PAYER’S name, street address, city or town, state or province, country, ZIP

or foreign postal code, and telephone no.

Marco Magana v. Castlerock Environmental, Inc.

c/o Phoenix Settlement Administrators

P.O. Box 7208

Orange, CA 92867

1 Rents

$

OMB No. 1545-0115

2021

Form 1099-MISC

2 Royalties

$

3 Other income

$10,331.07

4 Federal income tax withheld

$

Copy

B

For

Recipient

PAYER’S TIN

86-1760431

RECIPIENT’S TIN

***-**-****

5 Fishing boat proceeds

$

6 Medical and health care payments

$

RECIPIENT’S name

Marcos A Magana

13975 Spring Street

Fontana, CA 92335

7 Nonemployee compensation

$

8 Substitute payments in lieu of

dividends or interest

$

This is important tax

information and is

being furnished to

the IRS. If you are

required to file a

return, a negligence

penalty or other

sanction may be

imposed on you if

this income is

taxable and the IRS

determines that it

has not been

reported.

9 Payer made direct sales of

$5,000 or more of consumer

products to a buyer

(recipient) for resale

10 Crop insurance proceeds

$

11 12

Account number (see instructions) FATCA filing

requirement 13 Excess golden parachute

payments

$

14 Gross proceeds paid to an

attorney

$

15a Section 409A deferrals

$

15b Section 409A income

$

16 State tax withheld

$

17 State/Payer’s state no. 18 State income

$

$ $

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