2021 Form 1099-B - irs.gov

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3 7979 VOID CORRECTED. PAYER'S name, street address, city or town, state or province, country, ZIP Applicable checkbox on Form 8949 OMB No. 1545-0715 Proceeds From or foreign postal code, and telephone no. 2021 Broker and Barter Exchange Form 1099-B . Transactions 1a Description of property (Example: 100 sh. XYZ Co.). 1b Date acquired 1c Date sold or disposed PAYER'S TIN RECIPIENT'S TIN 1d Proceeds 1e Cost or other basis Copy A. $ $. 1f Accrued market discount 1g Wash sale loss disallowed For $ $ Internal Revenue RECIPIENT'S name 2 Short-term gain or loss 3 Check if proceeds from: Service Center Long-term gain or loss Collectibles File with Form 1096.

4 Ordinary QOF. 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 Net proceeds Reduction Act Notice, see the 8 Profit or (loss) realized in 9 Unrealized profit or (loss) on 2021 on closed contracts open contracts 12/31/2020 2021 General Account number (see instructions) 2nd TIN not. Instructions for $ $ Certain CUSIP number FATCA filing 10 Unrealized profit or (loss) on 11 Aggregate profit or (loss) Information requirement open contracts 12/31/2021 on contracts Returns.

5 14 State name 15 State identification no. 16 State tax withheld $ $. $ 12 Check if basis reported to 13 Bartering IRS. $ $. Form 1099-B 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 VOID CORRECTED. PAYER'S name, street address, city or town, state or province, country, ZIP Applicable checkbox on Form 8949 OMB No. 1545-0715 Proceeds From or foreign postal code, and telephone no. 2021 Broker and Barter Exchange Form 1099-B . Transactions 1a Description of property (Example: 100 sh.)

6 XYZ Co.). 1b Date acquired 1c Date sold or disposed PAYER'S TIN RECIPIENT'S TIN 1d Proceeds 1e Cost or other basis Copy 1. $ $ For State Tax 1f Accrued market discount 1g Wash sale loss disallowed Department $ $. RECIPIENT'S name 2 Short-term gain or loss 3 If checked, proceeds from: Long-term gain or loss Collectibles Ordinary QOF. Street address (including apt. no.) 4 Federal income tax withheld 5 If checked, noncovered security $. 6 Reported to IRS: 7 If checked, loss is not allowed based on amount in 1d City or town, state or province, country, and ZIP or foreign postal code Gross proceeds Net proceeds 8 Profit or (loss) realized in 9 Unrealized profit or (loss) on 2021 on closed contracts open contracts 12/31/2020.

7 Account number (see instructions). $ $. CUSIP number FATCA filing 10 Unrealized profit or (loss) on 11 Aggregate profit or (loss). requirement open contracts 12/31/2021 on contracts 14 State name 15 State identification no. 16 State tax withheld $ $. $ 12 If checked, basis reported 13 Bartering to IRS. $ $. Form 1099-B Department of the Treasury - Internal Revenue Service CORRECTED (if checked). PAYER'S name, street address, city or town, state or province, country, ZIP Applicable checkbox on Form 8949 OMB No. 1545-0715 Proceeds From or foreign postal code, and telephone no. 2021 Broker and Barter Exchange Form 1099-B .

8 Transactions 1a Description of property (Example: 100 sh. XYZ Co.). 1b Date acquired 1c Date sold or disposed PAYER'S TIN RECIPIENT'S TIN 1d Proceeds 1e Cost or other basis Copy B. $ $ For Recipient 1f Accrued market discount 1g Wash sale loss disallowed $ $. RECIPIENT'S name 2 Short-term gain or loss 3 If checked, proceeds from: Long-term gain or loss Collectibles Ordinary QOF This is important tax Street address (including apt. no.) 4 Federal income tax withheld 5 If checked, noncovered information and is security being furnished to $. 6 Reported to IRS: 7 If checked, loss is not allowed the IRS.

9 If you are based on amount in 1d required to file a City or town, state or province, country, and ZIP or foreign postal code Gross proceeds return, a negligence Net proceeds penalty or other 8 Profit or (loss) realized in 9 Unrealized profit or (loss) on sanction may be 2021 on closed contracts open contracts 12/31/2020 imposed on you if Account number (see instructions). this income is $ $ taxable and the IRS. CUSIP number FATCA filing 10 Unrealized profit or (loss) on 11 Aggregate profit or (loss) determines that it requirement open contracts 12/31/2021 on contracts has not been reported.

10 14 State name 15 State identification no. 16 State tax withheld $ $. $ 12 If checked, basis reported 13 Bartering to IRS. $ $. Form 1099-B (Keep for your records) Department of the Treasury - Internal Revenue Service Instructions for Recipient Brokers and barter exchanges must report proceeds from (and in some Box 1b. This box may be blank if box 5 is checked or if the securities cases, basis for) transactions to you and the IRS on Form 1099-B . sold were acquired on a variety of dates. For short sales, the date Reporting is also required when your broker knows or has reason to shown is the date you acquired the security delivered to close the know that a corporation in which you own stock has had a reportable short sale.