Create 1099-OID Form

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Date

Tax Year And Flags

* Tax Year Account Number

VOID CORRECTED TIN not provided FATCA filing requirement

Payer

* Payer Name * Payer TIN * Street Address City State ZIP Phone

Recipient

* Recipient Name * Recipient TIN * Street Address City State ZIP

1099-OID Amounts

Original Issue Discount Other Periodic Interest Early Withdrawal Penalty Federal Income Tax Withheld Market Discount Acquisition Premium Description OID on U.S. Treasury Obligations Investment Expenses Bond Premium Tax-Exempt OID State Tax Withheld State / Payer State No. State Code State Identification No. State Tax Withheld (2) State Code (2) State Identification No. (2)

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