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efta-efta01222602DOJ Data Set 9Other

I CORRECTED If check

Date
Unknown
Source
DOJ Data Set 9
Reference
efta-efta01222602
Pages
1
Persons
0
Integrity

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EFTA Disclosure
Text extracted via OCR from the original document. May contain errors from the scanning process.
I CORRECTED If check PAYERS name. street address, city or town, state or province. country. ZIP or foreign postal code. and telephone no. PAYER'S TIN RECIPIENTS TIN 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) 1 Rents 2 Royalties 3 Other income $ S Fishing boat proceeds $ 7 Nonemployee compensation 9 Payer made direct sales of $5,000 or more of consumer products to a buyer reci for resale f• K 11 13 Excess golden parachute payments 16 State tax withheld $ $ VNNI irs.gov/Form1099MISC OMB No. 1545-0115 2018 Form 1099-MISC Miscellaneous Income 4 Federal income tax withheld $ 6 Medical arid health care perm.% $ 8 Substitute payments ri lieu of dividends or interest 10 Crop inurance proceeds $ 12 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 IRS. If you am 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 SeMoe EFTA01222602

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Domainirs.gov
Phone1545-0115

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