Form 96-T - Idaho Magnetic Media Transmittal Page 2
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1
2EFO001071p2
6-17-09
Form 96-T — Page 2
Idaho Payer Summary
Tax year
for 1099 Magnetic Media
200
Form 96-T
Page
of
Name and address of transmitter
EIN of transmitter
(must be entered)
Summary of Payers Included on Magnetic Media
6.
7.
8.
9.
10.
Federal Employer
Number
Total Idaho Withholding
Idaho Withholding
Identification
of
from 1099s reported on
Account Number
Name of Payer
Number
Payees
Form 967
$
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