sageameridata 1099s 93-96 (gt-02)

8/14/2019 SageAmeriData 1099s 93-96 (GT-02)

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" (Keep For Yopr Record)o.m 1099-Mls e

. . .cORRECT!=D (if checked) . .P;';''ER'S nsrne, sire..at.,dd"'>-... c i l y ~ n ; e 1 " Z J p@ !l=' ' P e n b ~

--- OMS No. 1545-01 16

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Acro<.mt number t i l i " 1 2 l ) 12 Sl3te/P2yers slEl.3nurnbsr r I d th31 rt,has. .

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GOVERNMENT

EXHIBIT

GT-2

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DePartment of the Treasury- Inlp-mal Revenue & l r v ' ~ '

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PAYER'S name, street aooress, city, state, andZIPcode

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2

$

$

10C Insurnnc::e

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inc.

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Road

12180

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89 Bulson

Trov HY.Al:counl number (optional)

Form 1 O ~ 3 - M I S C D..pamnent o! If"'<> Treascry • Imema! R e I

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O VOID o CORRECTED DJi.VI D PE

PAYER'Sname•• treetsddress, city, state, and ZIP code 1 Rents OMU No. 1545·0 115 12031 3 0 . 00 Miscella

AMERIDATA TPCHNOLOGI ES INC 2 Royanies

1996I

7 0 0 CANAL STREET 0 . 00STANFORD CT 0 6 9 0 2 3 Oth er income

0 .0 0 FOlIl1 lO99-l'vIlSC

?A'fER'S Federnl identificationnumber IRECIPIEl'rS identification number 4 Federal income tax withh<1 d 5 Fi>!ung bOllt proceeds

i0 6 - 1 3 0 2 1 0 3 0.

00 0 . 00 for RIREClP£Elo.,TfS name, street address. Clly . state, andZIPcode oMedical arid health care payments 7 Nonempleyeecompenssucn

0 . 00 24 , 0 00 . 00 11W is''BRUNO J OSEPH &Substitute !X!yments in lieuof I) Pay" made direct •• \ of mformaticn

89 BULSON ROJl..n div dends 0: mterest S5,OOO 0:more of consumer tiJmlshcd to

TROY, Wi 12 180 RcvtJlI1: Servic

0 . 00 0 requred to f

toCrop insuranceproceeds 11 Stale meome tax w thheld nezhgeneepen

sanenon ",-,y be

0 . 0 0 0 . 0 0 yoo if <:c<>blt:in

Accountnumber (opuonal) 12 S l d v a statenum ber fromun.=,tlle lRS deter

1 h. . not b

Form 1099-MlS C Depuruncnt oftheTreasury- lniemal Revenue Serv

0012 84

sageameridata 1099s 93-96 (gt-02)

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