Form 1099-K - Payment Card And Third Party Network Transactions - 2013 Page 4
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8CORRECTED
FILER'S name, street address, city or town, province or state, country, ZIP
FILER’S federal identification no.
OMB No. 1545-2205
Payment Card and
or foreign postal code, and telephone no.
Third Party
2013
Network
PAYEE’S taxpayer identification no.
Transactions
1099-K
Form
1 Gross amount of payment
2
Merchant category code
Copy B
card/third party network
transactions
For Payee
$
Check to indicate transactions
Check to indicate if FILER is a (an):
reported are:
3 Number of payment
4 Federal income tax
Payment settlement entity (PSE)
transactions
withheld
Payment card
Electronic Payment Facilitator
This is important tax
$
(EPF)/Other third party
Third party network
information and is
being furnished to
PAYEE’S name
5a January
5b February
the Internal Revenue
$
$
Service. If you are
required to file a
5c March
5d April
return, a negligence
$
$
Street address (including apt. no.)
penalty or other
sanction may be
5e May
5f June
imposed on you if
$
$
taxable income
results from this
5g July
5h August
transaction and the
$
$
City or town, province or state, country, and ZIP or foreign postal code
IRS determines that it
has not been
5i September
5j October
reported.
$
$
PSE'S name and telephone number
5k November
5l December
$
$
Account number (see instructions)
6 State
7 State identification no.
8 State income tax withheld
$
$
1099-K
Form
(Keep for your records)
Department of the Treasury - Internal Revenue Service
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