Magnetic Media Transmittal Form - North Dakota Office Of State Tax Commissioner

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North Dakota Office of State Tax Commissioner
Department use
Magnetic Media
Transmittal Form
Date received _____________
Cover form for submission of 1099, 1042-S, W-2G, or W-2 data on
Date returned _____________
magnetic media
Purpose of form
This form must be completed and submitted along with each cartridge, CD, diskette, or Zip disk that is sent directly to
the North Dakota Office of State Tax Commissioner. If more than one cartridge, CD, diskette, or Zip disk is required to
submit the same type of data , only one form needs to be completed and submitted with them.
Recording specifications
•
Tape cartridge: IBM 3480, 3490 or 3490E compatible; 18- or 36-track; EBCDIC; IDRC (IBM) compression
acceptable.
•
Diskette (3 1/2" only), CD, Zip 100 disk or Zip 250 disk: Record using ASCII character set; record delimiters
preferred.
•
For purposes of submitting Form W-2 information, the RA, RE, RW, RS, and RF records must be included for North
Dakota purposes.
1 Name and address of company submitting the magnetic
5 Type of labels (magnetic cartridge only):
media:
Ë Standard
Ë None
Ë Non-standard
_____________________________________________
_____________________________________________
6 Maximum block length in characters:
_____________________________________________
(magnetic cartridge only)
_____________________________________________
_____________________________________________
_____________________________________________
7 Date this file was created:
2 Type of data being submitted:
_____________________________________________
Ë Form 1099, 1042-S, or W-2G
(IRS Publication 1220 format)
Ë Form W-2 (SSA MMREF-1 format)
8 Company contact person (in case of questions):
Name ________________________________________
3 Calendar year for which data is submitted:
Phone number _________________________________
________________________
9 Mail/ship magnetic media and this form to:
4 Serial number of magnetic cartridge:
Magnetic Media Coordinator
If more than one cartridge is required to submit the
Withholding Section
same type of data, enter the serial numbers for all of
Office of State Tax Commissioner
them.
600 E. Boulevard Ave. Dept. 127
Bismarck, ND 58505-0550
_____________________________________________
_____________________________________________
_____________________________________________
7

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