EFTA01222603.pdf

CORRECTED (if checked) PAYERS name. street address. city or town. state or province. country. ZIP 1Original issue discount for OMB No. 1545-0117 or foreign postal code. and telephone no. 2017' $ • TTY9 May not the the Coned figure Original Issue to report on your interne tax return.. See Inatruetiant on the teak. 2017 Discount 2 Other periodic retest $ Form 1099-OO PAYERS federal identification number RECIPIENTS identification number 3 Early withdrawal penalty 4 Federal income tax withheld Copy B $ 5 Market discount 6 Acquisition premium For Recipient RECIPIENTS name $ $ 7 Description This is important tax Street address (including apt. no.) information and is being furnished to the Internal Revenue Service. If you are required to file a City or tovm. state or province. country. and ZIP or foreign postal code 8 Original issue discount on 9 Investment expenses return, a negligence U.S. Treasury obligations' penalty or other sanction may be imposed on you if FATCA fifng 10 Bond premium 11 Tax-exempt OID this income is requirement taxable and the IRS determines that it 0 has not been reported. Account number (see instructions) 13 State identification no. 14 State tax withheld $ Form 1099-OID (keep for your records) www.irs gov/form1099oid Department of the Treason - Internal Revenue Service EFTA01222603