Case File
efta-efta01222602DOJ Data Set 9OtherI CORRECTED If check
Date
Unknown
Source
DOJ Data Set 9
Reference
efta-efta01222602
Pages
1
Persons
0
Integrity
Extracted Text (OCR)
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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Domain
irs.govPhone
1545-0115Forum Discussions
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