Changes in Corporate Control and Capital Structure (Info Copy Only)

• Legal Form Number: 1099-CAP
• Year: 2025
• Issuer: Treasury Department
• Section: Treasury Department

Form 1099-CAP

(Rev. September 2019)

Cat. No. 35115M

Changes in

Corporate

Control and

Capital Structure

Copy A

For

Internal Revenue

Service Center

Department of the Treasury - Internal Revenue Service

File with Form 1096.

OMB No. 1545-1814

For Paperwork

Reduction Act

Notice, see the

current General

Instructions for

Certain Information

Returns.

7373

For calendar year

20

VOIDCORRECTED

CORPORATION’S name, street address, city or town, state or province,

country, ZIP or foreign postal code, and telephone no.

CORPORATION’S TINSHAREHOLDER’S TIN

SHAREHOLDER’S name

Street address (including apt. no.)

City or town, state or province, country, and ZIP or foreign postal code

Account number (see instructions)

1 Date of sale or exchange

2 Aggregate amount rec’d*

$

3 No. of shares exchanged4

Classes of stock exchanged

5

* The shareholder cannot claim a loss based on the

amount in box 2.

Form 1099-CAP (Rev. 9-2019)www.irs.gov/Form1099CAP

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