of Dividends or Interest

Crop Insurance Proceeds

Gross Proceeds Paid To an Attorney

Fish Purchased For Resale

Section 409A Deferrals

Excess Golden Parachute Payments

State Tax Withheld (Line 1)

State/Payer's State No. (Line 1)

State Income (Line 1)

Are any of the taxes withheld in a secondary state?

5. Email Information

Insert the e-mail address to which you want to receive your 1099-MISC form.

Your Email Address