Your e-mail address:       

Payer Name on 1099:    

Check box if income reported to:Taxpayer or Spouse

Box 1a:      Box 1b:

Box 2:        Box 3:        

Box 4:        Box 5:        

Box 6:        Box 7:        

Box 8:        Box 9:    

Box 10:       Box 11:

Box 12:

In order to determine the gain or loss on the sale of the above please provide what it cost for you to acquire the investment being sold and the date you originally acquired the investment in the following comment box.  You may need to obtain this information from your broker or brokerage house.  Feel free to leave any questions or comments you have regarding this 1099-B as well in the following comment box:

After completing the information for one 1099-B, please review your entries and then click on the submit button below.  Just click on the submit button once and a confirmation page should display your entries and allow you to return to this form to enter any additional 1099-B you may have.