PAYER’S name, street address, city, state, ZIP code, and telephone number

CORRECTED (if checked) 1 Rents

OM BRONX (347) 853-6334 41-2245030
RECIPIENT’S name

$
2
Royalties

2012
Form 1099-MISC FDEA0302 4 Federal income tax withheld

Miscellaneous Income
08/16/12

$ NY 10458 MARILYN PEREZ
RECIPIENT’S identification number

3

Other income

$
5
Fishing boat proceeds

$
6
Med & health care payments Substitute payments in lieu of dividends or interest Crop insurance proceeds

Copy B For Recipient
This is important tax information and is being furnished to the Internal Revenue Service. If you are required to file a return, a negligence penalty or other sanction may be imposed on you if this income is taxable and the IRS determines that it has not been reported.

PAYER’S federal identification number

086-98-8404

$
7
Nonemployee compensation Payer made direct sales of $5,000 or more of consumer products to a buyer (recipient) for resale

$
8 10

NATIVIDAD VILLAMAR
Street address (including apartment number)

$
9

15600.00 $

317 E. 201ST APT 3
City State ZIP code

G

$
12 14 17
Gross proceeds paid to an attorney State/Payer’s state no.

11

BRONX
Account number (see instructions)

NY 10458
15 b
Section 409A income

13

Excess golden parachute payments State tax withheld

$
16 18

State income

15 a

Section 409A deferrals

$
BAA Form 1099-MISC

$

$ $

$ $
Department of the Treasury ' Internal Revenue Service

(Keep for your records.)

Instructions for Recipient
Recipient’s identification number. For your protection, this form may show only the last four digits of your social security number (SSN), individual taxpayer identification number (ITIN), or adoption taxpayer identification number (ATIN). However, the issuer has reported your complete identification number to the