Form 1099-K - Merchant Card And Third Party Network Payments

Form 1099-K - Merchant Card And Third Party Network Payments - 2011 Page 2

1010

VOID

CORRECTED

FILER’S name, street address, city, state, ZIP code, and telephone no.

FILER’S federal identification no.

OMB No. 1545-2205

Merchant Card

2011

and Third Party

PAYEE’S taxpayer identification no.

Network Payments

1099-K

Form

1 Gross amount of merchant

Merchant category code

Copy A

card/third party network

payments

For

Internal Revenue

Check box if FILER is Payment Settlement Entity (PSE)

Service Center

Check box if FILER is Electronic Payment Facilitator (EPF)/

File with Form 1096.

Third Party Payer (TPP)

PAYEE’S name

5a January

5b February

For Privacy Act

and Paperwork

5c March

5d April

Reduction Act

Notice, see the

Street address (including apt. no.)

2011 General

5e May

5f June

Instructions for

Certain Information

Returns.

5g July

5h August

City, state, and ZIP code

5i September

5j October

PSE'S name and telephone number

5k November

5l December

Account number (see instructions)

1099-K

Form

Cat. No. 54118B

IRS.gov/form1099k

Department of the Treasury - Internal Revenue Service

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Do Not Cut or Separate Forms on This Page

Form 1099-K - Merchant Card And Third Party Network Payments - 2011 Page 2

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