SAMPLEForm 1099-MISC Miscellaneous Information2026For informational / sample purposes only — not an official IRS document.PAYER'S name, address, city, state, ZIP, phone Payer Name , CA 1 Rents$0.002 Royalties$0.00PAYER'S TIN—RECIPIENT'S TIN—3 Other income$0.004 Federal income tax withheld$0.00RECIPIENT'S name, address, city, state, ZIP Recipient Name , CA 6 Medical and health care payments$0.007 Payer made direct sales totaling $5,000+No10 Gross proceeds paid to an attorney$0.00Account number—16 State tax withheld$0.0017 State/Payer's state no.CA —18 State income$0.00