Form 1099-Oid - Original Issue Discount - 2018 Page 3

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VOID
CORRECTED
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.
2018
$
Original Issue
2018
Discount
2 Other periodic interest
1099-OID
$
Form
PAYER’S TIN
RECIPIENT’S TIN
3 Early withdrawal penalty
4 Federal income tax withheld
Copy 1
$
$
For State Tax
5 Market discount
6 Acquisition premium
Department
RECIPIENT’S name
$
$
7 Description
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

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