Fillable Form 1099-CAP: Corporate Changes in Control and Capital (IRS)

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Form 1099-CAP: Corporate Changes in Control and Capital (IRS)

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Form 1099-CAP
(Rev. September 2019)
Cat. No. 35115M
Changes in
Corporate
Control and
Capital Structure
Copy A
For
Internal Revenue
Service Center
Department of the Treasury - Internal Revenue Service
File with Form 1096.
OMB No. 1545-1814
For Paperwork
Reduction Act
Notice, see the
current General
Instructions for
Certain Information
Returns.
7373
For calendar year
20
VOID CORRECTED
CORPORATION’S name, street address, city or town, state or province,
country, ZIP or foreign postal code, and telephone no.
CORPORATION’S TIN SHAREHOLDER’S TIN
SHAREHOLDER’S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)
1 Date of sale or exchange
2 Aggregate amount rec’d*
$
3 No. of shares exchanged 4
Classes of stock exchanged
5
* The shareholder cannot claim a loss based on the
amount in box 2.
Form 1099-CAP (Rev. 9-2019)
www.irs.gov/Form1099CAP
Do Not Cut or Separate Forms on This Page — Do Not Cut or Separate Forms on This Page
Form 1099-CAP
(Rev. September 2019)
Changes in
Corporate
Control and
Capital Structure
Copy B
For Shareholder
Department of the Treasury - Internal Revenue Service
This is important tax
information and is being
furnished to the IRS. If
you are required to file a
return, a negligence
penalty or other
sanction may be
imposed on you if
taxable income results
from this transaction
and the IRS determines
that it has not been
reported.
OMB No. 1545-1814
For calendar year
20
CORRECTED (if checked)
CORPORATION’S name, street address, city or town, state or province,
country, ZIP or foreign postal code, and telephone no.
CORPORATION’S TIN SHAREHOLDER’S TIN
SHAREHOLDER’S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)
1 Date of sale or exchange
2 Aggregate amount rec’d*
$
3 No. of shares exchanged 4
Classes of stock exchanged
5
* You cannot claim a loss based on the amount in box 2.
Form 1099-CAP (Rev. 9-2019)
(keep for your records)
www.irs.gov/Form1099CAP
Instructions for Shareholder
A corporation in which you own stock that has had a
change in control or a substantial change in capital
structure must send you this statement by January 31 of
the year following the calendar year of the change. You
have received this statement because the corporation
has reasonably determined that you may be required to
recognize gain from the receipt of cash, stock, or other
property that was exchanged for the corporation’s
stock. Report any gain from the exchange on Form
8949. However, you cannot claim a (loss) on Form 8949
as a result of this exchange. See chapter 4 of Pub. 550
for additional information.
Shareholder’s taxpayer identification number (TIN).
For your protection, this form may show only the last
four digits of your TIN (social security number (SSN),
individual taxpayer identification number (ITIN), adoption
taxpayer identification number (ATIN), or employer
identification number (EIN)). However, the issuer has
reported your complete TIN to the IRS.
Account number. May show an account or other
unique number the payer corporation assigned to
distinguish your account.
Box 1. Shows the date the stock was exchanged for
cash, stock, or other property.
Box 2. Shows the aggregate amount of any cash and
the fair market value of any stock or other property
received by you in the exchange for the stock you held.
Box 3. Shows the number of shares of the corporation’s
stock that you held which were exchanged in the
transaction.
Box 4. Shows the class or classes of stock that were
exchanged.
Future developments. For the latest information about
developments related to Form 1099-CAP and its
instructions, such as legislation enacted after they were
published, go to www.irs.gov/Form1099CAP.
Form 1099-CAP
(Rev. September 2019)
Changes in
Corporate
Control and
Capital Structure
Copy C
For Corporation
Department of the Treasury - Internal Revenue Service
OMB No. 1545-1814
For Paperwork
Reduction Act
Notice, see the
current General
Instructions for
Certain Information
Returns.
For calendar year
20
VOID CORRECTED
CORPORATION’S name, street address, city or town, state or province,
country, ZIP or foreign postal code, and telephone no.
CORPORATION’S TIN SHAREHOLDER’S TIN
SHAREHOLDER’S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)
1 Date of sale or exchange
2 Aggregate amount rec’d*
$
3 No. of shares exchanged 4
Classes of stock exchanged
5
* The shareholder cannot claim a loss based on the
amount in box 2.
Form 1099-CAP (Rev. 9-2019)
www.irs.gov/Form1099CAP
Instructions for Corporation
To complete Form 1099-CAP, use:
• The current General Instructions for Certain
Information Returns, and
• The current Instructions for Form 1099-CAP.
To get or to order these instructions, go to
www.irs.gov/Form1099CAP.
Filing and furnishing. For filing and furnishing
instructions, including due dates, and to request filing or
furnishing extensions, see the current General
Instructions for Certain Information Returns.
To file electronically, you must have software that
generates a file according to the specifications in Pub.
1220.
Need help? If you have questions about reporting on
Form 1099-CAP, call the information reporting customer
service site toll free at 866-455-7438 or 304-263-8700
(not toll free). Persons with a hearing or speech
disability with access to TTY/TDD equipment can call
304-579-4827 (not toll free).
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Form 1099-CAP: Corporate Changes in Control and Capital (IRS)

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Completed 11 March 2022

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