I CORRECTED ifcheck

I CORRECTED ifcheck PAYERS name. street address. city or town, state or province, country. ZIP or foreign postal code. and telephone no. 1 Rents OMB No. 1545-O115 PAYERS federal identification number RECIPIENTS identification number RECIPIENTS name Street address (including apt. no.) City or town. state or province. country. and ZIP or foreign postal code Account number (see instructions) 15a Section 409A deferrals $ Form 1099-MISC FATCA filing requirement 15b Section 409A income $ (keep fo your records) 2 Royalties 3 Other income $ S Fishing boat proceeds $ 7 Nonemployee compensation 8 Payer made direct sales of 55.000 or more of consumer products to a buyer reci for resale .• K 11 13 Excess golden parachute payments $ 16 State tax withheld $ $ vnAv.irs.gov/fom11088miac 2017 Form 1099-MISC Miscellaneous Income 4 Federal income tax withheld $ 6 Medical and health care partisan $ 8 Substitute payments n lieu of dividends or interest 10 Crop entrance proceeds $ t2 14 Gross proceeds paid to an attomey $ 17 State/Payer's state no. 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. 18 State income Department of the Treasury - Internal Revenue &tyke EFTA01222601