OMB No, 1545-0117

Statement for |
Recipients of

‘Type or print

PAYER'S Original Issue
ZIP code, and .
name, address, Discount
Federal
Identifying Copy C
number. For Payer
Record owner’s identifying number | 1 Fatal grcinal issue discount | 2 Stated interest 3 Amount of forfeiture 4 Federal income tax withheld
jor
Type or print RECORD OWNER’S name, address, and ZIP code below. 5 Description

For Paperwork Reduction Act Notice see
Instructions for Form 1096.

Form 1099-OID 3 GPO + 1983-0-369-114 363-114-1 Department of the Treasury—Internal Revenue Service


Instructions for Holder of Record

Original issue discount means the difference between the
stated redemption price at maturity and the issue price of a
bond, debenture, note or other evidence of indebtedness. This
also applies to certificates of deposit, time deposits, bonus sav-
ings plans, and other deposit arrangements having a term in
excess of one year, provided the payment of interest is deferred
until maturity.

Original issue discount is taxable over the life of the obliga-
tion. If you are the holder of one of these obligations, you must
include the original issue discount in your gross income over the
period you hold the obligation.

lf the amounts shown include original issue discount or
stated interest belonging to another person, the record holder
whose Federal identifying number is shown should file a nomi-
nee form to show the proper distribution of the amounts. Use
another 1099-OID, check the box on Form 1096, Annual Sum-
mary and Transmittal of U.S. Information Returns, for “NOMI-
NEE OID” and file both forms with the Service Center for your
area. A husband or wife is not required to file a nominee return
to show payments for the other.

Box 1 shows the total original issue discount on the obliga-

tion for the calendar year. If you held the obligation for
the entire year, report the entire amount in box 1 as interest in-

‘tr GPO : 1982-O-363-114

come on your income tax return. If you disposed of the obliga-
tion or acquired it from another holder during the year, you
must compute your share of the amount in box 1. See Publica-
tion 1212, List of Original Issue Discount Obligations, for guid-
ance in making this computation. Also, see the instructions
for your income tax return for information on how to report this
amount.

Box 2 shows the stated interest without regard to any original
issue discount. If you held the obligation the entire year, re-
port this amount as interest income on your income tax return.
If you disposed of the obligation or acquired it from another
holder during the year, see Publication 550, Investment Income
and Expenses, for reporting instructions.

Box 3 shows the amount of interest forfeited by you if you
withdrew the money before the maturity date of the obliga-
tion. You may deduct this amount on your Federal income
tax return, Form 1040, even if you do not itemize your deduc-
tions.

Box 4 shows the amount of Federal income tax withheld (if
any) from your payments. You may take a credit on your income
tax return for the tax withheld.

Box 5 shows the account, serial, or other identifying number
(such as a CUSIP number) and description of the obligation. If
the issuer of the obligation is other than the payer, the name
of the issuer will also be shown in this box.

363-114-1


OMB No. 1545-0117

Statement for

For Official Use Only Recipients of
pers” | Original Issue

name, address, Discount

ZIP code, and

Federal Copy A
Identifying For Internal Revenue
number, Service Center
Record owner’s identifying number f 1 otal a ariginal issue discount | 2 Stated interest 3 Amount of forfeiture 4 Federal income tax withheld
jor
a]
‘Type or print RECORD OWNER’S name, address, and ZIP code below (Name must align with § 5 Description
arrow).
Name

For Paperwork Reduction Act Notice and Instruc-
tions for completing this form, see instructions for
Form 1096.

Form 1099-OID ‘Ye GPO : 1983-0-363-114 363-114-1 Department of the Treasury—Internal Revenue Service





OMB No. 1545-0117

Statement for 19. 8 3
Recipients of

Type or print Aa
PAYER’S Original Issue
name, address, H
Zipcode, ana’ | Discount
Federal
Identifying Copy B
number. For Record Owner
Record owner's identifying number 1 Total original issue discount 2 Stated interest 3 Amount of forfeiture 4 Federal income tax withheld
for 1983 (see instructions)

Type or print RECORD OWNER’S name, address, and ZIP code below. 5 Description

For instructions for reporting these amounts, see
This information is being furnished to the Internal Revenue Service. back of this form.

Form 1099-OID ‘Ye GPO : 1983-0-363-114 363-114-1 Department of the Treasury—Internal Revenue Service