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 Pub. 550, chapter 4,
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
Box 4. Shows the class or classes of stock that were
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.