CORRECTED (if checked)
PAYER'S name, street address, city or town, state or                        1 Rents
province, country, ZIP or foreign postal code, and                                                                OMB No. 1545-0115
telephone no.
DOLDERER CONSTRUCTION
                                                                            $ 950.00
                                                                            2 Royalties                             2023
                                                                                                                    20 23                             Miscellaneous
                                                                                                                                                             Income
                                                                                                                   Form 1099-MISC
1101 CROCKER ST                                                             $
DES MOINES, IA 50309                                                        3 Other income                    4 Federal Income tax withheld                  Copy B
                                                                            $ 1,450.00                        $                                        For Recipient
PAYER'S TIN                        RECIPIENT'S TIN                          5 Fishing boat proceeds          6 Medical and health care
287500937                          484193363                                                                   payments
                                                                            $ 250.00                         $
RECIPIENT'S name                                                            7 Payer made direct sales of     8 Subsitute payments in lieu
                                                                                $5.000 or more of consumer     of dividends or interest
LINDSAY KENNEDY                                                                 products to a buyer                                               This is important tax
                                                                                (recipient) for resale                                               information and is
                                                                                                             $
                                                                                                                                                being furnished to the
Street address (including apt. no.)                                         9 Crop insurance proceeds        10 Gross proceeds paid to an      IRS. If you are required
                                                                                                                attorney
507 W ASHLAND AVE                                                                                                                                      to file a return, a
                                                                            $ 215.00                         $                                   negligence penalty or
City or town, state or province, country, ZIP or foreign postal code
                                                                                                             12   Section 409A deferrals
                                                                                                                                                other sanction may be
                                                                           11
INDIANOLA, IA 50125                                                                                                                             imposed on you if this
                                                                                                             $                                  income is taxable and
                                                                                                                                              the IRS determines that
Account number (see instructions)               FATCA filling               13 Excess golden parachute        14 Nonqualified deferred
                                                                              payments                          compensation                             it has not been
692199212087                                    requirement
                                                                                                                                                               reported.
                                                                            $                                $
                                                                           15 State tax withheld             16 State/Payer's state no.       17 State income
                                                                            $                                                                 $
                                                                            $                                                                 $
Form 1099-MISC             (keep for your records)                     www.irs.gov/Form1099MISC                    Department of the Treasury - Internal Revenue Service