Form 8935 - Airline Payments Report Page 4
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5VOID
CORRECTED
OMB No. 1545-2140
PAYER’S name, street address, city, state, ZIP code, and telephone no.
1 Total payments
Airline Payments
$
8935
Report
Form
(March 2009)
PAYER’S federal identification no.
RECIPIENT’S identification number
Year
Amount
Copy C
RECIPIENT’S name
2a
2b
For Payer
$
For Privacy Act
3a
3b
and Paperwork
Reduction Act
$
Notice, see
Street address (including apt. no.)
4a
4b
the separate
$
Instructions for
City, state, and ZIP code
5a
5b
Form 8935
(March 2009).
$
6a
6b
$
8935
Form
(3-2009)
Department of the Treasury - Internal Revenue Service
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