Form 1099-Oid - Original Issue Discount - 2018 Page 4
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9CORRECTED (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.
2018*
$
Original Issue
2018
* This may not be the correct figure
to report on your income tax return.
Discount
See instructions on the back.
2 Other periodic interest
1099-OID
$
Form
PAYER’S TIN
RECIPIENT’S TIN
3 Early withdrawal penalty
4 Federal income tax withheld
Copy B
$
$
5 Market discount
6 Acquisition premium
For Recipient
RECIPIENT’S name
$
$
7 Description
This is important tax
Street address (including apt. no.)
information and is
being furnished to
the IRS. If you are
required to file a
return, a negligence
City or town, state or province, country, and ZIP or foreign postal code
8 Original issue discount on
9 Investment expenses
penalty or other
U.S. Treasury obligations*
sanction may be
imposed on you if
$
$
this income is
10 Bond premium
11 Tax-exempt OID
FATCA filing
taxable and the IRS
requirement
determines that it
has not been
$
$
reported.
Account number (see instructions)
12 State 13 State identification no. 14 State tax withheld
$
$
1099-OID
(keep for your records)
Form
Department of the Treasury - Internal Revenue Service
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