Form 1099-Oid - Original Issue Discount - 2014 Page 6
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8CORRECTED (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.
2014
$
Original Issue
2014
2 Other periodic interest
Discount
1099-OID
$
Form
3 Early withdrawal penalty
4 Federal income tax withheld
Copy 2
PAYER’S federal identification number RECIPIENT’S identification number
$
$
5 Market discount
6 Acquisition premium
To be filed with
recipient's state
income tax
RECIPIENT’S name
$
$
return, when
7 Description
required.
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
8 Original issue discount on U.S. Treasury obligations
$
9 Investment expenses
$
Account number (see instructions)
10 State 11 State identification no. 12 State tax withheld
$
$
1099-OID
Form
Department of the Treasury - Internal Revenue Service
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