CORRECTED (if checked)

PAYER'S name, street address, city or town, state or province, country, ZIP OMB No. 1545-0116
or foreign postal code, and telephone no.
KITCHEN & BATH STORE USA INC
Nonemployee
9223 GREENBRIER CT
2021 Compensation
DAVIE FL 33328
Form 1099-NEC
PAYER'S TIN RECIPIENT’S TIN 1 Nonemployee compensation Copy B
47-2710381 672-51-8676 $ 12924.00 For Recipient
RECIPIENT’S name and address 2 Payer made direct sales totaling $5,000 or more of This is important tax
consumer products to recipient for resale information and is being
EDGAR CAICEDO furnished to the IRS. If you are
required to file a return, a
3 negligence penalty or other
1565 W 56TH ST sanction may be imposed on
HIALEAH FL 33016 4 Federal income tax withheld
you if this income is taxable
and the IRS determines that it
has not been reported.
$
5 State tax withheld 6 State/Payer’s state no. 7 State income
Account number (see instructions)
$ $
$ $
Form 1099-NEC (keep for your records) www.irs.gov/Form1099NEC Department of the Treasury - Internal Revenue Service
DXA

VOID CORRECTED
PAYER'S name, street address, city or town, state or province, country, ZIP OMB No. 1545-0116
or foreign postal code, and telephone no.
KITCHEN & BATH STORE USA INC
Nonemployee
9223 GREENBRIER CT
2021 Compensation
DAVIE FL 33328
Form 1099-NEC
PAYER'S TIN RECIPIENT’S TIN 1 Nonemployee compensation
47-2710381 672-51-8676 Copy 2
$ 12924.00
RECIPIENT’S name and address 2 Payer made direct sales totaling $5,000 or more of To be filed with
EDGAR CAICEDO consumer products to recipient for resale recipient’s state
income tax
3 return, when
1565 W 56TH ST required.
HIALEAH FL 33016 4 Federal income tax withheld

$
5 State tax withheld 6 State/Payer’s state no. 7 State income
Account number (see instructions)
$ $
$ $
Form 1099-NEC www.irs.gov/Form1099NEC Department of the Treasury - Internal Revenue Service
DXA

Instructions for Recipient

You received this form instead of Form W-2 because the payer did not Note: If you are receiving payments on which no income, social security,
consider you an employee and did not withhold income tax or social and Medicare taxes are withheld, you should make estimated tax
security and Medicare tax. payments. See Form 1040-ES (or Form 1040-ES (NR)). Individuals must
report these amounts as explained in these box 1 instructions.
If you believe you are an employee and cannot get the payer to correct
Corporations, fiduciaries, and partnerships must report these amounts on
this form, report this amount on the line for ''Wages, salaries, tips, etc'' of
the appropriate line of their tax returns.
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 Box 2. If checked, consumer products totaling $5,000 or more were sold
Contractor or Employee. 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
If you are not an employee but the amount in this box is not self-
C (Form 1040).
employment (SE) income (for example, it is income from a sporadic
activity or a hobby), report this amount on the ''Other income'' line (on Box 3. Reserved for future use.
Schedule 1 (Form 1040)).
Box 4. Shows backup withholding. A payer must backup withhold on
Recipient’s taxpayer identification number (TIN). For your protection, certain payments if you did not give your TIN to the payer. See Form W-9,
this form may show only the last four digits of your TIN (social security Request for Taxpayer Identification Number and Certification, for
number (SSN), individual taxpayer identification number (ITIN), adoption information on backup withholding. Include this amount on your income
taxpayer identification number (ATIN), or employer identification number tax return as tax withheld.
(EIN)). However, the issuer has reported your complete TIN to the IRS.
Boxes 5-7. State income tax withheld reporting boxes.
Account number. May show an account or other unique number the payer
Future developments. For the latest information about developments
assigned to distinguish your account.
related to Form 1099-NEC and its instructions, such as legislation enacted
Box 1. Shows nonemployee compensation. If the amount in this box is SE after they were published, go to www.irs.gov/Form1099NEC.
income, report it on Schedule C or F (Form 1040) if a sole proprietor, or on
Free File. Go to www.irs.gov/FreeFile to see if you qualify for no-cost
Form 1065 and Schedule K-1 (Form 1065) if a partnership, and the
online federal tax preparation, e-filing, and direct deposit or payment
recipient/partner completes Schedule SE (Form 1040).
options.