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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
information return forms that can’t be scanned. See part O in the current General
Instructions for Certain Information Returns, available at www.irs.gov/form1099, for more
information about penalties.
Please note that Copy B and other copies of this form, which appear in black, may be
downloaded and printed and used to satisfy the requirement to provide the information to
the recipient.
To order official IRS information returns, which include a scannable Copy A for filing with
the IRS and all other applicable copies of the form, visit www.IRS.gov/orderforms
. Click on
Employer and Information Returns, and we’ll mail you the forms you request and their
instructions, as well as any publications you may order.
Information returns may also be filed electronically using the IRS Filing Information Returns
Electronically (FIRE) system (visit www.IRS.gov/FIRE
) or the IRS Affordable Care Act
Information Returns (AIR) program (visit www.IRS.gov/AIR).
See IRS Publications 1141, 1167, and 1179 for more information about printing these tax
forms.
Form 1099-MISC
2017
Cat. No. 14425J
Miscellaneous
Income
Copy A
For
Internal Revenue
Service Center
Department of the Treasury - Internal Revenue Service
File with Form 1096.
OMB No. 1545-0115
For Privacy Act
and Paperwork
Reduction Act
Notice, see the
2017 General
Instructions for
Certain
Information
Returns.
9595
VOID CORRECTED
PAYER’S name, street address, city or town, state or province, country, ZIP
or foreign postal code, and telephone no.
PAYER’S federal identification number
RECIPIENT’S identification number
RECIPIENT’S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions) FATCA filing
requirement
2nd TIN not.
1 Rents
$
2 Royalties
$
3 Other income
$
4
Federal income tax withheld
$
5 Fishing boat proceeds
$
6
Medical and health care payments
$
7
Nonemployee compensation
$
8
Substitute payments in lieu of
dividends or interest
$
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
$
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
Do Not Cut or Separate Forms on This Page — Do Not Cut or Separate Forms on This Page
Form 1099-MISC
2017
Miscellaneous
Income
Copy 1
For State Tax
Department
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0115
VOID CORRECTED
PAYER’S name, street address, city or town, state or province, country, ZIP
or foreign postal code, and telephone no.
PAYER’S federal identification number
RECIPIENT’S identification number
RECIPIENT’S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions) FATCA filing
requirement
1 Rents
$
2 Royalties
$
3 Other income
$
4
Federal income tax withheld
$
5 Fishing boat proceeds
$
6
Medical and health care payments
$
7
Nonemployee compensation
$
8
Substitute payments in lieu of
dividends or interest
$
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
$
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
Form 1099-MISC
2017
Miscellaneous
Income
Copy B
For Recipient
Department of the Treasury - Internal Revenue Service
This is important tax
information and is
being furnished to
the Internal Revenue
Service. If you are
required to file a
return, a negligence
penalty or other
sanction may be
imposed on you if
this income is
taxable and the IRS
determines that it
has not been
reported.
OMB No. 1545-0115
CORRECTED (if checked)
PAYER’S name, street address, city or town, state or province, country, ZIP
or foreign postal code, and telephone no.
PAYER’S federal identification number
RECIPIENT’S identification number
RECIPIENT’S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions) FATCA filing
requirement
1 Rents
$
2 Royalties
$
3 Other income
$
4
Federal income tax withheld
$
5 Fishing boat proceeds
$
6
Medical and health care payments
$
7
Nonemployee compensation
$
8
Substitute payments in lieu of
dividends or interest
$
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
$
15a Section 409A deferrals
$
15b Section 409A income
$
16 State tax withheld
$
$
17 State/Payer’s state no. 18 State income
$
$
Form 1099-MISC
(keep for your records)
www.irs.gov/form1099misc
Form 1099-MISC
2017
Miscellaneous
Income
Copy 2
Department of the Treasury - Internal Revenue Service
To be filed with
recipient's state
income tax return,
when required.
OMB No. 1545-0115
CORRECTED (if checked)
PAYER’S name, street address, city or town, state or province, country, ZIP
or foreign postal code, and telephone no.
PAYER’S federal identification number
RECIPIENT’S identification number
RECIPIENT’S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)
FATCA filing
requirement
1 Rents
$
2 Royalties
$
3 Other income
$
4
Federal income tax withheld
$
5 Fishing boat proceeds
$
6
Medical and health care payments
$
7
Nonemployee compensation
$
8
Substitute payments in lieu of
dividends or interest
$
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
$
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
Form 1099-MISC
2017
Miscellaneous
Income
Copy C
For Payer
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0115
For Privacy Act
and Paperwork
Reduction Act
Notice, see the
2017 General
Instructions for
Certain
Information
Returns.
VOID CORRECTED
PAYER’S name, street address, city or town, state or province, country, ZIP
or foreign postal code, and telephone no.
PAYER’S federal identification number
RECIPIENT’S identification number
RECIPIENT’S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions) FATCA filing
requirement
2nd TIN not.
1 Rents
$
2 Royalties
$
3 Other income
$
4
Federal income tax withheld
$
5 Fishing boat proceeds
$
6
Medical and health care payments
$
7
Nonemployee compensation
$
8
Substitute payments in lieu of
dividends or interest
$
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
$
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
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Completed 26 January 2021

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