VOID CORRECTED

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

for 2004

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 (optional) 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

2004 General

Instructions for

Forms 1099, 1098,

5498, and W-2G.

2004
CORRECTED (if checked)

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

for 2004*

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 (optional)

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

$

$

2004
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-indexed 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

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

report on your return. See Pub. 1212, List of Original Issue Discount Instruments, for

details on how to figure the correct OID.

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.
VOID CORRECTED

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

for 2004

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 (optional) 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

2004 General

Instructions for

Forms 1099,

1098, 5498,

and W-2G.

Copy C

2004
Instructions for Payers

Due dates. Furnish Copy B of this form to the

recipient by January 31, 2005.

File Copy A of this form with the IRS by

February 28, 2005. If you file electronically, the due

date is March 31, 2005.

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 Caution: Because paper forms are scanned during Nonresident Aliens and Foreign Entities. processing, you cannot file with the IRS Forms 1096,

1098, 1099, or 5498 that you download and 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 2004 General

Instructions for Forms 1099, 1098, 5498, and W-2G

and the separate specific instructions, 2004

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, call 1-800-TAX-FORM (1-800-829-3676).