CORRECTED (if checked)
PAYER’S name, street address, city or town, state or province, country, ZIP or foreign OMB No. 1545-0116
postal code, and telephone no.
Nonemployee
EXISTECH LLC Form 1099-NEC Compensation
(Rev. January 2024)
2413 W ALGONQUIN RD #241
ALGONQUIN IL 60102 For calender year
(847) 809-6388 Mystery Evans 2024 FDEA2002 09/27/24
PAYER’S TIN RECIPIENT’S TIN 1 Nonemployee compensation
Copy B
85-1789602 472-35-1692 $ 17014.50
RECIPIENT’S name For Recipient
2 Payer made direct sales totaling $5,000 or more of consumer
products to recipient for resale This is important tax
DION BRADFORD information and is being
furnished to the IRS.If
3 you are required to file a
Street address (including apt. no.) return, a negligence
penalty or other sanction
525 BLACKHAWK DR may be imposed on you
City or town, state or province, country, and ZIP or foreign postal code if this income is taxable
4 Federal income tax withheld
and the IRS determines
LAKE IN THE HILLS IL 60156 $ 0.00 that it has not been
reported.
Account number (see instructions) 5 State tax withheld 6 State/Payer’s state no. 7 State income
$ 0.00 IL $
$ $
Form 1099-NEC (keep for your records) www.irs.gov/Form1099NEC Department of the Treasury ' Internal Revenue Service
Instructions for Recipient Note: If you are receiving payments on which no income, social security,
and Medicare taxes are withheld you should make estimated tax
You received this form instead of Form W-2 because the payer did payments. See Form 1040-ES (or Form 1040-ES (NR)). Individuals must
not consider you an employee and did not withhold income tax or report these amounts as explained in these box 1 instructions.
social security and Medicare tax. Corporations, fiduciaries, and partnerships must report these amounts
on the appropriate line of their tax returns.
If you believe you are an employee and cannot get the payer to
correct this form, report the amount shown in box 1 on the line for Box 2. If checked, consumer products totaling $5,000 or more were
"Wages, salaries, tips, etc." of Form 1040, 1040-SR, or 1040-NR. You sold to you for resale, on a buy-sell, a deposit-commission, or other
must also complete Form 8919 and attach it to your return. For more basis.
information, see Pub. 1779, Independent Contractor or Employee. Generally, report any income from your sale of these products on
Schedule C (Form 1040).
If you are not an employee but the amount in box 1 is not self-
employment (SE) income (for example, it is income from a sporadic Box 3. Reserved for future use.
activity or a hobby), report the amount shown in box 1 on the "Other Box 4. Shows backup withholding. A payer must backup withhold on
income" line (on schedule 1 (Form 1040). certain payments if you did not give your TIN to the payer. See Form
Recipient’s taxpayer identification number (TIN). For your protection W-9, Request for Taxpayer Identification Number and Certification, for
this form may show only the last four digits of your TIN(social security information on backup withholding. Include this amount on your
number (SSN), individual taxpayer identification number (ITIN), income tax return as tax withheld.
adoption taxpayer identification number (ATIN), or employer Boxes 5-7. State income tax withheld reporting boxes.
identification number (EIN)).
However the issuer has reported your complete TIN to the IRS. Future developments. For the latest information about
developments related to Form 1099-NEC and its instructions, such
Account number. May show an account or other unique number the as legislation enacted after they were published, go to www.irs.gov/
payer assigned to distinguish your account. Form1099NEC
Box 1. Shows nonemployee compensation. If the amount in this box
is SE income, report it on Schedule C or F (Form 1040) if a sole Free File Program. Go to www.irs.gov/FreeFile to see if you qualify for
proprietor, or on Form 1065 and Schedule K-1 (Form 1065) if a no-cost online federal tax preparation, e-filing, and direct deposit or
partnership, and the recipient/partner completes Schedule SE payment options.
(Form 1040).
VOID CORRECTED
PAYER’S name, street address, city or town, state or province, country, ZIP or foreign OMB No. 1545-0116
postal code, and telephone no.
Nonemployee
EXISTECH LLC Form 1099-NEC Compensation
(Rev. January 2024)
2413 W ALGONQUIN RD #241
For calender year
ALGONQUIN IL 60102
2024 FDEA2002 09/27/24
PAYER’S TIN RECIPIENT’S TIN 1 Nonemployee compensation Copy 1
85-1789602 472-35-1692 $ 17014.50 For State Tax
RECIPIENT’S name 2 Payer made direct sales totaling $5,000 or more of consumer
products to recipient for resale
Department
DION BRADFORD
3
Street address (including apt. no.)
525 BLACKHAWK DR
City or town, state or province, country, and ZIP or foreign postal code 4 Federal income tax withheld
LAKE IN THE HILLS IL 60156 $ 0.00
Account number (see instructions) 5 State tax withheld 6 State/Payer’s state no. 7 State income
$ 0.00 IL $
$ $
Form 1099-NEC www.irs.gov/Form1099NEC Department of the Treasury ' Internal Revenue Service
Do Not Staple 6969
OMB No. 1545-0108
Form 1096 Annual Summary and Transmittal of
Department of the Treasury U.S. Information Returns 2024
Internal Revenue Service
FILER’S name
EXISTECH LLC
Street address (including room or suite number)
2413 W ALGONQUIN RD #241
City or town, state or province, country, and ZIP or foreign postal code
ALGONQUIN IL 60102
Name of person to contact Telephone number For Official Use Only
MYSTERY EVANS (847) 809-6388
Email address Fax number
mysteryevans@yahoo.com
1 Employer identification number 2 Social security number 3 Total number of forms 4 Federal income tax withheld 5 Total amount reported with this Form 1096
85-1789602 1$ 0.00 $ 17014.50
6 Enter an "X" in only one box below to indicate the type of form being filed.
W-2G 1097-BTC 1098 1098-C 1098-E 1098-F 1098-Q 1098-T 1099-A 1099-B 1099-C 1099-CAP 1099-DIV 1099-G 1099-INT 1099-K
32 50 81 78 84 03 74 83 80 79 85 73 91 86 92 10
1099-LS 1099-LTC 1099-MISC 1099-NEC 1099-OID 1099- 1099-Q 1099-QA 1099-R 1099-S 1099-SA 1099-SB 3921 3922 5498 5498-ESA 5498-QA
16 93 95 71 96 PATR 31 1A 98 75 94 43 25 26 28 72 2A
97
X
5498-SA
27
Return this entire page to the Internal Revenue Service. Photocopies are not acceptable.
Send this form, with the copies of the form checked in box 6, to the IRS in a flat mailer (not folded).
Under penalties of perjury, I declare that I have examined this return and accompanying documents, and, to the best of my knowledge and belief, they are true, correct, and complete.
Signature Title Date
Instructions
When to file. If any date shown falls on a Saturday, Sunday, or legal
Future developments. For the latest information about holiday in the District of Columbia or where the return is to be filed,
developments related to Form 1096, such as legislation enacted
after it was published, go to www.irs.gov/Form1096. the due date is the next business day. File Form 1096 in the calendar
year following the year for which the information is being reported,
Reminder. You may be required to electronically file(e-file)
information returns. Go to www.irs.gov/inforeturn for e-file options. as follows.
Also, see part F in the 2024 General Instructions for Certain With Forms 1097, 1098, 1099, 3921, 3922, or W-2G, file by
Information Returns February 28.*
Purpose of form. Use this form to transmit paper Forms 1097, With Forms 1099-NEC, file by January 31.
1098, 1099, 3921, 3922, 5498, and W-2G to the IRS. With Forms 5498, file by May 31.
* Leap years do not impact the due date. See Announcement 91-179,
Caution: Form 5498-QA can only be filed on paper, regardless of 1991-49 I.R.B. 78, for more information.
the number of returns.
Where To File
Who must file. Any person or entity who files any form checked in Send all information returns filed on paper with Form 1096 to the
box 6 above must file Form 1096 to transmit those forms to the following.
IRS. If your principal business, Use the following
office or agency, or legal
Caution: Your name and taxpayer identification number (TIN) address:
residence in the case of an
(employer identification number (EIN) or social security number individual, is located in
(SSN)) must match the name and TIN used on your 94X series Alabama, Arizona, Arkansas,
tax return(s) or you may be subject to information return Delaware, Florida, Georgia,
penalties. Do not use the name and/or TIN of your paying agent Kentucky, Maine, Massachusetts,
or service bureau. Mississippi, New Hampshire, New Internal Revenue Service
Jersey, New Mexico, New York, P.O. Box 149213
Enter the filers name, address (including room, suite, or other Austin, TX 78714-9213
North Carolina, Ohio, Texas,
unitnumber), and TIN in the spaces provided on the form. The Vermont, Virginia
name, address, and TIN of the filer on this form must be the
same as those you enter in the upper left area of Form 1097,
1098, 1099, 3921, 3922, 5498, or W-2G
FDWA0401 08/22/24 Cat. No. 14400O Form 1096 (2024)
For more information and the Privacy Act and Paperwork Reduction Act Notice,
see the 2024 General Instructions for Certain Information Returns.
Form 1096 (2024) Page 2
Alaska, Colorado, Hawaii, Idaho,
Illinois, Indiana, Iowa, Kansas,
Michigan, Minnesota, Missouri,
Montana, Nebraska, Nevada, North Internal Revenue Service Center Form W-2G Box 1
Dakota, Oklahoma, Oregon, South P.O. Box 219256
Carolina, South Dakota, Tennessee, Form 1097-BTC Box 1
Kansas City, MO 64121-9256
Utah, Washington, Wisconsin, Form 1098 Boxes 1 and 6
Wyoming Form 1098-C Box 4c
California, Connecticut, District of Form 1098-E Box 1
Internal Revenue Service Center
Columbia, Louisiana, Maryland, 1973 North Rulon White Blvd. Form 1098-F Box 1
Pennsylvania, Rhode Island, Ogden, UT 84201 Form 1098-Q Box 4
West Virginia
Form 1099-B Boxes 1d and 13
If your legal residence or principal place of business is outside the
United States, file with the Internal Revenue Service, P.O. Box Form 1099-C Box 2
149213, Austin, TX 78714-9213. Form 1099-CAP Box 2
Transmitting to the IRS. Group the forms by form number and transmit Form 1099-DIV Boxes 1a, 2a, 3, 9, 10 and 12
each group with a separate Form 1096. For example, if you must file Form 1099-INT Boxes 1, 3, 8, 10, 11 and 13
both Forms 1098 and 1099-A, complete one Form 1096 to transmit your Form 1099-K Box 1a
Forms 1098 and another Form 1096 to transmit your Forms 1099-A. Do Form 1099-LS Box 1
not send a form (1099, 5498, etc.) containing summary (subtotal)
information with Form 1096. Summary information for the group of forms Form 1099-LTC Boxes 1 and 2
being sent is entered only in boxes 3, 4, and 5 of Form 1096. Form 1099-MISC Boxes 1, 2, 3, 5, 6, 8,9, 10, 11 and 14
Corrected returns. Originals and corrections of the same type of return can Form 1099-NEC Box 1
be submitted using one Form 1096. For information about filing corrections, Form 1099-OID Boxes 1, 2, 5, 6, and 8
see the 2024 General Instructions for Certain Information Returns
Form 1099-PATR Boxes 1, 2, 3, and 5
Box 1 or 2. Enter your TIN in either box 1 or 2, not both. Sole proprietors and Form 1099-Q Box 1
all others must enter their EIN in box 1. Individuals not in a trade or business Form 1099-QA Box 1
must enter their SSN in box 2. However, sole proprietors who do not have an Form 1099-R Box 1
EIN must enter their SSN in box 2. Use the same EIN or SSN on Form
1096that you use on Form 1097, 1098, 1099, 3921, 3922, 5498, or Form 1099-S Box 2
W-2G Form 1099-SA Box 1
Form 1099-SB Boxes 1 and 2
Box 3. Enter the number of forms you are transmitting with this Form
1096. Do not include blank or voided forms or the Form 1096 in your Form 3921 Boxes 3 and 4
total. Enter the number of correctly completed forms, not the number Form 3922 Boxes 3, 4, and 5
of pages, being transmitted. For example, if you send one page of Form 5498 Boxes 1, 2, 3, 4, 5, 8, 9, 10, 12b, 13a,
three-to-a-page Forms 1098-E with a Form 1096 and you have and 14a
correctly completed two Forms 1098-E on that page, enter "2" in box
3 of Form 1096 Form 5498-ESA Boxes 1 and 2
Form 5498-QA Boxes 1 and 2
Box 4. Enter the total federal income tax withheld shown on the forms being Form 5498-SA Box 1
transmitted with this Form 1096.
Online fillable forms. Forms 1097-BTC, 1098-C, 1098-MA,
Box 5. No entry is required if you are filing Form 1098-T, 1099-A, or 1098-Q,1099-CAP, 1099-LTC, 1099-Q, 1099-QA, 1099-SA,
1099-G. For all other forms in the listing that follows, enter the total of the 3922,5498-ESA, and 5498-SA have been converted to online
amounts from the specific boxes identified for each form. fillable PDFs. For more information, see Online fillable
forms in the 2024 General Instructions for Certain
Information Returns.
EXISTECH LLC
2413 W ALGONQUIN RD #241
ALGONQUIN , IL 60102
DION BRADFORD
525 BLACKHAWK DR
LAKE IN THE HILLS, IL 60156
This sheet is for your convenience when mailing the 1099-NEC to your recipients using standard 8-3/4 x 5-5/8 double window envelopes.
