Company:         Taxpayer ID No:        (Required)
Submitted by:    Your Email Address: (Required)

	Recipient No. 1	Recipient No. 2	Recipient No. 3
Name
SSN or FEIN.
Address 1
Address 2
City
State
Zip
Rents
Royalties
Other Income
Fed Inc Tax WH
Fishing Boat Proc
Med/HC Pmts
Nonemp Comp
Sub Pmts
Resale Pmts > 5,000 -
Crop Ins Proceeds
Payer's ST ID No
ST Inc Tax WH

NOTE: If you have additional entries:
Press "Send to Foot N Tick, CPAs" to submit these three, then press "Clear Form",
enter your additional entries and press "Send to Foot N Tick, CPAs" again
...repeat for additional recipients.