EFTA00176002

PAYER'S name, street address, city, state, ZIP code, and telephone no.	1 Rents	Cust No. 1846-0115 2004 Form 1099-MISC	Miscellaneous Income
	2 Royalties
	3 Other Income
	PAYER'S Federal identification number	RECIPIENT'S Identification number	8 Flashing boat proceeds	8 Medical and health care payments	Copy C For Payer or State Copy
66-0585379	66-0436649	$	$		Copy C For Payer or State Copy
RECIPIENT'S name, address, and ZIP code PAUL HOFFMAN P.C. E. VI 00804-0870	7 Nonemployee compensation	$25000.00	8 Substitute payments in lieu of dividends or interest	For Privacy Act and Paperwork Reduction Act Notice, see the 2004 General Instructions for Forms 1099, 1098, 5498, and W-2G.
	9 Payer made direct sales of $5,000 or more of consumer products to a buyer (replaced) for resale ▷	$	10 Crop insurance proceeds
	11	$	12
	13 Excess golden parachute payments	$	14 Gross proceeds paid to an attorney
15		18 State tax withheld	17 State/Payer's state no.	18 State Income

Form 1099-MISC Department of the Treasury - Internal Revenue Service □ VOID □ CORRECTED

PAYER'S name, street address, city, state, ZIP code, and telephone no.	1 Rents	OMB No. 1545-0115 2004 Form 1099-MISC	Miscellaneous Income
	2 Royalties	OMB No. 1545-0115 2004 Form 1099-MISC
	3 Other Income	4 Federal income tax withheld
	5 Fishing boat proceeds	6 Medical and health care payments
PAYER'S Federal identification number	RECIPIENT'S Identification number	6 Fishing boat proceeds		6 Medical and health care payments	Copy C For Payer or State Copy
RECIPIENT'S name, address, and ZIP code	7 Nonemployee compensation	0 Substitute payments in lieu of dividends or interest		For Privacy Act and Paperwork Reduction Act Notice, see the 2004 General Instructions for Forms 1099, 1098, 5498, and W-2G.
	9 Payer made direct sales of $5,000 or more of consumer products to a buyer (recipient) for resale ▷	10 Crop insurance proceeds
	11	12
Account number (optional)	2nd TIN not.	13 Excess golden parachute payments	14 Gross proceeds paid to an attorney
15		16 State tax withheld	17 State/Payer's state no.	18 State Income

Form 1099-MISC Department of the Treasury - Internal Revenue Service JEVIF003 | EFTA00176003 | | :--- | :--- ## Return this entire page to the Internal Revenue Service. Photocopies are not acceptable. Under perallitos of perjury, I declare that I have examined this return and accompanying documents, and, to the best of my knowledge and belief, they are true, correct, and complete. Signature ▶ COLLECTION & DEPOSIT SECTION - No. 2 ## Instructions Date > 2/11/04 Purpose of form. Use this form to transmit paper Forms 1099, 1098, 5498, and W-2G for National Revenue Service. Do not use Form 1096 to transmit electronic calls or magnetically. For magnetic media, see Form 4804. Transmission of information Returns Reported Magnetically; for electronic submissions, see Pub. 1220, Specifications for Filing Forms 1098, 1099, 5498 and W-2G Electronically or Magnetically. Who must file. The name, address, and TIN of the filer on this form must be the same as those you enter in the upper left area of Forms 1099, 1098, 5498, or W-2G. A filer includes a payer; a recipient of mortgage Interest payments (including points) or student loan Interest; an educational institution; a broker; a barter exchange; a creditor; a person reporting real estate transactions; a trustee or issuer of any Individual retirement arrangement, a Coverdell ESA, an Archer MSA (including a Medicare+Choice MSA); certain corporations; and a lender who acquires an interest in secured property or who has reason to know that the property has been abandoned. Preaddressed Form 1098, If you received a preaddressed Form 1096 from the IRS with Package 1099, use it to transmit paper Forms 1099, 1098, 5498, and W-2G to the Internal Revenue Service. If any of the preprinted information is incorrect, make corrections on the form. If you are not using a preaddressed form, enter the filer's name, address (including room, suite, or other unit number), and TIN in the spaces provided on the form. When to file. File Form 1096 with Forms 1099, 1098, or W-2G by March 1, 2004. File Form 1096 with Forms 5498, 5498-ESA, and 5498-MSA by May 31, 2004. ## Where To File Send all information returns filed on paper with Form 1096 to the following: If your principal business, office or agency, or legal residence in the case of an individual, is located in Use the following Internal Revenue Service Center address: Alabama, Arizona, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Texas, Austin, TX 7330 | Location | City | State | | :--- | :--- | :--- | | Arkansas, Connecticut, Delaware, Kentucky, Maine, Massachusetts, New Hampshire, New Jersey, New York, Ohio, Pennsylvania, Rhode Island, Vermont, West | Cincinnati, OH 4598 | | | Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Oklahoma, South Carolina, South Dakota, Tennessee, Wisconsin | | :--- | Kansas City, MO 6496 For more Information and the Privacy Act and Paperwork Reduction Act Notice, see the 2003 General Instructions for Forms 1098, 1098, 5498, and W-2G. Cat. No. 14400O Form 1096 (201 JEVÍF004