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VOID CORRECTED PAYER S name street address city state ZIP code and telephone no. 1 Rents OMB No. 1545-0115 2 Royalties Miscellaneous Income 3 Other income 1099-MISC RECIPIENT S identification number Form 4 Federal income tax withheld 5 Fishing boat proceeds PAYER S Federal identification number 6 Medical and health care payments 7 Nonemployee compensation RECIPIENT S name Street address including apt. no. 8 Substitute payments in lieu of dividend.

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