Form 1099-B, Proceeds from Broker and Barter Exchange Transactions 2011

Summary: This is an example of Form 1099-B (2011) with items included as described in the text. Additionally, these line items are completed:

Payer's name, street address, city, state, ZIP code, and telephone number field contains
- X.Y.Z. Trading Company
- 203 Bond Street
- Any City, Pennsylvania 18605
Payer's Federal identification number field contains 10-1111111
Recipient's identification number field contains 111-00-1111
Recipient's name field contains Emily Jones
- Street address (including apartment number) field contains 8307 Daisy Lane
- City, state, and ZIP code field contains Hometown, Alabama 36309
9. Description field contains R.F.C.
10. Profit or (loss) realized in 2011 on closed contracts field contains (11,000)
11. Unrealized profit or (loss) on open contracts—12/31/2010 field contains 1,000
12. Unrealized profit or (loss) on open contracts—12/31/2011 field contains 27,000
13. Aggregate profit or (loss) on contracts field contains 15,000