9 Keland Cossia 2019 Form 1099-MISC
9 Keland Cossia 2019 Form 1099-MISC
9 Keland Cossia 2019 Form 1099-MISC
PAYER’S name, street address, city or town, state or province, country, ZIP 1 Rents OMB No. 1545-0115
or foreign postal code, and telephone no.
Miscellaneous
KELAND CUTS
14746 DELANO ST APT 6
$ 9,200
2 Royalties
2019 Income
VAN NUYS, CA 91411
$ Form 1099-MISC
3 Other income 4 Federal income tax withheld Copy C
$ 45,000 $ 3,742.00 For Payer
PAYER’S TIN RECIPIENT’S TIN 5 Fishing boat proceeds 6 Medical and health care payments
325-88-0351 325-88-0351
$ $ 652.50
RECIPIENT’S name 7 Nonemployee compensation 8 Substitute payments in lieu of
dividends or interest For Privacy Act
KELAND COSSIA and Paperwork
Reduction Act
Street address (including apt. no.) $ $ Notice, see the
9 Payer made direct sales of 10 Crop insurance proceeds 2019 General
14746 DELANO ST APT 6 $5,000 or more of consumer
products to a buyer Instructions for
City or town, state or province, country, and ZIP or foreign postal code
(recipient) for resale ▶ $ Certain
VAN NUYS, CA 91411
11 12 Information
Returns.
Account number (see instructions) FATCA filing 2nd TIN not. 13 Excess golden parachute 14 Gross proceeds paid to an
requirement payments attorney
$ $
15a Section 409A deferrals 15b Section 409A income 16 State tax withheld 17 State/Payer’s state no. 18 State income
$ $
$ $ $ $
Form 1099-MISC www.irs.gov/Form1099MISC Department of the Treasury - Internal Revenue Service