EFTA01222599.pdf

❑ CORRECTED (if checked) FILERS name. street address. city or town. state or province. country. ZIP FILER'S federal identification no. OMB No. 1545-2205 or foreign postal code, and telephone no. Payment Card and PAYEE'S to dennficancn no. Third Party to Gross amoult of payment 2016 Network carcVthird party network transactions Transactions $ Form 1099-K lb Card Not Present 2 Merchant category code transactions Copy B Check to indicate if FILER is a (an): Check to kidicate transactions reported are: For Payee Payment settlement entity (PSE) ❑ Payment card 3 Number of payment 4 Federal mcome tax transactions withheld Electronic Payment Facilitator 'Ns is important tax (EPF)/Other third party ❑ Third party network $ information and is PAYEE'S name Se January Sb February being furnished to the Internal Revenue $ $ Service. If you are 5c March Sd April required to file a return. a negligence Street address (including apt. no.) $ $ penalty or other 5e May SI June sanction may be imposed on you if $ $ taxable income 5g July Sh August results from this transaction and the City or town. state or province. country. and ZIP or foreign postal code $ $ IRS determines that it Si September Si October has not been reported. PSE'S name and telephone number $ $ Sk November SI December $ $ Account number (see instructions) 6 State 7 State identification no. 8 State ncome tax witted $ $ Form 1099-K ((Keep for your records) www.irs.gov/form1099k Department of the Treasury - Internal Revenue Service EFTA01222599