Form 1099-B Proceeds From Broker and Barter Exchange Transactions

Please complete the form below by entering the information EXACTLY as it appears on your Form 1099-B
Use the Tab key to move to the next field. An asterisk ( * ) indicates a required field.

* Your email Address:

* PAYER’S name, street address, city, state, ZIP code, and telephone no.		1a Date of sale	2001 Form 1099-B
		1b CUSIP no.
		2 Stocks, bonds, etc	Reported Gross proceeds To IRS Gross pro less com
* PAYER’S Federal ID number	* RECIPIENT'S ID number	3 Barting	4 Federal income tax withheld
* RECIPIENT'S name, street address, city, state, and ZIP code		5 Description
		Regulated Futures Contracts
		6 Profit or loss realized in 2001	7 Unrealized profit or (loss) on open contracts – 12/31/2000
Account number (optional)		8 Unrealized profit or (loss) on open contracts – 12/31/2001	9 Aggregate profit or (loss)
Form 1099-B

The following information does not appear on Form 1099-B but is needed in order to determine the gain or loss.

Date Acquired: (Example 06/30/1997)

Cost: (Your initial investment)

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