1099 VENDOR WITH CLASS 02

SUITE # 234, STREET # 456

DUBLIN, CA 94566

Instructions for Recipient

Recipient's identification number. For your protection, this form may show only the last four digits of your social Box 6. For individuals, report on Schedule C (Form 1040).
security number (SSN), individual taxpayer identification number (ITIN), adoption taxpayer identification number Box 7. Shows nonemployee compensation. If you are in the trade or business of catching fish, box 7 may show cash
(ATIN), or employer identification number (EIN). However, the issuer has reported your complete identification number you received for the sale of fish. If the amount in this box is SE income, report it on Schedule C or F (Form 1040), and
to the IRS. complete Schedule SE (Form 1040). You received this form instead of Form W-2 because the payer did not consider
Account number. May show an account or other unique number the payer assigned to distinguish your account. you an employee and did not withhold income tax or social security and Medicare tax. If you believe you are an
FATCA filing requirement. If the FATCA filing requirement box is checked, the payer is reporting on this Form 1099 employee and cannot get the payer to correct this form, report the amount from box 7 on Form 1040, line 7 (or Form
to satisfy its chapter 4 account reporting requirement. You also may have a filing requirement. See the Instructions for 1040NR, line 8). You must also complete Form 8919 and attach it to your return. If you are not an employee but the
Form 8938. amount in this box is not SE income (for example, it is income from a sporadic activity or a hobby), report it on Form
Amounts shown may be subject to self-employment (SE) tax. If your net income from self-employment is $400 or 1040, line 21 (or Form 1040NR, line 21).
more, you must file a return and compute your SE tax on Schedule SE (Form 1040). See Pub. 334 for more information. Box 8. Shows substitute payments in lieu of dividends or tax-exempt interest received by your broker on your behalf
If no income or social security and Medicare taxes were withheld and you are still receiving these payments, see Form as a result of a loan of your securities. Report on the "Other income" line of Form 1040 (or Form 1040NR).
1040-ES (or Form 1040-ES(NR)). Individuals must report these amounts as explained in the box 7 instructions on this Box 9. If checked, $5,000 or more of sales of consumer products was paid to you on a buy-sell, deposit-commission,
page. Corporations, fiduciaries, or partnerships must report the amounts on the proper line of their tax returns. or other basis. A dollar amount does not have to be shown. Generally, report any income from your sale of these
Form 1099-MISC incorrect? If this form is incorrect or has been issued in error, contact the payer. If you cannot get products on Schedule C (Form 1040).
this form corrected, attach an explanation to your tax return and report your income correctly. Box 10. Report this amount on Schedule F (Form 1040).
Box 1. Report rents from real estate on Schedule E (Form 1040). However, report rents on Schedule C (Form 1040) if Box 13. Shows your total compensation of excess golden parachute payments subject to a 20% excise tax. See the
you provided significant services to the tenant, sold real estate as a business, or rented personal property as a business. Form 1040 (or Form 1040NR) instructions for where to report.
Box 2. Report royalties from oil, gas, or mineral properties, copyrights, and patents on Schedule E (Form 1040). Box 14. Shows gross proceeds paid to an attorney in connection with legal services. Report only the taxable part as
However, report payments for a working interest as explained in the box 7 instructions. For royalties on timber, coal, income on your return.
and iron ore, see Pub. 544. Box 15a. May show current year deferrals as a nonemployee under a nonqualified deferred compensation (NQDC)
Box 3. Generally, report this amount on the "Other income" line of Form 1040 (or Form 1040NR) and identify the plan that is subject to the requirements of section 409A, plus any earnings on current and prior year deferrals.
payment. The amount shown may be payments received as the beneficiary of a deceased employee, prizes, awards, Box 15b. Shows income as a nonemployee under an NQDC plan that does not meet the requirements of section 409A.
taxable damages, Indian gaming profits, or other taxable income. See Pub. 525. If it is trade or business income, report This amount is also included in box 7 as nonemployee compensation. Any amount included in box 15a that is
this amount on Schedule C or F (Form 1040). currently taxable is also included in this box. This income is also subject to a substantial additional tax to be reported
Box 4. Shows backup withholding or withholding on Indian gaming profits. Generally, a payer must backup withhold if on Form 1040 (or Form 1040NR). See "Total Tax" in the Form 1040 (or Form 1040NR) instructions.
you did not furnish your taxpayer identification number. See Form W-9 and Pub. 505 for more information. Report this Boxes 16-18. Shows state or local income tax withheld from the payments.
amount on your income tax return as tax withheld. Future developments. For the latest information about developments related to Form 1099-MISC and its instructions,
Box 5. An amount in this box means the fishing boat operator considers you self-employed. Report this amount on such as legislation enacted after they were published, go to www.irs.gov/form1099misc.
Schedule C (Form 1040). See Pub. 334.

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.
US MANUFACTURING PAYER1 NAME1 $ 0.00
Miscellaneous
US MANUFACTURING PAYER1 NAME2
CANADIAN FIRST AVENUE 2 Royalties 2016 Income
CIVIC CENTER
SUITE 145 $ 50,000.00
VANCOUVER, BC 14003 Form 1099-MISC
CANADA 3 Other income 4 Federal income tax withheld
Copy B
234/948-5603 $ 0.00 $ 0.00
For Recipient
PAYER'S federal identification number. RECIPIENT'S identification number 5 Fishing boat proceeds 6 Medical and health care payments

123456789 1234567891 $ 0.00 $ 0.00

RECIPIENT'S name 7 Nonemployee compensation 8 Substitute payments in lieu of

dividends or interest This is important tax
1099 VENDOR WITH CLASS 02 information and is being
furnished to the Internal
$ 0.00 $ 0.00 Revenue Service. If you are
Street address (including apt. no.) 9 Payer made direct sales of 10 Crop insurance proceeds
required to file a return, a
$5,000 or more of consumer
SUITE # 234, STREET # 456 negligence penalty or other
products to a buyer
$ 0.00 sanction may be imposed on
(recipient) for resale► you if this income is taxable
City or town, state or province, country, and ZIP or foreign postal code 11 12 and the IRS determines that it
DUBLIN, CA 94566 has not been reported.

Account number (see instructions) FATCA filing 13 Excess golden parachute payments 14 Gross proceeds paid to an attorney
requirement
1099-02 $ 0.00 $ 0.00
15a Section 409A deferrals 15b Section 409A income 16 State tax withheld 17 State/Payer's state no. 18 State income
$ 0.00 CA/68219999978 $ 0.00
$ 0.00 $ 0.00 $ $
Form 1099-MISC (keep for your records) www.irs.gov/form1099misc Department of the Treasury - Internal Revenue Service
 1099 VENDOR FOR CLASS 7 AND CLASS2

STREET # 100
SUIT # 078
SAN JOSE, CA 94587

Instructions for Recipient

Recipient's identification number. For your protection, this form may show only the last four digits of your social Box 6. For individuals, report on Schedule C (Form 1040).
security number (SSN), individual taxpayer identification number (ITIN), adoption taxpayer identification number Box 7. Shows nonemployee compensation. If you are in the trade or business of catching fish, box 7 may show cash
(ATIN), or employer identification number (EIN). However, the issuer has reported your complete identification number you received for the sale of fish. If the amount in this box is SE income, report it on Schedule C or F (Form 1040), and
to the IRS. complete Schedule SE (Form 1040). You received this form instead of Form W-2 because the payer did not consider
Account number. May show an account or other unique number the payer assigned to distinguish your account. you an employee and did not withhold income tax or social security and Medicare tax. If you believe you are an
FATCA filing requirement. If the FATCA filing requirement box is checked, the payer is reporting on this Form 1099 employee and cannot get the payer to correct this form, report the amount from box 7 on Form 1040, line 7 (or Form
to satisfy its chapter 4 account reporting requirement. You also may have a filing requirement. See the Instructions for 1040NR, line 8). You must also complete Form 8919 and attach it to your return. If you are not an employee but the
Form 8938. amount in this box is not SE income (for example, it is income from a sporadic activity or a hobby), report it on Form
Amounts shown may be subject to self-employment (SE) tax. If your net income from self-employment is $400 or 1040, line 21 (or Form 1040NR, line 21).
more, you must file a return and compute your SE tax on Schedule SE (Form 1040). See Pub. 334 for more information. Box 8. Shows substitute payments in lieu of dividends or tax-exempt interest received by your broker on your behalf
If no income or social security and Medicare taxes were withheld and you are still receiving these payments, see Form as a result of a loan of your securities. Report on the "Other income" line of Form 1040 (or Form 1040NR).
1040-ES (or Form 1040-ES(NR)). Individuals must report these amounts as explained in the box 7 instructions on this Box 9. If checked, $5,000 or more of sales of consumer products was paid to you on a buy-sell, deposit-commission,
page. Corporations, fiduciaries, or partnerships must report the amounts on the proper line of their tax returns. or other basis. A dollar amount does not have to be shown. Generally, report any income from your sale of these
Form 1099-MISC incorrect? If this form is incorrect or has been issued in error, contact the payer. If you cannot get products on Schedule C (Form 1040).
this form corrected, attach an explanation to your tax return and report your income correctly. Box 10. Report this amount on Schedule F (Form 1040).
Box 1. Report rents from real estate on Schedule E (Form 1040). However, report rents on Schedule C (Form 1040) if Box 13. Shows your total compensation of excess golden parachute payments subject to a 20% excise tax. See the
you provided significant services to the tenant, sold real estate as a business, or rented personal property as a business. Form 1040 (or Form 1040NR) instructions for where to report.
Box 2. Report royalties from oil, gas, or mineral properties, copyrights, and patents on Schedule E (Form 1040). Box 14. Shows gross proceeds paid to an attorney in connection with legal services. Report only the taxable part as
However, report payments for a working interest as explained in the box 7 instructions. For royalties on timber, coal, income on your return.
and iron ore, see Pub. 544. Box 15a. May show current year deferrals as a nonemployee under a nonqualified deferred compensation (NQDC)
Box 3. Generally, report this amount on the "Other income" line of Form 1040 (or Form 1040NR) and identify the plan that is subject to the requirements of section 409A, plus any earnings on current and prior year deferrals.
payment. The amount shown may be payments received as the beneficiary of a deceased employee, prizes, awards, Box 15b. Shows income as a nonemployee under an NQDC plan that does not meet the requirements of section 409A.
taxable damages, Indian gaming profits, or other taxable income. See Pub. 525. If it is trade or business income, report This amount is also included in box 7 as nonemployee compensation. Any amount included in box 15a that is
this amount on Schedule C or F (Form 1040). currently taxable is also included in this box. This income is also subject to a substantial additional tax to be reported
Box 4. Shows backup withholding or withholding on Indian gaming profits. Generally, a payer must backup withhold if on Form 1040 (or Form 1040NR). See "Total Tax" in the Form 1040 (or Form 1040NR) instructions.
you did not furnish your taxpayer identification number. See Form W-9 and Pub. 505 for more information. Report this Boxes 16-18. Shows state or local income tax withheld from the payments.
amount on your income tax return as tax withheld. Future developments. For the latest information about developments related to Form 1099-MISC and its instructions,
Box 5. An amount in this box means the fishing boat operator considers you self-employed. Report this amount on such as legislation enacted after they were published, go to www.irs.gov/form1099misc.
Schedule C (Form 1040). See Pub. 334.

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.
US MANUFACTURING PAYER1 NAME1 $ 0.00
Miscellaneous
US MANUFACTURING PAYER1 NAME2
CANADIAN FIRST AVENUE 2 Royalties 2016 Income
CIVIC CENTER
SUITE 145 $ 50,000.00
VANCOUVER, BC 14003 Form 1099-MISC
CANADA 3 Other income 4 Federal income tax withheld
Copy B
234/948-5603 $ 0.00 $ 15,500.00
For Recipient
PAYER'S federal identification number. RECIPIENT'S identification number 5 Fishing boat proceeds 6 Medical and health care payments

123456789 1234567890 $ 0.00 $ 0.00

RECIPIENT'S name 7 Nonemployee compensation 8 Substitute payments in lieu of

dividends or interest This is important tax
1099 VENDOR FOR CLASS 7 AND CLASS2 information and is being
furnished to the Internal
$ 50,000.00 $ 0.00 Revenue Service. If you are
Street address (including apt. no.) 9 Payer made direct sales of 10 Crop insurance proceeds
required to file a return, a
$5,000 or more of consumer
STREET # 100 negligence penalty or other
products to a buyer
SUIT # 078 $ 0.00 sanction may be imposed on
(recipient) for resale► you if this income is taxable
City or town, state or province, country, and ZIP or foreign postal code 11 12 and the IRS determines that it
SAN JOSE, CA 94587 has not been reported.

Account number (see instructions) FATCA filing 13 Excess golden parachute payments 14 Gross proceeds paid to an attorney
requirement
1099-07 $ 0.00 $ 0.00
15a Section 409A deferrals 15b Section 409A income 16 State tax withheld 17 State/Payer's state no. 18 State income
$ 0.00 CA/68219999978 $ 0.00
$ 0.00 $ 0.00 $ $
Form 1099-MISC (keep for your records) www.irs.gov/form1099misc Department of the Treasury - Internal Revenue Service
 RONALD RIVES

909 HACIENDA

PLEASANTON, CA 94598

Instructions for Recipient

Recipient's identification number. For your protection, this form may show only the last four digits of your social Box 6. For individuals, report on Schedule C (Form 1040).
security number (SSN), individual taxpayer identification number (ITIN), adoption taxpayer identification number Box 7. Shows nonemployee compensation. If you are in the trade or business of catching fish, box 7 may show cash
(ATIN), or employer identification number (EIN). However, the issuer has reported your complete identification number you received for the sale of fish. If the amount in this box is SE income, report it on Schedule C or F (Form 1040), and
to the IRS. complete Schedule SE (Form 1040). You received this form instead of Form W-2 because the payer did not consider
Account number. May show an account or other unique number the payer assigned to distinguish your account. you an employee and did not withhold income tax or social security and Medicare tax. If you believe you are an
FATCA filing requirement. If the FATCA filing requirement box is checked, the payer is reporting on this Form 1099 employee and cannot get the payer to correct this form, report the amount from box 7 on Form 1040, line 7 (or Form
to satisfy its chapter 4 account reporting requirement. You also may have a filing requirement. See the Instructions for 1040NR, line 8). You must also complete Form 8919 and attach it to your return. If you are not an employee but the
Form 8938. amount in this box is not SE income (for example, it is income from a sporadic activity or a hobby), report it on Form
Amounts shown may be subject to self-employment (SE) tax. If your net income from self-employment is $400 or 1040, line 21 (or Form 1040NR, line 21).
more, you must file a return and compute your SE tax on Schedule SE (Form 1040). See Pub. 334 for more information. Box 8. Shows substitute payments in lieu of dividends or tax-exempt interest received by your broker on your behalf
If no income or social security and Medicare taxes were withheld and you are still receiving these payments, see Form as a result of a loan of your securities. Report on the "Other income" line of Form 1040 (or Form 1040NR).
1040-ES (or Form 1040-ES(NR)). Individuals must report these amounts as explained in the box 7 instructions on this Box 9. If checked, $5,000 or more of sales of consumer products was paid to you on a buy-sell, deposit-commission,
page. Corporations, fiduciaries, or partnerships must report the amounts on the proper line of their tax returns. or other basis. A dollar amount does not have to be shown. Generally, report any income from your sale of these
Form 1099-MISC incorrect? If this form is incorrect or has been issued in error, contact the payer. If you cannot get products on Schedule C (Form 1040).
this form corrected, attach an explanation to your tax return and report your income correctly. Box 10. Report this amount on Schedule F (Form 1040).
Box 1. Report rents from real estate on Schedule E (Form 1040). However, report rents on Schedule C (Form 1040) if Box 13. Shows your total compensation of excess golden parachute payments subject to a 20% excise tax. See the
you provided significant services to the tenant, sold real estate as a business, or rented personal property as a business. Form 1040 (or Form 1040NR) instructions for where to report.
Box 2. Report royalties from oil, gas, or mineral properties, copyrights, and patents on Schedule E (Form 1040). Box 14. Shows gross proceeds paid to an attorney in connection with legal services. Report only the taxable part as
However, report payments for a working interest as explained in the box 7 instructions. For royalties on timber, coal, income on your return.
and iron ore, see Pub. 544. Box 15a. May show current year deferrals as a nonemployee under a nonqualified deferred compensation (NQDC)
Box 3. Generally, report this amount on the "Other income" line of Form 1040 (or Form 1040NR) and identify the plan that is subject to the requirements of section 409A, plus any earnings on current and prior year deferrals.
payment. The amount shown may be payments received as the beneficiary of a deceased employee, prizes, awards, Box 15b. Shows income as a nonemployee under an NQDC plan that does not meet the requirements of section 409A.
taxable damages, Indian gaming profits, or other taxable income. See Pub. 525. If it is trade or business income, report This amount is also included in box 7 as nonemployee compensation. Any amount included in box 15a that is
this amount on Schedule C or F (Form 1040). currently taxable is also included in this box. This income is also subject to a substantial additional tax to be reported
Box 4. Shows backup withholding or withholding on Indian gaming profits. Generally, a payer must backup withhold if on Form 1040 (or Form 1040NR). See "Total Tax" in the Form 1040 (or Form 1040NR) instructions.
you did not furnish your taxpayer identification number. See Form W-9 and Pub. 505 for more information. Report this Boxes 16-18. Shows state or local income tax withheld from the payments.
amount on your income tax return as tax withheld. Future developments. For the latest information about developments related to Form 1099-MISC and its instructions,
Box 5. An amount in this box means the fishing boat operator considers you self-employed. Report this amount on such as legislation enacted after they were published, go to www.irs.gov/form1099misc.
Schedule C (Form 1040). See Pub. 334.

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.
US MANUFACTURING PAYER1 NAME1 $ 0.00
Miscellaneous
US MANUFACTURING PAYER1 NAME2
CANADIAN FIRST AVENUE 2 Royalties 2016 Income
CIVIC CENTER
SUITE 145 $ 0.00
VANCOUVER, BC 14003 Form 1099-MISC
CANADA 3 Other income 4 Federal income tax withheld
Copy B
234/948-5603 $ 0.00 $ 0.00
For Recipient
PAYER'S federal identification number. RECIPIENT'S identification number 5 Fishing boat proceeds 6 Medical and health care payments

123456789 $ 0.00 $ 0.00

RECIPIENT'S name 7 Nonemployee compensation 8 Substitute payments in lieu of

dividends or interest This is important tax
RONALD RIVES information and is being
furnished to the Internal
$ 0.00 $ 0.00 Revenue Service. If you are
Street address (including apt. no.) 9 Payer made direct sales of 10 Crop insurance proceeds
required to file a return, a
$5,000 or more of consumer
909 HACIENDA negligence penalty or other
products to a buyer
$ 0.00 sanction may be imposed on
(recipient) for resale► X you if this income is taxable
City or town, state or province, country, and ZIP or foreign postal code 11 12 and the IRS determines that it
PLEASANTON, CA 94598 has not been reported.

Account number (see instructions) FATCA filing 13 Excess golden parachute payments 14 Gross proceeds paid to an attorney
requirement
USA0000018 $ 0.00 $ 0.00
15a Section 409A deferrals 15b Section 409A income 16 State tax withheld 17 State/Payer's state no. 18 State income
$ 600.00 CA/68219999978 $ 0.00
$ 0.00 $ 0.00 $ $
Form 1099-MISC (keep for your records) www.irs.gov/form1099misc Department of the Treasury - Internal Revenue Service
 RONALD RIVES

909 HACIENDA

PLEASANTON, CA 94598

Instructions for Recipient

Recipient's identification number. For your protection, this form may show only the last four digits of your social Box 6. For individuals, report on Schedule C (Form 1040).
security number (SSN), individual taxpayer identification number (ITIN), adoption taxpayer identification number Box 7. Shows nonemployee compensation. If you are in the trade or business of catching fish, box 7 may show cash
(ATIN), or employer identification number (EIN). However, the issuer has reported your complete identification number you received for the sale of fish. If the amount in this box is SE income, report it on Schedule C or F (Form 1040), and
to the IRS. complete Schedule SE (Form 1040). You received this form instead of Form W-2 because the payer did not consider
Account number. May show an account or other unique number the payer assigned to distinguish your account. you an employee and did not withhold income tax or social security and Medicare tax. If you believe you are an
FATCA filing requirement. If the FATCA filing requirement box is checked, the payer is reporting on this Form 1099 employee and cannot get the payer to correct this form, report the amount from box 7 on Form 1040, line 7 (or Form
to satisfy its chapter 4 account reporting requirement. You also may have a filing requirement. See the Instructions for 1040NR, line 8). You must also complete Form 8919 and attach it to your return. If you are not an employee but the
Form 8938. amount in this box is not SE income (for example, it is income from a sporadic activity or a hobby), report it on Form
Amounts shown may be subject to self-employment (SE) tax. If your net income from self-employment is $400 or 1040, line 21 (or Form 1040NR, line 21).
more, you must file a return and compute your SE tax on Schedule SE (Form 1040). See Pub. 334 for more information. Box 8. Shows substitute payments in lieu of dividends or tax-exempt interest received by your broker on your behalf
If no income or social security and Medicare taxes were withheld and you are still receiving these payments, see Form as a result of a loan of your securities. Report on the "Other income" line of Form 1040 (or Form 1040NR).
1040-ES (or Form 1040-ES(NR)). Individuals must report these amounts as explained in the box 7 instructions on this Box 9. If checked, $5,000 or more of sales of consumer products was paid to you on a buy-sell, deposit-commission,
page. Corporations, fiduciaries, or partnerships must report the amounts on the proper line of their tax returns. or other basis. A dollar amount does not have to be shown. Generally, report any income from your sale of these
Form 1099-MISC incorrect? If this form is incorrect or has been issued in error, contact the payer. If you cannot get products on Schedule C (Form 1040).
this form corrected, attach an explanation to your tax return and report your income correctly. Box 10. Report this amount on Schedule F (Form 1040).
Box 1. Report rents from real estate on Schedule E (Form 1040). However, report rents on Schedule C (Form 1040) if Box 13. Shows your total compensation of excess golden parachute payments subject to a 20% excise tax. See the
you provided significant services to the tenant, sold real estate as a business, or rented personal property as a business. Form 1040 (or Form 1040NR) instructions for where to report.
Box 2. Report royalties from oil, gas, or mineral properties, copyrights, and patents on Schedule E (Form 1040). Box 14. Shows gross proceeds paid to an attorney in connection with legal services. Report only the taxable part as
However, report payments for a working interest as explained in the box 7 instructions. For royalties on timber, coal, income on your return.
and iron ore, see Pub. 544. Box 15a. May show current year deferrals as a nonemployee under a nonqualified deferred compensation (NQDC)
Box 3. Generally, report this amount on the "Other income" line of Form 1040 (or Form 1040NR) and identify the plan that is subject to the requirements of section 409A, plus any earnings on current and prior year deferrals.
payment. The amount shown may be payments received as the beneficiary of a deceased employee, prizes, awards, Box 15b. Shows income as a nonemployee under an NQDC plan that does not meet the requirements of section 409A.
taxable damages, Indian gaming profits, or other taxable income. See Pub. 525. If it is trade or business income, report This amount is also included in box 7 as nonemployee compensation. Any amount included in box 15a that is
this amount on Schedule C or F (Form 1040). currently taxable is also included in this box. This income is also subject to a substantial additional tax to be reported
Box 4. Shows backup withholding or withholding on Indian gaming profits. Generally, a payer must backup withhold if on Form 1040 (or Form 1040NR). See "Total Tax" in the Form 1040 (or Form 1040NR) instructions.
you did not furnish your taxpayer identification number. See Form W-9 and Pub. 505 for more information. Report this Boxes 16-18. Shows state or local income tax withheld from the payments.
amount on your income tax return as tax withheld. Future developments. For the latest information about developments related to Form 1099-MISC and its instructions,
Box 5. An amount in this box means the fishing boat operator considers you self-employed. Report this amount on such as legislation enacted after they were published, go to www.irs.gov/form1099misc.
Schedule C (Form 1040). See Pub. 334.

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.
US MANUFACTURING PAYER2 NAME1 $ 0.00
Miscellaneous
US MANUFACTURING PAYER2 NAME2
4660 HACIENDA DRIVE 2 Royalties 2016 Income
BUILDING C
ROOM 408 $ 0.00
PLEASANTON, CA 94117 Form 1099-MISC
3 Other income 4 Federal income tax withheld
Copy B
925/694-4222 $ 0.00 $ 0.00
For Recipient
PAYER'S federal identification number. RECIPIENT'S identification number 5 Fishing boat proceeds 6 Medical and health care payments

987654321 $ 0.00 $ 0.00

RECIPIENT'S name 7 Nonemployee compensation 8 Substitute payments in lieu of

dividends or interest This is important tax
RONALD RIVES information and is being
furnished to the Internal
$ 0.00 $ 0.00 Revenue Service. If you are
Street address (including apt. no.) 9 Payer made direct sales of 10 Crop insurance proceeds
required to file a return, a
$5,000 or more of consumer
909 HACIENDA negligence penalty or other
products to a buyer
$ 0.00 sanction may be imposed on
(recipient) for resale► X you if this income is taxable
City or town, state or province, country, and ZIP or foreign postal code 11 12 and the IRS determines that it
PLEASANTON, CA 94598 has not been reported.

Account number (see instructions) FATCA filing 13 Excess golden parachute payments 14 Gross proceeds paid to an attorney
requirement
USA0000018 $ 0.00 $ 0.00
15a Section 409A deferrals 15b Section 409A income 16 State tax withheld 17 State/Payer's state no. 18 State income
$ 600.00 CA/68219999978 $ 0.00
$ 0.00 $ 0.00 $ $
Form 1099-MISC (keep for your records) www.irs.gov/form1099misc Department of the Treasury - Internal Revenue Service
 STEWART TAX SERVICES

9999 4TH ST.

MORAGA, CA 94887

Instructions for Recipient

Recipient's identification number. For your protection, this form may show only the last four digits of your social Box 6. For individuals, report on Schedule C (Form 1040).
security number (SSN), individual taxpayer identification number (ITIN), adoption taxpayer identification number Box 7. Shows nonemployee compensation. If you are in the trade or business of catching fish, box 7 may show cash
(ATIN), or employer identification number (EIN). However, the issuer has reported your complete identification number you received for the sale of fish. If the amount in this box is SE income, report it on Schedule C or F (Form 1040), and
to the IRS. complete Schedule SE (Form 1040). You received this form instead of Form W-2 because the payer did not consider
Account number. May show an account or other unique number the payer assigned to distinguish your account. you an employee and did not withhold income tax or social security and Medicare tax. If you believe you are an
FATCA filing requirement. If the FATCA filing requirement box is checked, the payer is reporting on this Form 1099 employee and cannot get the payer to correct this form, report the amount from box 7 on Form 1040, line 7 (or Form
to satisfy its chapter 4 account reporting requirement. You also may have a filing requirement. See the Instructions for 1040NR, line 8). You must also complete Form 8919 and attach it to your return. If you are not an employee but the
Form 8938. amount in this box is not SE income (for example, it is income from a sporadic activity or a hobby), report it on Form
Amounts shown may be subject to self-employment (SE) tax. If your net income from self-employment is $400 or 1040, line 21 (or Form 1040NR, line 21).
more, you must file a return and compute your SE tax on Schedule SE (Form 1040). See Pub. 334 for more information. Box 8. Shows substitute payments in lieu of dividends or tax-exempt interest received by your broker on your behalf
If no income or social security and Medicare taxes were withheld and you are still receiving these payments, see Form as a result of a loan of your securities. Report on the "Other income" line of Form 1040 (or Form 1040NR).
1040-ES (or Form 1040-ES(NR)). Individuals must report these amounts as explained in the box 7 instructions on this Box 9. If checked, $5,000 or more of sales of consumer products was paid to you on a buy-sell, deposit-commission,
page. Corporations, fiduciaries, or partnerships must report the amounts on the proper line of their tax returns. or other basis. A dollar amount does not have to be shown. Generally, report any income from your sale of these
Form 1099-MISC incorrect? If this form is incorrect or has been issued in error, contact the payer. If you cannot get products on Schedule C (Form 1040).
this form corrected, attach an explanation to your tax return and report your income correctly. Box 10. Report this amount on Schedule F (Form 1040).
Box 1. Report rents from real estate on Schedule E (Form 1040). However, report rents on Schedule C (Form 1040) if Box 13. Shows your total compensation of excess golden parachute payments subject to a 20% excise tax. See the
you provided significant services to the tenant, sold real estate as a business, or rented personal property as a business. Form 1040 (or Form 1040NR) instructions for where to report.
Box 2. Report royalties from oil, gas, or mineral properties, copyrights, and patents on Schedule E (Form 1040). Box 14. Shows gross proceeds paid to an attorney in connection with legal services. Report only the taxable part as
However, report payments for a working interest as explained in the box 7 instructions. For royalties on timber, coal, income on your return.
and iron ore, see Pub. 544. Box 15a. May show current year deferrals as a nonemployee under a nonqualified deferred compensation (NQDC)
Box 3. Generally, report this amount on the "Other income" line of Form 1040 (or Form 1040NR) and identify the plan that is subject to the requirements of section 409A, plus any earnings on current and prior year deferrals.
payment. The amount shown may be payments received as the beneficiary of a deceased employee, prizes, awards, Box 15b. Shows income as a nonemployee under an NQDC plan that does not meet the requirements of section 409A.
taxable damages, Indian gaming profits, or other taxable income. See Pub. 525. If it is trade or business income, report This amount is also included in box 7 as nonemployee compensation. Any amount included in box 15a that is
this amount on Schedule C or F (Form 1040). currently taxable is also included in this box. This income is also subject to a substantial additional tax to be reported
Box 4. Shows backup withholding or withholding on Indian gaming profits. Generally, a payer must backup withhold if on Form 1040 (or Form 1040NR). See "Total Tax" in the Form 1040 (or Form 1040NR) instructions.
you did not furnish your taxpayer identification number. See Form W-9 and Pub. 505 for more information. Report this Boxes 16-18. Shows state or local income tax withheld from the payments.
amount on your income tax return as tax withheld. Future developments. For the latest information about developments related to Form 1099-MISC and its instructions,
Box 5. An amount in this box means the fishing boat operator considers you self-employed. Report this amount on such as legislation enacted after they were published, go to www.irs.gov/form1099misc.
Schedule C (Form 1040). See Pub. 334.

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.
US MANUFACTURING PAYER1 NAME1 $ 0.00
Miscellaneous
US MANUFACTURING PAYER1 NAME2
CANADIAN FIRST AVENUE 2 Royalties 2016 Income
CIVIC CENTER
SUITE 145 $ 0.00
VANCOUVER, BC 14003 Form 1099-MISC
CANADA 3 Other income 4 Federal income tax withheld
Copy B
234/948-5603 $ 0.00 $ 0.00
For Recipient
PAYER'S federal identification number. RECIPIENT'S identification number 5 Fishing boat proceeds 6 Medical and health care payments

123456789 $ 0.00 $ 0.00

RECIPIENT'S name 7 Nonemployee compensation 8 Substitute payments in lieu of

dividends or interest This is important tax
STEWART TAX SERVICES information and is being
furnished to the Internal
$ 0.00 $ 0.00 Revenue Service. If you are
Street address (including apt. no.) 9 Payer made direct sales of 10 Crop insurance proceeds
required to file a return, a
$5,000 or more of consumer
9999 4TH ST. negligence penalty or other
products to a buyer
$ 0.00 sanction may be imposed on
(recipient) for resale► X you if this income is taxable
City or town, state or province, country, and ZIP or foreign postal code 11 12 and the IRS determines that it
MORAGA, CA 94887 has not been reported.

Account number (see instructions) FATCA filing 13 Excess golden parachute payments 14 Gross proceeds paid to an attorney
requirement
USA0000019 $ 0.00 $ 0.00
15a Section 409A deferrals 15b Section 409A income 16 State tax withheld 17 State/Payer's state no. 18 State income
$ 100.00 CA/68219999978 $ 0.00
$ 0.00 $ 0.00 $ $
Form 1099-MISC (keep for your records) www.irs.gov/form1099misc Department of the Treasury - Internal Revenue Service
 STEWART TAX SERVICES

9999 4TH ST.

MORAGA, CA 94887

Instructions for Recipient

Recipient's identification number. For your protection, this form may show only the last four digits of your social Box 6. For individuals, report on Schedule C (Form 1040).
security number (SSN), individual taxpayer identification number (ITIN), adoption taxpayer identification number Box 7. Shows nonemployee compensation. If you are in the trade or business of catching fish, box 7 may show cash
(ATIN), or employer identification number (EIN). However, the issuer has reported your complete identification number you received for the sale of fish. If the amount in this box is SE income, report it on Schedule C or F (Form 1040), and
to the IRS. complete Schedule SE (Form 1040). You received this form instead of Form W-2 because the payer did not consider
Account number. May show an account or other unique number the payer assigned to distinguish your account. you an employee and did not withhold income tax or social security and Medicare tax. If you believe you are an
FATCA filing requirement. If the FATCA filing requirement box is checked, the payer is reporting on this Form 1099 employee and cannot get the payer to correct this form, report the amount from box 7 on Form 1040, line 7 (or Form
to satisfy its chapter 4 account reporting requirement. You also may have a filing requirement. See the Instructions for 1040NR, line 8). You must also complete Form 8919 and attach it to your return. If you are not an employee but the
Form 8938. amount in this box is not SE income (for example, it is income from a sporadic activity or a hobby), report it on Form
Amounts shown may be subject to self-employment (SE) tax. If your net income from self-employment is $400 or 1040, line 21 (or Form 1040NR, line 21).
more, you must file a return and compute your SE tax on Schedule SE (Form 1040). See Pub. 334 for more information. Box 8. Shows substitute payments in lieu of dividends or tax-exempt interest received by your broker on your behalf
If no income or social security and Medicare taxes were withheld and you are still receiving these payments, see Form as a result of a loan of your securities. Report on the "Other income" line of Form 1040 (or Form 1040NR).
1040-ES (or Form 1040-ES(NR)). Individuals must report these amounts as explained in the box 7 instructions on this Box 9. If checked, $5,000 or more of sales of consumer products was paid to you on a buy-sell, deposit-commission,
page. Corporations, fiduciaries, or partnerships must report the amounts on the proper line of their tax returns. or other basis. A dollar amount does not have to be shown. Generally, report any income from your sale of these
Form 1099-MISC incorrect? If this form is incorrect or has been issued in error, contact the payer. If you cannot get products on Schedule C (Form 1040).
this form corrected, attach an explanation to your tax return and report your income correctly. Box 10. Report this amount on Schedule F (Form 1040).
Box 1. Report rents from real estate on Schedule E (Form 1040). However, report rents on Schedule C (Form 1040) if Box 13. Shows your total compensation of excess golden parachute payments subject to a 20% excise tax. See the
you provided significant services to the tenant, sold real estate as a business, or rented personal property as a business. Form 1040 (or Form 1040NR) instructions for where to report.
Box 2. Report royalties from oil, gas, or mineral properties, copyrights, and patents on Schedule E (Form 1040). Box 14. Shows gross proceeds paid to an attorney in connection with legal services. Report only the taxable part as
However, report payments for a working interest as explained in the box 7 instructions. For royalties on timber, coal, income on your return.
and iron ore, see Pub. 544. Box 15a. May show current year deferrals as a nonemployee under a nonqualified deferred compensation (NQDC)
Box 3. Generally, report this amount on the "Other income" line of Form 1040 (or Form 1040NR) and identify the plan that is subject to the requirements of section 409A, plus any earnings on current and prior year deferrals.
payment. The amount shown may be payments received as the beneficiary of a deceased employee, prizes, awards, Box 15b. Shows income as a nonemployee under an NQDC plan that does not meet the requirements of section 409A.
taxable damages, Indian gaming profits, or other taxable income. See Pub. 525. If it is trade or business income, report This amount is also included in box 7 as nonemployee compensation. Any amount included in box 15a that is
this amount on Schedule C or F (Form 1040). currently taxable is also included in this box. This income is also subject to a substantial additional tax to be reported
Box 4. Shows backup withholding or withholding on Indian gaming profits. Generally, a payer must backup withhold if on Form 1040 (or Form 1040NR). See "Total Tax" in the Form 1040 (or Form 1040NR) instructions.
you did not furnish your taxpayer identification number. See Form W-9 and Pub. 505 for more information. Report this Boxes 16-18. Shows state or local income tax withheld from the payments.
amount on your income tax return as tax withheld. Future developments. For the latest information about developments related to Form 1099-MISC and its instructions,
Box 5. An amount in this box means the fishing boat operator considers you self-employed. Report this amount on such as legislation enacted after they were published, go to www.irs.gov/form1099misc.
Schedule C (Form 1040). See Pub. 334.

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.
US MANUFACTURING PAYER2 NAME1 $ 0.00
Miscellaneous
US MANUFACTURING PAYER2 NAME2
4660 HACIENDA DRIVE 2 Royalties 2016 Income
BUILDING C
ROOM 408 $ 0.00
PLEASANTON, CA 94117 Form 1099-MISC
3 Other income 4 Federal income tax withheld
Copy B
925/694-4222 $ 0.00 $ 0.00
For Recipient
PAYER'S federal identification number. RECIPIENT'S identification number 5 Fishing boat proceeds 6 Medical and health care payments

987654321 $ 0.00 $ 0.00

RECIPIENT'S name 7 Nonemployee compensation 8 Substitute payments in lieu of

dividends or interest This is important tax
STEWART TAX SERVICES information and is being
furnished to the Internal
$ 0.00 $ 0.00 Revenue Service. If you are
Street address (including apt. no.) 9 Payer made direct sales of 10 Crop insurance proceeds
required to file a return, a
$5,000 or more of consumer
9999 4TH ST. negligence penalty or other
products to a buyer
$ 0.00 sanction may be imposed on
(recipient) for resale► X you if this income is taxable
City or town, state or province, country, and ZIP or foreign postal code 11 12 and the IRS determines that it
MORAGA, CA 94887 has not been reported.

Account number (see instructions) FATCA filing 13 Excess golden parachute payments 14 Gross proceeds paid to an attorney
requirement
USA0000019 $ 0.00 $ 0.00
15a Section 409A deferrals 15b Section 409A income 16 State tax withheld 17 State/Payer's state no. 18 State income
$ 100.00 CA/68219999978 $ 0.00
$ 0.00 $ 0.00 $ $
Form 1099-MISC (keep for your records) www.irs.gov/form1099misc Department of the Treasury - Internal Revenue Service
 HAND PAINTED FURNITURE
WHOLESALE DISTRIBUTOR
183 ARTHUR RD.
BLDQ.2
STE. #201
MARTINEZ, CA 94553

Instructions for Recipient

Recipient's identification number. For your protection, this form may show only the last four digits of your social Box 6. For individuals, report on Schedule C (Form 1040).
security number (SSN), individual taxpayer identification number (ITIN), adoption taxpayer identification number Box 7. Shows nonemployee compensation. If you are in the trade or business of catching fish, box 7 may show cash
(ATIN), or employer identification number (EIN). However, the issuer has reported your complete identification number you received for the sale of fish. If the amount in this box is SE income, report it on Schedule C or F (Form 1040), and
to the IRS. complete Schedule SE (Form 1040). You received this form instead of Form W-2 because the payer did not consider
Account number. May show an account or other unique number the payer assigned to distinguish your account. you an employee and did not withhold income tax or social security and Medicare tax. If you believe you are an
FATCA filing requirement. If the FATCA filing requirement box is checked, the payer is reporting on this Form 1099 employee and cannot get the payer to correct this form, report the amount from box 7 on Form 1040, line 7 (or Form
to satisfy its chapter 4 account reporting requirement. You also may have a filing requirement. See the Instructions for 1040NR, line 8). You must also complete Form 8919 and attach it to your return. If you are not an employee but the
Form 8938. amount in this box is not SE income (for example, it is income from a sporadic activity or a hobby), report it on Form
Amounts shown may be subject to self-employment (SE) tax. If your net income from self-employment is $400 or 1040, line 21 (or Form 1040NR, line 21).
more, you must file a return and compute your SE tax on Schedule SE (Form 1040). See Pub. 334 for more information. Box 8. Shows substitute payments in lieu of dividends or tax-exempt interest received by your broker on your behalf
If no income or social security and Medicare taxes were withheld and you are still receiving these payments, see Form as a result of a loan of your securities. Report on the "Other income" line of Form 1040 (or Form 1040NR).
1040-ES (or Form 1040-ES(NR)). Individuals must report these amounts as explained in the box 7 instructions on this Box 9. If checked, $5,000 or more of sales of consumer products was paid to you on a buy-sell, deposit-commission,
page. Corporations, fiduciaries, or partnerships must report the amounts on the proper line of their tax returns. or other basis. A dollar amount does not have to be shown. Generally, report any income from your sale of these
Form 1099-MISC incorrect? If this form is incorrect or has been issued in error, contact the payer. If you cannot get products on Schedule C (Form 1040).
this form corrected, attach an explanation to your tax return and report your income correctly. Box 10. Report this amount on Schedule F (Form 1040).
Box 1. Report rents from real estate on Schedule E (Form 1040). However, report rents on Schedule C (Form 1040) if Box 13. Shows your total compensation of excess golden parachute payments subject to a 20% excise tax. See the
you provided significant services to the tenant, sold real estate as a business, or rented personal property as a business. Form 1040 (or Form 1040NR) instructions for where to report.
Box 2. Report royalties from oil, gas, or mineral properties, copyrights, and patents on Schedule E (Form 1040). Box 14. Shows gross proceeds paid to an attorney in connection with legal services. Report only the taxable part as
However, report payments for a working interest as explained in the box 7 instructions. For royalties on timber, coal, income on your return.
and iron ore, see Pub. 544. Box 15a. May show current year deferrals as a nonemployee under a nonqualified deferred compensation (NQDC)
Box 3. Generally, report this amount on the "Other income" line of Form 1040 (or Form 1040NR) and identify the plan that is subject to the requirements of section 409A, plus any earnings on current and prior year deferrals.
payment. The amount shown may be payments received as the beneficiary of a deceased employee, prizes, awards, Box 15b. Shows income as a nonemployee under an NQDC plan that does not meet the requirements of section 409A.
taxable damages, Indian gaming profits, or other taxable income. See Pub. 525. If it is trade or business income, report This amount is also included in box 7 as nonemployee compensation. Any amount included in box 15a that is
this amount on Schedule C or F (Form 1040). currently taxable is also included in this box. This income is also subject to a substantial additional tax to be reported
Box 4. Shows backup withholding or withholding on Indian gaming profits. Generally, a payer must backup withhold if on Form 1040 (or Form 1040NR). See "Total Tax" in the Form 1040 (or Form 1040NR) instructions.
you did not furnish your taxpayer identification number. See Form W-9 and Pub. 505 for more information. Report this Boxes 16-18. Shows state or local income tax withheld from the payments.
amount on your income tax return as tax withheld. Future developments. For the latest information about developments related to Form 1099-MISC and its instructions,
Box 5. An amount in this box means the fishing boat operator considers you self-employed. Report this amount on such as legislation enacted after they were published, go to www.irs.gov/form1099misc.
Schedule C (Form 1040). See Pub. 334.

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.
US MANUFACTURING PAYER1 NAME1 $ 0.00
Miscellaneous
US MANUFACTURING PAYER1 NAME2
CANADIAN FIRST AVENUE 2 Royalties 2016 Income
CIVIC CENTER
SUITE 145 $ 0.00
VANCOUVER, BC 14003 Form 1099-MISC
CANADA 3 Other income 4 Federal income tax withheld
Copy B
234/948-5603 $ 0.00 $ 0.00
For Recipient
PAYER'S federal identification number. RECIPIENT'S identification number 5 Fishing boat proceeds 6 Medical and health care payments

123456789 $ 0.00 $ 0.00

RECIPIENT'S name 7 Nonemployee compensation 8 Substitute payments in lieu of

dividends or interest This is important tax
HAND PAINTED FURNITURE information and is being
furnished to the Internal
WHOLESALE DISTRIBUTOR $ 0.00 $ 0.00 Revenue Service. If you are
Street address (including apt. no.) 9 Payer made direct sales of 10 Crop insurance proceeds
required to file a return, a
$5,000 or more of consumer
183 ARTHUR RD. negligence penalty or other
products to a buyer
BLDQ.2 $ 0.00 sanction may be imposed on
(recipient) for resale► X you if this income is taxable
STE. #201
City or town, state or province, country, and ZIP or foreign postal code 11 12 and the IRS determines that it
MARTINEZ, CA 94553 has not been reported.

Account number (see instructions) FATCA filing 13 Excess golden parachute payments 14 Gross proceeds paid to an attorney
requirement
USA0000025 $ 0.00 $ 0.00
15a Section 409A deferrals 15b Section 409A income 16 State tax withheld 17 State/Payer's state no. 18 State income
$ 600.00 CA/68219999978 $ 0.00
$ 0.00 $ 0.00 $ $
Form 1099-MISC (keep for your records) www.irs.gov/form1099misc Department of the Treasury - Internal Revenue Service
 HAND PAINTED FURNITURE
WHOLESALE DISTRIBUTOR
183 ARTHUR RD.
BLDQ.2
STE. #201
MARTINEZ, CA 94553

Instructions for Recipient

Recipient's identification number. For your protection, this form may show only the last four digits of your social Box 6. For individuals, report on Schedule C (Form 1040).
security number (SSN), individual taxpayer identification number (ITIN), adoption taxpayer identification number Box 7. Shows nonemployee compensation. If you are in the trade or business of catching fish, box 7 may show cash
(ATIN), or employer identification number (EIN). However, the issuer has reported your complete identification number you received for the sale of fish. If the amount in this box is SE income, report it on Schedule C or F (Form 1040), and
to the IRS. complete Schedule SE (Form 1040). You received this form instead of Form W-2 because the payer did not consider
Account number. May show an account or other unique number the payer assigned to distinguish your account. you an employee and did not withhold income tax or social security and Medicare tax. If you believe you are an
FATCA filing requirement. If the FATCA filing requirement box is checked, the payer is reporting on this Form 1099 employee and cannot get the payer to correct this form, report the amount from box 7 on Form 1040, line 7 (or Form
to satisfy its chapter 4 account reporting requirement. You also may have a filing requirement. See the Instructions for 1040NR, line 8). You must also complete Form 8919 and attach it to your return. If you are not an employee but the
Form 8938. amount in this box is not SE income (for example, it is income from a sporadic activity or a hobby), report it on Form
Amounts shown may be subject to self-employment (SE) tax. If your net income from self-employment is $400 or 1040, line 21 (or Form 1040NR, line 21).
more, you must file a return and compute your SE tax on Schedule SE (Form 1040). See Pub. 334 for more information. Box 8. Shows substitute payments in lieu of dividends or tax-exempt interest received by your broker on your behalf
If no income or social security and Medicare taxes were withheld and you are still receiving these payments, see Form as a result of a loan of your securities. Report on the "Other income" line of Form 1040 (or Form 1040NR).
1040-ES (or Form 1040-ES(NR)). Individuals must report these amounts as explained in the box 7 instructions on this Box 9. If checked, $5,000 or more of sales of consumer products was paid to you on a buy-sell, deposit-commission,
page. Corporations, fiduciaries, or partnerships must report the amounts on the proper line of their tax returns. or other basis. A dollar amount does not have to be shown. Generally, report any income from your sale of these
Form 1099-MISC incorrect? If this form is incorrect or has been issued in error, contact the payer. If you cannot get products on Schedule C (Form 1040).
this form corrected, attach an explanation to your tax return and report your income correctly. Box 10. Report this amount on Schedule F (Form 1040).
Box 1. Report rents from real estate on Schedule E (Form 1040). However, report rents on Schedule C (Form 1040) if Box 13. Shows your total compensation of excess golden parachute payments subject to a 20% excise tax. See the
you provided significant services to the tenant, sold real estate as a business, or rented personal property as a business. Form 1040 (or Form 1040NR) instructions for where to report.
Box 2. Report royalties from oil, gas, or mineral properties, copyrights, and patents on Schedule E (Form 1040). Box 14. Shows gross proceeds paid to an attorney in connection with legal services. Report only the taxable part as
However, report payments for a working interest as explained in the box 7 instructions. For royalties on timber, coal, income on your return.
and iron ore, see Pub. 544. Box 15a. May show current year deferrals as a nonemployee under a nonqualified deferred compensation (NQDC)
Box 3. Generally, report this amount on the "Other income" line of Form 1040 (or Form 1040NR) and identify the plan that is subject to the requirements of section 409A, plus any earnings on current and prior year deferrals.
payment. The amount shown may be payments received as the beneficiary of a deceased employee, prizes, awards, Box 15b. Shows income as a nonemployee under an NQDC plan that does not meet the requirements of section 409A.
taxable damages, Indian gaming profits, or other taxable income. See Pub. 525. If it is trade or business income, report This amount is also included in box 7 as nonemployee compensation. Any amount included in box 15a that is
this amount on Schedule C or F (Form 1040). currently taxable is also included in this box. This income is also subject to a substantial additional tax to be reported
Box 4. Shows backup withholding or withholding on Indian gaming profits. Generally, a payer must backup withhold if on Form 1040 (or Form 1040NR). See "Total Tax" in the Form 1040 (or Form 1040NR) instructions.
you did not furnish your taxpayer identification number. See Form W-9 and Pub. 505 for more information. Report this Boxes 16-18. Shows state or local income tax withheld from the payments.
amount on your income tax return as tax withheld. Future developments. For the latest information about developments related to Form 1099-MISC and its instructions,
Box 5. An amount in this box means the fishing boat operator considers you self-employed. Report this amount on such as legislation enacted after they were published, go to www.irs.gov/form1099misc.
Schedule C (Form 1040). See Pub. 334.

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.
US MANUFACTURING PAYER2 NAME1 $ 0.00
Miscellaneous
US MANUFACTURING PAYER2 NAME2
4660 HACIENDA DRIVE 2 Royalties 2016 Income
BUILDING C
ROOM 408 $ 0.00
PLEASANTON, CA 94117 Form 1099-MISC
3 Other income 4 Federal income tax withheld
Copy B
925/694-4222 $ 0.00 $ 0.00
For Recipient
PAYER'S federal identification number. RECIPIENT'S identification number 5 Fishing boat proceeds 6 Medical and health care payments

987654321 $ 0.00 $ 0.00

RECIPIENT'S name 7 Nonemployee compensation 8 Substitute payments in lieu of

dividends or interest This is important tax
HAND PAINTED FURNITURE information and is being
furnished to the Internal
WHOLESALE DISTRIBUTOR $ 0.00 $ 0.00 Revenue Service. If you are
Street address (including apt. no.) 9 Payer made direct sales of 10 Crop insurance proceeds
required to file a return, a
$5,000 or more of consumer
183 ARTHUR RD. negligence penalty or other
products to a buyer
BLDQ.2 $ 0.00 sanction may be imposed on
(recipient) for resale► X you if this income is taxable
STE. #201
City or town, state or province, country, and ZIP or foreign postal code 11 12 and the IRS determines that it
MARTINEZ, CA 94553 has not been reported.

Account number (see instructions) FATCA filing 13 Excess golden parachute payments 14 Gross proceeds paid to an attorney
requirement
USA0000025 $ 0.00 $ 0.00
15a Section 409A deferrals 15b Section 409A income 16 State tax withheld 17 State/Payer's state no. 18 State income
$ 600.00 CA/68219999978 $ 0.00
$ 0.00 $ 0.00 $ $
Form 1099-MISC (keep for your records) www.irs.gov/form1099misc Department of the Treasury - Internal Revenue Service
 1099 REPORTING VENDOR - WITHHOLD NAME
1099 REPORTING VENDOR - WITHHOLD NAME2
123 MAIN STREET
FIRST FLOOR
ROOM 001
PLEASANTON, CA 94588

Instructions for Recipient

Recipient's identification number. For your protection, this form may show only the last four digits of your social Box 6. For individuals, report on Schedule C (Form 1040).
security number (SSN), individual taxpayer identification number (ITIN), adoption taxpayer identification number Box 7. Shows nonemployee compensation. If you are in the trade or business of catching fish, box 7 may show cash
(ATIN), or employer identification number (EIN). However, the issuer has reported your complete identification number you received for the sale of fish. If the amount in this box is SE income, report it on Schedule C or F (Form 1040), and
to the IRS. complete Schedule SE (Form 1040). You received this form instead of Form W-2 because the payer did not consider
Account number. May show an account or other unique number the payer assigned to distinguish your account. you an employee and did not withhold income tax or social security and Medicare tax. If you believe you are an
FATCA filing requirement. If the FATCA filing requirement box is checked, the payer is reporting on this Form 1099 employee and cannot get the payer to correct this form, report the amount from box 7 on Form 1040, line 7 (or Form
to satisfy its chapter 4 account reporting requirement. You also may have a filing requirement. See the Instructions for 1040NR, line 8). You must also complete Form 8919 and attach it to your return. If you are not an employee but the
Form 8938. amount in this box is not SE income (for example, it is income from a sporadic activity or a hobby), report it on Form
Amounts shown may be subject to self-employment (SE) tax. If your net income from self-employment is $400 or 1040, line 21 (or Form 1040NR, line 21).
more, you must file a return and compute your SE tax on Schedule SE (Form 1040). See Pub. 334 for more information. Box 8. Shows substitute payments in lieu of dividends or tax-exempt interest received by your broker on your behalf
If no income or social security and Medicare taxes were withheld and you are still receiving these payments, see Form as a result of a loan of your securities. Report on the "Other income" line of Form 1040 (or Form 1040NR).
1040-ES (or Form 1040-ES(NR)). Individuals must report these amounts as explained in the box 7 instructions on this Box 9. If checked, $5,000 or more of sales of consumer products was paid to you on a buy-sell, deposit-commission,
page. Corporations, fiduciaries, or partnerships must report the amounts on the proper line of their tax returns. or other basis. A dollar amount does not have to be shown. Generally, report any income from your sale of these
Form 1099-MISC incorrect? If this form is incorrect or has been issued in error, contact the payer. If you cannot get products on Schedule C (Form 1040).
this form corrected, attach an explanation to your tax return and report your income correctly. Box 10. Report this amount on Schedule F (Form 1040).
Box 1. Report rents from real estate on Schedule E (Form 1040). However, report rents on Schedule C (Form 1040) if Box 13. Shows your total compensation of excess golden parachute payments subject to a 20% excise tax. See the
you provided significant services to the tenant, sold real estate as a business, or rented personal property as a business. Form 1040 (or Form 1040NR) instructions for where to report.
Box 2. Report royalties from oil, gas, or mineral properties, copyrights, and patents on Schedule E (Form 1040). Box 14. Shows gross proceeds paid to an attorney in connection with legal services. Report only the taxable part as
However, report payments for a working interest as explained in the box 7 instructions. For royalties on timber, coal, income on your return.
and iron ore, see Pub. 544. Box 15a. May show current year deferrals as a nonemployee under a nonqualified deferred compensation (NQDC)
Box 3. Generally, report this amount on the "Other income" line of Form 1040 (or Form 1040NR) and identify the plan that is subject to the requirements of section 409A, plus any earnings on current and prior year deferrals.
payment. The amount shown may be payments received as the beneficiary of a deceased employee, prizes, awards, Box 15b. Shows income as a nonemployee under an NQDC plan that does not meet the requirements of section 409A.
taxable damages, Indian gaming profits, or other taxable income. See Pub. 525. If it is trade or business income, report This amount is also included in box 7 as nonemployee compensation. Any amount included in box 15a that is
this amount on Schedule C or F (Form 1040). currently taxable is also included in this box. This income is also subject to a substantial additional tax to be reported
Box 4. Shows backup withholding or withholding on Indian gaming profits. Generally, a payer must backup withhold if on Form 1040 (or Form 1040NR). See "Total Tax" in the Form 1040 (or Form 1040NR) instructions.
you did not furnish your taxpayer identification number. See Form W-9 and Pub. 505 for more information. Report this Boxes 16-18. Shows state or local income tax withheld from the payments.
amount on your income tax return as tax withheld. Future developments. For the latest information about developments related to Form 1099-MISC and its instructions,
Box 5. An amount in this box means the fishing boat operator considers you self-employed. Report this amount on such as legislation enacted after they were published, go to www.irs.gov/form1099misc.
Schedule C (Form 1040). See Pub. 334.

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.
US MANUFACTURING PAYER1 NAME1 $ 777.00
Miscellaneous
US MANUFACTURING PAYER1 NAME2
CANADIAN FIRST AVENUE 2 Royalties 2016 Income
CIVIC CENTER
SUITE 145 $ 0.00
VANCOUVER, BC 14003 Form 1099-MISC
CANADA 3 Other income 4 Federal income tax withheld
Copy B
234/948-5603 $ 0.00 $ 0.00
For Recipient
PAYER'S federal identification number. RECIPIENT'S identification number 5 Fishing boat proceeds 6 Medical and health care payments

123456789 345-67-8901 $ 0.00 $ 0.00

RECIPIENT'S name 7 Nonemployee compensation 8 Substitute payments in lieu of

dividends or interest This is important tax
1099 REPORTING VENDOR - WITHHOLD NAME information and is being
furnished to the Internal
1099 REPORTING VENDOR - WITHHOLD NAME2 $ 0.00 $ 0.00 Revenue Service. If you are
Street address (including apt. no.) 9 Payer made direct sales of 10 Crop insurance proceeds
required to file a return, a
$5,000 or more of consumer
123 MAIN STREET negligence penalty or other
products to a buyer
FIRST FLOOR $ 0.00 sanction may be imposed on
(recipient) for resale► you if this income is taxable
ROOM 001
City or town, state or province, country, and ZIP or foreign postal code 11 12 and the IRS determines that it
PLEASANTON, CA 94588 has not been reported.

Account number (see instructions) FATCA filing 13 Excess golden parachute payments 14 Gross proceeds paid to an attorney
requirement
USA1099001 $ 0.00 $ 0.00
15a Section 409A deferrals 15b Section 409A income 16 State tax withheld 17 State/Payer's state no. 18 State income
$ 0.00 CA/68219999978 $ 0.00
$ 0.00 $ 0.00 $ $
Form 1099-MISC (keep for your records) www.irs.gov/form1099misc Department of the Treasury - Internal Revenue Service
 1099 STANDARD REPORTING VENDOR

234 ELM STREET

BUILDING A
SUITE 100
CHICAGO, IL 93456

Instructions for Recipient

Recipient's identification number. For your protection, this form may show only the last four digits of your social Box 6. For individuals, report on Schedule C (Form 1040).
security number (SSN), individual taxpayer identification number (ITIN), adoption taxpayer identification number Box 7. Shows nonemployee compensation. If you are in the trade or business of catching fish, box 7 may show cash
(ATIN), or employer identification number (EIN). However, the issuer has reported your complete identification number you received for the sale of fish. If the amount in this box is SE income, report it on Schedule C or F (Form 1040), and
to the IRS. complete Schedule SE (Form 1040). You received this form instead of Form W-2 because the payer did not consider
Account number. May show an account or other unique number the payer assigned to distinguish your account. you an employee and did not withhold income tax or social security and Medicare tax. If you believe you are an
FATCA filing requirement. If the FATCA filing requirement box is checked, the payer is reporting on this Form 1099 employee and cannot get the payer to correct this form, report the amount from box 7 on Form 1040, line 7 (or Form
to satisfy its chapter 4 account reporting requirement. You also may have a filing requirement. See the Instructions for 1040NR, line 8). You must also complete Form 8919 and attach it to your return. If you are not an employee but the
Form 8938. amount in this box is not SE income (for example, it is income from a sporadic activity or a hobby), report it on Form
Amounts shown may be subject to self-employment (SE) tax. If your net income from self-employment is $400 or 1040, line 21 (or Form 1040NR, line 21).
more, you must file a return and compute your SE tax on Schedule SE (Form 1040). See Pub. 334 for more information. Box 8. Shows substitute payments in lieu of dividends or tax-exempt interest received by your broker on your behalf
If no income or social security and Medicare taxes were withheld and you are still receiving these payments, see Form as a result of a loan of your securities. Report on the "Other income" line of Form 1040 (or Form 1040NR).
1040-ES (or Form 1040-ES(NR)). Individuals must report these amounts as explained in the box 7 instructions on this Box 9. If checked, $5,000 or more of sales of consumer products was paid to you on a buy-sell, deposit-commission,
page. Corporations, fiduciaries, or partnerships must report the amounts on the proper line of their tax returns. or other basis. A dollar amount does not have to be shown. Generally, report any income from your sale of these
Form 1099-MISC incorrect? If this form is incorrect or has been issued in error, contact the payer. If you cannot get products on Schedule C (Form 1040).
this form corrected, attach an explanation to your tax return and report your income correctly. Box 10. Report this amount on Schedule F (Form 1040).
Box 1. Report rents from real estate on Schedule E (Form 1040). However, report rents on Schedule C (Form 1040) if Box 13. Shows your total compensation of excess golden parachute payments subject to a 20% excise tax. See the
you provided significant services to the tenant, sold real estate as a business, or rented personal property as a business. Form 1040 (or Form 1040NR) instructions for where to report.
Box 2. Report royalties from oil, gas, or mineral properties, copyrights, and patents on Schedule E (Form 1040). Box 14. Shows gross proceeds paid to an attorney in connection with legal services. Report only the taxable part as
However, report payments for a working interest as explained in the box 7 instructions. For royalties on timber, coal, income on your return.
and iron ore, see Pub. 544. Box 15a. May show current year deferrals as a nonemployee under a nonqualified deferred compensation (NQDC)
Box 3. Generally, report this amount on the "Other income" line of Form 1040 (or Form 1040NR) and identify the plan that is subject to the requirements of section 409A, plus any earnings on current and prior year deferrals.
payment. The amount shown may be payments received as the beneficiary of a deceased employee, prizes, awards, Box 15b. Shows income as a nonemployee under an NQDC plan that does not meet the requirements of section 409A.
taxable damages, Indian gaming profits, or other taxable income. See Pub. 525. If it is trade or business income, report This amount is also included in box 7 as nonemployee compensation. Any amount included in box 15a that is
this amount on Schedule C or F (Form 1040). currently taxable is also included in this box. This income is also subject to a substantial additional tax to be reported
Box 4. Shows backup withholding or withholding on Indian gaming profits. Generally, a payer must backup withhold if on Form 1040 (or Form 1040NR). See "Total Tax" in the Form 1040 (or Form 1040NR) instructions.
you did not furnish your taxpayer identification number. See Form W-9 and Pub. 505 for more information. Report this Boxes 16-18. Shows state or local income tax withheld from the payments.
amount on your income tax return as tax withheld. Future developments. For the latest information about developments related to Form 1099-MISC and its instructions,
Box 5. An amount in this box means the fishing boat operator considers you self-employed. Report this amount on such as legislation enacted after they were published, go to www.irs.gov/form1099misc.
Schedule C (Form 1040). See Pub. 334.

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.
US MANUFACTURING PAYER1 NAME1 $ 700.00
Miscellaneous
US MANUFACTURING PAYER1 NAME2
CANADIAN FIRST AVENUE 2 Royalties 2016 Income
CIVIC CENTER
SUITE 145 $ 0.00
VANCOUVER, BC 14003 Form 1099-MISC
CANADA 3 Other income 4 Federal income tax withheld
Copy B
234/948-5603 $ 0.00 $ 0.00
For Recipient
PAYER'S federal identification number. RECIPIENT'S identification number 5 Fishing boat proceeds 6 Medical and health care payments

123456789 987989877 $ 0.00 $ 0.00

RECIPIENT'S name 7 Nonemployee compensation 8 Substitute payments in lieu of

dividends or interest This is important tax
1099 STANDARD REPORTING VENDOR information and is being
furnished to the Internal
$ 0.00 $ 0.00 Revenue Service. If you are
Street address (including apt. no.) 9 Payer made direct sales of 10 Crop insurance proceeds
required to file a return, a
$5,000 or more of consumer
234 ELM STREET negligence penalty or other
products to a buyer
BUILDING A $ 0.00 sanction may be imposed on
(recipient) for resale► you if this income is taxable
SUITE 100
City or town, state or province, country, and ZIP or foreign postal code 11 12 and the IRS determines that it
CHICAGO, IL 93456 has not been reported.

Account number (see instructions) FATCA filing 13 Excess golden parachute payments 14 Gross proceeds paid to an attorney
requirement
USA1099002 $ 0.00 $ 0.00
15a Section 409A deferrals 15b Section 409A income 16 State tax withheld 17 State/Payer's state no. 18 State income
$ 0.00 $ 0.00
$ 0.00 $ 0.00 $ $
Form 1099-MISC (keep for your records) www.irs.gov/form1099misc Department of the Treasury - Internal Revenue Service
 1099 FOREIGN REPORTING VENDOR
1099 FOREIGN REPORTING VENDOR NAME2
BC PLAZA
1284 11TH STREET
30TH FLOOR
VANCOUVER, BC A9A 9A9
CANADA

Instructions for Recipient

Recipient's identification number. For your protection, this form may show only the last four digits of your social Box 6. For individuals, report on Schedule C (Form 1040).
security number (SSN), individual taxpayer identification number (ITIN), adoption taxpayer identification number Box 7. Shows nonemployee compensation. If you are in the trade or business of catching fish, box 7 may show cash
(ATIN), or employer identification number (EIN). However, the issuer has reported your complete identification number you received for the sale of fish. If the amount in this box is SE income, report it on Schedule C or F (Form 1040), and
to the IRS. complete Schedule SE (Form 1040). You received this form instead of Form W-2 because the payer did not consider
Account number. May show an account or other unique number the payer assigned to distinguish your account. you an employee and did not withhold income tax or social security and Medicare tax. If you believe you are an
FATCA filing requirement. If the FATCA filing requirement box is checked, the payer is reporting on this Form 1099 employee and cannot get the payer to correct this form, report the amount from box 7 on Form 1040, line 7 (or Form
to satisfy its chapter 4 account reporting requirement. You also may have a filing requirement. See the Instructions for 1040NR, line 8). You must also complete Form 8919 and attach it to your return. If you are not an employee but the
Form 8938. amount in this box is not SE income (for example, it is income from a sporadic activity or a hobby), report it on Form
Amounts shown may be subject to self-employment (SE) tax. If your net income from self-employment is $400 or 1040, line 21 (or Form 1040NR, line 21).
more, you must file a return and compute your SE tax on Schedule SE (Form 1040). See Pub. 334 for more information. Box 8. Shows substitute payments in lieu of dividends or tax-exempt interest received by your broker on your behalf
If no income or social security and Medicare taxes were withheld and you are still receiving these payments, see Form as a result of a loan of your securities. Report on the "Other income" line of Form 1040 (or Form 1040NR).
1040-ES (or Form 1040-ES(NR)). Individuals must report these amounts as explained in the box 7 instructions on this Box 9. If checked, $5,000 or more of sales of consumer products was paid to you on a buy-sell, deposit-commission,
page. Corporations, fiduciaries, or partnerships must report the amounts on the proper line of their tax returns. or other basis. A dollar amount does not have to be shown. Generally, report any income from your sale of these
Form 1099-MISC incorrect? If this form is incorrect or has been issued in error, contact the payer. If you cannot get products on Schedule C (Form 1040).
this form corrected, attach an explanation to your tax return and report your income correctly. Box 10. Report this amount on Schedule F (Form 1040).
Box 1. Report rents from real estate on Schedule E (Form 1040). However, report rents on Schedule C (Form 1040) if Box 13. Shows your total compensation of excess golden parachute payments subject to a 20% excise tax. See the
you provided significant services to the tenant, sold real estate as a business, or rented personal property as a business. Form 1040 (or Form 1040NR) instructions for where to report.
Box 2. Report royalties from oil, gas, or mineral properties, copyrights, and patents on Schedule E (Form 1040). Box 14. Shows gross proceeds paid to an attorney in connection with legal services. Report only the taxable part as
However, report payments for a working interest as explained in the box 7 instructions. For royalties on timber, coal, income on your return.
and iron ore, see Pub. 544. Box 15a. May show current year deferrals as a nonemployee under a nonqualified deferred compensation (NQDC)
Box 3. Generally, report this amount on the "Other income" line of Form 1040 (or Form 1040NR) and identify the plan that is subject to the requirements of section 409A, plus any earnings on current and prior year deferrals.
payment. The amount shown may be payments received as the beneficiary of a deceased employee, prizes, awards, Box 15b. Shows income as a nonemployee under an NQDC plan that does not meet the requirements of section 409A.
taxable damages, Indian gaming profits, or other taxable income. See Pub. 525. If it is trade or business income, report This amount is also included in box 7 as nonemployee compensation. Any amount included in box 15a that is
this amount on Schedule C or F (Form 1040). currently taxable is also included in this box. This income is also subject to a substantial additional tax to be reported
Box 4. Shows backup withholding or withholding on Indian gaming profits. Generally, a payer must backup withhold if on Form 1040 (or Form 1040NR). See "Total Tax" in the Form 1040 (or Form 1040NR) instructions.
you did not furnish your taxpayer identification number. See Form W-9 and Pub. 505 for more information. Report this Boxes 16-18. Shows state or local income tax withheld from the payments.
amount on your income tax return as tax withheld. Future developments. For the latest information about developments related to Form 1099-MISC and its instructions,
Box 5. An amount in this box means the fishing boat operator considers you self-employed. Report this amount on such as legislation enacted after they were published, go to www.irs.gov/form1099misc.
Schedule C (Form 1040). See Pub. 334.

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.
US MANUFACTURING PAYER2 NAME1 $ 0.00
Miscellaneous
US MANUFACTURING PAYER2 NAME2
4660 HACIENDA DRIVE 2 Royalties 2016 Income
BUILDING C
ROOM 408 $ 0.00
PLEASANTON, CA 94117 Form 1099-MISC
3 Other income 4 Federal income tax withheld
Copy B
925/694-4222 $ 0.00 $ 0.00
For Recipient
PAYER'S federal identification number. RECIPIENT'S identification number 5 Fishing boat proceeds 6 Medical and health care payments

987654321 123987654 $ 0.00 $ 0.00

RECIPIENT'S name 7 Nonemployee compensation 8 Substitute payments in lieu of

dividends or interest This is important tax
1099 FOREIGN REPORTING VENDOR information and is being
furnished to the Internal
1099 FOREIGN REPORTING VENDOR NAME2 $ 0.00 $ 0.00 Revenue Service. If you are
Street address (including apt. no.) 9 Payer made direct sales of 10 Crop insurance proceeds
required to file a return, a
$5,000 or more of consumer
BC PLAZA negligence penalty or other
products to a buyer
1284 11TH STREET $ 0.00 sanction may be imposed on
(recipient) for resale► X you if this income is taxable
30TH FLOOR
City or town, state or province, country, and ZIP or foreign postal code 11 12 and the IRS determines that it
VANCOUVER, BC A9A 9A9 has not been reported.
CANADA

Account number (see instructions) FATCA filing 13 Excess golden parachute payments 14 Gross proceeds paid to an attorney
requirement
USA1099011 $ 0.00 $ 0.00
15a Section 409A deferrals 15b Section 409A income 16 State tax withheld 17 State/Payer's state no. 18 State income
$ 100.00 $ 0.00
$ 0.00 $ 0.00 $ $
Form 1099-MISC (keep for your records) www.irs.gov/form1099misc Department of the Treasury - Internal Revenue Service
 1099 FOREIGN REPORTING VENDOR
1099 FOREIGN REPORTING VENDOR NAME2
BC PLAZA
1284 11TH STREET
30TH FLOOR
VANCOUVER, BC A9A 9A9
CANADA

Instructions for Recipient

Recipient's identification number. For your protection, this form may show only the last four digits of your social Box 6. For individuals, report on Schedule C (Form 1040).
security number (SSN), individual taxpayer identification number (ITIN), adoption taxpayer identification number Box 7. Shows nonemployee compensation. If you are in the trade or business of catching fish, box 7 may show cash
(ATIN), or employer identification number (EIN). However, the issuer has reported your complete identification number you received for the sale of fish. If the amount in this box is SE income, report it on Schedule C or F (Form 1040), and
to the IRS. complete Schedule SE (Form 1040). You received this form instead of Form W-2 because the payer did not consider
Account number. May show an account or other unique number the payer assigned to distinguish your account. you an employee and did not withhold income tax or social security and Medicare tax. If you believe you are an
FATCA filing requirement. If the FATCA filing requirement box is checked, the payer is reporting on this Form 1099 employee and cannot get the payer to correct this form, report the amount from box 7 on Form 1040, line 7 (or Form
to satisfy its chapter 4 account reporting requirement. You also may have a filing requirement. See the Instructions for 1040NR, line 8). You must also complete Form 8919 and attach it to your return. If you are not an employee but the
Form 8938. amount in this box is not SE income (for example, it is income from a sporadic activity or a hobby), report it on Form
Amounts shown may be subject to self-employment (SE) tax. If your net income from self-employment is $400 or 1040, line 21 (or Form 1040NR, line 21).
more, you must file a return and compute your SE tax on Schedule SE (Form 1040). See Pub. 334 for more information. Box 8. Shows substitute payments in lieu of dividends or tax-exempt interest received by your broker on your behalf
If no income or social security and Medicare taxes were withheld and you are still receiving these payments, see Form as a result of a loan of your securities. Report on the "Other income" line of Form 1040 (or Form 1040NR).
1040-ES (or Form 1040-ES(NR)). Individuals must report these amounts as explained in the box 7 instructions on this Box 9. If checked, $5,000 or more of sales of consumer products was paid to you on a buy-sell, deposit-commission,
page. Corporations, fiduciaries, or partnerships must report the amounts on the proper line of their tax returns. or other basis. A dollar amount does not have to be shown. Generally, report any income from your sale of these
Form 1099-MISC incorrect? If this form is incorrect or has been issued in error, contact the payer. If you cannot get products on Schedule C (Form 1040).
this form corrected, attach an explanation to your tax return and report your income correctly. Box 10. Report this amount on Schedule F (Form 1040).
Box 1. Report rents from real estate on Schedule E (Form 1040). However, report rents on Schedule C (Form 1040) if Box 13. Shows your total compensation of excess golden parachute payments subject to a 20% excise tax. See the
you provided significant services to the tenant, sold real estate as a business, or rented personal property as a business. Form 1040 (or Form 1040NR) instructions for where to report.
Box 2. Report royalties from oil, gas, or mineral properties, copyrights, and patents on Schedule E (Form 1040). Box 14. Shows gross proceeds paid to an attorney in connection with legal services. Report only the taxable part as
However, report payments for a working interest as explained in the box 7 instructions. For royalties on timber, coal, income on your return.
and iron ore, see Pub. 544. Box 15a. May show current year deferrals as a nonemployee under a nonqualified deferred compensation (NQDC)
Box 3. Generally, report this amount on the "Other income" line of Form 1040 (or Form 1040NR) and identify the plan that is subject to the requirements of section 409A, plus any earnings on current and prior year deferrals.
payment. The amount shown may be payments received as the beneficiary of a deceased employee, prizes, awards, Box 15b. Shows income as a nonemployee under an NQDC plan that does not meet the requirements of section 409A.
taxable damages, Indian gaming profits, or other taxable income. See Pub. 525. If it is trade or business income, report This amount is also included in box 7 as nonemployee compensation. Any amount included in box 15a that is
this amount on Schedule C or F (Form 1040). currently taxable is also included in this box. This income is also subject to a substantial additional tax to be reported
Box 4. Shows backup withholding or withholding on Indian gaming profits. Generally, a payer must backup withhold if on Form 1040 (or Form 1040NR). See "Total Tax" in the Form 1040 (or Form 1040NR) instructions.
you did not furnish your taxpayer identification number. See Form W-9 and Pub. 505 for more information. Report this Boxes 16-18. Shows state or local income tax withheld from the payments.
amount on your income tax return as tax withheld. Future developments. For the latest information about developments related to Form 1099-MISC and its instructions,
Box 5. An amount in this box means the fishing boat operator considers you self-employed. Report this amount on such as legislation enacted after they were published, go to www.irs.gov/form1099misc.
Schedule C (Form 1040). See Pub. 334.

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.
US MANUFACTURING PAYER1 NAME1 $ 0.00
Miscellaneous
US MANUFACTURING PAYER1 NAME2
CANADIAN FIRST AVENUE 2 Royalties 2016 Income
CIVIC CENTER
SUITE 145 $ 0.00
VANCOUVER, BC 14003 Form 1099-MISC
CANADA 3 Other income 4 Federal income tax withheld
Copy B
234/948-5603 $ 0.00 $ 0.00
For Recipient
PAYER'S federal identification number. RECIPIENT'S identification number 5 Fishing boat proceeds 6 Medical and health care payments

123456789 123987654 $ 0.00 $ 0.00

RECIPIENT'S name 7 Nonemployee compensation 8 Substitute payments in lieu of

dividends or interest This is important tax
1099 FOREIGN REPORTING VENDOR information and is being
furnished to the Internal
1099 FOREIGN REPORTING VENDOR NAME2 $ 0.00 $ 0.00 Revenue Service. If you are
Street address (including apt. no.) 9 Payer made direct sales of 10 Crop insurance proceeds
required to file a return, a
$5,000 or more of consumer
BC PLAZA negligence penalty or other
products to a buyer
1284 11TH STREET $ 0.00 sanction may be imposed on
(recipient) for resale► X you if this income is taxable
30TH FLOOR
City or town, state or province, country, and ZIP or foreign postal code 11 12 and the IRS determines that it
VANCOUVER, BC A9A 9A9 has not been reported.
CANADA

Account number (see instructions) FATCA filing 13 Excess golden parachute payments 14 Gross proceeds paid to an attorney
requirement
USA1099011 $ 0.00 $ 0.00
15a Section 409A deferrals 15b Section 409A income 16 State tax withheld 17 State/Payer's state no. 18 State income
$ 100.00 $ 0.00
$ 0.00 $ 0.00 $ $
Form 1099-MISC (keep for your records) www.irs.gov/form1099misc Department of the Treasury - Internal Revenue Service
 1099 REPORTING VENDOR - WITHHOLD NAME1
1099 REPORTING VENDOR - WITHHOLD NAME2
HQ BUILDING
124 14TH STREET
SUITE 298
PLEASANTON, CA 94588

Instructions for Recipient

Recipient's identification number. For your protection, this form may show only the last four digits of your social Box 6. For individuals, report on Schedule C (Form 1040).
security number (SSN), individual taxpayer identification number (ITIN), adoption taxpayer identification number Box 7. Shows nonemployee compensation. If you are in the trade or business of catching fish, box 7 may show cash
(ATIN), or employer identification number (EIN). However, the issuer has reported your complete identification number you received for the sale of fish. If the amount in this box is SE income, report it on Schedule C or F (Form 1040), and
to the IRS. complete Schedule SE (Form 1040). You received this form instead of Form W-2 because the payer did not consider
Account number. May show an account or other unique number the payer assigned to distinguish your account. you an employee and did not withhold income tax or social security and Medicare tax. If you believe you are an
FATCA filing requirement. If the FATCA filing requirement box is checked, the payer is reporting on this Form 1099 employee and cannot get the payer to correct this form, report the amount from box 7 on Form 1040, line 7 (or Form
to satisfy its chapter 4 account reporting requirement. You also may have a filing requirement. See the Instructions for 1040NR, line 8). You must also complete Form 8919 and attach it to your return. If you are not an employee but the
Form 8938. amount in this box is not SE income (for example, it is income from a sporadic activity or a hobby), report it on Form
Amounts shown may be subject to self-employment (SE) tax. If your net income from self-employment is $400 or 1040, line 21 (or Form 1040NR, line 21).
more, you must file a return and compute your SE tax on Schedule SE (Form 1040). See Pub. 334 for more information. Box 8. Shows substitute payments in lieu of dividends or tax-exempt interest received by your broker on your behalf
If no income or social security and Medicare taxes were withheld and you are still receiving these payments, see Form as a result of a loan of your securities. Report on the "Other income" line of Form 1040 (or Form 1040NR).
1040-ES (or Form 1040-ES(NR)). Individuals must report these amounts as explained in the box 7 instructions on this Box 9. If checked, $5,000 or more of sales of consumer products was paid to you on a buy-sell, deposit-commission,
page. Corporations, fiduciaries, or partnerships must report the amounts on the proper line of their tax returns. or other basis. A dollar amount does not have to be shown. Generally, report any income from your sale of these
Form 1099-MISC incorrect? If this form is incorrect or has been issued in error, contact the payer. If you cannot get products on Schedule C (Form 1040).
this form corrected, attach an explanation to your tax return and report your income correctly. Box 10. Report this amount on Schedule F (Form 1040).
Box 1. Report rents from real estate on Schedule E (Form 1040). However, report rents on Schedule C (Form 1040) if Box 13. Shows your total compensation of excess golden parachute payments subject to a 20% excise tax. See the
you provided significant services to the tenant, sold real estate as a business, or rented personal property as a business. Form 1040 (or Form 1040NR) instructions for where to report.
Box 2. Report royalties from oil, gas, or mineral properties, copyrights, and patents on Schedule E (Form 1040). Box 14. Shows gross proceeds paid to an attorney in connection with legal services. Report only the taxable part as
However, report payments for a working interest as explained in the box 7 instructions. For royalties on timber, coal, income on your return.
and iron ore, see Pub. 544. Box 15a. May show current year deferrals as a nonemployee under a nonqualified deferred compensation (NQDC)
Box 3. Generally, report this amount on the "Other income" line of Form 1040 (or Form 1040NR) and identify the plan that is subject to the requirements of section 409A, plus any earnings on current and prior year deferrals.
payment. The amount shown may be payments received as the beneficiary of a deceased employee, prizes, awards, Box 15b. Shows income as a nonemployee under an NQDC plan that does not meet the requirements of section 409A.
taxable damages, Indian gaming profits, or other taxable income. See Pub. 525. If it is trade or business income, report This amount is also included in box 7 as nonemployee compensation. Any amount included in box 15a that is
this amount on Schedule C or F (Form 1040). currently taxable is also included in this box. This income is also subject to a substantial additional tax to be reported
Box 4. Shows backup withholding or withholding on Indian gaming profits. Generally, a payer must backup withhold if on Form 1040 (or Form 1040NR). See "Total Tax" in the Form 1040 (or Form 1040NR) instructions.
you did not furnish your taxpayer identification number. See Form W-9 and Pub. 505 for more information. Report this Boxes 16-18. Shows state or local income tax withheld from the payments.
amount on your income tax return as tax withheld. Future developments. For the latest information about developments related to Form 1099-MISC and its instructions,
Box 5. An amount in this box means the fishing boat operator considers you self-employed. Report this amount on such as legislation enacted after they were published, go to www.irs.gov/form1099misc.
Schedule C (Form 1040). See Pub. 334.

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.
US MANUFACTURING PAYER2 NAME1 $ 0.00
Miscellaneous
US MANUFACTURING PAYER2 NAME2
4660 HACIENDA DRIVE 2 Royalties 2016 Income
BUILDING C
ROOM 408 $ 0.00
PLEASANTON, CA 94117 Form 1099-MISC
3 Other income 4 Federal income tax withheld
Copy B
925/694-4222 $ 0.00 $ 0.00
For Recipient
PAYER'S federal identification number. RECIPIENT'S identification number 5 Fishing boat proceeds 6 Medical and health care payments

987654321 123498334 $ 0.00 $ 0.00

RECIPIENT'S name 7 Nonemployee compensation 8 Substitute payments in lieu of

dividends or interest This is important tax
1099 REPORTING VENDOR - WITHHOLD NAME1 information and is being
furnished to the Internal
1099 REPORTING VENDOR - WITHHOLD NAME2 $ 0.00 $ 0.00 Revenue Service. If you are
Street address (including apt. no.) 9 Payer made direct sales of 10 Crop insurance proceeds
required to file a return, a
$5,000 or more of consumer
HQ BUILDING negligence penalty or other
products to a buyer
124 14TH STREET $ 0.00 sanction may be imposed on
(recipient) for resale► X you if this income is taxable
SUITE 298
City or town, state or province, country, and ZIP or foreign postal code 11 12 and the IRS determines that it
PLEASANTON, CA 94588 has not been reported.

Account number (see instructions) FATCA filing 13 Excess golden parachute payments 14 Gross proceeds paid to an attorney
requirement
USA1099014 $ 0.00 $ 0.00
15a Section 409A deferrals 15b Section 409A income 16 State tax withheld 17 State/Payer's state no. 18 State income
$ 200.00 CA/68219999978 $ 0.00
$ 0.00 $ 0.00 $ $
Form 1099-MISC (keep for your records) www.irs.gov/form1099misc Department of the Treasury - Internal Revenue Service
 1099 REPORTING VENDOR - WITHHOLD NAME1
1099 REPORTING VENDOR - WITHHOLD NAME2
HQ BUILDING
124 14TH STREET
SUITE 298
PLEASANTON, CA 94588

Instructions for Recipient

Recipient's identification number. For your protection, this form may show only the last four digits of your social Box 6. For individuals, report on Schedule C (Form 1040).
security number (SSN), individual taxpayer identification number (ITIN), adoption taxpayer identification number Box 7. Shows nonemployee compensation. If you are in the trade or business of catching fish, box 7 may show cash
(ATIN), or employer identification number (EIN). However, the issuer has reported your complete identification number you received for the sale of fish. If the amount in this box is SE income, report it on Schedule C or F (Form 1040), and
to the IRS. complete Schedule SE (Form 1040). You received this form instead of Form W-2 because the payer did not consider
Account number. May show an account or other unique number the payer assigned to distinguish your account. you an employee and did not withhold income tax or social security and Medicare tax. If you believe you are an
FATCA filing requirement. If the FATCA filing requirement box is checked, the payer is reporting on this Form 1099 employee and cannot get the payer to correct this form, report the amount from box 7 on Form 1040, line 7 (or Form
to satisfy its chapter 4 account reporting requirement. You also may have a filing requirement. See the Instructions for 1040NR, line 8). You must also complete Form 8919 and attach it to your return. If you are not an employee but the
Form 8938. amount in this box is not SE income (for example, it is income from a sporadic activity or a hobby), report it on Form
Amounts shown may be subject to self-employment (SE) tax. If your net income from self-employment is $400 or 1040, line 21 (or Form 1040NR, line 21).
more, you must file a return and compute your SE tax on Schedule SE (Form 1040). See Pub. 334 for more information. Box 8. Shows substitute payments in lieu of dividends or tax-exempt interest received by your broker on your behalf
If no income or social security and Medicare taxes were withheld and you are still receiving these payments, see Form as a result of a loan of your securities. Report on the "Other income" line of Form 1040 (or Form 1040NR).
1040-ES (or Form 1040-ES(NR)). Individuals must report these amounts as explained in the box 7 instructions on this Box 9. If checked, $5,000 or more of sales of consumer products was paid to you on a buy-sell, deposit-commission,
page. Corporations, fiduciaries, or partnerships must report the amounts on the proper line of their tax returns. or other basis. A dollar amount does not have to be shown. Generally, report any income from your sale of these
Form 1099-MISC incorrect? If this form is incorrect or has been issued in error, contact the payer. If you cannot get products on Schedule C (Form 1040).
this form corrected, attach an explanation to your tax return and report your income correctly. Box 10. Report this amount on Schedule F (Form 1040).
Box 1. Report rents from real estate on Schedule E (Form 1040). However, report rents on Schedule C (Form 1040) if Box 13. Shows your total compensation of excess golden parachute payments subject to a 20% excise tax. See the
you provided significant services to the tenant, sold real estate as a business, or rented personal property as a business. Form 1040 (or Form 1040NR) instructions for where to report.
Box 2. Report royalties from oil, gas, or mineral properties, copyrights, and patents on Schedule E (Form 1040). Box 14. Shows gross proceeds paid to an attorney in connection with legal services. Report only the taxable part as
However, report payments for a working interest as explained in the box 7 instructions. For royalties on timber, coal, income on your return.
and iron ore, see Pub. 544. Box 15a. May show current year deferrals as a nonemployee under a nonqualified deferred compensation (NQDC)
Box 3. Generally, report this amount on the "Other income" line of Form 1040 (or Form 1040NR) and identify the plan that is subject to the requirements of section 409A, plus any earnings on current and prior year deferrals.
payment. The amount shown may be payments received as the beneficiary of a deceased employee, prizes, awards, Box 15b. Shows income as a nonemployee under an NQDC plan that does not meet the requirements of section 409A.
taxable damages, Indian gaming profits, or other taxable income. See Pub. 525. If it is trade or business income, report This amount is also included in box 7 as nonemployee compensation. Any amount included in box 15a that is
this amount on Schedule C or F (Form 1040). currently taxable is also included in this box. This income is also subject to a substantial additional tax to be reported
Box 4. Shows backup withholding or withholding on Indian gaming profits. Generally, a payer must backup withhold if on Form 1040 (or Form 1040NR). See "Total Tax" in the Form 1040 (or Form 1040NR) instructions.
you did not furnish your taxpayer identification number. See Form W-9 and Pub. 505 for more information. Report this Boxes 16-18. Shows state or local income tax withheld from the payments.
amount on your income tax return as tax withheld. Future developments. For the latest information about developments related to Form 1099-MISC and its instructions,
Box 5. An amount in this box means the fishing boat operator considers you self-employed. Report this amount on such as legislation enacted after they were published, go to www.irs.gov/form1099misc.
Schedule C (Form 1040). See Pub. 334.

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.
US MANUFACTURING PAYER1 NAME1 $ 0.00
Miscellaneous
US MANUFACTURING PAYER1 NAME2
CANADIAN FIRST AVENUE 2 Royalties 2016 Income
CIVIC CENTER
SUITE 145 $ 0.00
VANCOUVER, BC 14003 Form 1099-MISC
CANADA 3 Other income 4 Federal income tax withheld
Copy B
925/694-4222 $ 0.00 $ 0.00
For Recipient
PAYER'S federal identification number. RECIPIENT'S identification number 5 Fishing boat proceeds 6 Medical and health care payments

123456789 123498334 $ 0.00 $ 0.00

RECIPIENT'S name 7 Nonemployee compensation 8 Substitute payments in lieu of

dividends or interest This is important tax
1099 REPORTING VENDOR - WITHHOLD NAME1 information and is being
furnished to the Internal
1099 REPORTING VENDOR - WITHHOLD NAME2 $ 0.00 $ 0.00 Revenue Service. If you are
Street address (including apt. no.) 9 Payer made direct sales of 10 Crop insurance proceeds
required to file a return, a
$5,000 or more of consumer
HQ BUILDING negligence penalty or other
products to a buyer
124 14TH STREET $ 0.00 sanction may be imposed on
(recipient) for resale► X you if this income is taxable
SUITE 298
City or town, state or province, country, and ZIP or foreign postal code 11 12 and the IRS determines that it
PLEASANTON, CA 94588 has not been reported.

Account number (see instructions) FATCA filing 13 Excess golden parachute payments 14 Gross proceeds paid to an attorney
requirement
USA1099014 $ 0.00 $ 0.00
15a Section 409A deferrals 15b Section 409A income 16 State tax withheld 17 State/Payer's state no. 18 State income
$ 200.00 CA/68219999978 $ 0.00
$ 0.00 $ 0.00 $ $
Form 1099-MISC (keep for your records) www.irs.gov/form1099misc Department of the Treasury - Internal Revenue Service