CORRECTED (if checked)

PAYER’S name, street address, city or town, state or province, country, ZIP or foreign
1 Rents OMB No. 1545-0115
postal code, and telephone no.
$ 15000.00 Miscellaneous
OLESON CONSTRUCTION 2 Royalties 2021 Information
71 TOWN AND COUNTRY DR 1470 CLOV $ Form 1099-MISC 1FDEA0302 09/14/21
3 Other income 4 Federal income tax withheld
DECATUR IL 62549 Copy B
(607) 372-1941 Robert Oleson $ 35000.00 $ 0.00 For Recipient
PAYER’S TIN RECIPIENT’S TIN 5 Fishing boat proceeds 6 Med & health care payments

330-34-4707 074-80-2413 $ $ This is important tax

RECIPIENT’S name 7 Payer made direct sales 8 Substitute payments in lieu information and is
totalling $5,000 or more of of dividends or interest being furnished to
PHILLIP CAMPBELL consumer products to
recipient for resale G $ the IRS. If you are
required to file a
9 Crop insurance proceeds 10 Gross proceeds paid to an attorney return, a negligence
Street address (including apartment number) $ $ penalty or other
sanction may be
618 W STATE ST 11 Fish purchased for resale 12 Section 409A deferrals imposed on you if
City or town, state or province, country, and ZIP or foreign postal code $ this income is
$ taxable and the IRS
ITHACA NY 14850 13 Excess golden 14 Nonqualified deferred
parachute payments compensation determines that it has
Account number (see instructions) FATCA filing
$ $ not been reported.
req.
15 State tax withheld 16 State/Payer’s state no. 17 State income
$ 9000.00 NY 335648895 $ 39500.00
$ 7900.00 $
Form 1099-MISC (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 Box 5. Shows the amount paid to a fishing boat crew member who
protection, this form may show only the last four digits of your social is considered by the operator to be self-employed. Self-employed
security number (SSN), individual taxpayer identification number individuals must report this amount on Schedule C (Form 1040).
(ITIN), adoption taxpayer identification number (ATIN), or employer See Pub. 334.
identification number (EIN). However, the payer has reported your Box 6. For individuals, report on Schedule C (Form 1040).
complete TIN to the IRS.
Box 7. If checked, consumer products totaling $5,000 or more
Account number. May show an account or other unique number the were sold to you for resale, on a buy-sell, a deposit-commission,
payer assigned to distinguish your account. or other basis. Generally, report any income from your sale of
FATCA filing requirement. If the FATCA filing requirement box is these products on Schedule C (Form 1040).
checked, the payer is reporting on this Form 1099 to satisfy its Box 8. Shows substitute payments in lieu of dividends or tax-
account reporting requirement under chapter 4 of the Internal exempt interestreceived by your broker on your behalf as a result
Revenue Code. You may also have a filing requirement. See the of a loan of your securities.Report on the Other income line of
Instructions for Form 8938. Schedule 1 (Form 1040).
Amounts shown may be subject to self-employment (SE) tax.
Individuals should see the instructions for schedule SE (Form 1040). Box 9. Report this amount on Schedule F (Form 1040).
Corporations, fiduciaries, or partnerships must report the amounts Box 10. Shows gross proceeds paid to an attorney in connection
on the appropiate line of their tax returns. with legal services. Report only the taxable part as income on
Form 1099-MISC incorrect? If this form is incorrect or has been your return.
issued in error, contact the payer. If you cannot get this form Box 11. Shows the amount paid for the purchase of fish for resale
corrected, attach an explanation to your tax return and report your from any person engaged in the trade or business of catching
information correctly.
fish. See the instructions for your tax return for reporting this
Box 1. Report rents from real estate on Schedule E (Form 1040 or income.
1040-SR). However, report rents on Schedule C (Form 1040 or Box 12. May show current year deferrals as a nonemployee under
1040-SR) if you provided significant services to the tenant, sold real a nonqualified deferred compensation (NQDC) plan that is subject
estate as a business, or rented personal property as a business. See to the requirements of section 409A plus any earnings on current
Pub. 527. and prior year deferrals
Box 2. Report royalties from oil, gas, or mineral properties; Box 13. Shows your total compensation of excess golden
copyrights; and patents on Schedule E (Form 1040 or 1040-SR). parachute payments subject to a 20% excise tax. See your tax
However, report payments for a working interest as explained in the return instructions for where to report.
Schedule E (Form 1040 or 1040-SR) instructions. For royalties on Box 14. Shows income as a nonemployee under an NQDC plan
timber, coal, and iron ore, see Pub. 544. that does not meet the requirements of section 409A. Any amount
Box 3. Generally, report this amount on the "Other income" line of included in box 12 that is currently taxable is also included in this
Schedule 1 (Form 1040 or 1040-SR), or Form 1040-NR and identify box. Report this amount as income on your tax return. This income
the payment. The amount shown may be payments received as the is also subject to a substantial additional tax to be reported on
beneficiary of a deceased employee, prizes, awards, taxable Form 1040, 1040-SR, or 1040-NR. See the instructions for your tax
damages, Indian gaming profits, or other taxable income. See Pub. return.
525. If it is trade or business income, report this amount on Schedule Box 15 -17. Show state or local income tax withheld from the
C or F (Form 1040 or 1040-SR). payments.
Box 4. Shows backup withholding or withholding on Indian gaming Future developments. For the latest information about
profits. Generally, a payer must backup withhold if you did not furnish developments related to Form 1099-MISC and its instructions,
your TIN. See Form W-9 and Pub. 505 for more information. Report such as legislation enacted after they were published, go to
this amount on your income tax return as tax withheld. www.irs.gov/Form1099MISC
Free File. 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.

1 of 4
 VOID CORRECTED
1 Rents
PAYER’S name, street address, city or town, state or province, country, ZIP or foreign OMB No. 1545-0115
postal code, and telephone no.
$ 15000.00 Miscellaneous
OLESON CONSTRUCTION
2 Royalties 2021 Information
71 TOWN AND COUNTRY DR 1470 CLOV $ Form 1099-MISC
DECATUR IL 62549 3 Other income 4 Federal income tax withheld
$ 35000.00 $ 0.00 Copy 1
PAYER’S TIN RECIPIENT’S TIN 5 Fishing boat proceeds 6 Med & health care payments For State Tax
$ $ Department
330-34-4707 074-80-2413
RECIPIENT’S name 7 Payer made direct sales 8 Substitute payments in lieu
totalling $5,000 or more of of dividends or interest
consumer products to
PHILLIP CAMPBELL recipient for resale G $
9 Crop insurance proceeds 10 Gross proceeds paid to an attorney
Street address (including apartment number)
$ $
618 W STATE ST 11 Fish purchased for resale 12 Section 409A deferrals
City or town, state or province, country, and ZIP or foreign postal code $ $
ITHACA NY 14850 13 Excess golden 14 Nonqualified deferred
parachute payments compensation
Account number (see instructions) FATCA filing
req. $ $
15 State tax withheld 16 State/Payer’s state no. 17 State income
$ 9000.00 NY 335648895 $ 39500.00
$ 7900.00 $
Form 1099-MISC FDEA0302 09/14/21 www.irs.gov/Form1099MISC Department of the Treasury ' Internal Revenue Service

2 of 4
 VOID CORRECTED
1 Rents
PAYER’S name, street address, city or town, state or province, country, ZIP or foreign OMB No. 1545-0115
postal code, and telephone no.
$ 15000.00 Miscellaneous
OLESON CONSTRUCTION
2 Royalties 2021 Information
71 TOWN AND COUNTRY DR 1470 CLOV $ Form 1099-MISC
DECATUR IL 62549 3 Other income 4 Federal income tax withheld Copy C
$ 35000.00 $ 0.00 For Payer
PAYER’S TIN RECIPIENT’S TIN 5 Fishing boat proceeds 6 Med & health care payments

330-34-4707 074-80-2413 $ $
RECIPIENT’S name 7 Payer made direct sales 8 Substitute payments in lieu For Privacy Act
totalling $5,000 or more of of dividends or interest and Paperwork
PHILLIP CAMPBELL consumer products to
recipient for resale G $ Reduction Act
Crop insurance proceeds Notice, see the
9 10 Gross proceeds paid to an attorney
2021 General
Street address (including apartment number)
$ $ Instructions for
618 W STATE ST Fish purchased for resale Section 409A deferrals Certain
11 12
City or town, state or province, country, and ZIP or foreign postal code Information
$ $ Returns.
ITHACA NY 14850 13 Excess golden
parachute payments 14 Nonqualified deferred
compensation
Account number (see instructions) FATCA filing 2nd TIN not.
req. $ $
15 State tax withheld 16 State/Payer’s state no. 17 State income
$ 9000.00 NY 335648895 $ 39500.00
$ 7900.00 $
Form 1099-MISC FDEA0302 09/14/21 www.irs.gov/Form1099MISC Department of the Treasury ' Internal Revenue Service

Instructions for Payer

To complete Form 1099-MISC, use: File Copy A of this form with the IRS by February 28, 2022, if
? The 2021 General Instructions for Certain Information you file on paper, or by March 31, 2022, if you file electronically.
Returns, and To file electronically, you must have software that generates
? The 2021 Instructions for Forms 1099-MISC and 1099-NEC. a file according to the specifications in Pub. 1220. The IRS does
not provide a fill-in form option for Copy A.
To complete corrected Forms 1099-MISC, see the 2021
General Instructions for Certain Information Returns. Need help? If you have questions about reporting on Form
1099-MISC, call the information reporting customer service site
To order these instructions and additional forms, go to toll free at 866-455-7438 or 304-263-8700 (not toll free). Persons
www.irs.gov/Form1099MISC with a hearing or speech disability with access to TTY/TDD
equipment can call 304-579-4827 (not toll free).
Caution: Because paper forms are scanned during processing,
you cannot file Forms 1096, 1097, 1098, 1099, 3921, or 5498
that you print from the IRS website.
Due dates. Furnish Copy B of this form to the recipient by
January 31, 2022. The due date is extended to February 15, 2022,
if you are reporting payments in box 8 or 10.

3 of 4
OLESON CONSTRUCTION
71 TOWN AND COUNTRY DR
1470 CLOVERLEAF RD LOCKE NY, 13092
DECATUR, IL 62549

PHILLIP CAMPBELL
618 W STATE ST
ITHACA , NY 14850

This sheet is for your convenience when mailing the 1099 to your recipients using standard 8-3/4 x 5-5/8 double window envelopes.

4 of 4