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Copy A of this form is provided for informational purposes only. Copy A appears in red,
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Please note that Copy B and other copies of this form, which appear in black, may be
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See IRS Publications 1141, 1167, and 1179 for more information about printing these tax
forms.
 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.

JADAS WILCHER
MELISSA WINGATE
$ 920
950 2020 Miscellaneous
Income
2 Royalties
501hartsell
2503 ave#2
N 54TH ST
$ Form 1099-MISC
Lakeland,
TAMPA, florida
FL 33619 33815 2156885086
3237947540 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
589-05-2131
589052131
594-48-9785
591-38-5207
591385207
547-47-1562
$ $ File with Form 1096.
RECIPIENT’S name 7 Payer made direct sales of 8 Substitute payments in lieu of For Privacy Act
$5,000 or more of consumer dividends or interest
NINA WILSON products to a buyer and Paperwork
MICHAEL W LARSON $ Reduction Act
(recipient) for resale
Street address (including apt. no.) 9 Crop insurance proceeds 10 Gross proceeds paid to an Notice, see the
attorney 2020 General
1457
1104 s kirkmanAVE
E HACIENDA rd 2016 Instructions for
$ $
City or town, state or province, country, and ZIP or foreign postal code 11 12 Section 409A deferrals
Certain
Information
Orlando,
LAS VEGAS,florida, 32811
NV 89119 Returns.
$
Account number (see instructions) FATCA filing 2nd TIN not. 13 Excess golden parachute 14 Nonqualified deferred
requirement payments compensation
2101166847
271120123085
$ $
15 State tax withheld 16 State/Payer’s state no. 17 State income
$ $
$ $
Form 1099-MISC Cat. No. 14425J www.irs.gov/Form1099MISC 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 1 Rents OMB No. 1545-0115
or foreign postal code, and telephone no.

JADAS WILCHER $950

920 2020 Miscellaneous
Income
2 Royalties
MELISSA WINGATE
501hartsell ave#2
2503 N 54TH ST $ Form 1099-MISC
3 Other income 4 Federal income tax withheld
Lakeland, florida 33815 3237947540
TAMPA FL 33619 2156885086 $ $ Copy 1
PAYER’S TIN RECIPIENT’S TIN 5 Fishing boat proceeds 6 Medical and health care payments For State Tax
Department
589052131
589-05-2131 591385207
591-38-5207
594-48-9785 547-47-1562
$ $
RECIPIENT’S name 7 Payer made direct sales of 8 Substitute payments in lieu of
$5,000 or more of consumer dividends or interest
NINA WILSON
MICHAEL W LARSON products to a buyer
(recipient) for resale $
Street address (including apt. no.) 9 Crop insurance proceeds 10 Gross proceeds paid to an
attorney
1104
1457E sHACIENDA
kirkman AVE
rd 2016 $ $
City or town, state or province, country, and ZIP or foreign postal code 11 12 Section 409A deferrals

Orlando,
LAS VEGAS
florida, 32811
NV 89119 $
Account number (see instructions) FATCA filing 2nd TIN not. 13 Excess golden parachute 14 Nonqualified deferred
requirement payments compensation
271120123085
2101166847 $ $
15 State tax withheld 16 State/Payer’s state no. 17 State income
$ $
$ $
Form 1099-MISC www.irs.gov/Form1099MISC Department of the Treasury - Internal Revenue Service
 VOID  CORRECTED CORRECTED (if checked)
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.

JADAS WILCHER $950

920
2 Royalties
2020 Miscellaneous
Income
MELISSA WINGATE
501hartsell ave#2
2503 N 54TH ST $ Form 1099-MISC
Lakeland, florida 33815 3237947540 3 Other income 4 Federal income tax withheld Copy B
TAMPA FL 33619 2156885086 $ $ For Recipient
PAYER’S TIN RECIPIENT’S TIN 5 Fishing boat proceeds 6 Medical and health care payments

589052131
589-05-2131 591385207
591-38-5207
594-48-9785 547-47-1562
$ $
RECIPIENT’S name 7 Payer made direct sales of 8 Substitute payments in lieu of
$5,000 or more of consumer dividends or interest This is important tax
NINA WILSON
MICHAEL W LARSON products to a buyer information and is
(recipient) for resale $ being furnished to
Street address (including apt. no.) 9 Crop insurance proceeds 10 Gross proceeds paid to an the IRS. If you are
attorney required to file a
1457
1104 EsHACIENDA
kirkman rd
AVE2016 return, a negligence
$ $ penalty or other
City or town, state or province, country, and ZIP or foreign postal code 11 12 Section 409A deferrals sanction may be
imposed on you if
Orlando,
LAS VEGASflorida, 32811
NV 89119 this income is
$ taxable and the IRS
Account number (see instructions) FATCA filing 2nd TIN not. 13 Excess golden parachute 14 Nonqualified deferred determines that it
requirement payments compensation has not been
2101166847
271120123085 reported.
$ $
15 State tax withheld 16 State/Payer’s state no. 17 State income
$ $
$ $
Form 1099-MISC (keep for your records) www.irs.gov/Form1099MISC Department of the Treasury - Internal Revenue Service
Instructions for Recipient
Recipient’s taxpayer identification number (TIN). For your protection, this form may Box 4. Shows backup withholding or withholding on Indian gaming profits.
show only the last four digits of your social security number (SSN), individual taxpayer Generally, a payer must backup withhold if you did not furnish your TIN. See Form
identification number (ITIN), adoption taxpayer identification number (ATIN), or W-9 and Pub. 505 for more information. Report this amount on your income tax
employer identification number (EIN). However, the payer has reported your complete return as tax withheld.
TIN to the IRS. Box 5. An amount in this box means the fishing boat operator considers you self-
Account number. May show an account or other unique number the payer employed. Report this amount on Schedule C (Form 1040 or 1040-SR). See Pub. 334.
assigned to distinguish your account.
FATCA filing requirement. If the FATCA filing requirement box is checked, the Box 6. For individuals, report on Schedule C (Form 1040 or 1040-SR).
payer is reporting on this Form 1099 to satisfy its chapter 4 account reporting Box 7. If checked, $5,000 or more of sales of consumer products was sold to you on
requirement. You may also have a filing requirement. See the Instructions for Form buy-sell, deposit-commission, or other basis. A dollar amount does not have to be
8938. shown. Generally, report any income from your sale of these products on Schedule C
Amounts shown may be subject to self-employment (SE) tax. If your net income from (Form 1040 or 1040-SR).
SE is $400 or more, you must file a return and compute your SE tax on Schedule SE Box 8. Shows substitute payments in lieu of dividends or tax-exempt interest received
(Form 1040 or 1040-SR). See Pub. 334 for more information. Note: If you are still by your broker on your behalf as a result of a loan of your securities. Report on the
receiving payments on which no income, social security, and Medicare taxes are “Other income” line of Schedule 1 (Form 1040 or 1040-SR), or Form 1040-NR.
withheld, you should make estimated tax payments. See Form 1040-ES (or Form 1040-
ES-NR). Individuals must report these amounts as explained in the box 14 instructions on Box 9. Report this amount on Schedule F (Form 1040 or 1040-SR).
this page. Corporations, fiduciaries, or partnerships must report the amounts on the Box 10. Shows gross proceeds paid to an attorney in connection with legal
proper line of their tax returns. services. Report only the taxable part as income on your return.
Box 12. May show current year deferrals as a nonemployee under a nonqualified
Form 1099-MISC incorrect? If this form is incorrect or has been issued in error, contact deferred compensation (NQDC) plan that is subject to the requirements of
the payer. If you cannot get this form corrected, attach an explanation to your tax return section 409A plus any earnings on current and prior year deferrals. This amount
and report your income correctly. is also shown in box 1 of Form 1099-NEC.
Box 1. Report rents from real estate on Schedule E (Form 1040 or 1040-SR). Box 13. Shows your total compensation of excess golden parachute payments subject to a
However, report rents on Schedule C (Form 1040 or 1040-SR) if you provided
20% excise tax. See your tax return instructions for where to report. Box 14. Shows
significant services to the tenant, sold real estate as a business, or rented personal
property as a business. See Pub. 527. income as a nonemployee under an NQDC plan that does not meet the requirements of
Box 2. Report royalties from oil, gas, or mineral properties; copyrights; and patents on section 409A. This amount is also included in box 1, Form 1099-NEC as nonemployee
Schedule E (Form 1040 or 1040-SR). However, report payments for a working interest as compensation. Any amount included in box 12 that is currently taxable is also included in
explained in the Schedule E (Form 1040 or 1040-SR) instructions. For royalties on this box. This income is also subject to a substantial additional tax to be reported on Form
timber, coal, and iron ore, see Pub. 544. 1040, 1040-SR, or 1040-NR. See the Instructions for Forms 1040 and 1040-SR, or the
Box 3. Generally, report this amount on the “Other income” line of Schedule 1 (Form Instructions for Form 1040-NR.
1040 or 1040-SR), or Form 1040-NR and identify the payment. The amount shown Boxes 15–17. Show state or local income tax withheld from the payments. Future
may be payments received as the beneficiary of a deceased employee, prizes, awards, developments. For the latest information about developments related to Form 1099-
taxable damages, Indian gaming profits, or other taxable income. See Pub. 525. If it is MISC and its instructions, such as legislation enacted after they were published, go to
trade or business income, report this amount on Schedule C or F (Form 1040 or 1040- WWW.IRS.GOV/FORM1099MISC.
SR).
 VOID  CORRECTED CORRECTED (if checked)
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.
JADAS
MELISSAWILCHER
WINGATE $950
920
2 Royalties
2020 Miscellaneous
Income
501hartsell ave#2
2503 N 54TH ST
$ Form 1099-MISC
Lakeland,
TAMPA, FLflorida 33815
33619 3237947540
2156885086 3 Other income 4 Federal income tax withheld
$ $ Copy 2
PAYER’S TIN RECIPIENT’S TIN 5 Fishing boat proceeds 6 Medical and health care payments To be filed with
recipient’s state
589-05-2131
589052131
594-48-9785 591-38-5207
591385207
547-47-1562 income tax return,
when required.
$ $
RECIPIENT’S name 7 Payer made direct sales of 8 Substitute payments in lieu of
$5,000 or more of consumer dividends or interest
NINA WILSON
MICHAEL W LARSON products to a buyer
(recipient) for resale $
Street address (including apt. no.) 9 Crop insurance proceeds 10 Gross proceeds paid to an
attorney
1457
1104 s kirkmanAVE
E HACIENDA rd 2016
$ $
City or town, state or province, country, and ZIP or foreign postal code 11 12 Section 409A deferrals

Orlando, florida, 32811

LAS VEGAS NV 89119 $
Account number (see instructions) FATCA filing 2nd TIN not. 13 Excess golden parachute 14 Nonqualified deferred
requirement payments compensation
2101166847
271120123085
$ $
15 State tax withheld 16 State/Payer’s state no. 17 State income
$ $
$ $
Form 1099-MISC www.irs.gov/Form1099MISC Department of the Treasury - Internal Revenue Service
 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.

JADAS
MELISSAWILCHER
WINGATE $950
920 2020 Miscellaneous
Income
2 Royalties
501hartsell ave#2
2503 N 54TH ST
$ Form 1099-MISC
TAMPA FL
Lakeland, 33619
florida 33815 2156885086 3 Other income 4 Federal income tax withheld Copy C
3237947540
$ $ For Payer
PAYER’S TIN RECIPIENT’S TIN 5 Fishing boat proceeds 6 Medical and health care payments

589052131
589-05-2131 591385207
591-38-5207
547-47-1562
594-48-9785
$ $
RECIPIENT’S name 7 Payer made direct sales of 8 Substitute payments in lieu of
NINA WILSON $5,000 or more of consumer dividends or interest For Privacy Act
MICHAEL W LARSON products to a buyer and Paperwork
(recipient) for resale $ Reduction Act
Street address (including apt. no.) 9 Crop insurance proceeds 10 Gross proceeds paid to an
attorney
Notice, see the
1457 s kirkman rd 2016
1104 E HACIENDA AVE
2020 General
$ $ Instructions for
City or town, state or province, country, and ZIP or foreign postal code 11 12 Section 409A deferrals Certain
Information
Orlando, florida, 32811
LAS VEGAS NV 89119 $ Returns.
Account number (see instructions) FATCA filing 2nd TIN not. 13 Excess golden parachute 14 Nonqualified deferred
requirement payments compensation
271120123085
2101166847 $ $
15 State tax withheld 16 State/Payer’s state no. 17 State income
$ $
$ $
Form 1099-MISC www.irs.gov/Form1099MISC Department of the Treasury - Internal Revenue Service
Instructions for Payer
To complete Form 1099-MISC, use: File Copy A of this form with the IRS by March 1, 2021,
• The 2020 General Instructions for Certain Information if you file on paper, or by March 31, 2021, if you file
Returns, and electronically.
• The 2020 Instructions for Forms 1099-MISC and To file electronically, you must have software that
1099-NEC. generates a file according to the specifications in Pub. 1220.
To complete corrected Forms 1099-MISC, see the 2020 The IRS does not provide a fill-in form option for Copy A.
General Instructions for Certain Information Returns.
Need help? If you have questions about reporting on Form
To order these instructions and additional forms, go 1099-MISC, call the information reporting customer
to WWW.IRS.GOV/FORM1099MISC. service site toll free at 866-455-7438 or
304-263-8700 (not toll free). Persons with a hearing or
Caution: Because paper forms are scanned during processing,
speech disability with access to TTY/TDD equipment can
you cannot file Forms 1096, 1097, 1098, 1099, 3921, or 5498
call 304-579-4827 (not toll free).
that you print from the IRS website.
Due dates. Furnish Copy B of this form to the recipient by
February 1, 2021. The due date is extended to February 16,
2021, if you are reporting payments in box 8 or 10.