Proceeds From Broker and Barter Exchange Transactions
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1 Attention! This form is provided for informational purposes and should not be reproduced on personal computer printers by individual taxpayers for filing. The printed version of this form is a "machine readable" form. As such, it must be printed using special paper, special inks, and within precise specifications. Additional information about the printing of these specialized tax forms can be found in: Publication 1167, Substitute Printed, Computer-Prepared, and Computer-Generated Tax Forms and Schedules; and, Publication 1179, Specifications for Paper Document Reporting and Paper Substitutes for Forms 1096, 1098, 1099 Series, 5498, and W-2G. The publications listed above may be obtained by calling TAX-FORM ( ). Be sure to order using the IRS publication number.
2 PAYER S name, street address, city, state, ZIP code, and telephone no. 1a Date of sale (MMDDYY) 1b CUSIP No. OMB No Proceeds From Broker and Barter Exchange Transactions 2 Stocks, bonds, etc. Reported Gross proceeds $ to IRS Gross proceeds less commissions and option premiums PAYER S Federal identification number RECIPIENT S identification number 3 Bartering 4 Federal income tax withheld RECIPIENT S name Street address (including apt. no.) 5 6 Description Regulated Futures Contracts Profit or (loss) realized in 1997 City, state, and ZIP code Account number (optional) 7979 VOID CORRECTED 2nd TIN Not. 8 Unrealized profit or (loss) on open contracts 12/31/97 7 Unrealized profit or (loss) on open contracts 12/31/96 9 Aggregate profit or (loss) Cat. No V Department of the Treasury - Internal Revenue Service Do NOT Cut or Separate Forms on This Page 97 Copy A For Internal Revenue Service Center File with Form For Paperwork Reduction Act Notice and instructions for completing this form, see Instructions for Forms 1099, 1098, 5498, and W-2G.
3 PAYER S name, street address, city, state, ZIP code, and telephone no. 1a Date of sale 1b CUSIP No. Proceeds From Broker and Barter Exchange Transactions 2 Stocks, bonds, etc. Reported Gross proceeds $ to IRS Gross proceeds less commissions and option premiums PAYER S Federal identification number RECIPIENT S identification number 3 Bartering 4 Federal income tax withheld RECIPIENT S name Street address (including apt. no.) 5 6 Description Regulated Futures Contracts Profit or (loss) realized in 1997 City, state, and ZIP code Account number (optional) CORRECTED (if checked) 8 Unrealized profit or (loss) on open contracts 12/31/97 (Keep for your records.) OMB No Unrealized profit or (loss) on open contracts 12/31/96 9 Aggregate profit or (loss) 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. Department of the Treasury - Internal Revenue Service
4 Instructions for Recipient Brokers and barter exchanges must report proceeds from transactions to the Internal Revenue Service. This form is used to report these proceeds. Box 1a. Shows the trade date of the transaction. For aggregate reporting, no entry will be present. Box 1b. For broker transactions, may show the CUSIP (Committee on Uniform Security Identification Procedures) number of the item reported. Box 2. Shows the proceeds from transactions involving stocks, bonds, other debt obligations, commodities, or forward contracts. Losses on forward contracts are shown in parentheses. This box does not include proceeds from regulated futures contracts. The broker must indicate whether gross proceeds or gross proceeds less commissions and option premiums were reported to the IRS. Report this amount on Schedule D (Form 1040), Capital Gains and Losses. Box 3. Shows the fair market value of any trade credits or scrip credited to your account for exchanges of property or services as well as cash received through a barter exchange. Report bartering income in the proper part of Form See Pub. 525, Taxable and Nontaxable Income, for information on how to report this income. Box 4. Shows backup withholding. For example, persons not furnishing their taxpayer identification number to the payer become subject to backup withholding at a 31% rate on certain payments. See Form W-9, Request for Taxpayer Identification Number and Certification, for information on backup withholding. Include this amount on your income tax return as tax withheld. Box 5. Shows a brief description of the item or service for which the proceeds or bartering income is being reported. For regulated futures contracts and forward contracts, RFC or other appropriate description, and any amount subject to backup withholding, may be shown. Box 6. Shows the profit or (loss) realized on regulated futures or foreign currency contracts closed during Box 7. Shows any year-end adjustment to the profit or (loss) shown in box 6 due to open contracts on December 31, Box 8. Shows the unrealized profit or (loss) on open contracts held in your account on December 31, These are considered sold as of that date. This will become an adjustment reported in box 7 in Box 9. Boxes 6, 7, and 8 are used to figure the aggregate profit or (loss) on regulated futures or foreign currency contracts for the year. Include this figure on your 1997 Form 6781, Gains and Losses From Section 1256 Contracts and Straddles.
5 PAYER S name, street address, city, state, ZIP code, and telephone no. 1a Date of sale 1b CUSIP No. Proceeds From Broker and Barter Exchange Transactions 2 Stocks, bonds, etc. Reported Gross proceeds $ to IRS Gross proceeds less commissions and option premiums PAYER S Federal identification number RECIPIENT S identification number 3 Bartering 4 Federal income tax withheld RECIPIENT S name Street address (including apt. no.) 5 6 Description Regulated Futures Contracts Profit or (loss) realized in 1997 City, state, and ZIP code Account number (optional) VOID CORRECTED 2nd TIN Not. 8 Unrealized profit or (loss) on open contracts 12/31/97 OMB No Unrealized profit or (loss) on open contracts 12/31/96 9 Aggregate profit or (loss) Copy C For Payer For Paperwork Reduction Act Notice and instructions for completing this form, see Instructions for Forms 1099, 1098, 5498, and W-2G. Department of the Treasury - Internal Revenue Service
6 Payers, Please Note Specific information needed to complete this form and other forms in the 1099 series is given in the 1997 Instructions for Forms 1099, 1098, 5498, and W-2G. A chart in those instructions gives a quick guide to which form must be filed to report a particular payment. You can order those instructions and additional forms by calling TAX-FORM ( ). Furnish Copy B of this form to the recipient by February 2, File Copy A of this form with the IRS by March 2, 1998.
Additional information about the printing of these specialized tax forms can be found in IRS Publications 1141, 1167, 1179, and other IRS resources.
Attention: This form is provided for informational purposes and should not be reproduced on personal computer printers by individual taxpayers for filing. The printed version of this form is designed as
Proceeds From Broker and Barter Exchange Transactions
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Certain Government Payments
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Dividends and Distributions
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Original Issue Discount
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Additional information about the printing of these specialized tax forms can be found in IRS Publications 1141, 1167, 1179, and other IRS resources.
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$ 2 Royalties. 3 Other income. 8 Substitute payments in lieu of dividends or interest. Department of the Treasury - Internal Revenue Service
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Mortgage Interest Statement
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2 Royalties. 3 Other income. 8 Substitute payments in lieu of dividends or interest. Department of the Treasury - Internal Revenue Service
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CORRECTED OMB No For DEBTOR S name. 3 Interest if included in box 2 4
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9191 VOID CORRECTED Street address (including apt. no.) 4 Federal income tax withheld 5 Investment expenses 3 Nontaxable distributions Account number (optional) 2nd TIN not. 8 Cash liquidation distr. 9
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2 Royalties. 3 Other income. 8 Substitute payments in lieu of dividends or interest. Cat. No J
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Shareholder s Statement of IC-DISC Distributions 1997
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CORRECTED OMB No For DEBTOR S name. 3 Interest if included in box 2 4
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3 Type of wager 4 Date won. 5 Transaction 6 Race. 7 Winnings from identical wagers 8 Cashier. 9 Winner s taxpayer identification no.
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