EFTA00186319 9595 VOID CORRECTED
PAYER'S name, street address, city, state, ZIP code, and telephone no.1 RentsOMB No. 1545-0115
2004
Form 1099-MISC		Miscellaneous Income
2 Royalties
3 Other income
PAYER'S Federal Identification numberRECIPIENT'S Identification number5 Fishing boat proceeds6 Medical and health care paymentsCopy A For Internal Revenue Service Center File with Form 1096.
RECIPIENT'S name7 Nonemployee compensation $8500.008 Substitute payments in lieu of dividends or interest
Street address (including apt. no.)9 Payer made direct sales of $6,000 or more of consumer products to a buyer (recipient) for resale ▶10 Crop insurance proceeds
City, state, and ZIP code WEST PALM BEACH, FL 334071112
Account number (optional)2nd TIN not.13 Excess golden parachute payments14 Gross proceeds paid to an attorney
1516 State tax withheld17 State/Payer's state no.
Department of the Treasury - Internal Revenue Service Do Not Cut or Separate Forms on This Page — Do Not Cut or Separate Forms on This Page 9595 □ VOID □ CORRECTED
PAYER'S name, street address, city, state, ZIP code, and telephone no.
JEGE, INC.
C/O GEORGE V. DELSON & ASSOCIATES
110 EAST 59TH STREET, 28TH FL.
NEW YORK, NY 10022		1 RentsOMB No. 1545-0115
2004
Form 1099-MISC		Miscellaneous Income
$
$
3 Other Income$4 Federal income tax withheldCopy A
For Internal Revenue Service Center
File with Form 1096.
5 Fishing boat proceeds$6 Medical and health care payments
7 Nonemployee compensation
$1000.00		8 Substitute payments in lieu of dividends or interestFor 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
1112
13 Excess golden parachute payments14 Gross proceeds paid to an attorney
Account number (optional)2nd TIN not.
1516 State tax withheld17 State/Payer's state no.18 State income
Form 1099-MISC Department of the Treasury - Internal Revenue Service 06694