Form 1099-Oid - Original Issue Discount - 2017 (Page 6 of 9) in pdf

Form 1099-Oid - Original Issue Discount - 2017 Page 6

CORRECTED (if checked)

PAYER’S name, street address, city or town, state or province, country, ZIP

1 Original issue discount for

OMB No. 1545-0117

or foreign postal code, and telephone no.

2017

Original Issue

2017

Discount

2 Other periodic interest

1099-OID

Form

PAYER’S federal identification number RECIPIENT’S identification number

3 Early withdrawal penalty

4 Federal income tax withheld

Copy 2

5 Market discount

6 Acquisition premium

To be filed with

recipient's state

income tax

RECIPIENT’S name

return, when

7 Description

required.

Street address (including apt. no.)

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

8 Original issue discount on

9 Investment expenses

U.S. Treasury obligations

10 Bond premium

11 Tax-exempt OID

FATCA filing

requirement

Account number (see instructions)

12 State 13 State identification no. 14 State tax withheld

1099-OID

Form

Department of the Treasury - Internal Revenue Service

Form 1099-Oid - Original Issue Discount - 2017 Page 6