EFTA00176046 □ VOID □ CORRECTED
PAYER's name, street address, city, state, ZIP code, and telephone no.1 RentleOMB No. 1548-0115
2005
Form 1099-MISC		Miscellaneous Income
2 Royalities
3 Other Income4 Federal income tax withhold
$$
PAYER'S Federal Identification number
66-0567418		RECIPIENT'S Identification number
66-0578959		6 Fishing boat proceeds6 Medical and health care paymentsFor Privacy and Paperwork Reduction Notice, see the 2005 General Instructions for Forms 1099, 1098, 5499 and W-2
RECIPIENT'S name, address, and ZIP code
MAJORIE RAWLS ROBERTS
PO BOX 6347
THOMAS, VI 00804-6347		7 Nonemployee compensation
$ 13328.69		8 Substitute payments in lieu of dividends or interest
9 Payer made direct sales of $5,000 or more of consumer product to a buyer (recipient) for resale10 Crop insurance proceeds
11 Excess golden parachute payments12 Gross proceeds paid to an attorney
Account number (see instructions)2nd TIN not.13 Excess golden parachute payments14 Gross proceeds paid to an attorney
18a Section 409A deferrals15b Section 409A Income16 State tax withheld17 State/Payer's state no.
$$$$
Form 1099-MISC Department of the Treasury - Internal Revenue Serv 1099-MISC / COPY C 31, 2006. electronically, the due date is March by February 28, 2006. If you file File Copy A of this form with the IRS 2006, IRS website. form to the recolpient by January 31, Due dates. Furnish Copy B of this Caution: Because paper forms are scanned during processing, you cannot file with the IRS Forms 1096, 1098, 1099, or 5498 that you print from the (1-800-829-3676). General and specific form Instructions are provided as separate products. The products you should use to complete Form 1099-MISC are the 2005 General Instructions for Forms 1099, 1098, 5498, and W-2G and the 2005 Instructions for Form 1099-MISC. A chart in the general instructions gives a quick guide to which form must be filed to report a particular payment. To order these instructions and additional forms, call 1-800-TAX-FORM (1-800-829-3676). Instructions for Payers FTCD036