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l <br /> ! ❑ CORRECTED if checked ;. <br /> PAYER'S name,street address,city,state, code,and telephone no. 1 Rents rMB No.1545-0115 <br /> $ <br /> H 6 H ENGINEERING CONSTRUCTION 2 Royalties [�j O®O <br /> 212 INDUSTRIAL DRIVE y C� O Miscellaneous <br /> STOCKTON. CA 95206-3905 $ Income <br /> � 3 Other income <br /> $ Form 1099•MISC I. <br /> PAYER'S Federal identification number RECIPIENT'S Identification number 4 Federal income tax withheld 5 Fishing boat proceeds COPY B <br /> 68-0072166 94-6000531 g <br /> For Recipient i <br /> RECIPIENT'S name,address,and ZIP code 6 Medical and health care payments 7 Nonemployee compensation <br /> This is important tax <br /> $ $ 750.00 information and is <br /> COUNTIY OF SAN JOA UIN 8 Substitute payments in lieu of 9 Pa being furnished to the <br /> Q paym .DO made direct sales m Internal Revenue <br /> dividends or interest $5,000 or more of consumer Service. If you are <br /> RM 610 COURTHOUSE, 222 E. WEBER AVE. $ (recl ctsq fur reuM ► required to file a return, .I <br /> a negligence penalty or <br /> 0 Crop insurance proceeds 11 State income tax withheld- other sanction maybe <br /> STOCKTON x CA 95202 imposed on you if this <br /> $ $ Income is taxable and <br /> Account number(opi the IRS determines that <br /> ( p 9 2 State state number 13 it has not been <br /> $ reported. <br /> Form 1099•MISC (Keep for your records.) Department of the Treasury. Internal Revenue Service <br /> — -- ------.--_ <br /> RECE�VR® <br /> FEB 2 2001 <br /> ANJO� EMERGENCYS RERE ACES <br />