EFTA00176042

<table><thead><tr><th rowspan="4">PAYER&#39;s name, street address, city, state, ZIP code, and telephone no.</th><td>1 Renta</td><td rowspan="2">Ohio No. 1545-0115<br>2006<br>Form 1099-MISC</td><td rowspan="4" colspan="2">Miscellaneous Income</td></tr><tr><td>$</td></tr><tr><td>2 Royalties</td><td>$</td></tr><tr><td>3 Other income</td><td>$</td></tr></thead><tbody><tr><td>PAYER&#39;s federal identification number</td><td>RECIPIENT&#39;s identification number</td><td>5 Fishing boat proceeds</td><td>4 Federal income tax withheld</td><td rowspan="2">State Copy or Extra File Copy</td></tr><tr><td>66-0567418</td><td>66-0473483</td><td>$</td><td>6 Medical and health care payments</td></tr><tr><td rowspan="3">RECIPIENT&#39;s name, address, and ZIP code</td><td>7 Nonemployee compensation</td><td>$ 796.64</td><td>8 Subsidize payments in lieu of dividends or interest</td><td rowspan="4"></td></tr><tr><td>9 Payer made direct sales of $5,000 or more consumer products to a buyer (recipient) for reads □</td><td></td><td>10 Crop insurance proceeds</td></tr><tr><td>11</td><td></td><td>12</td></tr><tr><td colspan="2">Account number (see instructions)</td><td>13 Excess golden parachute payments</td><td>14 Gross proceeds paid to an attorney</td></tr><tr><td>15a Section 409A deferrals</td><td>15b Section 409A Income</td><td>16 State tax withheld</td><td>17 State/Payer&#39;s state no.</td><td>18 State Income</td></tr></tbody></table>

Department of the Treasury - Internal Revenue Service

<table><thead><tr><th rowspan="4">PAYER&#39;s name, street address, city, state, ZIP code, and telephone no.</th><td>1 Rents</td><td rowspan="3">OMB No. 1545-0115<br>2006<br>Form 1099-MISC</td><td rowspan="3" colspan="2">Miscellaneous Income</td></tr><tr><td>$</td></tr><tr><td>$</td></tr></thead><tbody><tr><td></td><td>2 Royalties</td><td></td><td></td><td></td></tr><tr><td></td><td>3 Other Income</td><td colspan="2">4 Federal income tax withheld</td><td rowspan="2">State Copy or Extra File Copy</td></tr><tr><td></td><td>$</td><td colspan="2">6 Medical and health care payments</td></tr><tr><td>PAYER&#39;s federal identification number<br>66-0567418</td><td>RECIPIENT&#39;s identification number<br>66-0578959</td><td colspan="2">8 Fishing boat proceeds</td><td></td></tr><tr><td rowspan="3">RECIPIENT&#39;s name, address, and ZIP code<br>MARJORIE RAWLS ROBERTS<br>DO BOX 6047<br>ST. THOMAS, VI 00804-6247</td><td>7 Nonemployee compensation<br>$22,373.16</td><td colspan="2">8 Substitute payments to lieu of dividends or interest</td><td rowspan="4"></td></tr><tr><td>8 Payer made direct sales of $5,000 or more of consumer products to a buyer (recipient) for, retail ▷</td><td colspan="2">10 Crop insurance proceeds</td></tr><tr><td>11 Excess golden parachute payments</td><td colspan="2">12 Groca proceeds paid to an attorney</td></tr><tr><td colspan="2">Account number (see instructions)</td><td colspan="2">13 Excess golden parachute payments</td><td>14 Groca proceeds paid to an attorney</td></tr><tr><td>15a Section 409A deferrals</td><td>15b Section 409A Income</td><td colspan="2">18 State tax withhold</td><td>17 State/Payer&#39;s state no.</td><td>18 State income</td></tr></tbody></table>

Form 1099-MISC

Department of the Treasury - Internal Revenue Service

FTC0032

EFTA00176043

<table><thead><tr><th rowspan="4">PAYER&#39;s name, street address, city, state, ZIP code, and telephone no.</th><td>1 Runte</td><td rowspan="2">OMB No. 1545-0115<br>2006<br>Form 1099-MISC</td><td rowspan="4">Miscellaneous Income</td></tr><tr><td>$</td></tr><tr><td>2 Royalties</td><td>$</td></tr><tr><td>3 Other income</td><td>$</td></tr></thead><tbody><tr><td>PAYER&#39;s federal identification number</td><td>RECIPIENT&#39;s identification number</td><td>5 Fishing boat proceeds</td><td>4 Federal income tax withhold</td><td rowspan="2">State Copy or Extra File Copy</td></tr><tr><td>66-0567418</td><td>52-0749196</td><td>$</td><td>6 Medical and begin care payments</td></tr><tr><td rowspan="3">RECIPIENT&#39;s name, address, and ZIP code</td><td>7 Nonamptoyes compensation</td><td>$ 7,150.00</td><td>8 Substitute payments in lieu of dividends or interest</td><td rowspan="4"></td></tr><tr><td>9 Payer made direct sales of $5,000 or more of consumer products to a buyer (noliplant) for resale ▷</td><td>$</td><td>10 Crop insurance proceeds</td></tr><tr><td>11</td><td></td><td>12</td></tr><tr><td colspan="2">Account number (see instructions)</td><td>13 Expense golden parachute payments</td><td>14 Grose proceeds paid to an attorney</td></tr><tr><td>15a Section 409A deferrals</td><td>16b Section 409A Income</td><td>16 State tax withhold</td><td>17 State/Payer&#39;s state no.</td><td>18 State Income</td></tr></tbody></table>

Form 1099-MISC

Department of the Treasury - Internal Revenue Service



□ VOID □ CORRECTED


<table><thead><tr><th rowspan="4">PAYER&#39;S name, street address, city, state, ZIP code, and telephone no.</th><td>1 Rents</td><td rowspan="2">OMB No. 1545-0115<br>2006<br>Form 1099-MISC</td><td rowspan="4" colspan="2">Miscellaneous Income</td></tr><tr><td>$</td></tr><tr><td>2 Royalties</td><td>$</td></tr><tr><td>$</td><td>$</td></tr></thead><tbody><tr><td>3 Other Income</td><td colspan="2">4 Federal income tax withheld</td><td rowspan="2" colspan="2">State Copy or Extra File Copy</td></tr><tr><td>$</td><td colspan="2">$</td></tr><tr><td>5 Fishing-bont prooceds</td><td colspan="2">6 Medical and health care payments</td><td rowspan="4" colspan="2"></td></tr><tr><td>$</td><td colspan="2">$</td></tr><tr><td>7 Nonemployee compensation</td><td colspan="2">8 Subsidize payments in lieu of dividends or interest</td></tr><tr><td>$</td><td colspan="2">$</td></tr><tr><td>9 Payer made direct sales of $5,000 or more of consumer products to a buyer (repliant) for resale</td><td colspan="2">10 Crop insurance proceeds</td><td rowspan="2" colspan="2"></td></tr><tr><td>$</td><td colspan="2">$</td></tr><tr><td>11</td><td colspan="2">12</td><td rowspan="2" colspan="2"></td></tr><tr><td></td><td colspan="2"></td></tr><tr><td>Account number (see instructions)</td><td>18 Excess golden parachute payments</td><td>14 Gross proceeds paid to an attorney</td><td rowspan="2" colspan="2"></td></tr><tr><td></td><td colspan="2">$</td></tr><tr><td>15a Section 409A deferrals</td><td>15b Section 409A Income</td><td>17 State/Payer&#39;s state no.</td><td rowspan="2" colspan="2">18 State Income</td></tr><tr><td></td><td colspan="2">$</td></tr></tbody></table>

Form 1099-MISC

Department of the Treasury - Internal Revenue Service

FTC0033

EFTA00176044



Under penalties 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.





Title ▶ \textcircled{1}$$\textcircled{2}$\textcircled{3}$\textcircled{4}$\textcircled{5}$\textcircled{6}$\textcircled{7}$\textcircled{8}$\textcircled{9}$\textcircled{10}$\textcircled{11}$\textcircled{12}$\textcircled{13}$\textcircled{14}$\textcircled{15}$\textcircled{16}$\textcircled{17}$\textcircled{18}$\textcircled{19}$\textcircled{20}$\textcircled{21}$\textcircled{22}$\textcircled{23}$\textcircled{24}$\textcircled{25}$\textcircled{26}$\textcircled{27}$\textcircled{28}$\textcircled{29}$\textcircled{30}$\textcircled{31}$\textcircled{32}$\textcircled{33}$\textcircled{34}$\textcircled{35}$\textcircled{36}$\textcircled{37}$\textcircled{38}$\textcircled{39}$\textcircled{40}$\textcircled{41}$\textcircled{42}$\textcircled{43}$\textcircled{44}$\textcircled{45}$\textcircled{46}$\textcircled{47}$\textcircled{48}$\textcircled{49}$\textcircled{50}$\textcircled{51}$\textcircled{52}$\textcircled{53}$\textcircled{54}$\textcircled{55}$\textcircled{56}$\textcircled{57}$\textcircled{58}$\textcircled{59}$\textcircled{60}$\textcircled{61}$\textcircled{62}$\textcircled{63}$\textcircled{64}$\textcircled{65}$\textcircled{66}$\textcircled{67}$\textcircled{68}$\textcircled{69}$\textcircled{70}$\textcircled{71}$\textcircled{72}$\textcircled{73}$\textcircled{74}$\textcircled{75}$\textcircled{76}$\textcircled{77}$\textcircled{78}$\textcircled{79}$\textcircled{80}$\textcircled{81}$\textcircled{82}$\textcircled{83}$\textcircled{84}$\textcircled{85}$\textcircled{86}$\textcircled{87}$\textcircled{88}$\textcircled{89}$\textcircled{90}$\textcircled{91}$\textcircled{92}$\textcircled{93}$\textcircled{94}$\textcircled{95}$\textcircled{96}$\textcircled{97}$\textcircled{98}$\textcircled{99}$\textcircled{100}$\textcircled{101}$\textcircled{102}$\textcircled{103}$\textcircled{104}$\textcircled{105}$\textcircled{106}$\textcircled{107}$\textcircled{108}$\textcircled{109}$\textcircled{110}$\textcircled{111}$\textcircled{112}$\textcircled{113}$\textcircled{114}$\textcircled{115}$\textcircled{116}$\textcircled{117}$\textcircled{118}$\textcircled{119}$\textcircled{120}$\textcircled{121}$\textcircled{122}$\textcircled{123}$\textcircled{124}$\textcircled{125}$\textcircled{126}$\textcircled{127}$\textcircled{128}$\textcircled{129}$\textcircled{130}$\textcircled{131}$\textcircled{132}$\textcircled{133}$\textcircled{134}$\textcircled{135}$\textcircled{136}$\textcircled{137}$\textcircled{138}$\textcircled{139}$\textcircled{140}$\textcircled{141}$\textcircled{142}$\textcircled{143}$\textcircled{144}$\textcircled{145}$\textcircled{146}$\textcircled{147}$\textcircled{148}$\textcircled{149}$\textcircled{150}$\textcircled{151}$\textcircled{152}$\textcircled{153}$\textcircled{154}$\textcircled{155}$\textcircled{156}$\textcircled{157}$\textcircled{158}$\textcircled{159}$\textcircled{160}$\textcircled{161}$\textcircled{162}$\textcircled{163}$\textcircled{164}$\textcircled{165}$\textcircled{166}$\textcircled{167}$\textcircled{168}$\textcircled{169}$\textcircled{170}$\textcircled{171}$\textcircled{172}$\textcircled{173}$\textcircled{174}$\textcircled{175}$\textcircled{176}$\textcircled{177}$\textcircled{178}$\textcircled{179}$\textcircled{180}$\textcircled{181}$\textcircled{182}$\textcircled{183}$\textcircled{184}$\textcircled{185}$\textcircled{186}$\textcircled{187}$\textcircled{188}$\textcircled{189}$\textcircled{190}$\textcircled{191}$\textcircled{192}$\textcircled{193}$\textcircled{194}$\textcircled{195}$\textcircled{196}$\textcircled{197}$\textcircled{198}$\textcircled{199}$\textcircled{200}$\textcircled{201}$\textcircled{202}$\textcircled{203}$\textcircled{204}$\textcircled{205}$\textcircled{206}$\textcircled{207}$\textcircled{208}$\textcircled{209}$\textcircled{210}$\textcircled{211}$\textcircled{212}$\textcircled{213}$\textcircled{214}$\textcircled{215}$\textcircled{216}$\textcircled{217}$\textcircled{218}$\textcircled{219}$\textcircled{220}$\textcircled{221}$\textcircled{222}$\textcircled{223}$\textcircled{224}$\textcircled{225}$\textcircled{226}$\textcircled{227}$\textcircled{228}$\textcircled{229}$\textcircled{230}$\textcircled{231}$\textcircled{232}$\textcircled{233}$\textcircled{234}$\textcircled{235}$\textcircled{236}$\textcircled{237}$\textcircled{238}$\textcircled{239}$\textcircled{240}$\textcircled{241}$\textcircled{242}$\textcircled{243}$\textcircled{244}$\textcircled{245}$\textcircled{246}$\textcircled{247}$\textcircled{248}$\textcircled{249}$\textcircled{250}$\textcircled{251}$\textcircled{252}$\textcircled{253}$\textcircled{254}$\textcircled{255}$\textcircled{256}$\textcircled{257}$\textcircled{258}$\textcircled{259}$\textcircled{260}$\textcircled{261}$\textcircled{262}$\textcircled{263}$\textcircled{264}$\textcircled{265}$\textcircled{266}$\textcircled{267}$\textcircled{268}$\textcircled{269}$\textcircled{270}$\textcircled{271}$\textcircled{272}$\textcircled{273}$\textcircled{274}$\textcircled{275}$\textcircled{276}$\textcircled{277}$\textcircled{278}$\textcircled{279}$\textcircled{280}$\textcircled{281}$\textcircled{282}$\textcircled{283}$\textcircled{284}$\textcircled{285}$\textcircled{286}$\textcircled{287}$\textcircled{288}$\textcircled{289}$\textcircled{290}$\textcircled{291}$\textcircled{292}$\textcircled{293}$\textcircled{294}$\textcircled{295}$\textcircled{296}$\textcircled{297}$\textcircled{298}$\textcircled{299}$\textcircled{300}$\textcircled{301}$\textcircled{302}$\textcircled{303}$\textcircled{304}$\textcircled{305}$\textcircled{306}$\textcircled{307}$\textcircled{308}$\textcircled{309}$\textcircled{310}$\textcircled{311}$\textcircled{312}$\textcircled{313}$\textcircled{314}$\textcircled{315}$\textcircled{316}$\textcircled{317}$\textcircled{318}$\textcircled{319}$\textcircled{320}$\textcircled{321}$\textcircled{322}$\textcircled{323}$\textcircled{324}$\textcircled{325}$\textcircled{326}$\textcircled{327}$\textcircled{328}$\textcircled{329}$\textcircled{330}$\textcircled{331}$\textcircled{332}$\textcircled{333}$\textcircled{334}$\textcircled{335}$\textcircled{336}$\textcircled{337}$\textcircled{338}$\textcircled{339}$\textcircled{340}$\textcircled{341}$\textcircled{342}$\textcircled{343}$\textcircled{344}$\textcircled{345}$\textcircled{346}$\textcircled{347}$\textcircled{348}$\textcircled{349}$\textcircled{350}$\textcircled{351}$\textcircled{352}$\textcircled{353}$\textcircled{354}$\textcircled{355}$\textcircled{356}$\textcircled{357}$\textcircled{358}$\textcircled{359}$\textcircled{360}$\textcircled{361}$\textcircled{362}$\textcircled{363}$\textcircled{364}$\textcircled{365}$\textcircled{366}$\textcircled{367}$\textcircled{368}$\textcircled{369}$\textcircled{370}$\textcircled{371}$\textcircled{372}$\textcircled{373}$\textcircled{374}$\textcircled{375}$\textcircled{376}$\textcircled{377}$\textcircled{378}$\textcircled{379}$\textcircled{380}$\textcircled{381}$\textcircled{382}$\textcircled{383}$\textcircled{384}$\textcircled{385}$\textcircled{386}$\textcircled{387}$\textcircled{388}$\textcircled{389}$\textcircled{390}$\textcircled{391}$\textcircled{392}$\textcircled{393}$\textcircled{394}$\textcircled{395}$\textcircled{396}$\textcircled{397}$\textcircled{398}$\textcircled{399}$\textcircled{400}$\textcircled{401}$\textcircled{402}$\textcircled{403}$\textcircled{404}$\textcircled{405}$\textcircled{406}$\textcircled{407}$\textcircled{408}$\textcircled{409}$\textcircled{410}$\textcircled{411}$\textcircled{412}$\textcircled{413}$\textcircled{414}$\textcircled{415}$\textcircled{416}$\textcircled{417}$\textcircled{418}$\textcircled{419}$\textcircled{420}$\textcircled{421}$\textcircled{422}$\textcircled{423}$\textcircled{424}$\textcircled{425}$\textcircled{426}$\textcircled{427}$\textcircled{428}$\textcircled{429}$\textcircled{430}$\textcircled{431}$\textcircled{432}$\textcircled{433}$\textcircled{434}$\textcircled{435}$\textcircled{436}$\textcircled{437}$\textcircled{438}$\textcircled{439}$\textcircled{440}$\textcircled{441}$\textcircled{442}$\textcircled{443}$\textcircled{444}$\textcircled{445}$\textcircled{446}$\textcircled{447}$\textcircled{448}$\textcircled{449}$\textcircled{450}$\textcircled{451}$\textcircled{452}$\textcircled{453}$\textcircled{454}$\textcircled{455}$\textcircled{456}$\textcircled{457}$\textcircled{458}$\textcircled{459}$\textcircled{460}$\textcircled{461}$\textcircled{462}$\textcircled{463}$\textcircled{464}$\textcircled{465}$\textcircled{466}$\textcircled{467}$\textcircled{468}$\textcircled{469}$\textcircled{470}$\textcircled{471}$\textcircled{472}$\textcircled{473}$\textcircled{474}$\textcircled{475}$\textcircled{476}$\textcircled{477}$\textcircled{478}$\textcircled{479}$\textcircled{480}$\textcircled{481}$\textcircled{482}$\textcircled{483}$\textcircled{484}$\textcircled{485}$\textcircled{486}$\textcircled{487}$\textcircled{488}$\textcircled{489}$\textcircled{490}$\textcircled{491}$\textcircled{492}$\textcircled{493}$\textcircled{494}$\textcircled{495}$\textcircled{496}$\textcircled{497}$\textcircled{498}$\textcircled{499}$\textcircled{500}$\textcircled{501}$\textcircled{502}$\textcircled{503}$\textcircled{504}$\textcircled{505}$\textcircled{506}$\textcircled{507}$\textcircled{508}$\textcircled{509}$\textcircled{510}$\textcircled{511}$\textcircled{512}$\textcircled{513}$\textcircled{514}$\textcircled{515}$\textcircled{516}$\textcircled{517}$\textcircled{518}$\textcircled{519}$\textcircled{520}$\textcircled{521}$\textcircled{522}$\textcircled{523}$\textcircled{524}$\textcircled{525}$\textcircled{526}$\textcircled{527}$\textcircled{528}$\textcircled{529}$\textcircled{530}$\textcircled{531}$\textcircled{532}$\textcircled{533}$\textcircled{534}$\textcircled{535}$\textcircled{536}$\textcircled{537}$\textcircled{538}$\textcircled{539}$\textcircled{540}$\textcircled{541}$\textcircled{542}$\textcircled{543}$\textcircled{544}$\textcircled{545}$\textcircled{546}$\textcircled{547}$\textcircled{548}$\textcircled{549}$\textcircled{550}$\textcircled{551}$\textcircled{552}$\textcircled{553}$\textcircled{554}$\textcircled{555}$\textcircled{556}$\textcircled{557}$\textcircled{558}$\textcircled{559}$\textcircled{560}$\textcircled{561}$\textcircled{562}$\textcircled{563}$\textcircled{564}$\textcircled{565}$\textcircled{566}$\textcircled{567}$\textcircled{568}$\textcircled{569}$\textcircled{570}$\textcircled{571}$\textcircled{572}$\textcircled{573}$\textcircled{574}$\textcircled{575}$\textcircled{576}$\textcircled{577}$\textcircled{578}$\textcircled{579}$\textcircled{580}$\textcircled{581}$\textcircled{582}$\textcircled{583}$\textcircled{584}$\textcircled{585}$\textcircled{586}$\textcircled{587}$\textcircled{588}$\textcircled{589}$\textcircled{590}$\textcircled{591}$\textcircled{592}$\textcircled{593}$\textcircled{594}$\textcircled{595}$\textcircled{596}$\textcircled{597}$\textcircled{598}$\textcircled{599}$\textcircled{600}$\textcircled{601}$\textcircled{602}$\textcircled{603}$\textcircled{604}$\textcircled{605}$\textcircled{606}$\textcircled{607}$\textcircled{608}$\textcircled{609}$\textcircled{610}$\textcircled{611}$\textcircled{612}$\textcircled{613}$\textcircled{614}$\textcircled{615}$\textcircled{616}$\textcircled{617}$\textcircled{618}$\textcircled{619}$\textcircled{620}$\textcircled{621}$\textcircled{622}$\textcircled{623}$\textcircled{624}$\textcircled{625}$\textcircled{626}$\textcircled{627}$\textcircled{628}$\textcircled{629}$\textcircled{630}$\textcircled{631}$\textcircled{632}$\textcircled{633}$\textcircled{634}$\textcircled{635}$\textcircled{636}$\textcircled{637}$\textcircled{638}$\textcircled{639}$\textcircled{640}$\textcircled{641}$\textcircled{642}$\textcircled{643}$\textcircled{644}$\textcircled{645}$\textcircled{646}$\textcircled{647}$\textcircled{648}$\textcircled{649}$\textcircled{650}$\textcircled{651}$\textcircled{652}$\textcircled{653}$\textcircled{654}$\textcircled{655}$\textcircled{656}$\textcircled{657}$\textcircled{658}$\textcircled{659}$\textcircled{660}$\textcircled{661}$\textcircled{662}$\textcircled{663}$\textcircled{664}$\textcircled{665}$\textcircled{666}$\textcircled{667}$\textcircled{668}$\textcircled{669}$\textcircled{670}$\textcircled{671}$\textcircled{672}$\textcircled{673}$\textcircled{674}$\textcircled{675}$\textcircled{676}$\textcircled{677}$\textcircled{678}$\textcircled{679}$\textcircled{680}$\textcircled{681}$\textcircled{682}$\textcircled{683}$\textcircled{684}$\textcircled{685}$\textcircled{686}$\textcircled{687}$\textcircled{688}$\textcircled{689}$\textcircled{690}$\textcircled{691}$\textcircled{692}$\textcircled{693}$\textcircled{694}$\textcircled{695}$\textcircled{696}$\textcircled{697}$\textcircled{698}$\textcircled{699}$\textcircled{700}$\textcircled{701}$\textcircled{702}$\textcircled{703}$\textcircled{704}$\textcircled{705}$\textcircled{706}$\textcircled{707}$\textcircled{708}$\textcircled{709}$\textcircled{710}$\textcircled{711}$\textcircled{712}$\textcircled{713}$\textcircled{714}$\textcircled{715}$\textcircled{716}$\textcircled{717}$\textcircled{718}$\textcircled{719}$\textcircled{720}$\textcircled{721}$\textcircled{722}$\textcircled{723}$\textcircled{724}$\textcircled{725}$\textcircled{726}$\textcircled{727}$\textcircled{728}$\textcircled{729}$\textcircled{730}$\textcircled{731}$\textcircled{732}$\textcircled{733}$\textcircled{734}$\textcircled{735}$\textcircled{736}$\textcircled{737}$\textcircled{738}$\textcircled{739}$\textcircled{740}$\textcircled{741}$\textcircled{742}$\textcircled{743}$\textcircled{744}$\textcircled{745}$\textcircled{746}$\textcircled{747}$\textcircled{748}$\textcircled{749}$\textcircled{750}$\textcircled{751}$\textcircled{752}$\textcircled{753}$\textcircled{754}$\textcircled{755}$\textcircled{756}$\textcircled{757}$\textcircled{758}$\textcircled{759}$\textcircled{760}$\textcircled{761}$\textcircled{762}$\textcircled{763}$\textcircled{764}$\textcircled{765}$\textcircled{766}$\textcircled{767}$\textcircled{768}$\textcircled{769}$\textcircled{770}$\textcircled{771}$\textcircled{772}$\textcircled{773}$\textcircled{774}$\textcircled{775}$\textcircled{776}$\textcircled{777}$\textcircled{778}$\textcircled{779}$\textcircled{780}$\textcircled{781}$\textcircled{782}$\textcircled{783}$\textcircled{784}$\textcircled{785}$\textcircled{786}$\textcircled{787}$\textcircled{788}$\textcircled{789}$\textcircled{790}$\textcircled{791}$\textcircled{792}$\textcircled{793}$\textcircled{794}$\textcircled{795}$\textcircled{796}$\textcircled{797}$\textcircled{798}$\textcircled{799}$\textcircled{800}$\textcircled{801}$\textcircled{802}$\textcircled{803}$\textcircled{804}$\textcircled{805}$\textcircled{806}$\textcircled{807}$\textcircled{808}$\textcircled{809}$\textcircled{810}$\textcircled{811}$\textcircled{812}$\textcircled{813}$\textcircled{814}$\textcircled{815}$\textcircled{816}$\textcircled{817}$\textcircled{818}$\textcircled{819}$\textcircled{820}$\textcircled{821}$\textcircled{822}$\textcircled{823}$\textcircled{824}$\textcircled{825}$\textcircled{826}$\textcircled{827}$\textcircled{828}$\textcircled{829}$\textcir

## Instructions

Purpose of form. Use this form to transmit paper Forms 1099, 1098, 5498, and W-2G to the Internal Revenue Service. Do not use Form 1096 to transmit electronically 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.



Date ▶ $c = -7, 06$



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 HSA, an Archer MSA (including a Medicare Advantage MSA); certain corporations; certain donees of motor vehicles, boats, and airplanes; and a lender who acquires an interest in secured property or who has reason to know that the property has been abandoned.

Preaddressed Form 1096. 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 February 28, 2006. File Form 1096 with Forms 5498, 5498-ESA, and 5498-SA by May 31, 2006.

Where To File

Send all information returns file with Form 1096 to the following:

COLLECTIONS & DEPOSIT NO. 3

If your principal business, office or agency, or legal residence in the case of an individual, is located in VIRGIN ISLANDS BUREAU OF INTERNAL REVENUE, ST. THOMAS, VI

Use the following Internal Revenue Service Center address:

Alabama, Arizona, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Texas,

Austin, TX 73301

Arkansas, Connecticut, Delaware,

Kentucky, Maine, Massachusetts,

New Hampshire, New Jersey,

New York, Ohio, Pennsylvania,

Rhode Island, Vermont, West

Cincinnati, OH 45999

Illinois, Indiana, Iowa, Kansas,

Michigan, Minnesota, Missouri,

Nebraska, North Dakota, Oklahoma,

South Carolina, South Dakota,

Tennessee, Wisconsin

For more information and the Privacy Act and Paperwork Reduction Act Notice, see the 2005 General Instructions for Forms 1099, 1098, 5498, and W-2G.

Kansas City, MO 64999

FTC0034

EFTA00176045

<table border="1"><tr><td rowspan="4">PAYER&#x27;s name, street address, city, state, ZIP code, and telephone no.
FINANCIAL TRUST COMPANY, INC.
6100 RED HOOK QTRS, B3
ST. THOMAS, VI 00802</td><td>1 Ranta</td><td rowspan="4">OMB No. 1545-0115
Form 1099-MISC</td><td rowspan="4" colspan="2">Miscellaneous Income</td></tr><tr><td>2 Royalties</td></tr><tr><td>3 Other income</td></tr><tr><td>4 Federal income tax withheld</td></tr><tr><td>PAYER&#x27;s Federal Identification number
66-0567418</td><td>RECIPIENT&#x27;s identification number
13-3085114</td><td>5 Fishing boat proceeds</td><td>6 Medical health care payments</td><td>Copy for Payer or State Copy</td></tr><tr><td rowspan="4">RECIPIENT&#x27;s name, address, and ZIP code
GERALD B. LEFCOURT, P.C.
148 EAST 78TH STREET
NEW YORK, NY 10021</td><td>7 Nonemployees compensation
15070.07</td><td>8 Subsidies payments in lieu of dividends or interest</td><td rowspan="4">For Privacy A and Paperw/o Reduction A Notice, see the 2005 General Instructions for Forms 1098, 548 and W-2</td></tr><tr><td>8 Power made direct sales of 85,000 or more consumer products to a buyer (recipient) for resale</td><td>10 Crop insurance proceeds</td></tr><tr><td>11</td><td>13</td></tr><tr><td>10 Excess golden parachute payments</td><td>14 Gross proceeds paid to an attorney</td></tr><tr><td>Account number (see instructions)</td><td>2nd TIN not.</td><td>10 Excess golden parachute payments</td><td>14 Gross proceeds paid to an attorney</td><td></td></tr><tr><td>19a Section 409A deferrals</td><td>19b Section 409A Income</td><td>10 State tax withheld</td><td>17 State/Payer&#x27;s state no.</td><td>18 State Income</td></tr><tr><td colspan="5">Form 1099-MISC Department of the Treasury - Internal Revenue Service</td></tr><tr><td rowspan="4">PAYER&#x27;s name, street address, city, state, ZIP code, and telephone no.
FINANCIAL TRUST COMPANY, INC.
6100 RED HOOK QTRS, B3
ST. THOMAS, VI 00802</td><td>1 Rinta</td><td rowspan="4">OMB No. 1545-0115
Form 1099-MISC</td><td rowspan="4" colspan="2">Miscellaneous Income</td></tr><tr><td>2 Royalties</td></tr><tr><td>3 Other income</td></tr><tr><td>4 Federal income tax withheld</td></tr><tr><td>PAYER&#x27;s Federal Identification number
66-0567418</td><td>RECIPIENT&#x27;s identification number
66-0473483</td><td>6 Fishing boat proceeds</td><td>8 Medical and health care payments</td><td>Copy for Payer or State Co</td></tr><tr><td rowspan="4">RECIPIENT&#x27;s name, address, and ZIP code
HODGE &amp; FRANCOSIS
1340 TAARENBERG GADS
CHARLOTTE AMALIE, VI 00802</td><td>7 Nonemployees compensation
5949.49</td><td>8 Schedule payments in lieu of dividends or interest</td><td rowspan="4">For Privacy A and Paperw/o Reduction A Notice, see the 2005 Gene Instructions for Forms 1098, 548 and W-2</td></tr><tr><td>8 Power made direct sales of 45,000 or more consumer products to a buyer (recipient) for resale</td><td>10 Crop insurance proceeds</td></tr><tr><td>11</td><td>12</td></tr><tr><td>10 Excess golden parachute payments</td><td>14 Gross proceeds paid to an attorney</td></tr><tr><td>Account number (see instructions)</td><td>2nd TIN not.</td><td>10 Excess golden parachute payments</td><td>14 Gross proceeds paid to an attorney</td><td></td></tr><tr><td>16a Section 409A deferrals</td><td>10b Section 409A Income</td><td>10 State tax withheld</td><td>17 State/Payer&#x27;s state no.</td><td>18 State Income</td></tr></table>

Form 1099-MISC

FTCD035

Department of the Treasury - Internal Revenue Service