Form 1099-B - Proceeds From Broker And Barter Exchange Transactions - 2012 Page 2
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CORRECTED
7979
PAYER'S name, street address, city, state, ZIP code, and telephone no.
1a Date of sale or exchange
OMB No. 1545-0715
Proceeds From
2012
Broker and
1b Date of acquisition
Barter Exchange
Transactions
1c Type of gain or loss
1099-B
Form
Short-term
1d Stock or other symbol
1e Quantity sold
Long-term
2a Stocks, bonds, etc.
2b Check if loss not
}
Gross proceeds
Reported
allowed based on
to IRS
PAYER'S federal identification number
RECIPIENT'S identification number
Gross proceeds less
amount in box 2a
commissions and
$
option premiums
Copy A
3 Cost or other basis
4 Federal income tax withheld
$
$
RECIPIENT'S name
For
Internal Revenue
5 Wash sale loss disallowed
6 Check if:
Service Center
$
File with Form 1096.
Street address (including apt. no.)
7 Bartering
a
Noncovered security
Basis reported to IRS
b
For Privacy Act and
$
Paperwork Reduction
Act Notice, see the
City, state, and ZIP code
8 Description
2012 General
Instructions for Certain
Information Returns.
9 Profit or (loss) realized in
10 Unrealized profit or (loss) on
13 State
Account number (see instructions)
2nd TIN not.
2012 on closed contracts
open contracts—12/31/2011
$
$
14 State identification no.
CUSIP number
11 Unrealized profit or (loss) on
12 Aggregate profit or (loss) on
open contracts—12/31/2012
contracts
15 State tax withheld
$
$
$
1099-B
Form
Cat. No. 14411V
Department of the Treasury - Internal Revenue Service
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