1099-B Template That Has To Be Supplied To Us

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Whoever you have a Wagering Monetary Contract with has to supply the form to us otherwise we need to submit a 3949A

against them.

7979 VOID CORRECTED


PAYER’S name, street address, city, state, ZIP code, and telephone no. 1a Date of sale or exchange OMB No. 1545-0715
Proceeds From
Who, you worked for or got a check from, it was wagering money Broker and
Barter Exchange
or the Bank for a loan
or the corporate Court/Bank with their charging documents
1b CUSIP no. 2009 Transactions
see below
Form 1099-B
其 X Gross
2 Stocks, bonds, etc. proceeds
Reported
to IRS Gross proceeds less commissions and option premiums
$
PAYER’S federal identification number RECIPIENT’S identification number 3 Bartering 4 Federal income tax withheld

Their EINor SSN your SSN Copy A


see below
see below
$ $ For
RECIPIENT’S name 5 No. of shares exchanged 6 Classes of stock Internal Revenue
exchanged
Your Artificial Person, esq. see below Service Center
see below
File with Form 1096.
Street address (including apt. no.) 7 Description
For Privacy Act
see below
and Paperwork
Reduction Act
City, state, and ZIP code 8 Profit or (loss) realized in 9 Unrealized profit or (loss) on
2009 open contracts—12/31/2008 Notice, see the
see below see below 2009 General
$ $ Instructions for
CORPORATION’S name 10 Unrealized profit or (loss) on 11 Aggregate profit or (loss) Forms 1099, 1098,
open contracts–12/31/2009
name of the Bank or company you work for 3921, 3922, 5498,
see below see below
$ $ and W-2G.
Account number (see instructions) 2nd TIN not. 12 Check the box if recipient cannot take a loss on their tax
return based on the amount in box 2
your account number or loan number

Form 1099-B Cat. No. 14411V 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
Whoever you have a Wagering Monetary Contract with has to supply the form to us otherwise we need to submit a 3949A against them.
Block 3 - the Amount you received for your signature
Block 4 - the amount they withheld

Block 5 - their bonds that the wrote against us

Block 6 - Bonds per lien


Block 7 - what was the Transaction
Block 8 - It should be Zero because we were not the real beneficiary of the barter
Block 9 - the interest that is due to us from the First year of the Contract
Block 10 - the interest that is due to us from the Second year of the Contract
Block 11 - Zero

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