PAYER’S TIN
RECIPIENT’S TIN
Form *099-NEC (Rev. 4-2025) www.tax1099.com -IRS Approved e File Provider www.irs.gov/Form1099NEC Instructions for Recipient
You received this form instead of Form W-2 because the payer did not consider you an employee and did not withhold income tax or social security and Medicare tax
If you believe you are an employee and cannot get the payer to correct this form, report the amount shown in box 1 on the line for
“Wages, salaries, tips, etc.” of Form 1040, 1040-SR, or 1040-NR. You must also complete Form 8919 and attach it to your return. For more information, see Pub. 1779, Independent Contractor or Employee
If you are not an employee but the amount in box 1 is not selfemployment (SE) income (for example, it is income from a sporadic activity or a hobby), report the amount shown in box 1 on the “Other income” line (on Schedule 1 (Form 1040)). Recipient's taxpayer identification number (TIN).For your protection, this form may show only the last four digits of your TIN
(social security number (SSN), individual taxpayer identification number (ITIN), adoption taxpayer identification number (ATIN), or employer identification number (EIN)). However, the issuer has reported your complete TIN to the IRS.
Account number. May show an account or other unique number the payer assigned to distinguish your account.
Box 1. Shows nonemployee compensation. If the amount in this box is SE income, report it on Schedule C or F (Form 1040) if a sole proprietor, or on Form 1065 and Schedule K-1 (Form 1065) if a partnership, and the recipient/partner completes Schedule SE
(Form 1040).
Note: If you are receiving payments on which no income, social security, and Medicare taxes are withheld, you should make estimated tax payments. See Form 1040-ES (or Form 1040-ES (NR)). Individuals must report these amounts as explained in these box 1 instructions. Corporations, fiduciaries, and partnerships must report these amounts on the appropriate line of their tax returns
Box 2. If checked, consumer products totaling $5,000 or more were sold to you for resale, on a buy-sell, a deposit-commission, or other basis. Generally, report any income from your sale of these products on Schedule C (Form 1040).
Box 3. Shows your total compensation of excess golden parachute payments subject to a 20% excise tax. See your tax return instructions for where to report.
Box 4. Shows backup withholding. A payer must backup withhold on certain payments if you did not give your TIN to the payer. See Form W-9, Request for Taxpayer Identification Number and Certification, for information on backup withholding. Include this amount on your income tax return as tax withheld.
Boxes 5-7.State income tax withheld reporting boxes. Future developments.For the latest information about developments related to Form 1099-NEC and its instructions, such as legislation enacted after they were published, go to www.irs.gov/Form1099NEC Free File Program. Go to www.irs.gov/FreeFile to see if you qualify for no-cost online federal tax preparation, e-filing, and direct deposit or payment options
CORRECTED (if checked)
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
Wesley Medical Staffing, Inc
PO Box 987
Tiburon CA 94920
US - Phone: 888-***-****
OMB No. 1545-0116
Form 1099-NEC
(Rev. April 2025)
Nonemployee
Compensation
For calendar year
2025
1 Nonemployee compensation
$ 4837.80
Copy B
For Recipient
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
RECIPIENT'S name, street address(including apt. no.), City or town, state or province, country, and ZIP or foreign postal code Stephanie Toles
1119 CANTERBURY
HERCULES CA 94547-3620
US
2 Payer made direct sales totaling $5,000 or
more of consumer products to recipient for
resale
3 Excess golden parachute payments
$
4 Federal income tax withheld
$
Account number (see instructions)
5 State tax
withheld
$
$
6 State/Payer’s state
no.
CA 680472621
7 State income
$ 4837.80
$
XXX-XX-3836