9595 VOID CORRECTED

PAYER’S name, street address, city or town, state or province, country, ZIP 1 Rents OMB No. 1545-0115
or foreign postal code, and telephone no.

Miscellaneous
David Kovach
8205 W Gibson
VESSEY Ranch
PATRICK Rd
FRANCIS
$
2 Royalties
36,000
2019 Income
Payson AZ 85541Ave Unit 36
2544 W Campbell
Phoenix, AZ 85017
$ Form 1099-MISC
3 Other income 4 Federal income tax withheld Copy A
$ $ For
PAYER’S TIN RECIPIENT’S TIN 5 Fishing boat proceeds 6 Medical and health care payments Internal Revenue
Service Center
057-54-5630
305-82-9500 057-54-5630
305-82-9500

$ $ File with Form 1096.

RECIPIENT’S name 7 Nonemployee compensation 8 Substitute payments in lieu of For Privacy Act
dividends or interest
VESSEY
David PATRICK FRANCIS
Kovach and Paperwork
Reduction Act
Street address (including apt. no.) $ $ Notice, see the
9 Payer made direct sales of 10 Crop insurance proceeds 2019 General
2544 WGibson
8205 W Campbell Ave
Ranch Rd Unit 36 $5,000 or more of consumer Instructions for
products to a buyer
City or town, state or province, country, and ZIP or foreign postal code (recipient) for resale ▶ $ Certain
11 12
Information
Phoenix,
Payson AZAZ 85017
85541 Returns.
Account number (see instructions) FATCA filing 2nd TIN not. 13 Excess golden parachute 14 Gross proceeds paid to an
requirement payments attorney

$ $
15a Section 409A deferrals 15b Section 409A income 16 State tax withheld 17 State/Payer’s state no. 18 State income
$ $
$ $ $ $
Form 1099-MISC Cat. No. 14425J www.irs.gov/Form1099MISC Department of the Treasury - Internal Revenue Service
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