Form 1099-B - Proceeds From Broker And Barter Exchange Transactions - 2016 Page 2
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9VOID
CORRECTED
7979
PAYER'S name, street address, city or town, state or province, country, ZIP
Applicable check box on Form 8949
OMB No. 1545-0715
Proceeds From
or foreign postal code, and telephone no.
2016
Broker and
Barter Exchange
Transactions
1099-B
Form
1a Description of property (Example 100 sh. XYZ Co.)
1b Date acquired
1c Date sold or disposed
Copy A
PAYER'S federal identification number
RECIPIENT'S identification number
1d Proceeds
1e Cost or other basis
$
$
1f Accrued market discount
1g Wash sale loss disallowed
For
$
$
Internal Revenue
Service Center
RECIPIENT'S name
2 Short-term gain or loss
3 Check if basis reported to
IRS
File with Form 1096.
Long-term gain or loss
Ordinary
Street address (including apt. no.)
4 Federal income tax withheld
5 Check if noncovered
security
$
6 Reported to IRS:
7 Check if loss is not allowed
For Privacy Act
based on amount in 1d
and Paperwork
City or town, state or province, country, and ZIP or foreign postal code
Gross proceeds
Reduction Act
Net proceeds
Notice, see the
8 Profit or (loss) realized in
9 Unrealized profit or (loss) on
2016 General
2016 on closed contracts
open contracts—12/31/2015
Account number (see instructions)
2nd TIN not.
Instructions for
$
$
Certain
Information
CUSIP number
FATCA filing
10 Unrealized profit or (loss) on
11 Aggregate profit or (loss)
requirement
open contracts—12/31/2016
on contracts
Returns.
$
$
14 State name
15 State identification no. 16 State tax withheld
$
12 Check if proceeds from
13 Bartering
collectibles
$
$
1099-B
Form
Cat. No. 14411V
Department of the Treasury - Internal Revenue Service
Do Not Cut or Separate Forms on This Page — Do Not Cut or Separate Forms on This Page
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