Attention: 

Copy A of this form is provided for informational purposes only. Copy A appears in red, 
similar to the official IRS form. The official printed version of Copy A of this IRS form is 
scannable, but the online version of it, printed from this website, is not. Do not print and file 
copy A downloaded from this website; a penalty may be imposed for filing with the IRS 
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information about penalties.

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forms.

            9595                         VOID         CORRECTED
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.
                                                                            $                            Form 1099-MISC               Miscellaneous 
                                                                            2 Royalties                  (Rev. January 2022)              Information
                                                                                                         For calendar year     
                                                                            $                                 20
                                                                            3 Other income               4 Federal income tax withheld    Copy A
                                                                            $                            $                                            For 
PAYER’S TIN                         RECIPIENT’S TIN                         5 Fishing boat proceeds      6 Medical and health care     Internal Revenue 
                                                                                                          payments                        Service Center

                                                                            $                            $                             File with Form 1096.
RECIPIENT’S name                                                            7 Payer made direct sales    8 Substitute payments in lieu  For Privacy Act 
                                                                            totaling $5,000 or more of    of dividends or interest
                                                                            consumer products to                                        and Paperwork 
                                                                            recipient for resale         $                                Reduction Act 
Street address (including apt. no.)                                         9 Crop insurance proceeds    10 Gross proceeds paid to an     Notice, see the 
                                                                                                            attorney                   current General 
                                                                            $                            $                             Instructions for 
City or town, state or province, country, and ZIP or foreign postal code    11 Fish purchased for resale 12 Section 409A deferrals        Certain 
                                                                                                                                          Information 
                                                                                                                                          Returns.
                                                                            $                            $
                                                    13 FATCA filing         14 Excess golden parachute   15 Nonqualified deferred 
                                                      requirement              payments                     compensation
                                                                            $                            $
Account number (see instructions)                   2nd TIN not.            16 State tax withheld        17 State/Payer’s state no.    18 State income
                                                                            $                                                          $
                                                                            $                                                          $
Form 1099-MISC (Rev. 1-2022)        Cat. No. 14425J                      www.irs.gov/Form1099MISC        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

                                         VOID         CORRECTED
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.
                                                                            $                            Form 1099-MISC               Miscellaneous 
                                                                            2 Royalties                  (Rev. January 2022)              Information 
                                                                                                         For calendar year     
                                                                            $                                 20
                                                                            3 Other income               4 Federal income tax withheld    Copy 1
                                                                            $                            $                                For State Tax 
PAYER’S TIN                         RECIPIENT’S TIN                         5 Fishing boat proceeds      6 Medical and health care        Department
                                                                                                          payments

                                                                            $                            $
RECIPIENT’S name                                                            7 Payer made direct sales    8 Substitute payments in lieu 
                                                                            totaling $5,000 or more of    of dividends or interest
                                                                            consumer products to 
                                                                            recipient for resale         $
Street address (including apt. no.)                                         9 Crop insurance proceeds    10 Gross proceeds paid to an 
                                                                                                            attorney
                                                                            $                            $
City or town, state or province, country, and ZIP or foreign postal code    11 Fish purchased for resale 12 Section 409A deferrals

                                                                            $                            $
                                                    13 FATCA filing         14 Excess golden parachute   15 Nonqualified deferred 
                                                      requirement              payments                     compensation
                                                                            $                            $
Account number (see instructions)                                           16 State tax withheld        17 State/Payer’s state no.    18 State income
                                                                            $                                                          $
                                                                            $                                                          $
Form 1099-MISC (Rev. 1-2022)                        www.irs.gov/Form1099MISC                             Department of the Treasury - Internal Revenue Service

                                                      CORRECTED (if checked)
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.
                                                                            $                            Form 1099-MISC               Miscellaneous 
                                                                            2 Royalties                  (Rev. January 2022)              Information
                                                                                                         For calendar year     
                                                                            $                                 20
                                                                            3 Other income               4 Federal income tax withheld    Copy B
                                                                            $                            $                                For Recipient
PAYER’S TIN                         RECIPIENT’S TIN                         5 Fishing boat proceeds      6 Medical and health care 
                                                                                                          payments

                                                                            $                            $
RECIPIENT’S name                                                            7 Payer made direct sales    8 Substitute payments in lieu 
                                                                            totaling $5,000 or more of    of dividends or interest     This is important tax 
                                                                            consumer products to                                          information and is 
                                                                            recipient for resale         $                                being furnished to 
Street address (including apt. no.)                                         9 Crop insurance proceeds    10 Gross proceeds paid to an     the IRS. If you are 
                                                                                                            attorney                      required to file a 
                                                                                                                                       return, a negligence 
                                                                            $                            $                                penalty or other 
City or town, state or province, country, and ZIP or foreign postal code    11 Fish purchased for resale 12 Section 409A deferrals        sanction may be 
                                                                                                                                          imposed on you if 
                                                                                                                                          this income is 
                                                                            $                            $                             taxable and the IRS 
                                                    13 FATCA filing         14 Excess golden parachute   15 Nonqualified deferred         determines that it 
                                                      requirement              payments                     compensation                  has not been 
                                                                                                                                          reported.
                                                                            $                            $
Account number (see instructions)                                           16 State tax withheld        17 State/Payer’s state no.    18 State income
                                                                            $                                                          $
                                                                            $                                                          $
Form 1099-MISC (Rev. 1-2022)             (keep for your records)            www.irs.gov/Form1099MISC     Department of the Treasury - Internal Revenue Service

Instructions for Recipient
Recipient’s taxpayer identification number (TIN). For your protection, this        Box 6. For individuals, report on Schedule C (Form 1040).
form may show only the last four digits of your social security number (SSN),      Box 7. If checked, consumer products totaling $5,000 or more were sold to you 
individual taxpayer identification number (ITIN), adoption taxpayer identification for resale, on a buy-sell, a deposit-commission, or other basis. Generally, report 
number (ATIN), or employer identification number (EIN). However, the payer has     any income from your sale of these products on Schedule C (Form 1040).
reported your complete TIN to the IRS.                                             Box 8. Shows substitute payments in lieu of dividends or tax-exempt interest 
Account number. May show an account or other unique number the payer               received by your broker on your behalf as a result of a loan of your securities. 
assigned to distinguish your account.                                              Report on the “Other income” line of Schedule 1 (Form 1040).
Amounts shown may be subject to self-employment (SE) tax. Individuals              Box 9. Report this amount on Schedule F (Form 1040).
should see the Instructions for Schedule SE (Form 1040). Corporations,             Box 10. Shows gross proceeds paid to an attorney in connection with legal 
fiduciaries, or partnerships must report the amounts on the appropriate line of    services. Report only the taxable part as income on your return.
their tax returns.                                                                 Box 11. Shows the amount of cash you received for the sale of fish if you are in 
Form 1099-MISC incorrect? If this form is incorrect or has been issued in error,   the trade or business of catching fish.
contact the payer. If you cannot get this form corrected, attach an explanation    Box 12. May show current year deferrals as a nonemployee under a 
to your tax return and report your information correctly.                          nonqualified deferred compensation (NQDC) plan that is subject to the 
Box 1.Report rents from real estate on Schedule E (Form 1040). However,            requirements of section 409A plus any earnings on current and prior year 
report rents on Schedule C (Form 1040) if you provided significant services to     deferrals. 
the tenant, sold real estate as a business, or rented personal property as a       Box 13. If the FATCA filing requirement box is checked, the payer is reporting 
business. See Pub. 527.                                                            on this Form 1099 to satisfy its account reporting requirement under chapter 4 
Box 2.Report royalties from oil, gas, or mineral properties; copyrights; and       of the Internal Revenue Code. You may also have a filing requirement. See the 
patents on Schedule E (Form 1040). However, report payments for a working          Instructions for Form 8938.
interest as explained in the Schedule E (Form 1040) instructions. For royalties on Box 14. Shows your total compensation of excess golden parachute payments 
timber, coal, and iron ore, see Pub. 544.                                          subject to a 20% excise tax. See your tax return instructions for where to report.
Box 3. Generally, report this amount on the “Other income” line of Schedule 1      Box 15. Shows income as a nonemployee under an NQDC plan that does not 
(Form 1040) and identify the payment. The amount shown may be payments             meet the requirements of section 409A. Any amount included in box 12 that is 
received as the beneficiary of a deceased employee, prizes, awards, taxable        currently taxable is also included in this box. Report this amount as income on 
damages, Indian gaming profits, or other taxable income. See Pub. 525. If it is    your tax return. This income is also subject to a substantial additional tax to be 
trade or business income, report this amount on Schedule C or F (Form 1040).       reported on Form 1040, 1040-SR, or 1040-NR. See the instructions for your tax 
Box 4. Shows backup withholding or withholding on Indian gaming profits.           return.
Generally, a payer must backup withhold if you did not furnish your TIN. See       Boxes 16–18. Show state or local income tax withheld from the payments.
Form W-9 and Pub. 505 for more information. Report this amount on your 
income tax return as tax withheld.                                                 Future developments. For the latest information about developments related to 
Box 5. Shows the amount paid to you as a fishing boat crew member by the           Form 1099-MISC and its instructions, such as legislation enacted after they 
operator, who considers you to be self-employed. Self-employed individuals         were published, go to www.irs.gov/Form1099MISC.
must report this amount on Schedule C (Form 1040). See Pub. 334.                   Free File Program. Go to www.irs.gov/FreeFile to see if you qualify for no-cost 
                                                                                   online federal tax preparation, e-filing, and direct deposit or payment options.

                                                      CORRECTED (if checked)
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.
                                                                            $                            Form 1099-MISC               Miscellaneous 
                                                                            2 Royalties                  (Rev. January 2022)              Information
                                                                                                         For calendar year     
                                                                            $                                 20
                                                                            3 Other income               4 Federal income tax withheld    Copy 2
                                                                            $                            $                                To be filed with 
PAYER’S TIN                         RECIPIENT’S TIN                         5 Fishing boat proceeds      6 Medical and health care      recipient’s state 
                                                                                                          payments                     income tax return, 
                                                                                                                                          when required.
                                                                            $                            $
RECIPIENT’S name                                                            7 Payer made direct sales    8 Substitute payments in lieu 
                                                                            totaling $5,000 or more of    of dividends or interest
                                                                            consumer products to 
                                                                            recipient for resale         $
Street address (including apt. no.)                                         9 Crop insurance proceeds    10 Gross proceeds paid to an 
                                                                                                            attorney
                                                                            $                            $
City or town, state or province, country, and ZIP or foreign postal code    11 Fish purchased for resale 12 Section 409A deferrals

                                                                            $                            $
                                                    13 FATCA filing         14 Excess golden parachute   15 Nonqualified deferred 
                                                      requirement              payments                     compensation
                                                                            $                            $
Account number (see instructions)                                           16 State tax withheld        17 State/Payer’s state no.    18 State income
                                                                            $                                                          $
                                                                            $                                                          $
Form 1099-MISC (Rev. 1-2022)                        www.irs.gov/Form1099MISC                             Department of the Treasury - Internal Revenue Service

                                         VOID         CORRECTED
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.
                                                                            $                            Form 1099-MISC               Miscellaneous 
                                                                            2 Royalties                  (Rev. January 2022)              Information
                                                                                                         For calendar year     
                                                                            $                                 20
                                                                            3 Other income               4 Federal income tax withheld    Copy C
                                                                            $                            $                                For Payer
PAYER’S TIN                         RECIPIENT’S TIN                         5 Fishing boat proceeds      6 Medical and health care 
                                                                                                          payments

                                                                            $                            $
RECIPIENT’S name                                                            7 Payer made direct sales    8 Substitute payments in lieu 
                                                                            totaling $5,000 or more of    of dividends or interest      For Privacy Act 
                                                                            consumer products to                                        and Paperwork 
                                                                            recipient for resale         $                                Reduction Act 
Street address (including apt. no.)                                         9 Crop insurance proceeds    10 Gross proceeds paid to an     Notice, see the 
                                                                                                            attorney
                                                                                                                                       current General 
                                                                            $                            $                             Instructions for 
City or town, state or province, country, and ZIP or foreign postal code    11 Fish purchased for resale 12 Section 409A deferrals        Certain 
                                                                                                                                          Information 
                                                                            $                            $                                Returns.
                                                    13 FATCA filing         14 Excess golden parachute   15 Nonqualified deferred 
                                                      requirement              payments                     compensation
                                                                            $                            $
Account number (see instructions)                   2nd TIN not.            16 State tax withheld        17 State/Payer’s state no.    18 State income
                                                                            $                                                          $
                                                                            $                                                          $
Form 1099-MISC (Rev. 1-2022)                        www.irs.gov/Form1099MISC                             Department of the Treasury - Internal Revenue Service

Instructions for Payer
To complete Form 1099-MISC, use:                      Filing and furnishing. For filing and furnishing 
• The current General Instructions for Certain        instructions, including due dates, and to request filing or 
Information Returns, and                              furnishing extensions, see the current General 
• The current Instructions for Forms 1099-MISC and    Instructions for Certain Information Returns.
1099-NEC.                                             Need help? If you have questions about reporting on 
To complete corrected Forms 1099-MISC, see the        Form 1099-MISC, call the information reporting 
current General Instructions for Certain Information  customer service site toll free at 866-455-7438 or 
Returns.                                              304-263-8700 (not toll free). Persons with a hearing or 
                                                      speech disability with access to TTY/TDD equipment 
To order these instructions and additional forms, go  can call 304-579-4827 (not toll free). 
to www.irs.gov/EmployerForms.
Caution: Because paper forms are scanned during 
processing, you cannot file certain Forms 1096, 1097, 
1098, 1099, 3921, or 5498 that you print from the IRS 
website.