Form 1099-Oid - Original Issue Discount - 2012 Page 2
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1
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5
6VOID
CORRECTED
9696
PAYER’S name, street address, city, state, ZIP code, and telephone no.
1 Original issue discount for
OMB No. 1545-0117
2012
2012
Original Issue
$
Discount
2 Other periodic interest
1099-OID
$
Form
Copy A
PAYER’S federal identification number RECIPIENT’S identification number
3 Early withdrawal penalty
4 Federal income tax withheld
$
$
For
Internal Revenue
RECIPIENT’S name
5 Description
Service Center
File with Form 1096.
For Privacy Act
Street address (including apt. no.)
6 Original issue discount on U.S. Treasury obligations
and Paperwork
$
Reduction Act
7 Investment expenses
Notice, see the
City, state, and ZIP code
2012 General
$
Instructions for
Account number (see instructions)
2nd TIN not.
8 State 9 State identification no.
10 State tax withheld
Certain Information
$
Returns.
1099-OID
Form
Cat. No. 14421R
Department of the Treasury - Internal Revenue Service
Do Not Cut or Separate Forms on This Page — Do Not Cut or Separate Forms on This Page
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