9595
CORRECTED
VOID
PAYER’S name, street address, city or town, state or province, country, ZIP
or foreign postal code, and telephone no.
1 Rents
Eclipse Corporation
434 NE 3rd Avenue
Suite 1000
Cape Coral, FL 33914
$
OMB No. 1545-0115
$
2,500.00
3 Other income
$
PAYER’S federal identification number
25-65874
RECIPIENT’S identification number
98-68768
RECIPIENT’S name
Miscellaneous
Income
2014
105,236.32
2 Royalties
Form 1099-MISC
$
1,254.35
5 Fishing boat proceeds
6 Medical and health care payments
$
$
100.00
650.22
7 Nonemployee compensation
8 Substitute payments in lieu of
Street address (including apt. no.)
$
$
224 Evergreen Drive
Unit 725
9 Payer made direct sales of
dividends or interest
Lauren Jackson
Kissimmee, AL 30518
United States
11
2nd TIN not.
1,200.00
12
13 Excess golden parachute
payments
6876868
450.25
14 Gross proceeds paid to an
attorney
1,000.00
15a Section 409A deferrals
Form 1099-MISC
452.55
10 Crop insurance proceeds
7,540.25
Account number (see instructions)
$
124.50
$5,000 or more of consumer
products to a buyer
(recipient) for resale
City or town, state or province, country, and ZIP or foreign postal code
98,236.15
15b Section 409A income
16 State tax withheld
$
$
$
Cat. No. 14425J
85,241.36
Copy A
4 Federal income tax withheld
235.00
5,203.54
2,351.02
www.irs.gov/form1099misc
For
Internal Revenue
Service Center
File with Form 1096.
For Privacy Act
and Paperwork
Reduction Act
Notice, see the
2014 General
Instructions for
Certain
Information
Returns.
3,500.00
17 State/Payer’s state no.
2564735
9865654
18 State income
$
$
75,236.54
72,513.25
Department of the Treasury - Internal Revenue Service
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