Form 1096 - Annual Summary And Transmittal Of U.s. Information Returns

6969

Do Not Staple

1096

OMB No. 1545-0108

Annual Summary and Transmittal of

Form

U.S. Information Returns

Department of the Treasury

Internal Revenue Service

FILER'S name

Street address (including room or suite number)

City or town, province or state, country, and ZIP or foreign postal code

For Official Use Only

Name of person to contact

Telephone number

Email address

Fax number

1 Employer identification number 2 Social security number

3 Total number of forms

4 Federal income tax withheld

5 Total amount reported with this Form 1096

6 Enter an “X” in only one box below to indicate the type of form being filed.

7 If this is your final return, enter an “X” here

▶

W-2G

1097-BTC

1098

1098-C

1098-E

1098-T

1099-A

1099-B

1099-C

1099-CAP

1099-DIV

1099-G

1099-H

1099-INT

1099-K

1099-LTC

1099-

1099-OID

MISC

1099-

1099-Q

1099-R

1099-S

1099-SA

3921

3922

5498

5498-ESA

5498-SA

PATR

Return this entire page to the Internal Revenue Service. Photocopies are not acceptable.

Under penalties of perjury, I declare that I have examined this return and accompanying documents, and, to the best of my knowledge and belief, they are true, correct,

and complete.

Signature

Title

Date

▶

Instructions

When to file. File Form 1096 as follows.

• With Forms 1097, 1098, 1099, 3921, 3922, or W-2G, file by February

Future developments. For the latest information about developments

28, 2014.

related to Form 1096, such as legislation enacted after they were

• With Forms 5498, file by June 2, 2014.

published, go to

Reminder. The only acceptable method of filing information returns

Where To File

with Internal Revenue Service/Information Returns Branch is

Send all information returns filed on paper with Form 1096 to the

electronically through the FIRE system. See Pub. 1220, Specifications

following:

for Filing Forms 1097, 1098, 1099, 3921, 3922, 5498, 8935, and W-2G

Electronically.

If your principal business, office

Use the following

or agency, or legal residence in

Purpose of form. Use this form to transmit paper Forms 1097, 1098,

three-line address

the case of an individual, is

1099, 3921, 3922, 5498, and W-2G to the Internal Revenue Service.

located in

Do not use Form 1096 to transmit electronically. For electronic

submissions, see Pub. 1220.

Alabama, Arizona, Arkansas,

Caution. If you are required to file 250 or more information returns of

Connecticut, Delaware, Florida, Georgia,

any one type, you must file electronically. If you are required to file

Kentucky, Louisiana, Maine,

Department of the Treasury

electronically but fail to do so, and you do not have an approved

Massachusetts, Mississippi, New

Internal Revenue Service Center

waiver, you may be subject to a penalty. For more information, see

Hampshire, New Jersey, New Mexico,

Austin, TX 73301

part F in the 2013 General Instructions for Certain Information Returns.

New York, North Carolina, Ohio,

Pennsylvania, Rhode Island, Texas,

Who must file. The name, address, and TIN of the filer on this form

Vermont, Virginia, West Virginia

must be the same as those you enter in the upper left area of Forms

1097, 1098, 1099, 3921, 3922, 5498, or W-2G. A filer is any person or

entity who files any of the forms shown in line 6 above.

Enter the filer’s name, address (including room, suite, or other unit

number), and TIN in the spaces provided on the form.

1096

Cat. No. 14400O

Form

(2013)

For more information and the Privacy Act and Paperwork Reduction Act Notice,

see the 2013 General Instructions for Certain Information Returns.

Form 1096 - Annual Summary And Transmittal Of U.s. Information Returns - 2013 Page 2

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