EFTA00186319¶
9595 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 | ||||
| 3 Other income | ||||
| PAYER'S Federal Identification number | RECIPIENT'S Identification number | 5 Fishing boat proceeds | 6 Medical and health care payments | Copy A For Internal Revenue Service Center File with Form 1096. |
| RECIPIENT'S name | 7 Nonemployee compensation $8500.00 | 8 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 33407 | 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. | ||
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 Rents | OMB No. 1545-0115 2004 Form 1099-MISC | Miscellaneous Income | ||
|---|---|---|---|---|---|
| $ | |||||
| $ | |||||
| 3 Other Income | $ | 4 Federal income tax withheld | Copy 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 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 | ||||
| 13 Excess golden parachute payments | 14 Gross proceeds paid to an attorney | ||||
| Account number (optional) | 2nd TIN not. | ||||
| 15 | 16 State tax withheld | 17 State/Payer's state no. | 18 State income | ||
Form 1099-MISC¶
Department of the Treasury - Internal Revenue Service¶
06694¶