Attention:

Do not download, print, and file Copy A with the IRS.

Copy A appears in red, similar to the official IRS form,
but is for informational purposes only. A penalty of $50 per
information return may be imposed for filing copies of forms
that cannot be scanned.
You may order these forms online at Forms and Publications
By U.S. Mail (http://www.irs.gov/formspubs) or by calling
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See IRS Publications 1141, 1167, 1179, and other IRS
resources for information about printing these tax forms.
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transmitted all R
Page 1 of 6 Form 1099-PATR (Page 2 is blank) 4 Action Date Signature
text files for this O.K. to print
cycle update? The type and rule above prints on all proofs including departmental
reproduction proofs. MUST be removed before printing. T:FP:F
O.K. to print
Date
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Separation 1 for page 1 of Form 1099-PATR. Prints in scan organization
Red (J-6983) Ink. Revised proofs
Separation 2 for page 1 of Form 1099-PATR. Prints in Black Ink. requested

9797 VOID CORRECTED

PAYER’S name, street address, city, state, ZIP code, and telephone no. 1 Patronage dividends OMB No. 1545-0118
$ Taxable
2 Nonpatronage distributions Distributions
$ 2006 Received From
3 Per-unit retain allocations Cooperatives
$ Form 1099-PATR
PAYER’S federal identification number RECIPIENT’S identification number 4 Federal income tax withheld
Copy A
$ For
RECIPIENT’S name 5 Redemption of nonqualified 6 Domestic production activities Internal Revenue
notices and retain allocations deduction
Service Center
$ $ File with Form 1096.
7 Investment credit
For Privacy Act
Street address (including apt. no.)
and Paperwork
$ Reduction Act
City, state, and ZIP code 8 Work opportunity credit 9 Patron’s AMT adjustment Notice, see the
2006 General
$ $ Instructions for
Account number (see instructions) 2nd TIN not. 10 Other credits and deductions Forms 1099, 1098,
$ 5498, and W-2G.

Form 1099-PATR Cat. No. 14435F 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
Page 3 of 6 of Form 1099-PATR 4
The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

CORRECTED (if checked)

PAYER’S name, street address, city, state, ZIP code, and telephone no. 1 Patronage dividends OMB No. 1545-0118
$ Taxable
Distributions
2 Nonpatronage distributions

$ 2006 Received From

3 Per-unit retain allocations Cooperatives
$ Form 1099-PATR
PAYER’S federal identification number RECIPIENT’S identification number 4 Federal income tax withheld
Copy B
$ For Recipient
RECIPIENT’S name 5 Redemption of nonqualified 6 Domestic production activities
notices and retain allocations deduction This is important
tax information and is
being furnished to the
$ $ Internal Revenue
Street address (including apt. no.) 7 Investment credit Service. If you are
required to file a
$ return, a negligence
penalty or other
City, state, and ZIP code 8 Work opportunity credit 9 Patron’s AMT adjustment sanction may be
imposed on you if this
$ $ income is taxable and
Account number (see instructions) 10 Other credits and deductions the IRS determines
that it has not been
$ reported.

Form 1099-PATR (keep for your records) Department of the Treasury - Internal Revenue Service
Page 4 of 6 of Form 1099-PATR 4
The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

Instructions for Recipient Certification, for information on backup withholding. Include this amount on
Reminder. See box 6 for a new deduction that may be available to you. See your income tax return as tax withheld.
box 10 for new pass-through credits and an additional new deduction. Box 5. Shows amounts you received when you redeemed nonqualified written
Distributions you received from a cooperative may be includible in your notices of allocation and nonqualified per-unit retain allocations. Because
income. Generally, if you are an individual, report any amounts shown in boxes these were not taxable when issued to you, you must report the redemption as
1, 2, 3, and 5 as income, unless nontaxable, on Schedule F (Form 1040), Profit ordinary income to the extent of the stated dollar value.
or Loss From Farming; Schedule C (Form 1040), Profit or Loss From Business; Box 6. Shows the deduction amount you may take based on your portion of
Schedule C-EZ (Form 1040), Net Profit From Business; or Form 4835, Farm patronage dividends or per-unit retain allocations (boxes 1 and 3) attributable
Rental Income and Expenses. See the instructions for Schedule F (Form 1040) to qualified production activities income. To claim the deduction amount, this
and Pub. 225, Farmer’s Tax Guide, for more information. amount must have been designated in a written notice sent to you from the
Account number. May show an account or other unique number the payer cooperative within the payment period under section 1382(d). Enter on the
assigned to distinguish your account. appropriate line of Form 8903, Domestic Production Activities Deduction.
Boxes 7, 8, and 10. These boxes may show unused credits and deductions
Box 1. Shows patronage dividends paid to you during the year in cash,
passed through to you by the cooperative. Report these credits on the
qualified written notices of allocation (at stated dollar value), or other property
following forms: 3468—investment credit; 5884—work opportunity credit;
(not including nonqualified allocations). Any of the dividends that were paid on
5884-A—employee retention credit; 6478—small ethanol producer credit;
(1) property bought for personal use or (2) capital assets or depreciable
8835—renewable electricity, refined coal, and Indian coal production credit;
property used in your business are not taxable. However, if (2) applies, reduce
8844—empowerment zone and renewal community employment credit;
the basis of the assets by this amount.
8845—Indian employment credit; 8861—welfare-to-work credit; 8864—small
Box 2. Shows nonpatronage distributions paid to you during the year in cash, agri-biodiesel producer credit; and 8896—low sulfur diesel fuel production
qualified written notices of allocation, or other property (not including credit. A deduction for capital costs incurred by small refiner cooperatives
nonqualified written notices of allocation). when complying with EPA sulfur regulations may also be passed through to
Box 3. Shows per-unit retain allocations paid to you during the year in cash, you. See the Form 1040 Instructions for how to report other credits and
qualified per-unit retain certificates, or other property. deductions.
Box 4. Shows backup withholding. Generally, a payer must backup withhold at Box 9. Shows the alternative minimum tax (AMT) adjustment passed through
a 28% rate if you did not furnish your taxpayer identification number to the to you by the cooperative. Report this amount on Form 6251, Alternative
payer. See Form W-9, Request for Taxpayer Identification Number and Minimum Tax—Individuals, on the appropriate line in Part I.
Page 5 of 6 of Form 1099-PATR 4
The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

VOID CORRECTED
PAYER’S name, street address, city, state, ZIP code, and telephone no. 1 Patronage dividends OMB No. 1545-0118
$ Taxable
Distributions
2 Nonpatronage distributions
$ 2006 Received From
3 Per-unit retain allocations Cooperatives
$ Form 1099-PATR
PAYER’S federal identification number RECIPIENT’S identification number 4 Federal income tax withheld
$ Copy C
RECIPIENT’S name 5 Redemption of nonqualified 6 Domestic production activities For
notices and retain allocations deduction Payer

$ $ For Privacy Act

7 Investment credit and Paperwork
Street address (including apt. no.)
Reduction Act
$ Notice, see the
City, state, and ZIP code 8 Work opportunity credit 9 Patron’s AMT adjustment 2006 General
Instructions for
$ $ Forms 1099,
Account number (see instructions) 2nd TIN not. 10 Other credits and deductions 1098, 5498,
$ and W-2G.

Form 1099-PATR Department of the Treasury - Internal Revenue Service

Page 6 of 6 of Form 1099-PATR 4
The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

Instructions for Payers

General and specific form instructions are provided as File Copy A of this form with the IRS by February 28, 2007.
separate products. The products you should use to complete If you file electronically, the due date is April 2, 2007. To file
Form 1099-PATR are the 2006 General Instructions for electronically, you must have software that generates a file
Forms 1099, 1098, 5498, and W-2G, and the 2006 according to the specifications in Pub. 1220, Specifications
Instructions for Form 1099-PATR. A chart in the general for Filing Forms 1098, 1099, 5498, and W-2G Electronically
instructions gives a quick guide to which form must be filed or Magnetically. IRS does not provide a fill-in form option.
to report a particular payment. To order these instructions Foreign recipient. If the recipient is a nonresident alien, you
and additional forms, call 1-800-TAX-FORM may have to withhold federal income tax and file Form
(1-800-829-3676). 1042-S, Foreign Person’s U.S. Source Income Subject to
Caution: Because paper forms are scanned during Withholding. See the Instructions for Form 1042-S and Pub.
processing, you cannot file Forms 1096, 1098, 1099, or 5498 515, Withholding of Tax on Nonresident Aliens and Foreign
that you download and print from the IRS website. Entities.
Due dates. Furnish Copy B of this form to the recipient by
January 31, 2007.

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