VOID CORRECTED

PAYER’S name, street address, city, state, ZIP code, and telephone no. Original issue discount OMB No. 1545-0117

for 2009

1

Original Issue

2 Other periodic interest Discount

PAYER’S federal identification number RECIPIENT’S identification number 3 Early withdrawal penalty 4 Federal income tax withheld

6 Original issue discount on U.S. Treasury obligations

RECIPIENT’S name

Street address (including apt. no.)

City, state, and ZIP code

Account number (see instructions) 2nd TIN not.

Form 1099-OID Department of the Treasury - Internal Revenue Service

$

$

$ $

9696

Cat. No. 14421R

Form 1099-OID

Do Not Cut or Separate Forms on This Page — Do Not Cut or Separate Forms on This Page

7 Investment expenses

5 Description

$

$

Copy A

For

Internal Revenue

Service Center

File with Form 1096.

For Privacy Act 

and Paperwork

Reduction Act 

Notice, see the 

2009 General 

Instructions for 

Forms 1099,

1098, 3921, 3922, 

5498, and W-2G.

2009
CORRECTED (if checked)

PAYER’S name, street address, city, state, ZIP code, and telephone no. Original issue discount OMB No. 1545-0117

for 2009*

1

Original Issue

2 Other periodic interest Discount

PAYER’S federal identification number RECIPIENT’S identification number 3 Early withdrawal penalty 4 Federal income tax withheld

RECIPIENT’S name

Street address (including apt. no.)

City, state, and ZIP code

Account number (see instructions)

Form 1099-OID Department of the Treasury - Internal Revenue Service

$

$

$ $

Copy B

This is important tax

information and is

being furnished to the

Internal Revenue

Service. If you are

required to file a

return, a negligence

penalty or other

sanction may be

imposed on you if this

income is taxable and

the IRS determines

that it has not been

reported.

(keep for your records)

* This may not be the correct figure to report on your

income tax return. See instructions on the back.

For Recipient

Form 1099-OID

Original issue discount on U.S. Treasury obligations*

5

Investment expenses

6

Description

7

$

$

2009
Instructions for Recipient

Original issue discount (OID) is the excess of an obligation’s stated redemption price

at maturity over its issue price (acquisition price for a stripped bond or coupon). OID

is taxable as interest over the life of the obligation. If you are the holder of an OID

obligation, generally you must include an amount of OID in your gross income each

year you hold the obligation. Obligations that may have OID include a bond,

debenture, note, certificate, or other evidence of indebtedness having a term of more

than 1 year. For example, the OID rules may apply to certificates of deposit (CDs),

time deposits, bonus savings plans, and other deposit arrangements, especially if the

payment of interest is deferred until maturity. In addition, the OID rules apply to

Treasury inflation-protected securities. See Pub. 550, Investment Income and

Expenses, for more information.

Box 2. Shows other interest on this obligation for the year, which is an amount

separate from the OID. If you held the obligation the entire year, report this amount

as interest income on your tax return. If you disposed of the obligation or acquired it

from another holder during the year, see Pub. 550 for reporting instructions. If there

is an amount in both boxes 2 and 6, the amount in box 2 is interest on a U.S.

Treasury obligation and is exempt from state and local income taxes.

If, as the record holder, you receive Form 1099-OID showing amounts belonging

to another person, you are considered a nominee recipient. Complete a Form

1099-OID for each of the other owners showing the amounts allocable to each. File

Copy A of the form with the IRS. Furnish Copy B to each owner. List yourself as the

“payer” and the other owner as the “recipient.” File Form(s) 1099-OID with Form

1096, Annual Summary and Transmittal of U.S. Information Returns, with the Internal

Revenue Service Center for your area. On Form 1096, list yourself as the “filer.” A

husband or wife is not required to file a nominee return to show amounts owned by

the other. If you bought or sold an obligation during the year and you are not a

nominee, you are not required to issue or file Form 1099-OID showing the OID or

stated interest allocable to the seller/buyer of the obligation.

Box 3. Shows interest or principal forfeited if you withdrew the money before the

maturity date of the obligation, such as from a CD. You may deduct this amount to

figure your adjusted gross income on your income tax return. See the instructions for

Form 1040 to see where to take the deduction.

Box 4. Shows backup withholding. Generally, a payer must backup withhold at a

28% rate if you did not furnish your taxpayer identification number (TIN) or you did

not furnish the correct TIN to the payer. See Form W-9, Request for Taxpayer

Identification Number and Certification, for information on backup withholding.

Include this amount on your income tax return as tax withheld.

Box 1. Shows the OID on the obligation for the part of the year you owned it. Report

the amount in box 1 as interest income on your income tax return. However,

depending on the type of debt instrument, the issue or acquisition date, and other

factors (for example, if you paid acquisition or bond premium, or the obligation is a

Box 6. Shows OID on a U.S. Treasury obligation for the part of the year you owned

it. Report this amount as interest income on your federal income tax return, and see

Pub. 1212 to figure any appropriate adjustments to this amount. This OID is exempt

from state and local income taxes and is not included in box 1.

Box 5. Shows the identification number (CUSIP number) or description of the

obligation. The description may include the stock exchange, issuer, coupon rate, and

year of maturity.

Box 7. Any amount shown is your share of investment expenses of a single-class

REMIC. If you file Form 1040, you may deduct these expenses on the “Other

expenses” line of Schedule A (Form 1040) subject to the 2% limit. This amount is

included in box 2.

Account number. May show an account or other unique number the payer assigned

to distinguish your account.

stripped bond or coupon), you may have to figure the correct amount of OID to report

on your return. See Pub. 1212, Guide to Original Issue Discount (OID) Instruments, for

details on how to figure the correct OID.
VOID CORRECTED

PAYER’S name, street address, city, state, ZIP code, and telephone no. Original issue discount OMB No. 1545-0117

for 2009

1

Original Issue

2 Other periodic interest Discount

PAYER’S federal identification number RECIPIENT’S identification number 3 Early withdrawal penalty 4 Federal income tax withheld

RECIPIENT’S name 5

Street address (including apt. no.)

City, state, and ZIP code

Account number (see instructions) 2nd TIN not.

Form 1099-OID Department of the Treasury - Internal Revenue Service

$

$

$ $

Form 1099-OID

Original issue discount on U.S. Treasury obligations

5

Investment expenses

6

Description

7

$

$

For Payer

For Privacy Act

and Paperwork

Reduction Act

Notice, see the

2009 General

Instructions for

Forms 1099,

1098, 3921, 3922,

5498, and W-2G.

Copy C

2009
Instructions for Payers

Due dates. Furnish Copy B of this form to the recipient by

February 1, 2010.

software that generates a file according to the specifications

in Pub. 1220, Specifications for Filing Forms 1098, 1099,

3921, 3922, 5498, and W-2G Electronically. IRS does not

provide a fill-in form option.

Foreign recipient. If the recipient is a nonresident alien, you

may have to withhold federal income tax and file Form

1042-S, Foreign Person’s U.S. Source Income Subject to

Withholding. See the Instructions for Form 1042-S and Pub.

515, Withholding of Tax on Nonresident Aliens and Foreign

Caution: Because paper forms are scanned during Entities.

processing, you cannot file with the IRS Forms 1096, 1098,

1099, 3921, 3922, or 5498 that you print from the IRS

website.

General and specific form instructions are provided as

separate products. The products you should use to complete

Form 1099-OID are the 2009 General Instructions for Forms

1099, 1098, 3921, 3922, 5498, and W-2G and the 2009

Instructions for Forms 1099-INT and 1099-OID. A chart in the

general instructions gives a quick guide to which form must

be filed to report a particular payment. To order these

instructions and additional forms, visit the IRS website at

www.irs.gov or call 1-800-TAX-FORM (1-800-829-3676).

Need help? If you have questions about reporting on Form

1099-OID, call the information reporting customer service site

toll free at 1-866-455-7438 or 304-263-8700 (not toll free).

For TTY/TDD equipment, call 304-267-3367 (not toll free).

File Copy A of this form with the IRS by

March 1, 2010. If you file electronically, the due date is

March 31, 2010. To file electronically, you must have