0425 Form 1099-CAP (PDF) — verbatim text

Official source: IRS Forms, Instructions & Publications (https://www.irs.gov/pub/irs-pdf/f1099cap.pdf), retrieved 2026-10-03. U.S. Government work (17 U.S.C. § 105).

Changes in

Corporate Control and

Copy A

For Internal Revenue

Service Center

For filing information,

Privacy Act, and Paperwork Reduction

Act Notice, see the General Instructions

for Certain Information Returns .

www.irs.gov/Form1099

7373 VOID CORREC		CTED
CORPORATION’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.	CORPORATION’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.	1 Date of sale or exchange	Form1099-CAP (Rev. April 2025) OMB No. 1545-1814
CORPORATION’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.	CORPORATION’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.	2 Aggregate amount rec’d* $	2 Aggregate amount rec’d* $
CORPORATION’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.	CORPORATION’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.	2 Aggregate amount rec’d* $	For calendar year
CORPORATION’S TIN	SHAREHOLDER’S TIN	3 No. of shares exchanged	4 Classes of stock exchanged
SHAREHOLDER’S name	SHAREHOLDER’S name
Street address (including apt. no.)	Street address (including apt. no.)	Street address (including apt. no.)	Street address (including apt. no.)
Street address (including apt. no.)	Street address (including apt. no.)	5	5
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)	Account number (see instructions)	* The shareholder cannot claim a loss based on the amount in box 2.	* The shareholder cannot claim a loss based on the amount in box 2.

Do Not Cut or Separate Forms on This Page — Do Not Cut or Separate Forms on This Page

Cat. No. 35115M

Department of the Treasury - Internal Revenue Service

CORRECTED (if checked)

Changes in

Corporate Control and

that it has not been

Copy B For Shareholder

reported.

This is important tax information and is being

furnished to the IRS. If you are required to file a

return, a negligence

penalty or other sanction may be imposed on you if taxable income results

from this transaction and the IRS determines

CORPORATION’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.		1 Date of sale or exchange	OMB No. 1545-1814 1099-CAP Form (Rev. April 2025)
CORPORATION’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.	CORPORATION’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.	2 Aggregate amount rec’d* $	2 Aggregate amount rec’d* $
CORPORATION’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.	CORPORATION’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.	2 Aggregate amount rec’d* $	For calendar year
CORPORATION’S TIN	SHAREHOLDER’S TIN	3 No. of shares exchanged	4 Classes of stock exchanged
SHAREHOLDER’S name	SHAREHOLDER’S name
Street address (including apt. no.)	Street address (including apt. no.)	Street address (including apt. no.)	Street address (including apt. no.)
Street address (including apt. no.)	Street address (including apt. no.)	5	5
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)	Account number (see instructions)	* You cannot claim a loss based on the amount in box 2.	* You cannot claim a loss based on the amount in box 2.

Department of the Treasury - Internal Revenue Service

Instructions for Shareholder A corporation in which you own stock that has had a change in control or a substantial change in capital structure must send you this statement by January 31 of the year following the calendar year of the change. You have received this statement because the corporation has reasonably determined that you may be required to recognize gain from the receipt of cash, stock, or other property that was exchanged for the corporation’s stock. Report any gain from the exchange on Form 8949. However, you cannot claim a (loss) on Form 8949 as a result of this exchange. See chapter 4 of Pub. 550 for additional information. Shareholder’s taxpayer identification number (TIN) . For your protection, this form may show only the last four digits of your TIN (social security number (SSN), individual taxpayer identification number (ITIN), adoption taxpayer identification number (ATIN), or employer identification number (EIN)). However, the issuer has reported your complete TIN to the IRS.

Account number. May show an account or other unique number the payer corporation assigned to distinguish your account. Box 1. Shows the date the stock was exchanged for cash, stock, or other property. Box 2. Shows the aggregate amount of any cash and the fair market value of any stock or other property received by you in the exchange for the stock you held. Box 3. Shows the number of shares of the corporation’s stock that you held which were exchanged in the transaction. Box 4. Shows the class or classes of stock that were exchanged. Future developments. For the latest information about developments related to Form 1099-CAP and its instructions, such as legislation enacted after they were published, go to www.irs.gov/Form1099CAP. Free File Program. Go to www.irs.gov/FreeFile to see if you qualify for no-cost online federal tax preparation, e-filing, and direct deposit or payment options.