Form 1099-K - Payment Card And Third Party Network Transactions - 2012 Page 2
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61010
VOID
CORRECTED
OMB No. 1545-2205
FILER’S name, street address, city, state, ZIP code, and telephone no.
FILER’S federal identification no.
Payment Card
and Third Party
2012
Network
PAYEE’S taxpayer identification no.
Transactions
1099-K
Form
1 Gross amount of payment card/
2 Merchant category code
Copy A
third party network transactions
For
$
Internal Revenue
Check to indicate transactions
Check to indicate if FILER is a (an):
Service Center
reported are:
3 Number of purchase
4
Payment settlement entity (PSE)
transactions (optional)
Payment card
Electronic Payment Facilitator
File with Form 1096.
(EPF)/Other third party
Third party network
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.)
2012 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)
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8
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
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