Real Business Solutions
Your reliable source for Payroll Software, W2/1099
Software and tax forms
www.PayrollMate.com • 1-800-507-1992
®
2016 - 2017
1095 Mate
1094-C / 1095-C Printing
and E-�ling SoftwarePayroll Mate
Best Value inPayroll Software
Wide Range of TaxForms and Envelopes
Including W2s and 1099s
W2 Mate
W2 and 1099 Printing
and E-�ling Software
Big Selectionof Computer
Checks and Envelopes
Payroll Mate Receives 4.5 Stars out of 5 by the CPA Practice Advisor Magazine
4.5
We are pleased to o�er youour products catalog:Payroll Mate software allows usersto prepare payroll, pay employees,calculate payroll taxes, print payrollchecks generate payroll reports,export payroll data to ERP / accounting software and processpayroll forms.
You will also �nd W2 MateSoftware for preparing,printing and E-�ling: W2,1099-MISC, 1099-INT, 1099-DIV, 1099-K, 1099-R,1099-S, 1098-T, 1098, 1099-A,1099-B, 1099-C, 1099-OIDand 1099-PATR forms.
You can also rely on1095 Mateto meet your A�ordable CareAct reporting requirements.
To compliment our softwareyou will also �nd a widerange of checks, tax formsand compatible envelopes,all guaranteed to be 100%compliant with governmentregulations.
Please don’t hesitate to call ifyou have a question or needinformation about a productor tax form.
W2/1099 Software......................................................1Payroll Software...........................................................2Payroll Mate Compatible Checks...........................3W-2/1099 Kits...............................................................4W-2 Forms......................................................................51099-MISC Forms........................................................61099-INT/1099-DIV/1099-R Forms........................71099-S/1098-T/1098 Forms.....................................81099-A/1099-B/1099-C Forms................................91099-OID/1099-PATR/ 1099-K.............................. 10W-2 Envelopes and Perforated Paper................ 111099 Envelopes and Perforated Paper.............. 12W-2/1099 Sets............................................................ 13
Tax FormsA complete line of W-2 and 1099 tax forms areavailable. If you are ready to place your order or you can’t �nd what you are looking for,please do not hesitate to call our sales teamat: 800-507-1992.
Real Business Solutions - PO Box 1010 - Orland Park, IL 60462Website: www.W2Mate.com
To place your order call 800-507-1992
Place your order online at:
www.W2Mate.com
www.W2Mate.com • 1-800-507-1992 1
W2 Mate Features
W3, W2 Copy A, W2 Copy B, W2 Copy C, W2 Copy D, W2 Copy State 1 and Copy State 2
IMPORTS DATA FROM QUICKBOOKS, PEACHTREE, DACEASY,M.S. DYNAMICS, AND CSV
This option allows users to import W2 and 1099 data from QuickBooks, Microsoft Dynamics GP, DacEasy, andCSV / Excel format. Import 1099 data from Peachtree. Import W2 data from electronic filing format (EFW2 format) andimport 1099 data from 1099 electronic filing format (IRS publication 1220 format).
REQUIRESOPTION #1
This option allows you to create SSA and IRS E-File submissions for W-2 and 1099 forms supported by W2 Mate.**
REQUIRESOPTION #2
*SSA requires that forms submitted to SSA in black and white must be printed from a laser printer (non-reflective ink).**You must have an IRS Transmitter Control Code (TCC) in order to send your 1099 to the IRS electronically. The SSA requires all transmitters to register for W2 reporting.***Utility requires W2 Mate software and W2 Mate Option #6 for the same tax year.
PRINTS ON THE FOLLOWING OFFICIAL IRS LASER FORMS:
Automatically calculates totals for W3 and 1096. Exports W2 and 1099 forms to Excel. Password protection and Data validation.Generates Mailing Labels. Backup and Restore Capability. Data Rollover from year to year.
This feature allows you to create employee copies of W2 form and recipient copies of 1099 form in PDF format (with password protection for security purposes). The resulting PDF file(s) can then be sent to employees/recipients instead of paper copies.
REQUIRESOPTION #3
REQUIRESOPTION #4
REQUIRESOPTION #5
1096, 1099-MISC Copy A, 1099-MISC Copy B, 1099-MISC Copy C, 1099-MISC Copy State 1 and1099-MISC Copy State 2
PRINTS THE FOLLOWING FORMS ON BLANK PAPER WITH BLACK INK:
W2 Copy B, W2 Copy C, W2 Copy D, W2 Copy State 1 and W2 Copy State 2
1099-MISC Copy B, 1099-MISC Copy C, 1099-MISC Copy State 1 and 1099-MISC Copy State 2
PRINTS SSA APPROVED FORMS ON BLANK PAPER WITH BLACK INK:
This option adds the ability to W2 Mate to print government-approved substitutes for forms W2 Copy A and W3 on plain white paper using a laser printer.*
NETWORK SUPPORT
With this option you can share the data managed by W2 Mate between more than one machine on your network.
ELECTRONIC FILING**
1099 (INT, DIV, K, R, S, A, B , C, PATR, OID), 1098 and 1098-T
GENERATES PASSWORD-PROTECTED W2 AND 1099-MISC FORMS IN PDF FORMAT
This option prints on blank paper 1099-INT,1099-DIV,1099-S,1098-T,1098,1099-A ,1099-B,1099-C,1099-PATR,1099-OIDcopies (B and C) and1099-R Copies (B, C and D). It also prints on official IRS laser forms 1099-INT,1099-DIV,1099-S,1098-T,1098,1099-A ,1099-B,1099-C,1099-PATR,1099-OID, 1099-R and 1099-K.
REQUIRESOPTION #6
W2 Mate generates forms for one tax year only. Other years would require a purchase of W2 Mate for that specific year.
1099 Emailer is bulk email sending utility that allows users to automatically batch e-mail to recipient's emails W2,1099, and 1098 forms in PDF format instead of mailing out hard copy forms ***
AUTOMATICALLY BATCH EMAIL PDF 1099S / W2S REQUIRES1099 EMAILER
1
Our W2 Forms and 1099 FormsPrinting/E-filing software is veryeasy, powerful and yet veryaffordable. W2 Mate fits theneeds of most users regardlessof their W2 and 1099 Formspreparation needs.
So if you are a small businesspreparing W2 Forms for youremployees in house, you are amid-size business preparing1099 Forms for your contractors,or printing W2 Forms from yourlegacy accounting software, orif you are an accountantpreparing W2/1099 forms andtransmittals for your clientsthen W2 Mate is definitely for you.
The Ultimate W2 & 1099 Forms Printing and E-Filing Software
Your reliable source for Payroll Software, W2/1099 Software and tax forms.22
Finally a payroll program that is easy, powerful and most importantly affordable. Payroll Mate is a complete software for payroll, that fits the needs of most users regardless of their payroll needs.
So if you are an accountant preparing payroll for your clients, you are a small business doing your payroll in house, or you are payroll services provider, Payroll Mate will do the job for you.
Payroll Mate greatly reduces the time to prepare payroll, create forms and print checks: Payroll Mate automatically calculates net pay, federal withholding tax, Social Security tax, Medicare, state and local payroll taxes.
Payroll Mate also supports different types of payroll pay periods, prints checks, prepares payrol1 forms 941, 943, 944, 940, W2 and W3. Payroll Mate also supports user-defined Income, Tax, and Deduction categories making it very flexible and powerful.
**Please check online to see if your state is supported.
Vendor Center REQUIRES OPTION #6
Payroll Mate Features
Prints on preprinted red scannable W2 Copy A and W3 forms
Supports customizable income, tax and deductions categories
Supports income per mile and per piece
Supports fringe benefi ts Generates comprehensive reports including payroll journal, tax liability and deposit requirement
Prints forms 940, 941, 943, 944, W2 Copy B, W2 Copy C, W2 Copy D, W2 Copy State 1 and W2 Copy State 2 on blank paper
Exports Payroll reports to Excel, CSV and PDF
Automatically calculates federal and state tax withholding
Prints on Laser and Inkjet checks
Free updates during the tax year
One step backup and restore
Number of companies supported
Number of employees per company
Prints SSA approved W2 Copy A and W3 forms on blank paper REQUIRES OPTION #1
Generates Direct Deposit File REQUIRES OPTION #2
Ability to support up to 100 Companies and 1000 Employees per company
Ability to print MICR checks on blank check stock
Support for State Payroll Tax reporting**
Login password
REQUIRES OPTION #3
REQUIRES OPTION #4
REQUIRES OPTION #5
Exports payroll check data into formats importable by QuickBooks, Quicken and other small business accounting software solutions.
Export Payroll Data to Peachtree (Sage50)
Import Employee list from CSV and Peachtree (Sage50)
Payroll Mate Networking NETWORK OPTION
10
75
www.PayrollMate.com 1-800-507-1992 33
We offer Payroll Mate compatible checks and envelopes at very low
prices
Save addressing time with dual window envelopes!Use this double window envelope for convenience when mailing checks. Guaranteed to work with Payroll Mate Laser or Ink Jet Payroll Checks.
For check orders, send us a sample voided check. We will print the account number as shown on the sample voided check. Please indicate any changes on the face of the voided check. Fax this order form along with the voided check to 708-590-0910. Once we have received your order, you will receive an e-mail requesting to approve a proof of the check. If you have any questions, please contact our support team at 708-479-8731.
Double-Window Compatible
Check Envelope#CK2UPENVRB
Payroll Mate Blank Check Stock
We also offer blank check
stock
22222 Voida Employee’s social security number For O�cial Use Only �
OMB No. 1545-0008
b Employer identi�cation number (EIN)
c Employer’s name, address, and ZIP code
d Control number
e Employee’s �rst name and initial Last name Su�.
f Employee’s address and ZIP code
1 Wages, tips, other compensation 2 Federal income tax withheld
3 Social security wages 4 Social security tax withheld
5 Medicare wages and tips 6 Medicare tax withheld
7 Social security tips 8 Allocated tips
9 10 Dependent care bene�ts
11 Nonquali�ed plans 12a See instructions for box 12Co d e
12bCo d e
12cCo d e
12dCo d e
13 Statutory employee
Retirement plan
Third-party sick pay
14 Other
15 State Employer’s state ID number 16 State wages, tips, etc. 17 State income tax 18 Local wages, tips, etc. 19 Local income tax 20 Locality name
Form W-2 Wage and Tax Statement
Copy A For Social Security Administration — Send this entire page with Form W-3 to the Social Security Administration; photocopies are not acceptable.
Department of the Treasury—Internal Revenue Service For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 10134D
Do Not Cut, Fold, or Staple Forms on This Page
22222 Voida Employee’s social security number For O�cial Use Only �
OMB No. 1545-0008
b Employer identi�cation number (EIN)
c Employer’s name, address, and ZIP code
d Control number
e Employee’s �rst name and initial Last name Su�.
f Employee’s address and ZIP code
1 Wages, tips, other compensation 2 Federal income tax withheld
3 Social security wages 4 Social security tax withheld
5 Medicare wages and tips 6 Medicare tax withheld
7 Social security tips 8 Allocated tips
9 10 Dependent care bene�ts
11 Nonquali�ed plans 12a See instructions for box 12Co d e
12bCo d e
12cCo d e
12dCo d e
13 Statutory employee
Retirement plan
Third-party sick pay
14 Other
15 State Employer’s state ID number 16 State wages, tips, etc. 17 State income tax 18 Local wages, tips, etc. 19 Local income tax 20 Locality name
Form W-2 Wage and Tax Statement
Copy A For Social Security Administration — Send this entire page with Form W-3 to the Social Security Administration; photocopies are not acceptable.
Department of the Treasury—Internal Revenue Service For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 10134D
Do Not Cut, Fold, or Staple Forms on This Page
Form 1099-MISC
Cat. No. 14425J
Miscellaneous Income
Copy AFor
Internal Revenue Service Center
Department of the Treasury - Internal Revenue Service
File with Form 1096.
OMB No. 1545-0115
For Privacy Act and Paperwork
Reduction Act Notice, see the
2015 General Instructions for
Certain Information
Returns.
9595 VOID CORRECTEDPAYER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
PAYER’S federal identi�cation number RECIPIENT’S identi�cation number
RECIPIENT’S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions) FATCA �ling requirement
2nd TIN not.
1 Rents
$2 Royalties
$3 Other income
$4 Federal income tax withheld
$5 Fishing boat proceeds
$
6 Medical and health care payments
$7 Nonemployee compensation
$
8 Substitute payments in lieu of dividends or interest
$9 Payer made direct sales of
$5,000 or more of consumer products to a buyer (recipient) for resale �
10 Crop insurance proceeds
$11 12
13 Excess golden parachute payments
$
14 Gross proceeds paid to an attorney
$15a Section 409A deferrals
$
15b Section 409A income
$
16 State tax withheld
$$
17 State/Payer’s state no. 18 State income
$$
Form 1099-MISC www.irs.gov/form1099misc
Do Not C ut or S e pa ra t e F orms on T his P a ge — Do Not C ut or S e pa ra t e F orms on T his P a ge
Form 1099-MISC
Cat. No. 14425J
Miscellaneous Income
Copy AFor
Internal Revenue Service Center
Department of the Treasury - Internal Revenue Service
File with Form 1096.
OMB No. 1545-0115
For Privacy Act and Paperwork
Reduction Act Notice, see the
2015 General Instructions for
Certain Information
Returns.
9595 VOID CORRECTEDPAYER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
PAYER’S federal identi�cation number RECIPIENT’S identi�cation number
RECIPIENT’S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions) FATCA �ling requirement
2nd TIN not.
1 Rents
$2 Royalties
$3 Other income
$4 Federal income tax withheld
$5 Fishing boat proceeds
$
6 Medical and health care payments
$7 Nonemployee compensation
$
8 Substitute payments in lieu of dividends or interest
$9 Payer made direct sales of
$5,000 or more of consumer products to a buyer (recipient) for resale �
10 Crop insurance proceeds
$11 12
13 Excess golden parachute payments
$
14 Gross proceeds paid to an attorney
$15a Section 409A deferrals
$
15b Section 409A income
$
16 State tax withheld
$$
17 State/Payer’s state no. 18 State income
$$
Form 1099-MISC www.irs.gov/form1099misc
Do Not C ut or S e pa ra t e F orms on T his P a ge — Do Not C ut or S e pa ra t e F orms on T his P a ge
Your reliable source for Payroll Software, W2/1099 Software and tax forms.44
All you need to file your W2 and 1099 Forms!
W2 KitIncludes: • 30 W-2 Copy A Laser or Ink Jet Forms • 5 W-3 Summary Forms • W2 Mate software
W2 Mate will print Copies B, C, D, State 1 and State 2 on blank paper with black ink.
1099 KitIncludes • 30 1099-Misc Copy A Laser or Ink Jet Forms • 5 1096 Summary Forms • W2 Mate software
W2 Mate will print Copies B, C, State 1 and State 2 on blank paper with black ink.
1099 Kit#1099KIT08
Kits
1099 Kit#1099KIT08
Do Not Staple
Form 1096Department of the Treasury Internal Revenue Service
Annual Summary and Transmittal of U.S. Information Returns
OMB No. 1545-0108
FILER'S name
Street address (including room or suite number)
City or town, state or province, country, and ZIP or foreign postal code
Name of person to contact Telephone number
Email address Fax number
For O�cial Use Only
1 Employer identi�cation number 2 Social security number 3 Total number of forms 4 Federal income tax withheld
$
5 Total amount reported with this Form 1096
$6 Enter an “X” in only one box below to indicate the type of form being �led.
W-2G 32
1097-BTC 50
1098 81
1098-C 78
1098-E 84
1098-Q 74
1098-T 83
1099-A 80
1099-B 79
1099-C 85
1099-CAP 73
1099-DIV 91
1099-G 86
1099-INT 92
1099-K 10
1099-LTC 93
1099-MISC 95
1099-OID 96
1099-PATR 97
1099-Q 31
1099-R 98
1099-S 75
1099-SA 94
3921 25
3922 26
5498 28
5498-ESA 72
5498-SA 27
7 If this is your �nal return , enter an “X” here . . . . . �
Return this entire page to the Internal Revenue Service. Photocopies are not acceptable.
Under penalties of perjury, I declare that I have examined this return and accompanying documents, and, to the best of my knowledge and belief, they are true, correct, and complete.
Signature � Title � Date �
InstructionsFuture developments. For the latest information about developments related to Form 1096, such as legislation enacted after it was published, go to www.irs.gov/form1096.Reminder. The only acceptable method of �ling information returns with Internal Revenue Service/Information Returns Branch is electronically through the FIRE system. See Pub. 1220, Speci�cations for Electronic Filing of Forms 1097, 1098, 1099, 3921, 3922, 5498, and W-2G.Purpose of form. Use this form to transmit paper Forms 1097, 1098, 1099, 3921, 3922, 5498, and W-2G to the Internal Revenue Service. Do not use Form 1096 to transmit electronically. For electronic submissions, see Pub. 1220.Caution. If you are required to �le 250 or more information returns of any one type, you must �le electronically. If you are required to �le electronically but fail to do so, and you do not have an approved waiver, you may be subject to a penalty. For more information, see part F in the 2015 General Instructions for Certain Information Returns.Who must �le. The name, address, and TIN of the �ler on this form must be the same as those you enter in the upper left area of Forms 1097, 1098, 1099, 3921, 3922, 5498, or W-2G. A �ler is any person or entity who �les any of the forms shown in line 6 above.
Enter the �ler’s name, address (including room, suite, or other unit number), and TIN in the spaces provided on the form.
When to �le. File Form 1096 as follows.• With Forms 1097, 1098, 1099, 3921, 3922, or W-2G, file by February 29, 2016.• With Forms 5498, file by May 31, 2016.
Where To FileSend all information returns �led on paper with Form 1096 to the following.
If your principal business, o�ce or agency, or legal residence in
the case of an individual, is located in
Use the following three-line address
� �
Alabama, Arizona, Arkansas, Connecticut, Delaware, Florida, Georgia, Kentucky, Louisiana, Maine, Massachusetts, Mississippi, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Pennsylvania, Rhode Island, Texas, Vermont, Virginia, West Virginia
Department of the Treasury Internal Revenue Service Center
Austin, TX 73301
For more information and the Privacy Act and Paperwork Reduction Act Notice, see the 2015 General Instructions for Certain Information Returns.
Cat. No. 14400O Form 1096 (2015)
DO NOT STAPLE
33333a Control number For O�cial Use Only �
OMB No. 1545-0008
b Kind of Payer (Check one)
941 Military 943 944
CT-1Hshld. emp.
Medicare govt. emp.
Kind of Employer (Check one)
None apply 501c non-govt.
State/local non-501c State/local 501c Federal govt.
Third-party sick pay
(Check if
applicable)
c Total number of Forms W-2 d Establishment number
e Employer identi�cation number (EIN)
f Employer’s name
g Employer’s address and ZIP code
h Other EIN used this year
1 Wages, tips, other compensation 2 Federal income tax withheld
3 Social security wages 4 Social security tax withheld
5 Medicare wages and tips 6 Medicare tax withheld
7 Social security tips 8 Allocated tips
9 10 Dependent care bene�ts
11 Nonquali�ed plans 12a Deferred compensation
12b13 For third-party sick pay use only
14 Income tax withheld by payer of third-party sick pay15 State Employer’s state ID number
16 State wages, tips, etc. 17 State income tax 18 Local wages, tips, etc. 19 Local income tax
Employer's contact person Employer's telephone number For O�cial Use Only
Employer's fax number Employer's email address
Under penalties of perjury, I declare that I have examined this return and accompanying documents and, to the best of my knowledge and belief, they are true, correct, and complete.
Signature � Title � Date �
Form W-3 Transmittal of Wage and Tax Statements Department of the Treasury Internal Revenue Service
Send this entire page with the entire Copy A page of Form(s) W-2 to the Social Security Administration (SSA). Photocopies are not acceptable. Do not send Form W-3 if you �led electronically with the SSA. Do not send any payment (cash, checks, money orders, etc.) with Forms W-2 and W-3.
ReminderSeparate instructions. See the 2016 General Instructions for Forms W-2 and W-3 for information on completing this form. Do not �le Form W-3 for Form(s) W-2 that were submitted electronically to the SSA.
Purpose of FormA Form W-3 Transmittal is completed only when paper Copy A of Form(s) W-2, Wage and Tax Statement, is being �led. Do not �le Form W-3 alone. All paper forms must comply with IRS standards and be machine readable. Photocopies are not acceptable. Use a Form W-3 even if only one paper Form W-2 is being �led. Make sure both the Form W-3 and Form(s) W-2 show the correct tax year and Employer Identi�cation Number (EIN). Make a copy of this form and keep it with Copy D (For Employer) of Form(s) W-2 for your records. The IRS recommends retaining copies of these forms for four years.
E-FilingThe SSA strongly suggests employers report Form W-3 and Forms W-2 Copy A electronically instead of on paper. The SSA provides two free e-�ling options on its Business Services Online (BSO) website:• W-2 Online. Use �ll-in forms to create, save, print, and submit up to 50 Forms W-2 at a time to the SSA.• File Upload. Upload wage �les to the SSA you have created using payroll or tax software that formats the �les according to the SSA’s Speci�cations for Filing Forms W-2 Electronically (EFW2).
W-2 Online �ll-in forms or �le uploads will be on time if submitted by March 31, 2017. For more information, go to www.socialsecurity.gov/employer . First time �lers, select “ Go to Register ”; returning �lers select “Go To Log In .”
When To FileMail Form W-3 with Copy A of Form(s) W-2 by February 28, 2017.
Where To File Paper FormsSend this entire page with the entire Copy A page of Form(s) W-2 to:
Social Security Administration Data Operations Center Wilkes-Barre, PA 18769-0001
Note: If you use “Certi�ed Mail” to �le, change the ZIP code to “18769-0002.” If you use an IRS-approved private delivery service, add “ATTN: W-2 Process, 1150 E. Mountain Dr.” to the address and change the ZIP code to “18702-7997.” See Publication 15 (Circular E), Employer’s Tax Guide, for a list of IRS-approved private delivery services.
For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions.
800-507-1992
www.W2Mate.com
XP, Vista, 7, 8,10
RFor Windows
R
R
800-507-1992
www.W2Mate.com
XP, Vista, 7, 8,10
RFor Windows
R
R
W2 Kit#W2KIT08
www.PayrollMate.com • 1-800-507-1992 55
W-2 Forms
• SSA - compliant forms guaranteed compatible with W2 Mate, Payroll Mate or your W2 Filing Software
• Each 8½” x 11” sheet is developed in compliance with IRS regulations
• Order the quantity equal to the number of employees for which you file
W-2 Forms
Item Number Description Envelope
Traditional Forms
W3FED08RB W-3 Transmittal Form –W2FED08RB W-2 Employer Federal Copy A –W2B08RB W-2 Employee Federal Copy B W2UPENVRB
W2C08RB W-2 Employee File Copy C W2UPENVRBW2D08RB W-2 Employer File Copy D –W2S108RB W-2 Employer State/City Copy 1 –W2S208RB W-2 Employee State/City Copy 2 W2UPENVRB
EMPLOYER’S COPY
Copy A: For Social Security AdministrationCopy 1: For State, City or Local Tax Department Copy D: For Employer’s Records
EMPLOYEE’S COPY Copy B: Filed with Employee’s federal Tax Return Copy C: For Employee’s RecordsCopy 2: Filed with Employee’s State, City or Local Income Tax Return
W-2 Employer Federal Copy A#W2FED08RB
W-2 Employee File Copy C#W2C08RB
W-2 Employee Federal Copy B#W2B08RB
W-2 Employee State/City Copy 2#W2S208RB
W-2 Employer State/City Copy 1#W2S108RB
W-2 Employer File Copy D#W2D08RB
W-3 Transmittal Form
Great for Small Business!
22222 Voida Employee’s social security number For O�cial Use Only �
OMB No. 1545-0008
b Employer identi�cation number (EIN)
c Employer’s name, address, and ZIP code
d Control number
e Employee’s �rst name and initial Last name Su�.
f Employee’s address and ZIP code
1 Wages, tips, other compensation 2 Federal income tax withheld
3 Social security wages 4 Social security tax withheld
5 Medicare wages and tips 6 Medicare tax withheld
7 Social security tips 8 Allocated tips
9 10 Dependent care bene�ts
11 Nonquali�ed plans 12a See instructions for box 12Co d e
12bCo d e
12cCo d e
12dCo d e
13 Statutory employee
Retirement plan
Third-party sick pay
14 Other
15 State Employer’s state ID number 16 State wages, tips, etc. 17 State income tax 18 Local wages, tips, etc. 19 Local income tax 20 Locality name
Form W-2 Wage and Tax Statement
Copy A For Social Security Administration — Send this entire page with Form W-3 to the Social Security Administration; photocopies are not acceptable.
Department of the Treasury—Internal Revenue Service For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 10134D
Do Not Cut, Fold, or Staple Forms on This Page
22222 Voida Employee’s social security number For O�cial Use Only �
OMB No. 1545-0008
b Employer identi�cation number (EIN)
c Employer’s name, address, and ZIP code
d Control number
e Employee’s �rst name and initial Last name Su�.
f Employee’s address and ZIP code
1 Wages, tips, other compensation 2 Federal income tax withheld
3 Social security wages 4 Social security tax withheld
5 Medicare wages and tips 6 Medicare tax withheld
7 Social security tips 8 Allocated tips
9 10 Dependent care bene�ts
11 Nonquali�ed plans 12a See instructions for box 12Co d e
12bCo d e
12cCo d e
12dCo d e
13 Statutory employee
Retirement plan
Third-party sick pay
14 Other
15 State Employer’s state ID number 16 State wages, tips, etc. 17 State income tax 18 Local wages, tips, etc. 19 Local income tax 20 Locality name
Form W-2 Wage and Tax Statement
Copy A For Social Security Administration — Send this entire page with Form W-3 to the Social Security Administration; photocopies are not acceptable.
Department of the Treasury—Internal Revenue Service For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 10134D
Do Not Cut, Fold, or Staple Forms on This Page
DO NOT STAPLE
33333a Control number For O�cial Use Only �
OMB No. 1545-0008
b Kind of Payer (Check one)
941 Military 943 944
CT-1Hshld. emp.
Medicare govt. emp.
Kind of Employer (Check one)
None apply 501c non-govt.
State/local non-501c State/local 501c Federal govt.
Third-party sick pay
(Check if
applicable)
c Total number of Forms W-2 d Establishment number
e Employer identi�cation number (EIN)
f Employer’s name
g Employer’s address and ZIP code
h Other EIN used this year
1 Wages, tips, other compensation 2 Federal income tax withheld
3 Social security wages 4 Social security tax withheld
5 Medicare wages and tips 6 Medicare tax withheld
7 Social security tips 8 Allocated tips
9 10 Dependent care bene�ts
11 Nonquali�ed plans 12a Deferred compensation
12b13 For third-party sick pay use only
14 Income tax withheld by payer of third-party sick pay15 State Employer’s state ID number
16 State wages, tips, etc. 17 State income tax 18 Local wages, tips, etc. 19 Local income tax
Employer's contact person Employer's telephone number For O�cial Use Only
Employer's fax number Employer's email address
Under penalties of perjury, I declare that I have examined this return and accompanying documents and, to the best of my knowledge and belief, they are true, correct, and complete.
Signature � Title � Date �
Form W-3 Transmittal of Wage and Tax Statements Department of the Treasury Internal Revenue Service
Send this entire page with the entire Copy A page of Form(s) W-2 to the Social Security Administration (SSA). Photocopies are not acceptable. Do not send Form W-3 if you �led electronically with the SSA. Do not send any payment (cash, checks, money orders, etc.) with Forms W-2 and W-3.
ReminderSeparate instructions. See the 2016 General Instructions for Forms W-2 and W-3 for information on completing this form. Do not �le Form W-3 for Form(s) W-2 that were submitted electronically to the SSA.
Purpose of FormA Form W-3 Transmittal is completed only when paper Copy A of Form(s) W-2, Wage and Tax Statement, is being �led. Do not �le Form W-3 alone. All paper forms must comply with IRS standards and be machine readable. Photocopies are not acceptable. Use a Form W-3 even if only one paper Form W-2 is being �led. Make sure both the Form W-3 and Form(s) W-2 show the correct tax year and Employer Identi�cation Number (EIN). Make a copy of this form and keep it with Copy D (For Employer) of Form(s) W-2 for your records. The IRS recommends retaining copies of these forms for four years.
E-FilingThe SSA strongly suggests employers report Form W-3 and Forms W-2 Copy A electronically instead of on paper. The SSA provides two free e-�ling options on its Business Services Online (BSO) website:• W-2 Online. Use �ll-in forms to create, save, print, and submit up to 50 Forms W-2 at a time to the SSA.• File Upload. Upload wage �les to the SSA you have created using payroll or tax software that formats the �les according to the SSA’s Speci�cations for Filing Forms W-2 Electronically (EFW2).
W-2 Online �ll-in forms or �le uploads will be on time if submitted by www.socialsecurity.gov/
employer . First time �lers, select “ Go to Register ”; returning �lers select “Go To Log In .”
When To FileMail Form W-3 with Copy A of Form(s) W-2 by February 28, 2017.
Where To File Paper FormsSend this entire page with the entire Copy A page of Form(s) W-2 to:
Social Security Administration Data Operations Center Wilkes-Barre, PA 18769-0001
Note: If you use “Certi�ed Mail” to �le, change the ZIP code to “18769-0002.” If you use an IRS-approved private delivery service, add “ATTN: W-2 Process, 1150 E. Mountain Dr.” to the address and change the ZIP code to “18702-7997.” See Publication 15 (Circular E), Employer’s Tax Guide, for a list of IRS-approved private delivery services.
For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions.
22222a Employee’s social security number
OMB No. 1545-0008
b Employer identi�cation number (EIN)
c Employer’s name, address, and ZIP code
d Control number
e Employee’s �rst name and initial Last name Su�.
f Employee’s address and ZIP code
1 Wages, tips, other compensation 2 Federal income tax withheld
3 Social security wages 4 Social security tax withheld
5 Medicare wages and tips 6 Medicare tax withheld
7 Social security tips 8 Allocated tips
9 10 Dependent care bene�ts
11 Nonquali�ed plans 12a Co d e
12bCo d e
12cCo d e
12dCo d e
13 Statutory employee
Retirement plan
Third-party sick pay
14 Other
15 State Employer’s state ID number 16 State wages, tips, etc. 17 State income tax 18 Local wages, tips, etc. 19 Local income tax 20 Locality name
Form W-2 Wage and Tax Statement
Department of the Treasury—Internal Revenue Service
22222a Employee’s social security number
OMB No. 1545-0008
b Employer identi�cation number (EIN)
c Employer’s name, address, and ZIP code
d Control number
e Employee’s �rst name and initial Last name Su�.
f Employee’s address and ZIP code
1 Wages, tips, other compensation 2 Federal income tax withheld
3 Social security wages 4 Social security tax withheld
5 Medicare wages and tips 6 Medicare tax withheld
7 Social security tips 8 Allocated tips
9 10 Dependent care bene�ts
11 Nonquali�ed plans 12a Co d e
12bCo d e
12cCo d e
12dCo d e
13 Statutory employee
Retirement plan
Third-party sick pay
14 Other
15 State Employer’s state ID number 16 State wages, tips, etc. 17 State income tax 18 Local wages, tips, etc. 19 Local income tax 20 Locality name
Form W-2 Wage and Tax Statement
Department of the Treasury—Internal Revenue Service
22222a Employee’s social security number
OMB No. 1545-0008
b Employer identi�cation number (EIN)
c Employer’s name, address, and ZIP code
d Control number
e Employee’s �rst name and initial Last name Su�.
f Employee’s address and ZIP code
1 Wages, tips, other compensation 2 Federal income tax withheld
3 Social security wages 4 Social security tax withheld
5 Medicare wages and tips 6 Medicare tax withheld
7 Social security tips 8 Allocated tips
9 10 Dependent care bene�ts
11 Nonquali�ed plans 12a Co d e
12bCo d e
12cCo d e
12dCo d e
13 Statutory employee
Retirement plan
Third-party sick pay
14 Other
15 State Employer’s state ID number 16 State wages, tips, etc. 17 State income tax 18 Local wages, tips, etc. 19 Local income tax 20 Locality name
Form W-2 Wage and Tax Statement
Department of the Treasury—Internal Revenue Service
22222a Employee’s social security number
OMB No. 1545-0008
b Employer identi�cation number (EIN)
c Employer’s name, address, and ZIP code
d Control number
e Employee’s �rst name and initial Last name Su�.
f Employee’s address and ZIP code
1 Wages, tips, other compensation 2 Federal income tax withheld
3 Social security wages 4 Social security tax withheld
5 Medicare wages and tips 6 Medicare tax withheld
7 Social security tips 8 Allocated tips
9 10 Dependent care bene�ts
11 Nonquali�ed plans 12a Co d e
12bCo d e
12cCo d e
12dCo d e
13 Statutory employee
Retirement plan
Third-party sick pay
14 Other
15 State Employer’s state ID number 16 State wages, tips, etc. 17 State income tax 18 Local wages, tips, etc. 19 Local income tax 20 Locality name
Form W-2 Wage and Tax Statement
Department of the Treasury—Internal Revenue Service
22222a Employee’s social security number
OMB No. 1545-0008
b Employer identi�cation number (EIN)
c Employer’s name, address, and ZIP code
d Control number
e Employee’s �rst name and initial Last name Su�.
f Employee’s address and ZIP code
1 Wages, tips, other compensation 2 Federal income tax withheld
3 Social security wages 4 Social security tax withheld
5 Medicare wages and tips 6 Medicare tax withheld
7 Social security tips 8 Allocated tips
9 10 Dependent care bene�ts
11 Nonquali�ed plans 12a Co d e
12bCo d e
12cCo d e
12dCo d e
13 Statutory employee
Retirement plan
Third-party sick pay
14 Other
15 State Employer’s state ID number 16 State wages, tips, etc. 17 State income tax 18 Local wages, tips, etc. 19 Local income tax 20 Locality name
Form W-2 Wage and Tax Statement
Department of the Treasury—Internal Revenue Service
22222a Employee’s social security number
OMB No. 1545-0008
b Employer identi�cation number (EIN)
c Employer’s name, address, and ZIP code
d Control number
e Employee’s �rst name and initial Last name Su�.
f Employee’s address and ZIP code
1 Wages, tips, other compensation 2 Federal income tax withheld
3 Social security wages 4 Social security tax withheld
5 Medicare wages and tips 6 Medicare tax withheld
7 Social security tips 8 Allocated tips
9 10 Dependent care bene�ts
11 Nonquali�ed plans 12a Co d e
12bCo d e
12cCo d e
12dCo d e
13 Statutory employee
Retirement plan
Third-party sick pay
14 Other
15 State Employer’s state ID number 16 State wages, tips, etc. 17 State income tax 18 Local wages, tips, etc. 19 Local income tax 20 Locality name
Form W-2 Wage and Tax Statement
Department of the Treasury—Internal Revenue Service
22222a Employee’s social security number
OMB No. 1545-0008
b Employer identi�cation number (EIN)
c Employer’s name, address, and ZIP code
d Control number
e Employee’s �rst name and initial Last name Su�.
f Employee’s address and ZIP code
1 Wages, tips, other compensation 2 Federal income tax withheld
3 Social security wages 4 Social security tax withheld
5 Medicare wages and tips 6 Medicare tax withheld
7 Social security tips 8 Allocated tips
9 10 Dependent care bene�ts
11 Nonquali�ed plans 12a Co d e
12bCo d e
12cCo d e
12dCo d e
13 Statutory employee
Retirement plan
Third-party sick pay
14 Other
15 State Employer’s state ID number 16 State wages, tips, etc. 17 State income tax 18 Local wages, tips, etc. 19 Local income tax 20 Locality name
Form W-2 Wage and Tax Statement
Department of the Treasury—Internal Revenue Service
22222a Employee’s social security number
OMB No. 1545-0008
b Employer identi�cation number (EIN)
c Employer’s name, address, and ZIP code
d Control number
e Employee’s �rst name and initial Last name Su�.
f Employee’s address and ZIP code
1 Wages, tips, other compensation 2 Federal income tax withheld
3 Social security wages 4 Social security tax withheld
5 Medicare wages and tips 6 Medicare tax withheld
7 Social security tips 8 Allocated tips
9 10 Dependent care bene�ts
11 Nonquali�ed plans 12a Co d e
12bCo d e
12cCo d e
12dCo d e
13 Statutory employee
Retirement plan
Third-party sick pay
14 Other
15 State Employer’s state ID number 16 State wages, tips, etc. 17 State income tax 18 Local wages, tips, etc. 19 Local income tax 20 Locality name
Form W-2 Wage and Tax Statement
Department of the Treasury—Internal Revenue Service
22222a Employee’s social security number
OMB No. 1545-0008
b Employer identi�cation number (EIN)
c Employer’s name, address, and ZIP code
d Control number
e Employee’s �rst name and initial Last name Su�.
f Employee’s address and ZIP code
1 Wages, tips, other compensation 2 Federal income tax withheld
3 Social security wages 4 Social security tax withheld
5 Medicare wages and tips 6 Medicare tax withheld
7 Social security tips 8 Allocated tips
9 10 Dependent care bene�ts
11 Nonquali�ed plans 12a Co d e
12bCo d e
12cCo d e
12dCo d e
13 Statutory employee
Retirement plan
Third-party sick pay
14 Other
15 State Employer’s state ID number 16 State wages, tips, etc. 17 State income tax 18 Local wages, tips, etc. 19 Local income tax 20 Locality name
Form W-2 Wage and Tax Statement
Department of the Treasury—Internal Revenue Service
22222a Employee’s social security number
OMB No. 1545-0008
b Employer identi�cation number (EIN)
c Employer’s name, address, and ZIP code
d Control number
e Employee’s �rst name and initial Last name Su�.
f Employee’s address and ZIP code
1 Wages, tips, other compensation 2 Federal income tax withheld
3 Social security wages 4 Social security tax withheld
5 Medicare wages and tips 6 Medicare tax withheld
7 Social security tips 8 Allocated tips
9 10 Dependent care bene�ts
11 Nonquali�ed plans 12a Co d e
12bCo d e
12cCo d e
12dCo d e
13 Statutory employee
Retirement plan
Third-party sick pay
14 Other
15 State Employer’s state ID number 16 State wages, tips, etc. 17 State income tax 18 Local wages, tips, etc. 19 Local income tax 20 Locality name
Form W-2 Wage and Tax Statement
Department of the Treasury—Internal Revenue Service
#W3FED08RB
W-2 Form Parts Description
Your reliable source for Payroll Software, W2/1099 Software and tax forms.66
1099-MISC Forms
• IRS - compliant forms guaranteed compatible with W2 Mate or your 1099 printing software
• Each 8½” x 11” sheet is developed in compliance with IRS regulations
• Order the quantity equal to the number of recipients for which you file
1099-MISC Federal Copy A#MISFED08RB
1099-MISC Forms
Item Number Description Envelope
1096FED08RB 1096 Transmittal Form –MISFED08RB 1099-MISC Federal Copy A –MISREC08RB 1099-MISC Recipient Copy B 10992UPENV08RB
MISPAY08RB 1099-MISC Payer Copy C –MIS108RB 1099-MISC Payer State Copy 1 –MIS208RB 1099-MISC Recipient State Copy 2 10992UPENV08RB
1099-MISC Payer Copy C#MISPAY08RB
1099-MISC Recipient Copy B
1099-MISC Recipient State Copy 2#MIS208RB
1099-MISC Payer State Copy 1#MIS108RB
1096 Transmittal Form#1096FED08RB
PAYER’S COPY
Copy A: For Internal Revenue ServiceCopy C: For Payer’s record State 1: For State, City, or Local Tax Department
RECIPIENT’S COPY
Copy B: To be filed with Recipient’sTax ReturnState 2: To be filed with Recipient’s State, City, or Local Income Tax Return
Form 1099-MISC
Cat. No. 14425J
Miscellaneous Income
Copy AFor
Internal Revenue Service Center
Department of the Treasury - Internal Revenue Service
File with Form 1096.
OMB No. 1545-0115
For Privacy Act and Paperwork
Reduction Act Notice, see the
Instructions for
Certain Information
Returns.
9595 VOID CORRECTEDPAYER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
PAYER’S federal identi�cation number RECIPIENT’S identi�cation number
RECIPIENT’S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions) FATCA �ling requirement
2nd TIN not.
1 Rents
$2 Royalties
$3 Other income
$4 Federal income tax withheld
$5 Fishing boat proceeds
$
6 Medical and health care payments
$7 Nonemployee compensation
$
8 Substitute payments in lieu of dividends or interest
$9 Payer made direct sales of
$5,000 or more of consumer products to a buyer (recipient) for resale �
10 Crop insurance proceeds
$11 12
13 Excess golden parachute payments
$
14 Gross proceeds paid to an attorney
$15a Section 409A deferrals
$
15b Section 409A income
$
16 State tax withheld
$$
17 State/Payer’s state no. 18 State income
$$
Form 1099-MISC www.irs.gov/form1099misc
Do Not C ut or S e pa ra t e F orms on T his P a ge — Do Not C ut or S e pa ra t e F orms on T his P a ge
Form 1099-MISC
Cat. No. 14425J
Miscellaneous Income
Copy AFor
Internal Revenue Service Center
Department of the Treasury - Internal Revenue Service
File with Form 1096.
OMB No. 1545-0115
For Privacy Act and Paperwork
Reduction Act Notice, see the
Instructions for
Certain Information
Returns.
9595 VOID CORRECTEDPAYER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
PAYER’S federal identi�cation number RECIPIENT’S identi�cation number
RECIPIENT’S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions) FATCA �ling requirement
2nd TIN not.
1 Rents
$2 Royalties
$3 Other income
$4 Federal income tax withheld
$5 Fishing boat proceeds
$
6 Medical and health care payments
$7 Nonemployee compensation
$
8 Substitute payments in lieu of dividends or interest
$9 Payer made direct sales of
$5,000 or more of consumer products to a buyer (recipient) for resale �
10 Crop insurance proceeds
$11 12
13 Excess golden parachute payments
$
14 Gross proceeds paid to an attorney
$15a Section 409A deferrals
$
15b Section 409A income
$
16 State tax withheld
$$
17 State/Payer’s state no. 18 State income
$$
Form 1099-MISC www.irs.gov/form1099misc
Do Not C ut or S e pa ra t e F orms on T his P a ge — Do Not C ut or S e pa ra t e F orms on T his P a ge
Form 1099-MISC
Miscellaneous Income
Copy 1For State Tax
Department
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0115VOID CORRECTED
PAYER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
PAYER’S federal identi�cation number RECIPIENT’S identi�cation number
RECIPIENT’S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions) FATCA �ling requirement
1 Rents
$2 Royalties
$3 Other income
$4 Federal income tax withheld
$5 Fishing boat proceeds
$
6 Medical and health care payments
$7 Nonemployee compensation
$
8 Substitute payments in lieu of dividends or interest
$9 Payer made direct sales of
$5,000 or more of consumer products to a buyer (recipient) for resale �
10 Crop insurance proceeds
$11 12
13 Excess golden parachute payments
$
14 Gross proceeds paid to an attorney
$15a Section 409A deferrals
$
15b Section 409A income
$
16 State tax withheld
$$
17 State/Payer’s state no. 18 State income
$$
Form 1099-MISC www.irs.gov/form1099misc
Form 1099-MISC
Miscellaneous Income
Copy 1For State Tax
Department
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0115VOID CORRECTED
PAYER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
PAYER’S federal identi�cation number RECIPIENT’S identi�cation number
RECIPIENT’S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions) FATCA �ling requirement
1 Rents
$2 Royalties
$3 Other income
$4 Federal income tax withheld
$5 Fishing boat proceeds
$
6 Medical and health care payments
$7 Nonemployee compensation
$
8 Substitute payments in lieu of dividends or interest
$9 Payer made direct sales of
$5,000 or more of consumer products to a buyer (recipient) for resale �
10 Crop insurance proceeds
$11 12
13 Excess golden parachute payments
$
14 Gross proceeds paid to an attorney
$15a Section 409A deferrals
$
15b Section 409A income
$
16 State tax withheld
$$
17 State/Payer’s state no. 18 State income
$$
Form 1099-MISC www.irs.gov/form1099misc
Form 1099-MISC
Miscellaneous Income
Copy BFor Recipient
Department of the Treasury - Internal Revenue Service
This is important tax information and is being furnished to
the Internal Revenue Service. If you are
required to �le 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.
OMB No. 1545-0115CORRECTED (if checked)
PAYER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
PAYER’S federal identi�cation number RECIPIENT’S identi�cation number
RECIPIENT’S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions) FATCA �ling requirement
1 Rents
$2 Royalties
$3 Other income
$4 Federal income tax withheld
$5 Fishing boat proceeds
$
6 Medical and health care payments
$7 Nonemployee compensation
$
8 Substitute payments in lieu of dividends or interest
$9 Payer made direct sales of
$5,000 or more of consumer products to a buyer (recipient) for resale �
10 Crop insurance proceeds
$11 12
13 Excess golden parachute payments
$
14 Gross proceeds paid to an attorney
$15a Section 409A deferrals
$
15b Section 409A income
$
16 State tax withheld
$$
17 State/Payer’s state no. 18 State income
$$
Form 1099-MISC (keep for your records) www.irs.gov/form1099misc
Form 1099-MISC
Miscellaneous Income
Copy BFor Recipient
Department of the Treasury - Internal Revenue Service
This is important tax information and is being furnished to
the Internal Revenue Service. If you are
required to �le 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.
OMB No. 1545-0115CORRECTED (if checked)
PAYER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
PAYER’S federal identi�cation number RECIPIENT’S identi�cation number
RECIPIENT’S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions) FATCA �ling requirement
1 Rents
$2 Royalties
$3 Other income
$4 Federal income tax withheld
$5 Fishing boat proceeds
$
6 Medical and health care payments
$7 Nonemployee compensation
$
8 Substitute payments in lieu of dividends or interest
$9 Payer made direct sales of
$5,000 or more of consumer products to a buyer (recipient) for resale �
10 Crop insurance proceeds
$11 12
13 Excess golden parachute payments
$
14 Gross proceeds paid to an attorney
$15a Section 409A deferrals
$
15b Section 409A income
$
16 State tax withheld
$$
17 State/Payer’s state no. 18 State income
$$
Form 1099-MISC (keep for your records) www.irs.gov/form1099misc
#MISREC08RB
Form 1099-MISC
Miscellaneous Income
Copy 2
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0115CORRECTED (if checked)
PAYER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
PAYER’S federal identi�cation number RECIPIENT’S identi�cation number
RECIPIENT’S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions) FATCA �ling requirement
1 Rents
$2 Royalties
$3 Other income
$4 Federal income tax withheld
$5 Fishing boat proceeds
$
6 Medical and health care payments
$7 Nonemployee compensation
$
8 Substitute payments in lieu of dividends or interest
$9 Payer made direct sales of
$5,000 or more of consumer products to a buyer (recipient) for resale �
10 Crop insurance proceeds
$11 12
13 Excess golden parachute payments
$
14 Gross proceeds paid to an attorney
$15a Section 409A deferrals
$
15b Section 409A income
$
16 State tax withheld
$$
17 State/Payer’s state no. 18 State income
$$
Form 1099-MISC www.irs.gov/form1099misc
To be �led with recipient's state
income tax return, when required.
Form 1099-MISC
Miscellaneous Income
Copy 2
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0115CORRECTED (if checked)
PAYER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
PAYER’S federal identi�cation number RECIPIENT’S identi�cation number
RECIPIENT’S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions) FATCA �ling requirement
1 Rents
$2 Royalties
$3 Other income
$4 Federal income tax withheld
$5 Fishing boat proceeds
$
6 Medical and health care payments
$7 Nonemployee compensation
$
8 Substitute payments in lieu of dividends or interest
$9 Payer made direct sales of
$5,000 or more of consumer products to a buyer (recipient) for resale �
10 Crop insurance proceeds
$11 12
13 Excess golden parachute payments
$
14 Gross proceeds paid to an attorney
$15a Section 409A deferrals
$
15b Section 409A income
$
16 State tax withheld
$$
17 State/Payer’s state no. 18 State income
$$
Form 1099-MISC www.irs.gov/form1099misc
To be �led with recipient's state
income tax return, when required.
Form 1099-MISC
Miscellaneous Income
Copy CFor Payer
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0115
For Privacy Act and Paperwork
Reduction Act Notice, see the
2015 General Instructions for
Certain Information
Returns.
VOID CORRECTEDPAYER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
PAYER’S federal identi�cation number RECIPIENT’S identi�cation number
RECIPIENT’S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions) FATCA �ling requirement
2nd TIN not.
1 Rents
$2 Royalties
$3 Other income
$4 Federal income tax withheld
$5 Fishing boat proceeds
$
6 Medical and health care payments
$7 Nonemployee compensation
$
8 Substitute payments in lieu of dividends or interest
$9 Payer made direct sales of
$5,000 or more of consumer products to a buyer (recipient) for resale �
10 Crop insurance proceeds
$11 12
13 Excess golden parachute payments
$
14 Gross proceeds paid to an attorney
$15a Section 409A deferrals
$
15b Section 409A income
$
16 State tax withheld
$$
17 State/Payer’s state no. 18 State income
$$
Form 1099-MISC www.irs.gov/form1099misc
Form 1099-MISC
Miscellaneous Income
Copy CFor Payer
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0115
For Privacy Act and Paperwork
Reduction Act Notice, see the
2015 General Instructions for
Certain Information
Returns.
VOID CORRECTEDPAYER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
PAYER’S federal identi�cation number RECIPIENT’S identi�cation number
RECIPIENT’S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions) FATCA �ling requirement
2nd TIN not.
1 Rents
$2 Royalties
$3 Other income
$4 Federal income tax withheld
$5 Fishing boat proceeds
$
6 Medical and health care payments
$7 Nonemployee compensation
$
8 Substitute payments in lieu of dividends or interest
$9 Payer made direct sales of
$5,000 or more of consumer products to a buyer (recipient) for resale �
10 Crop insurance proceeds
$11 12
13 Excess golden parachute payments
$
14 Gross proceeds paid to an attorney
$15a Section 409A deferrals
$
15b Section 409A income
$
16 State tax withheld
$$
17 State/Payer’s state no. 18 State income
$$
Form 1099-MISC www.irs.gov/form1099misc
Do Not Staple 6969
Form 1096Department of the Treasury Internal Revenue Service
Annual Summary and Transmittal of U.S. Information Returns
OMB No. 1545-0108
FILER'S name
Street address (including room or suite number)
City or town, state or province, country, and ZIP or foreign postal code
Name of person to contact Telephone number
Email address Fax number
For O�cial Use Only
1 Employer identi�cation number 2 Social security number 3 Total number of forms 4 Federal income tax withheld
$
5 Total amount reported with this Form 1096
$6 Enter an “X” in only one box below to indicate the type of form being �led.
W-2G 32
1097-BTC 50
1098 81
1098-C 78
1098-E 84
1098-Q 74
1098-T 83
1099-A 80
1099-B 79
1099-C 85
1099-CAP 73
1099-DIV 91
1099-G 86
1099-INT 92
1099-K 10
1099-LTC 93
1099-MISC 95
1099-OID 96
1099-PATR 97
1099-Q 31
1099-R 98
1099-S 75
1099-SA 94
3921 25
3922 26
5498 28
5498-ESA 72
5498-SA 27
7 If this is your �nal return , enter an “X” here . . . . . �
Return this entire page to the Internal Revenue Service. Photocopies are not acceptable.
Under penalties of perjury, I declare that I have examined this return and accompanying documents, and, to the best of my knowledge and belief, they are true, correct, and complete.
Signature � Title � Date �
InstructionsFuture developments. For the latest information about developments related to Form 1096, such as legislation enacted after it was published, go to www.irs.gov/form1096.Reminder. The only acceptable method of �ling information returns with Internal Revenue Service/Information Returns Branch is electronically through the FIRE system. See Pub. 1220, Speci�cations for Electronic Filing of Forms 1097, 1098, 1099, 3921, 3922, 5498, and W-2G.Purpose of form. Use this form to transmit paper Forms 1097, 1098, 1099, 3921, 3922, 5498, and W-2G to the Internal Revenue Service. Do not use Form 1096 to transmit electronically. For electronic submissions, see Pub. 1220.Caution. If you are required to �le 250 or more information returns of any one type, you must �le electronically. If you are required to �le electronically but fail to do so, and you do not have an approved waiver, you may be subject to a penalty. For more information, see part F in the 2015 General Instructions for Certain Information Returns.Who must �le. The name, address, and TIN of the �ler on this form must be the same as those you enter in the upper left area of Forms 1097, 1098, 1099, 3921, 3922, 5498, or W-2G. A �ler is any person or entity who �les any of the forms shown in line 6 above.
Enter the �ler’s name, address (including room, suite, or other unit number), and TIN in the spaces provided on the form.
When to �le. File Form 1096 as follows.• With Forms 1097, 1098, 1099, 3921, 3922, or W-2G, file by February 29, 2016.• With Forms 5498, file by May 31, 2016.
Where To FileSend all information returns �led on paper with Form 1096 to the following.
If your principal business, o�ce or agency, or legal residence in
the case of an individual, is located in
Use the following three-line address
� �
Alabama, Arizona, Arkansas, Connecticut, Delaware, Florida, Georgia, Kentucky, Louisiana, Maine, Massachusetts, Mississippi, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Pennsylvania, Rhode Island, Texas, Vermont, Virginia, West Virginia
Department of the Treasury Internal Revenue Service Center
Austin, TX 73301
Cat. No. 14400O Form 1096
1099-MISC Form Parts Description
www.W2Mate.com • 1-800-507-1992 77
Most Popular Preprinted 1099 Forms• IRS - compliant forms guaranteed compatible with
W2 Mate or your 1099 filing Software
• Each 8½” x 11” sheet is developed in compliance with IRS regulations
• Order the quantity equal to the number of recipients for which you file
• Payments of Dividends and Capital Gains
Item Number Description Envelope
DIVFED08RB 1099-DIV Federal Copy A –DIVREC08RB 1099-DIV Recipient Copy B 10992UPENVRB
DIVPAY08RB 1099-DIV Payer Copy C –
• Distributions from Pensions, Annuities, etc.
Item Number Description Envelope
RFED08RB 1099-R Federal Copy A –RREC08RB 1099-R Recipient Copy B 10992UPENVRB
RPAY08RB 1099-R Recipient File Copy C –R1D08RB 1099-R State Copy 1/Payer Copy D –R208RB 1099-R Recipient State Copy 2 10992UPENVRB
1099-DIV Forms
1099-R Forms
1099-INT Forms• Payments of Interest Income
Item Number Description Envelope
INTFED08RB 1099-INT Federal Copy A –INTREC08RB 1099-INT Recipient Copy B
INTPAY08RB 1099-INT Payer Copy C –
1099-INT Federal Copy A
#INTFED08RB
1099-DIV Federal Copy A
#DIVFED08RB
1099-R Federal Copy A
#RFED08RB1099-R Recipient Copy B#RREC08RB
1099-R Recipient File Copy C
#RPAY08RB
1099-DIV Recipient Copy B
#DIVREC08RB
1099-INT Recipient Copy B
#INTREC08RB
1099-DIV Payer Copy C
#DIVPAY08RB
1099-INT Payer Copy C
#INTPAY08RB
1099-INT / 1099-DIV / 1099-R Forms
Form 1099-INT
Cat. No. 14410K
Interest Income
Copy A
For Internal Revenue
Service Center
Department of the Treasury - Internal Revenue Service
File with Form 1096.
OMB No. 1545-0112
For Privacy Act and Paperwork
Reduction Act Notice, see the
2016 General Instructions for
Certain Information
Returns.
9292 VOID CORRECTEDPAYER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
PAYER’S federal identi�cation number RECIPIENT’S identi�cation number
RECIPIENT’S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
FATCA �ling requirement
Account number (see instructions) 2nd TIN not.
Payer's RTN (optional)
1 Interest income
$2 Early withdrawal penalty
$3 Interest on U.S. Savings Bonds and Treas. obligations
$4 Federal income tax withheld
$5 Investment expenses
$6 Foreign tax paid
$7 Foreign country or U.S. possession
8 Tax-exempt interest
$
9 Speci�ed private activity bond interest
$10 Market discount
$
11 Bond premium
$12 Bond premium on Treasury obligations
$13 Bond premium on tax–exempt bond
$14 Tax-exempt and tax credit
bond CUSIP no.15 State 16 State identi�cation no. 17 State tax withheld
$$
Form 1099-INT www.irs.gov/form1099int
Do Not C ut or S e pa ra t e F orms on T his P a ge — Do Not C ut or S e pa ra t e F orms on T his P a ge
Form 1099-INT
Cat. No. 14410K
Interest Income
Copy A
For Internal Revenue
Service Center
Department of the Treasury - Internal Revenue Service
File with Form 1096.
OMB No. 1545-0112
For Privacy Act and Paperwork
Reduction Act Notice, see the
2016 General Instructions for
Certain Information
Returns.
9292 VOID CORRECTEDPAYER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
PAYER’S federal identi�cation number RECIPIENT’S identi�cation number
RECIPIENT’S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
FATCA �ling requirement
Account number (see instructions) 2nd TIN not.
Payer's RTN (optional)
1 Interest income
$2 Early withdrawal penalty
$3 Interest on U.S. Savings Bonds and Treas. obligations
$4 Federal income tax withheld
$5 Investment expenses
$6 Foreign tax paid
$7 Foreign country or U.S. possession
8 Tax-exempt interest
$
9 Speci�ed private activity bond interest
$10 Market discount
$
11 Bond premium
$12 Bond premium on Treasury obligations
$13 Bond premium on tax–exempt bond
$14 Tax-exempt and tax credit
bond CUSIP no.15 State 16 State identi�cation no. 17 State tax withheld
$$
Form 1099-INT www.irs.gov/form1099int
Do Not C ut or S e pa ra t e F orms on T his P a ge — Do Not C ut or S e pa ra t e F orms on T his P a ge
Form 1099-INT
Interest Income
Copy B
For Recipient
Department of the Treasury - Internal Revenue Service
This is important tax information and is
being furnished to the Internal Revenue
Service. If you are required to �le 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.
OMB No. 1545-0112
CORRECTED (if checked)PAYER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
PAYER’S federal identi�cation number RECIPIENT’S identi�cation number
RECIPIENT’S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
FATCA �ling requirement
Account number (see instructions)
Payer's RTN (optional)
1 Interest income
$2 Early withdrawal penalty
$3 Interest on U.S. Savings Bonds and Treas. obligations
$4 Federal income tax withheld
$5 Investment expenses
$6 Foreign tax paid
$7 Foreign country or U.S. possession
8 Tax-exempt interest
$
9 Speci�ed private activity bond interest
$10 Market discount
$
11 Bond premium
$12 Bond premium on Treasury obligations
$13 Bond premium on tax-exempt bond
$14 Tax-exempt and tax credit
bond CUSIP no.15 State 16 State identi�cation no. 17 State tax withheld
$$
Form 1099-INT (keep for your records) www.irs.gov/form1099int
Form 1099-INT
Interest Income
Copy B
For Recipient
Department of the Treasury - Internal Revenue Service
This is important tax information and is
being furnished to the Internal Revenue
Service. If you are required to �le a
return, a negligence penalty or other
sanction may be imposed on you if
this income is taxable and the IRS
determines that it has not been reported.
OMB No. 1545-0112
CORRECTED (if checked)PAYER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
PAYER’S federal identi�cation number RECIPIENT’S identi�cation number
RECIPIENT’S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
FATCA �ling requirement
Account number (see instructions)
Payer's RTN (optional)
1 Interest income
$2 Early withdrawal penalty
$3 Interest on U.S. Savings Bonds and Treas. obligations
$4 Federal income tax withheld
$5 Investment expenses
$6 Foreign tax paid
$7 Foreign country or U.S. possession
8 Tax-exempt interest
$
9 Speci�ed private activity bond interest
$10 Market discount
$
11 Bond premium
$12 Bond premium on Treasury obligations
$13 Bond premium on tax-exempt bond
$14 Tax-exempt and tax credit
bond CUSIP no.15 State 16 State identi�cation no. 17 State tax withheld
$$
Form 1099-INT (keep for your records) www.irs.gov/form1099int
Form 1099-INT
Interest Income
Copy C
For Payer
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0112
For Privacy Act and Paperwork
Reduction Act Notice, see the
2016 General Instructions for
Certain Information
Returns.
VOID CORRECTEDPAYER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
PAYER’S federal identi�cation number RECIPIENT’S identi�cation number
RECIPIENT’S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
FATCA �ling requirement
Account number (see instructions) 2nd TIN not.
Payer's RTN (optional)
1 Interest income
$2 Early withdrawal penalty
$3 Interest on U.S. Savings Bonds and Treas. obligations
$4 Federal income tax withheld
$5 Investment expenses
$6 Foreign tax paid
$7 Foreign country or U.S. possession
8 Tax-exempt interest
$
9 Speci�ed private activity bond interest
$10 Market discount
$
11 Bond premium
$12 Bond premium on Treasury obligations
$13 Bond premium on tax-exempt bond
$14 Tax-exempt and tax credit
bond CUSIP no.15 State 16 State identi�cation no. 17 State tax withheld
$$
Form 1099-INT www.irs.gov/form1099int
Form 1099-INT
Interest Income
Copy C
For Payer
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0112
For Privacy Act and Paperwork
Reduction Act Notice, see the
2016 General Instructions for
Certain Information
Returns.
VOID CORRECTEDPAYER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
PAYER’S federal identi�cation number RECIPIENT’S identi�cation number
RECIPIENT’S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
FATCA �ling requirement
Account number (see instructions) 2nd TIN not.
Payer's RTN (optional)
1 Interest income
$2 Early withdrawal penalty
$3 Interest on U.S. Savings Bonds and Treas. obligations
$4 Federal income tax withheld
$5 Investment expenses
$6 Foreign tax paid
$7 Foreign country or U.S. possession
8 Tax-exempt interest
$
9 Speci�ed private activity bond interest
$10 Market discount
$
11 Bond premium
$12 Bond premium on Treasury obligations
$13 Bond premium on tax-exempt bond
$14 Tax-exempt and tax credit
bond CUSIP no.15 State 16 State identi�cation no. 17 State tax withheld
$$
Form 1099-INT www.irs.gov/form1099int
Form 1099-DIV
Cat. No. 14415N
Dividends and Distributions
Copy AFor
Internal Revenue Service Center
Department of the Treasury - Internal Revenue Service
File with Form 1096.
OMB No. 1545-0110
For Privacy Act and Paperwork
Reduction Act Notice, see the
2016 General Instructions for
Certain Information
Returns.
9191 VOID CORRECTEDPAYER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
PAYER’S federal identi�cation number RECIPIENT’S identi�cation number
RECIPIENT’S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
FATCA �ling requirement
Account number (see instructions) 2nd TIN not.
1a Total ordinary dividends
$ 1b Quali�ed dividends
$ 2a Total capital gain distr.
$ 2b Unrecap. Sec. 1250 gain
$ 2c Section 1202 gain
$
2d Collectibles (28%) gain
$ 3 Nondividend distributions
$ 4 Federal income tax withheld
$ 5 Investment expenses
$ 6 Foreign tax paid
$
7 Foreign country or U.S. possession
8 Cash liquidation distributions
$ 9 Noncash liquidation distributions
$ 10 Exempt-interest dividends
$
11 Speci�ed private activity bond interest dividends
$ 12 State 13 State identi�cation no. 14 State tax withheld
$ $
Form 1099-DIV www.irs.gov/form1099div
Do Not Cut or Separate Forms on This Page — Do Not Cut or Separate Forms on This Page
Form 1099-DIV
Cat. No. 14415N
Dividends and Distributions
Copy AFor
Internal Revenue Service Center
Department of the Treasury - Internal Revenue Service
File with Form 1096.
OMB No. 1545-0110
For Privacy Act and Paperwork
Reduction Act Notice, see the
2016 General Instructions for
Certain Information
Returns.
9191 VOID CORRECTEDPAYER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
PAYER’S federal identi�cation number RECIPIENT’S identi�cation number
RECIPIENT’S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
FATCA �ling requirement
Account number (see instructions) 2nd TIN not.
1a Total ordinary dividends
$ 1b Quali�ed dividends
$ 2a Total capital gain distr.
$ 2b Unrecap. Sec. 1250 gain
$ 2c Section 1202 gain
$
2d Collectibles (28%) gain
$ 3 Nondividend distributions
$ 4 Federal income tax withheld
$ 5 Investment expenses
$ 6 Foreign tax paid
$
7 Foreign country or U.S. possession
8 Cash liquidation distributions
$ 9 Noncash liquidation distributions
$ 10 Exempt-interest dividends
$
11 Speci�ed private activity bond interest dividends
$ 12 State 13 State identi�cation no. 14 State tax withheld
$ $
Form 1099-DIV www.irs.gov/form1099div
Do Not Cut or Separate Forms on This Page — Do Not Cut or Separate Forms on This Page
Form 1099-INT
Interest Income
Copy B
For Recipient
Department of the Treasury - Internal Revenue Service
This is important tax information and is
being furnished to the Internal Revenue
Service. If you are required to �le 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.
OMB No. 1545-0112
CORRECTED (if checked)PAYER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
PAYER’S federal identi�cation number RECIPIENT’S identi�cation number
RECIPIENT’S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
FATCA �ling requirement
Account number (see instructions)
Payer's RTN (optional)
1 Interest income
$2 Early withdrawal penalty
$3 Interest on U.S. Savings Bonds and Treas. obligations
$4 Federal income tax withheld
$5 Investment expenses
$6 Foreign tax paid
$7 Foreign country or U.S. possession
8 Tax-exempt interest
$
9 Speci�ed private activity bond interest
$10 Market discount
$
11 Bond premium
$12 Bond premium on Treasury obligations
$13 Bond premium on tax-exempt bond
$14 Tax-exempt and tax credit
bond CUSIP no.15 State 16 State identi�cation no. 17 State tax withheld
$$
Form 1099-INT (keep for your records) www.irs.gov/form1099int
Form 1099-INT
Interest Income
Copy B
For Recipient
Department of the Treasury - Internal Revenue Service
This is important tax information and is
being furnished to the Internal Revenue
Service. If you are required to �le a
return, a negligence penalty or other
sanction may be imposed on you if
this income is taxable and the IRS
determines that it has not been reported.
OMB No. 1545-0112
CORRECTED (if checked)PAYER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
PAYER’S federal identi�cation number RECIPIENT’S identi�cation number
RECIPIENT’S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
FATCA �ling requirement
Account number (see instructions)
Payer's RTN (optional)
1 Interest income
$2 Early withdrawal penalty
$3 Interest on U.S. Savings Bonds and Treas. obligations
$4 Federal income tax withheld
$5 Investment expenses
$6 Foreign tax paid
$7 Foreign country or U.S. possession
8 Tax-exempt interest
$
9 Speci�ed private activity bond interest
$10 Market discount
$
11 Bond premium
$12 Bond premium on Treasury obligations
$13 Bond premium on tax-exempt bond
$14 Tax-exempt and tax credit
bond CUSIP no.15 State 16 State identi�cation no. 17 State tax withheld
$$
Form 1099-INT (keep for your records) www.irs.gov/form1099int
Form 1099-DIV
Dividends and Distributions
Copy C
For Payer
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0110
For Privacy Act and Paperwork
Reduction Act Notice, see the
2016 General Instructions for
Certain Information
Returns.
VOID CORRECTEDPAYER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
PAYER’S federal identi�cation number RECIPIENT’S identi�cation number
RECIPIENT’S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
FATCA �ling requirement
Account number (see instructions) 2nd TIN not.
1a Total ordinary dividends
$ 1b Quali�ed dividends
$ 2a Total capital gain distr.
$ 2b Unrecap. Sec. 1250 gain
$ 2c Section 1202 gain
$
2d Collectibles (28%) gain
$ 3 Nondividend distributions
$ 4 Federal income tax withheld
$ 5 Investment expenses
$ 6 Foreign tax paid
$
7 Foreign country or U.S. possession
8 Cash liquidation distributions
$ 9 Noncash liquidation distributions
$ 10 Exempt-interest dividends
$
11 Speci�ed private activity bond interest dividends
$ 12 State 13 State identi�cation no. 14 State tax withheld
$ $
Form 1099-DIV www.irs.gov/form1099div
Form 1099-DIV
Dividends and Distributions
Copy C
For Payer
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0110
For Privacy Act and Paperwork
Reduction Act Notice, see the
2016 General Instructions for
Certain Information
Returns.
VOID CORRECTEDPAYER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
PAYER’S federal identi�cation number RECIPIENT’S identi�cation number
RECIPIENT’S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
FATCA �ling requirement
Account number (see instructions) 2nd TIN not.
1a Total ordinary dividends
$ 1b Quali�ed dividends
$ 2a Total capital gain distr.
$ 2b Unrecap. Sec. 1250 gain
$ 2c Section 1202 gain
$
2d Collectibles (28%) gain
$ 3 Nondividend distributions
$ 4 Federal income tax withheld
$ 5 Investment expenses
$ 6 Foreign tax paid
$
7 Foreign country or U.S. possession
8 Cash liquidation distributions
$ 9 Noncash liquidation distributions
$ 10 Exempt-interest dividends
$
11 Speci�ed private activity bond interest dividends
$ 12 State 13 State identi�cation no. 14 State tax withheld
$ $
Form 1099-DIV www.irs.gov/form1099div
Form 1099-R
Cat. No. 14436Q
Distributions From Pensions, Annuities,
Retirement or Pro�t-Sharing
Plans, IRAs, Insurance
Contracts, etc.
Copy A For
Internal Revenue Service Center
File with Form 1096.
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0119
For Privacy Act and Paperwork
Reduction Act Notice, see the 2015 General
Instructions for Certain
Information Returns.
9898 VOID CORRECTEDPAYER’S name, street address, city or town, state or province, country, and ZIP or foreign postal code
PAYER’S federal identi�cation number
RECIPIENT’S identi�cation number
RECIPIENT’S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
10 Amount allocable to IRR within 5 years
$
11 1st year of desig. Roth contrib.
Account number (see instructions)
1 Gross distribution
$2a Taxable amount
$2b Taxable amount
not determinedTotal distribution
3 Capital gain (included in box 2a)
$
4 Federal income tax withheld
$5 Employee contributions
/Designated Roth contributions or insurance premiums
$
6 Net unrealized appreciation in employer’s securities
$7 Distribution code(s)
IRA/ SEP/
SIMPLE
8 Other
$ %9a Your percentage of total
distribution %
9b Total employee contributions
$12 State tax withheld
$$
13 State/Payer’s state no. 14 State distribution
$$
15 Local tax withheld
$$
16 Name of locality 17 Local distribution
$$
Form 1099-R www.irs.gov/form1099r
Do Not Cut or Separate Forms on This Page — Do Not Cut or Separate Forms on This Page
Form 1099-R
Cat. No. 14436Q
Distributions From Pensions, Annuities,
Retirement or Pro�t-Sharing
Plans, IRAs, Insurance
Contracts, etc.
Copy A For
Internal Revenue Service Center
File with Form 1096.
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0119
For Privacy Act and Paperwork
Reduction Act Notice, see the 2015 General
Instructions for Certain
Information Returns.
9898 VOID CORRECTEDPAYER’S name, street address, city or town, state or province, country, and ZIP or foreign postal code
PAYER’S federal identi�cation number
RECIPIENT’S identi�cation number
RECIPIENT’S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
10 Amount allocable to IRR within 5 years
$
11 1st year of desig. Roth contrib.
Account number (see instructions)
1 Gross distribution
$2a Taxable amount
$2b Taxable amount
not determinedTotal distribution
3 Capital gain (included in box 2a)
$
4 Federal income tax withheld
$5 Employee contributions
/Designated Roth contributions or insurance premiums
$
6 Net unrealized appreciation in employer’s securities
$7 Distribution code(s)
IRA/ SEP/
SIMPLE
8 Other
$ %9a Your percentage of total
distribution %
9b Total employee contributions
$12 State tax withheld
$$
13 State/Payer’s state no. 14 State distribution
$$
15 Local tax withheld
$$
16 Name of locality 17 Local distribution
$$
Form 1099-R www.irs.gov/form1099r
Do Not Cut or Separate Forms on This Page — Do Not Cut or Separate Forms on This Page
Form 1099-R
Distributions From Pensions, Annuities,
Retirement or Pro�t-Sharing
Plans, IRAs, Insurance
Contracts, etc.
Copy B Report this
income on your federal tax
return. If this form shows
federal income tax withheld in
box 4, attach this copy to your return.
Department of the Treasury - Internal Revenue Service
This information is being furnished to
the Internal Revenue Service.
OMB No. 1545-0119CORRECTED (if checked)
PAYER’S name, street address, city or town, state or province, country, and ZIP or foreign postal code
PAYER’S federal identi�cation number
RECIPIENT’S identi�cation number
RECIPIENT’S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
10 Amount allocable to IRR within 5 years
$
11 1st year of desig. Roth contrib.
Account number (see instructions)
1 Gross distribution
$2a Taxable amount
$2b Taxable amount
not determinedTotal distribution
3 Capital gain (included in box 2a)
$
4 Federal income tax withheld
$5 Employee contributions
/Designated Roth contributions or insurance premiums
$
6 Net unrealized appreciation in employer’s securities
$7 Distribution code(s)
IRA/ SEP/
SIMPLE
8 Other
$ %9a Your percentage of total
distribution %
9b Total employee contributions
$12 State tax withheld
$$
13 State/Payer’s state no. 14 State distribution
$$
15 Local tax withheld
$$
16 Name of locality 17 Local distribution
$$
Form 1099-R www.irs.gov/form1099r
Form 1099-R
Distributions From Pensions, Annuities,
Retirement or Pro�t-Sharing
Plans, IRAs, Insurance
Contracts, etc.
Copy B Report this
income on your federal tax
return. If this form shows
federal income tax withheld in
box 4, attach this copy to your return.
Department of the Treasury - Internal Revenue Service
This information is being furnished to
the Internal Revenue Service.
OMB No. 1545-0119CORRECTED (if checked)
PAYER’S name, street address, city or town, state or province, country, and ZIP or foreign postal code
PAYER’S federal identi�cation number
RECIPIENT’S identi�cation number
RECIPIENT’S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
10 Amount allocable to IRR within 5 years
$
11 1st year of desig. Roth contrib.
Account number (see instructions)
1 Gross distribution
$2a Taxable amount
$2b Taxable amount
not determinedTotal distribution
3 Capital gain (included in box 2a)
$
4 Federal income tax withheld
$5 Employee contributions
/Designated Roth contributions or insurance premiums
$
6 Net unrealized appreciation in employer’s securities
$7 Distribution code(s)
IRA/ SEP/
SIMPLE
8 Other
$ %9a Your percentage of total
distribution %
9b Total employee contributions
$12 State tax withheld
$$
13 State/Payer’s state no. 14 State distribution
$$
15 Local tax withheld
$$
16 Name of locality 17 Local distribution
$$
Form 1099-R www.irs.gov/form1099r
Form 1099-R
Distributions From Pensions, Annuities,
Retirement or Pro�t-Sharing
Plans, IRAs, Insurance
Contracts, etc.
Copy C For Recipient's
Records
Department of the Treasury - Internal Revenue Service
This information is being furnished to
the Internal Revenue Service.
OMB No. 1545-0119CORRECTED (if checked)
PAYER’S name, street address, city or town, state or province, country, and ZIP or foreign postal code
PAYER’S federal identi�cation number
RECIPIENT’S identi�cation number
RECIPIENT’S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
10 Amount allocable to IRR within 5 years
$
11 1st year of desig. Roth contrib.
Account number (see instructions)
1 Gross distribution
$2a Taxable amount
$2b Taxable amount
not determinedTotal distribution
3 Capital gain (included in box 2a)
$
4 Federal income tax withheld
$5 Employee contributions
/Designated Roth contributions or insurance premiums
$
6 Net unrealized appreciation in employer’s securities
$7 Distribution code(s)
IRA/ SEP/
SIMPLE
8 Other
$ %9a Your percentage of total
distribution %
9b Total employee contributions
$12 State tax withheld
$$
13 State/Payer’s state no. 14 State distribution
$$
15 Local tax withheld
$$
16 Name of locality 17 Local distribution
$$
Form 1099-R (keep for your records) www.irs.gov/form1099r
Form 1099-R
Distributions From Pensions, Annuities,
Retirement or Pro�t-Sharing
Plans, IRAs, Insurance
Contracts, etc.
Copy C For Recipient's
Records
Department of the Treasury - Internal Revenue Service
This information is being furnished to
the Internal Revenue Service.
OMB No. 1545-0119CORRECTED (if checked)
PAYER’S name, street address, city or town, state or province, country, and ZIP or foreign postal code
PAYER’S federal identi�cation number
RECIPIENT’S identi�cation number
RECIPIENT’S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
10 Amount allocable to IRR within 5 years
$
11 1st year of desig. Roth contrib.
Account number (see instructions)
1 Gross distribution
$2a Taxable amount
$2b Taxable amount
not determinedTotal distribution
3 Capital gain (included in box 2a)
$
4 Federal income tax withheld
$5 Employee contributions
/Designated Roth contributions or insurance premiums
$
6 Net unrealized appreciation in employer’s securities
$7 Distribution code(s)
IRA/ SEP/
SIMPLE
8 Other
$ %9a Your percentage of total
distribution %
9b Total employee contributions
$12 State tax withheld
$$
13 State/Payer’s state no. 14 State distribution
$$
15 Local tax withheld
$$
16 Name of locality 17 Local distribution
$$
Form 1099-R (keep for your records) www.irs.gov/form1099r
10992UPENVRB
Your reliable source for Payroll Software, W2/1099 Software and tax forms.88
Most Popular Preprinted 1099 Forms• IRS - compliant forms guaranteed compatible with
W2 Mate or your 1099 filing Software
• Each 8½” x 11” sheet is developed in compliance with IRS regulations
• Order the quantity equal to the number of recipients for which you file
• Tuition Statement
Item Number Description Envelope
1098TFED08RB 1098-T Federal Copy A –1098TREC08RB 1098-T Recipient Copy B 3UPENVRB
1098TPAY08RB 1098-T Payer Copy C –
1098-T Forms
1098 Forms
1099-S Forms• Proceeds from Real Estate Transactions
Item Number Description Envelope
SFED08RB 1099-S Federal Copy A –SREC08RB 1099-S Recipient Copy B 3UPENVRB
SPAY08RB 1099-S Payer Copy C –
1098-T Federal Copy A
1098 Federal Copy A 1098 Recipient
Copy B#1098REC08RB
1098 Payer Copy C
#1098PAY08RB
Copy B
#1098TREC08RB
1099-S RecipientCopy B
#SREC08RB
1098-T Pay reCopy C
#1098TPAY08RB
1099-S Payer Copy C
#SPAY08RB
1099-S FederalCopy A
#SFED08RB
• Mortgage Interest Statement
Item Number Description Envelope
1098FED08RB 1098 Federal Copy A –1098REC08RB 1098 Recipient Copy B 10992UPNVRB
1098PAY08RB 1098 Payer Copy C –
1099-S / 1098-T / 1098 Forms
Form 1099-S
Proceeds From Real Estate Transactions
OMB No. 1545-0997
Copy AFor
Internal Revenue Service Center
File with Form 1096. For Privacy Act and Paperwork
Reduction Act Notice, see the
2016 General Instructions for
Certain Information
Returns.
7575 VOID CORRECTED
Form 1099-S Cat. No. 64292E www.irs.gov/form1099s Department of the Treasury - Internal Revenue Service
FILER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number
TRANSFEROR'S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account or escrow number (see instructions)
1 Date of closing
2 Gross proceeds
$3 Address or legal description (including city, state, and ZIP code)
4 Check here if the transferor received or will receive property or services as part of the consideration
5 Buyer's part of real estate tax
$
Do Not C ut or S epa ra t e F orms on T his P a ge — Do Not C ut or S epa ra t e F orms on T his P a ge
Form 1099-S
Proceeds From Real Estate Transactions
OMB No. 1545-0997
Copy AFor
Internal Revenue Service Center
File with Form 1096. For Privacy Act and Paperwork
Reduction Act Notice, see the
2016 General Instructions for
Certain Information
Returns.
7575 VOID CORRECTED
Form 1099-S Cat. No. 64292E www.irs.gov/form1099s Department of the Treasury - Internal Revenue Service
FILER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number
TRANSFEROR'S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account or escrow number (see instructions)
1 Date of closing
2 Gross proceeds
$3 Address or legal description (including city, state, and ZIP code)
4 Check here if the transferor received or will receive property or services as part of the consideration
5 Buyer's part of real estate tax
$
Do Not C ut or S epa ra t e F orms on T his P a ge — Do Not C ut or S epa ra t e F orms on T his P a ge
Form 1099-S
Proceeds From Real Estate Transactions
OMB No. 1545-0997
Copy AFor
Internal Revenue Service Center
File with Form 1096. For Privacy Act and Paperwork
Reduction Act Notice, see the
2016 General Instructions for
Certain Information
Returns.
7575 VOID CORRECTED
Form 1099-S Cat. No. 64292E www.irs.gov/form1099s Department of the Treasury - Internal Revenue Service
FILER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number
TRANSFEROR'S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account or escrow number (see instructions)
1 Date of closing
2 Gross proceeds
$3 Address or legal description (including city, state, and ZIP code)
4 Check here if the transferor received or will receive property or services as part of the consideration
5 Buyer's part of real estate tax
$
Do Not C ut or S epa ra t e F orms on T his P a ge — Do Not C ut or S epa ra t e F orms on T his P a ge
Form 1099-S
Proceeds From Real Estate Transactions
OMB No. 1545-0997
Copy BFor Transferor
This is important tax information and is being furnished to the Internal Revenue Service. If you
return, a negligence penalty or other
sanction may be imposed on you if this item is required to be reported and the IRS
determines that it has not been reported.
CORRECTED (if checked)
Department of the Treasury - Internal Revenue Servicewww.irs.gov/form1099s
FILER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number
TRANSFEROR'S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account or escrow number (see instructions)
1 Date of closing
2 Gross proceeds
$3 Address or legal description
4 Transferor received or will receive property or services as part of the consideration (if checked) . . .
5 Buyer's part of real estate tax
$Form 1099-S (keep for your records)
Form 1099-S
Proceeds From Real Estate Transactions
OMB No. 1545-0997
Copy BFor Transferor
This is important tax information and is being furnished to the Internal Revenue Service. If you
return, a negligence penalty or other
sanction may be imposed on you if this item is required to be reported and the IRS
determines that it has not been reported.
CORRECTED (if checked)
Department of the Treasury - Internal Revenue Servicewww.irs.gov/form1099s
FILER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number
TRANSFEROR'S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account or escrow number (see instructions)
1 Date of closing
2 Gross proceeds
$3 Address or legal description
4 Transferor received or will receive property or services as part of the consideration (if checked) . . .
5 Buyer's part of real estate tax
$Form 1099-S (keep for your records)
Form 1099-S
Proceeds From Real Estate Transactions
OMB No. 1545-0997
Copy BFor Transferor
This is important tax information and is being furnished to the Internal Revenue Service. If you
return, a negligence penalty or other
sanction may be imposed on you if this item is required to be reported and the IRS
determines that it has not been reported.
CORRECTED (if checked)
Department of the Treasury - Internal Revenue Servicewww.irs.gov/form1099s
FILER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number
TRANSFEROR'S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account or escrow number (see instructions)
1 Date of closing
2 Gross proceeds
$3 Address or legal description
4 Transferor received or will receive property or services as part of the consideration (if checked) . . .
5 Buyer's part of real estate tax
$Form 1099-S (keep for your records)
Form 1099-S
Proceeds From Real Estate Transactions
OMB No. 1545-0997
Copy CFor Filer
For Privacy Act and Paperwork
Reduction Act Notice, see the
Instructions for Certain
Information Returns.
VOID CORRECTED
Department of the Treasury - Internal Revenue Servicewww.irs.gov/form1099s
FILER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number
TRANSFEROR'S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account or escrow number (see instructions)
1 Date of closing
2 Gross proceeds
$3 Address or legal description (including city, state, and ZIP code)
4 Check here if the transferor received or will receive property or services as part of the consideration
5 Buyer's part of real estate tax
$Form 1099-S
Form 1099-S
Proceeds From Real Estate Transactions
OMB No. 1545-0997
Copy CFor Filer
For Privacy Act and Paperwork
Reduction Act Notice, see the
Instructions for Certain
Information Returns.
VOID CORRECTED
Department of the Treasury - Internal Revenue Servicewww.irs.gov/form1099s
FILER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number
TRANSFEROR'S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account or escrow number (see instructions)
1 Date of closing
2 Gross proceeds
$3 Address or legal description (including city, state, and ZIP code)
4 Check here if the transferor received or will receive property or services as part of the consideration
5 Buyer's part of real estate tax
$Form 1099-S
Form 1099-S
Proceeds From Real Estate Transactions
OMB No. 1545-0997
Copy CFor Filer
For Privacy Act and Paperwork
Reduction Act Notice, see the
Instructions for Certain
Information Returns.
VOID CORRECTED
Department of the Treasury - Internal Revenue Servicewww.irs.gov/form1099s
FILER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number
TRANSFEROR'S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account or escrow number (see instructions)
1 Date of closing
2 Gross proceeds
$3 Address or legal description (including city, state, and ZIP code)
4 Check here if the transferor received or will receive property or services as part of the consideration
5 Buyer's part of real estate tax
$Form 1099-S
1098-T Recipient
#1098TFED08RB
#1098FED08RB
Form 1098-T
Cat. No. 25087J
Tuition Statement
Copy AFor
Internal Revenue Service Center
Department of the Treasury - Internal Revenue Service
File with Form 1096.
OMB No. 1545-1574
For Privacy Act and Paperwork Reduction
Act Notice, see the
Instructions for Certain Information
Returns.
8383 VOID CORRECTEDFILER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number
STUDENT'S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Service Provider/Acct. No. (see instr.)
1 Payments received for
expenses
$2 Amounts billed for
related expenses
$3 Check if you have changed your
reporting method for 2016
4 Adjustments made for a prior year
$
5 Scholarships or grants
$6 Adjustments to
scholarships or grants for a prior year
$
7 Check this box if the amount in box 1 or 2 includes amounts for an academic period beginning January — March 2017
8 Check if at least
half-time student
9 Check if a graduate
student . . . .
10 Ins. contract reimb./refund
$Form 1098-T www.irs.gov/form1098tDo Not C ut or S e pa ra t e F orms on T his P a ge — Do Not C ut or S e pa ra t e F orms on T his P a ge
Form 1098-T
Cat. No. 25087J
Tuition Statement
Copy AFor
Internal Revenue Service Center
Department of the Treasury - Internal Revenue Service
File with Form 1096.
OMB No. 1545-1574
For Privacy Act and Paperwork Reduction
Act Notice, see the
Instructions for Certain Information
Returns.
8383 VOID CORRECTEDFILER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number
STUDENT'S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Service Provider/Acct. No. (see instr.)
1 Payments received for
expenses
$2 Amounts billed for
related expenses
$3 Check if you have changed your
reporting method for 2016
4 Adjustments made for a prior year
$
5 Scholarships or grants
$6 Adjustments to
scholarships or grants for a prior year
$
7 Check this box if the amount in box 1 or 2 includes amounts for an academic period beginning January — March 2017
8 Check if at least
half-time student
9 Check if a graduate
student . . . .
10 Ins. contract reimb./refund
$Form 1098-T www.irs.gov/form1098tDo Not C ut or S e pa ra t e F orms on T his P a ge — Do Not C ut or S e pa ra t e F orms on T his P a ge
Form 1098-T
Cat. No. 25087J
Tuition Statement
Copy AFor
Internal Revenue Service Center
Department of the Treasury - Internal Revenue Service
File with Form 1096.
OMB No. 1545-1574
For Privacy Act and Paperwork Reduction
Act Notice, see the
Instructions for Certain Information
Returns.
8383 VOID CORRECTEDFILER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number
STUDENT'S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Service Provider/Acct. No. (see instr.)
1 Payments received for
expenses
$2 Amounts billed for
related expenses
$3 Check if you have changed your
reporting method for 2016
4 Adjustments made for a prior year
$
5 Scholarships or grants
$6 Adjustments to
scholarships or grants for a prior year
$
7 Check this box if the amount in box 1 or 2 includes amounts for an academic period beginning January — March 2017
8 Check if at least
half-time student
9 Check if a graduate
student . . . .
10 Ins. contract reimb./refund
$Form 1098-T www.irs.gov/form1098tDo Not C ut or S e pa ra t e F orms on T his P a ge — Do Not C ut or S e pa ra t e F orms on T his P a ge
Form 1098-T
Tuition Statement
Copy BFor Student
Department of the Treasury - Internal Revenue Service
This is important tax information
and is being furnished to the
Internal Revenue Service. This form
must be used to complete Form 8863
to claim education credits. Give it to the
tax preparer or use it to prepare the tax return.
OMB No. 1545-1574CORRECTED
FILER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number
STUDENT'S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Service Provider/Acct. No. (see instr.)
1 Payments received for
expenses
$2 Amounts billed for
related expenses
$3 If this box is checked, your educational institution
has changed its reporting method for 2016
4 Adjustments made for a prior year
$
5 Scholarships or grants
$6 Adjustments to
scholarships or grants for a prior year
$
7 Checked if the amount in box 1 or 2 includes
amounts for an academic period beginning January — March 2017
8 Check if at least
half-time student
9 Checked if a graduate
student . . . .
10 Ins. contract reimb./refund
$Form 1098-T (keep for your records) www.irs.gov/form1098t
Form 1098-T
Tuition Statement
Copy BFor Student
Department of the Treasury - Internal Revenue Service
This is important tax information
and is being furnished to the
Internal Revenue Service. This form
must be used to complete Form 8863
to claim education credits. Give it to the
tax preparer or use it to prepare the tax return.
OMB No. 1545-1574CORRECTED
FILER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number
STUDENT'S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Service Provider/Acct. No. (see instr.)
1 Payments received for
expenses
$2 Amounts billed for
related expenses
$3 If this box is checked, your educational institution
has changed its reporting method for 2016
4 Adjustments made for a prior year
$
5 Scholarships or grants
$6 Adjustments to
scholarships or grants for a prior year
$
7 Checked if the amount in box 1 or 2 includes
amounts for an academic period beginning January — March 2017
8 Check if at least
half-time student
9 Checked if a graduate
student . . . .
10 Ins. contract reimb./refund
$Form 1098-T (keep for your records) www.irs.gov/form1098t
Form 1098-T
Tuition Statement
Copy BFor Student
Department of the Treasury - Internal Revenue Service
This is important tax information
and is being furnished to the
Internal Revenue Service. This form
must be used to complete Form 8863
to claim education credits. Give it to the
tax preparer or use it to prepare the tax return.
OMB No. 1545-1574CORRECTED
FILER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number
STUDENT'S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Service Provider/Acct. No. (see instr.)
1 Payments received for
expenses
$2 Amounts billed for
related expenses
$3 If this box is checked, your educational institution
has changed its reporting method for 2016
4 Adjustments made for a prior year
$
5 Scholarships or grants
$6 Adjustments to
scholarships or grants for a prior year
$
7 Checked if the amount in box 1 or 2 includes
amounts for an academic period beginning January — March 2017
8 Check if at least
half-time student
9 Checked if a graduate
student . . . .
10 Ins. contract reimb./refund
$Form 1098-T (keep for your records) www.irs.gov/form1098t
Form 1098-T
Tuition Statement
Copy CFor Filer
Department of the Treasury - Internal Revenue Service
OMB No. 1545-1574
For Privacy Act and Paperwork
Reduction Act Notice, see
the Instructions for
Certain Information Returns.
VOID CORRECTEDFILER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number
STUDENT'S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Service Provider/Acct. No. (see instr.)
1 Payments received for
expenses
$2 Amounts billed for
related expenses
$3 Check if you have changed your
reporting method for 2016
4 Adjustments made for a prior year
$
5 Scholarships or grants
$6 Adjustments to
scholarships or grants for a prior year
$
7 Check this box if the amount in box 1 or 2 includes amounts for an academic period beginning January — March 2017
8 Check if at least
half-time student
9 Check if a graduate
student . . . .
10 Ins. contract reimb./refund
$Form 1098-T www.irs.gov/form1098t
Form 1098-T
Tuition Statement
Copy CFor Filer
Department of the Treasury - Internal Revenue Service
OMB No. 1545-1574
For Privacy Act and Paperwork
Reduction Act Notice, see
the Instructions for
Certain Information Returns.
VOID CORRECTEDFILER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number
STUDENT'S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Service Provider/Acct. No. (see instr.)
1 Payments received for
expenses
$2 Amounts billed for
related expenses
$3 Check if you have changed your
reporting method for 2016
4 Adjustments made for a prior year
$
5 Scholarships or grants
$6 Adjustments to
scholarships or grants for a prior year
$
7 Check this box if the amount in box 1 or 2 includes amounts for an academic period beginning January — March 2017
8 Check if at least
half-time student
9 Check if a graduate
student . . . .
10 Ins. contract reimb./refund
$Form 1098-T www.irs.gov/form1098t
Form 1098-T
Tuition Statement
Copy CFor Filer
Department of the Treasury - Internal Revenue Service
OMB No. 1545-1574
For Privacy Act and Paperwork
Reduction Act Notice, see
the Instructions for
Certain Information Returns.
VOID CORRECTEDFILER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone number
STUDENT'S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Service Provider/Acct. No. (see instr.)
1 Payments received for
expenses
$2 Amounts billed for
related expenses
$3 Check if you have changed your
reporting method for 2016
4 Adjustments made for a prior year
$
5 Scholarships or grants
$6 Adjustments to
scholarships or grants for a prior year
$
7 Check this box if the amount in box 1 or 2 includes amounts for an academic period beginning January — March 2017
8 Check if at least
half-time student
9 Check if a graduate
student . . . .
10 Ins. contract reimb./refund
$Form 1098-T www.irs.gov/form1098t
Form 1098
(Rev. July 2016)
Cat. No. 14402K
Mortgage Interest
Statement
Copy A For
Internal Revenue Service Center
File with Form 1096.
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0901
For Privacy Act and Paperwork
Reduction Act Notice, see the
2016 General Instructions for
Certain Information
Returns.
8181 VOID CORRECTED RECIPIENT'S/LENDER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
RECIPIENT'S/LENDER'S federal identi�cation number
PAYER'S/BORROWER'S taxpayer identi�cation no.
PAYER'S/BORROWER'S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
10 Other
Account number (see instructions)
1 Mortgage interest received from payer(s)/borrower(s)
$ 2 Outstanding mortgage principal as of 1/1/2016
$
3 Mortgage origination date
4 Refund of overpaid interest
$
5 Mortgage insurance premiums
$6 Points paid on purchase of principal residence
$7 Is address of property securing mortgage same as PAYER'S/BORROWER'S address? If Yes, check box . . . . . . . . . . If No, enter address of property securing mortgage below
8 Address of property securing mortgage (see instructions)
9 If property securing mortgage has no address, provide description of the property (see instructions)
Form 1098 www.irs.gov/form1098
Do Not Cut or S eparate Forms on This Page — Do Not Cut or S eparate Forms on This Page
Form 1098
(Rev. July 2016)
Cat. No. 14402K
Mortgage Interest
Statement
Copy A For
Internal Revenue Service Center
File with Form 1096.
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0901
For Privacy Act and Paperwork
Reduction Act Notice, see the
2016 General Instructions for
Certain Information
Returns.
8181 VOID CORRECTED RECIPIENT'S/LENDER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
RECIPIENT'S/LENDER'S federal identi�cation number
PAYER'S/BORROWER'S taxpayer identi�cation no.
PAYER'S/BORROWER'S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
10 Other
Account number (see instructions)
1 Mortgage interest received from payer(s)/borrower(s)
$ 2 Outstanding mortgage principal as of 1/1/2016
$
3 Mortgage origination date
4 Refund of overpaid interest
$
5 Mortgage insurance premiums
$6 Points paid on purchase of principal residence
$7 Is address of property securing mortgage same as PAYER'S/BORROWER'S address? If Yes, check box . . . . . . . . . . If No, enter address of property securing mortgage below
8 Address of property securing mortgage (see instructions)
9 If property securing mortgage has no address, provide description of the property (see instructions)
Form 1098 www.irs.gov/form1098
Do Not Cut or S eparate Forms on This Page — Do Not Cut or S eparate Forms on This Page
Form 1098
Mortgage Interest
Statement
Department of the Treasury - Internal Revenue Service
The information in boxes 1 through 9 is important tax
information and is being furnished to the Internal
Revenue Service. If you are required to �le a return, a
negligence penalty or other sanction may be imposed
on you if the IRS determines that an underpayment oftax results because youoverstated a deduction
for this mortgage interest or for these points, reported
in boxes 1 and 6; or because you didn't report
the refund of interest (box 4); or because you
claimed a non-deductible item.
OMB No. 1545-0901CORRECTED (if checked)
RECIPIENT'S/LENDER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
RECIPIENT'S/LENDER'S federal identi�cation number
PAYER'S/BORROWER'S taxpayer identi�cation no.
PAYER'S/BORROWER'S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
10 Other
Account number (see instructions)
*Caution: The amount shown may not be fully deductible by you. Limits based on the loan amount and the cost and value of the secured property may apply. Also, you may only deduct interest to the extent it was incurred by you, actually paid by you, and not reimbursed by another person.
1 Mortgage interest received from payer(s)/borrower(s)*
$ 2 Outstanding mortgage
$
3 Mortgage origination date
4 Refund of overpaid interest
$
5 Mortgage insurance premiums
$6 Points paid on purchase of principal residence
$7 Is address of property securing mortgage same as PAYER'S/BORROWER'S address? If Yes, box is checked . . . . . . . . . If No, see box 8 or 9, below
8 Address of property securing mortgage
9 If property securing mortgage has no address, below is the description of the property
Form 1098 (Keep for your records) www.irs.gov/form1098
Form 1098
Mortgage Interest
Statement
Department of the Treasury - Internal Revenue Service
The information in boxes 1 through 9 is important tax
information and is being furnished to the Internal
Revenue Service. If you are required to �le a return, a
negligence penalty or other sanction may be imposed
on you if the IRS determines that an underpayment oftax results because youoverstated a deduction
for this mortgage interest or for these points, reported
in boxes 1 and 6; or because you didn't report
the refund of interest (box 4); or because you
claimed a non-deductible item.
OMB No. 1545-0901CORRECTED (if checked)
RECIPIENT'S/LENDER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
RECIPIENT'S/LENDER'S federal identi�cation number
PAYER'S/BORROWER'S taxpayer identi�cation no.
PAYER'S/BORROWER'S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
10 Other
Account number (see instructions)
*Caution: The amount shown may not be fully deductible by you. Limits based on the loan amount and the cost and value of the secured property may apply. Also, you may only deduct interest to the extent it was incurred by you, actually paid by you, and not reimbursed by another person.
1 Mortgage interest received from payer(s)/borrower(s)*
$ 2 Outstanding mortgage
$
3 Mortgage origination date
4 Refund of overpaid interest
$
5 Mortgage insurance premiums
$6 Points paid on purchase of principal residence
$7 Is address of property securing mortgage same as PAYER'S/BORROWER'S address? If Yes, box is checked . . . . . . . . . If No, see box 8 or 9, below
8 Address of property securing mortgage
9 If property securing mortgage has no address, below is the description of the property
Form 1098 (Keep for your records) www.irs.gov/form1098
Form 1098
Mortgage Interest
Statement
Department of the Treasury - Internal Revenue Service
The information in boxes 1 through 9 is important tax
information and is being furnished to the Internal
Revenue Service. If you are required to �le a return, a
negligence penalty or other sanction may be imposed
on you if the IRS determines that an underpayment oftax results because youoverstated a deduction
for this mortgage interest or for these points, reported
in boxes 1 and 6; or because you didn't report
the refund of interest (box 4); or because you
claimed a non-deductible item.
OMB No. 1545-0901CORRECTED (if checked)
RECIPIENT'S/LENDER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
RECIPIENT'S/LENDER'S federal identi�cation number
PAYER'S/BORROWER'S taxpayer identi�cation no.
PAYER'S/BORROWER'S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
10 Other
Account number (see instructions)
*Caution: The amount shown may not be fully deductible by you. Limits based on the loan amount and the cost and value of the secured property may apply. Also, you may only deduct interest to the extent it was incurred by you, actually paid by you, and not reimbursed by another person.
1 Mortgage interest received from payer(s)/borrower(s)*
$ 2 Outstanding mortgage
$
3 Mortgage origination date
4 Refund of overpaid interest
$
5 Mortgage insurance premiums
$6 Points paid on purchase of principal residence
$7 Is address of property securing mortgage same as PAYER'S/BORROWER'S address? If Yes, box is checked . . . . . . . . . If No, see box 8 or 9, below
8 Address of property securing mortgage
9 If property securing mortgage has no address, below is the description of the property
Form 1098 (Keep for your records) www.irs.gov/form1098
Form 1098
Mortgage Interest
Statement
Department of the Treasury - Internal Revenue Service
The information in boxes 1 through 9 is important tax
information and is being furnished to the Internal
Revenue Service. If you are required to �le a return, a
negligence penalty or other sanction may be imposed
on you if the IRS determines that an underpayment oftax results because youoverstated a deduction
for this mortgage interest or for these points, reported
in boxes 1 and 6; or because you didn't report
the refund of interest (box 4); or because you
claimed a non-deductible item.
OMB No. 1545-0901CORRECTED (if checked)
RECIPIENT'S/LENDER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
RECIPIENT'S/LENDER'S federal identi�cation number
PAYER'S/BORROWER'S taxpayer identi�cation no.
PAYER'S/BORROWER'S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
10 Other
Account number (see instructions)
*Caution: The amount shown may not be fully deductible by you. Limits based on the loan amount and the cost and value of the secured property may apply. Also, you may only deduct interest to the extent it was incurred by you, actually paid by you, and not reimbursed by another person.
1 Mortgage interest received from payer(s)/borrower(s)*
$ 2 Outstanding mortgage
$
3 Mortgage origination date
4 Refund of overpaid interest
$
5 Mortgage insurance premiums
$6 Points paid on purchase of principal residence
$7 Is address of property securing mortgage same as PAYER'S/BORROWER'S address? If Yes, box is checked . . . . . . . . . If No, see box 8 or 9, below
8 Address of property securing mortgage
9 If property securing mortgage has no address, below is the description of the property
Form 1098 (Keep for your records) www.irs.gov/form1098
www.PayrollMate.com • 1-800-507-1992 99
Most Popular Preprinted 1099 Forms• IRS - compliant forms guaranteed compatible with
W2 Mate or your 1099 filing Software
• Each 8½” x 11” sheet is developed in compliance with IRS regulations
• Order the quantity equal to the number of recipients for which you file
• Proceeds from Broker and Barter Exchange Transactions
Item Number Description Envelope
BFED08RB 1099-B Federal Copy A –BREC08RB 1099-B Recipient Copy B 10992UPENVRB
BPAY08RB 1099-B Payer Copy C –
1099-B Forms
1099-C Forms
1099-A Forms• Acquisition or Abandonment of Secured Property
Item Number Description Envelope
AFED08RB 1099-A Federal Copy A –AREC08RB 1099-A Recipient Copy B 3UPENVRB
APAY08RB 1099-A Payer Copy C –
1099-B FederalCopy A
#BFED08RB1099-B Recipient
Copy B#BREC08RB
1099-A RecipientCopy B
#AREC08RB
1099-B PayerCopy C
#BPAY08RB
1099-A PayerCopy C
#APAY08RB
1099- A Federal
#AFED08RB
• Cancellation of Debt
Item Number Description Envelope
CFED08RB 1099-C Federal Copy A –CREC08RB 1099-C Recipient Copy B 3UPENVRB
CPAY08RB 1099-C Payer Copy C –
1099-A / 1099-B / 1099-C Forms
1099-C FederalCopy A
#CFED08RB1099-C Recipient
Copy B#CREC08RB
1099-C PayerCopy C
#CPAY08RB
Form 1099-A
Acquisition or Abandonment of
Secured Property
Copy AFor
Internal Revenue Service Center
File with Form 1096.
OMB No. 1545-0877
For Privacy Act and Paperwork
Reduction Act Notice, see the
Instructions for Certain
Information Returns.
8080 VOID CORRECTEDLENDER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, a nd telephone no.
LENDER’S federal identi�cation number BORROWER’S identi�cation number
BORROWER’S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)
1 Date of lender's acquisition or knowledge of abandonment
2 Balance of principal outstanding
$3 4 Fair market value of property
$5 If checked, the borrower was personally liable for repayment
of the debt . . . . . . . . . . . �
6 Description of property
Form 1099-ADo Not C ut or S epa ra t e F orms on T his P a ge — Do Not C ut or S epa ra t e F orms on T his P a ge
Form 1099-A
Acquisition or Abandonment of
Secured Property
Copy AFor
Internal Revenue Service Center
File with Form 1096.
OMB No. 1545-0877
For Privacy Act and Paperwork
Reduction Act Notice, see the
Instructions for Certain
Information Returns.
8080 VOID CORRECTEDLENDER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, a nd telephone no.
LENDER’S federal identi�cation number BORROWER’S identi�cation number
BORROWER’S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)
1 Date of lender's acquisition or knowledge of abandonment
2 Balance of principal outstanding
$3 4 Fair market value of property
$5 If checked, the borrower was personally liable for repayment
of the debt . . . . . . . . . . . �
6 Description of property
Form 1099-ADo Not C ut or S epa ra t e F orms on T his P a ge — Do Not C ut or S epa ra t e F orms on T his P a ge
Form 1099-A
Acquisition or Abandonment of
Secured Property
Copy AFor
Internal Revenue Service Center
File with Form 1096.
OMB No. 1545-0877
For Privacy Act and Paperwork
Reduction Act Notice, see the
Instructions for Certain
Information Returns.
8080 VOID CORRECTEDLENDER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, a nd telephone no.
LENDER’S federal identi�cation number BORROWER’S identi�cation number
BORROWER’S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)
1 Date of lender's acquisition or knowledge of abandonment
2 Balance of principal outstanding
$3 4 Fair market value of property
$5 If checked, the borrower was personally liable for repayment
of the debt . . . . . . . . . . . �
6 Description of property
Form 1099-ADo Not C ut or S epa ra t e F orms on T his P a ge — Do Not C ut or S epa ra t e F orms on T his P a ge
Form 1099-A
Acquisition or Abandonment of
Secured Property
Copy BFor Borrower
Department of the Treasury - Internal Revenue Service
This is important tax information and is being furnished to the Internal Revenue Service. If you
are required to �le a return, a negligence
penalty or other sanction may be
imposed on you if taxable income results
from this transaction and the IRS determines
that it has not been reported.
OMB No. 1545-0877
CORRECTED (if checked)LENDER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, a nd telephone no.
LENDER’S federal identi�cation number BORROWER’S identi�cation number
BORROWER’S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)
1 Date of lender's acquisition or knowledge of abandonment
2 Balance of principal outstanding
$3 4 Fair market value of property
$5 If checked, the borrower was personally liable for repayment
of the debt . . . . . . . . . . . �
6 Description of property
Form 1099-A (keep for your records) www.irs.gov/form1099a
Form 1099-A
Acquisition or Abandonment of
Secured Property
Copy BFor Borrower
Department of the Treasury - Internal Revenue Service
This is important tax information and is being furnished to the Internal Revenue Service. If you
are required to �le a return, a negligence
penalty or other sanction may be
imposed on you if taxable income results
from this transaction and the IRS determines
that it has not been reported.
OMB No. 1545-0877
CORRECTED (if checked)LENDER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, a nd telephone no.
LENDER’S federal identi�cation number BORROWER’S identi�cation number
BORROWER’S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)
1 Date of lender's acquisition or knowledge of abandonment
2 Balance of principal outstanding
$3 4 Fair market value of property
$5 If checked, the borrower was personally liable for repayment
of the debt . . . . . . . . . . . �
6 Description of property
Form 1099-A (keep for your records) www.irs.gov/form1099a
Form 1099-A
Acquisition or Abandonment of
Secured Property
Copy BFor Borrower
Department of the Treasury - Internal Revenue Service
This is important tax information and is being furnished to the Internal Revenue Service. If you
are required to �le a return, a negligence
penalty or other sanction may be
imposed on you if taxable income results
from this transaction and the IRS determines
that it has not been reported.
OMB No. 1545-0877
CORRECTED (if checked)LENDER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, a nd telephone no.
LENDER’S federal identi�cation number BORROWER’S identi�cation number
BORROWER’S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)
1 Date of lender's acquisition or knowledge of abandonment
2 Balance of principal outstanding
$3 4 Fair market value of property
$5 If checked, the borrower was personally liable for repayment
of the debt . . . . . . . . . . . �
6 Description of property
Form 1099-A (keep for your records) www.irs.gov/form1099a
Form 1099-A
Acquisition or Abandonment of
Secured Property
Copy CFor Lender
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0877
For Privacy Act and Paperwork
Reduction Act Notice, see the
Instructions for Certain
Information Returns.
VOID CORRECTEDLENDER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
LENDER’S federal identi�cation number BORROWER’S identi�cation number
BORROWER’S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)
1 Date of lender's acquisition or knowledge of abandonment
2 Balance of principal outstanding
$3 4 Fair market value of property
$5 If checked, the borrower was personally liable for repayment
of the debt . . . . . . . . . . . �
6 Description of property
Form 1099-A www.irs.gov/form1099a
Form 1099-A
Acquisition or Abandonment of
Secured Property
Copy CFor Lender
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0877
For Privacy Act and Paperwork
Reduction Act Notice, see the
Instructions for Certain
Information Returns.
VOID CORRECTEDLENDER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
LENDER’S federal identi�cation number BORROWER’S identi�cation number
BORROWER’S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)
1 Date of lender's acquisition or knowledge of abandonment
2 Balance of principal outstanding
$3 4 Fair market value of property
$5 If checked, the borrower was personally liable for repayment
of the debt . . . . . . . . . . . �
6 Description of property
Form 1099-A www.irs.gov/form1099a
Form 1099-A
Acquisition or Abandonment of
Secured Property
Copy CFor Lender
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0877
For Privacy Act and Paperwork
Reduction Act Notice, see the
Instructions for Certain
Information Returns.
VOID CORRECTEDLENDER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
LENDER’S federal identi�cation number BORROWER’S identi�cation number
BORROWER’S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)
1 Date of lender's acquisition or knowledge of abandonment
2 Balance of principal outstanding
$3 4 Fair market value of property
$5 If checked, the borrower was personally liable for repayment
of the debt . . . . . . . . . . . �
6 Description of property
Form 1099-A www.irs.gov/form1099a
7979 VOID CORRECTED
Form 1099-B
Proceeds From Broker and
Barter Exchange Transactions
Copy A
For Internal Revenue
Service Center
File with Form 1096.
OMB No. 1545-0715
For Privacy Act and Paperwork
Reduction Act Notice, see the
Instructions for
Certain Information
Returns.
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
PAYER'S federal identi�cation number RECIPIENT'S identi�cation number
RECIPIENT'S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions) 2nd TIN not.
CUSIP number
Applicable check box on Form 8949
1a Description of property (Example 100 sh. XYZ Co.)
1b Date acquired 1c Date sold or disposed
1d Proceeds
$1e Cost or other basis
$1f Code, if any 1g Adjustments
$2 Type of gain or loss:
Short-term
Long-term
3 Check if basis reported to IRS
4 Federal income tax withheld
$5 Check if noncovered
security
6 Reported to IRS:
Gross proceeds
Net proceeds
7 Check if loss is not allowed based on amount in 1d
8 Pro�t or (loss) realized in 2015 on closed contracts
$
9 Unrealized pro�t or (loss) on open contracts—12/31/2014
$10 Unrealized pro�t or (loss) on
open contracts—12/31/2015
$
11 Aggregate pro�t or (loss) on contracts
$12 13 Bartering
$
14 State name 15 State identi�cation no. 16 State tax withheld
$$
Form 1099-BDo Not C ut or S e pa ra t e F orms on T his P a ge — Do Not C ut or S e pa ra t e F orms on T his P a ge
7979 VOID CORRECTED
Form 1099-B
Proceeds From Broker and
Barter Exchange Transactions
Copy A
For Internal Revenue
Service Center
File with Form 1096.
OMB No. 1545-0715
For Privacy Act and Paperwork
Reduction Act Notice, see the
Instructions for
Certain Information
Returns.
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
PAYER'S federal identi�cation number RECIPIENT'S identi�cation number
RECIPIENT'S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions) 2nd TIN not.
CUSIP number
Applicable check box on Form 8949
1a Description of property (Example 100 sh. XYZ Co.)
1b Date acquired 1c Date sold or disposed
1d Proceeds
$1e Cost or other basis
$1f Code, if any 1g Adjustments
$2 Type of gain or loss:
Short-term
Long-term
3 Check if basis reported to IRS
4 Federal income tax withheld
$5 Check if noncovered
security
6 Reported to IRS:
Gross proceeds
Net proceeds
7 Check if loss is not allowed based on amount in 1d
8 Pro�t or (loss) realized in 2015 on closed contracts
$
9 Unrealized pro�t or (loss) on open contracts—12/31/2014
$10 Unrealized pro�t or (loss) on
open contracts—12/31/2015
$
11 Aggregate pro�t or (loss) on contracts
$12 13 Bartering
$
14 State name 15 State identi�cation no. 16 State tax withheld
$$
Form 1099-BDo Not C ut or S e pa ra t e F orms on T his P a ge — Do Not C ut or S e pa ra t e F orms on T his P a ge
CORRECTED (if checked)
Form 1099-B
Proceeds From Broker and
Barter Exchange Transactions
Copy BFor Recipient
Department of the Treasury - Internal Revenue Service
This is important tax information and is being furnished to
the Internal Revenue Service. If you are
required to �le 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.
OMB No. 1545-0715PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
PAYER'S federal identi�cation number RECIPIENT'S identi�cation number
RECIPIENT'S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)
CUSIP number
Applicable check box on Form 8949
1a Description of property (Example 100 sh. XYZ Co.)
1b Date acquired 1c Date sold or disposed
1d Proceeds
$1e Cost or other basis
$1f Code, if any 1g Adjustments
$2 Type of gain or loss:
Short-term
Long-term
3 If checked, basis reported to IRS
4 Federal income tax withheld
$5 If checked, noncovered
security
6 Reported to IRS:
Gross proceeds
Net proceeds
7 If checked, loss is not allowed based on amount in 1d
8 Pro�t or (loss) realized in 2015 on closed contracts
$
9 Unrealized pro�t or (loss) on open contracts—12/31/2014
$10 Unrealized pro�t or (loss) on
open contracts—12/31/2015
$
11 Aggregate pro�t or (loss) on contracts
$12 13 Bartering
$
14 State name 15 State identi�cation no. 16 State tax withheld
$$
Form 1099-B (Keep for your records) www.irs.gov/form1099b
CORRECTED (if checked)
Form 1099-B
Proceeds From Broker and
Barter Exchange Transactions
Copy BFor Recipient
Department of the Treasury - Internal Revenue Service
This is important tax information and is being furnished to
the Internal Revenue Service. If you are
required to �le a return, a negligence
penalty or other sanction may be
imposed on you if this income is
taxable and the IRS determines that it
has not been reported.
OMB No. 1545-0715PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
PAYER'S federal identi�cation number RECIPIENT'S identi�cation number
RECIPIENT'S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)
CUSIP number
Applicable check box on Form 8949
1a Description of property (Example 100 sh. XYZ Co.)
1b Date acquired 1c Date sold or disposed
1d Proceeds
$1e Cost or other basis
$1f Code, if any 1g Adjustments
$2 Type of gain or loss:
Short-term
Long-term
3 If checked, basis reported to IRS
4 Federal income tax withheld
$5 If checked, noncovered
security
6 Reported to IRS:
Gross proceeds
Net proceeds
7 If checked, loss is not allowed based on amount in 1d
8 Pro�t or (loss) realized in 2015 on closed contracts
$
9 Unrealized pro�t or (loss) on open contracts—12/31/2014
$10 Unrealized pro�t or (loss) on
open contracts—12/31/2015
$
11 Aggregate pro�t or (loss) on contracts
$12 13 Bartering
$
14 State name 15 State identi�cation no. 16 State tax withheld
$$
Form 1099-B (Keep for your records) www.irs.gov/form1099b
VOID CORRECTED
Form 1099-B
Proceeds From Broker and
Barter Exchange Transactions
Copy CFor Payer
OMB No. 1545-0715
For Privacy Act and Paperwork
Reduction Act Notice, see the
Instructions for
Certain Information
Returns.
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
PAYER'S federal identi�cation number RECIPIENT'S identi�cation number
RECIPIENT'S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions) 2nd TIN not.
CUSIP number
Applicable check box on Form 8949
1a Description of property (Example 100 sh. XYZ Co.)
1b Date acquired 1c Date sold or disposed
1d Proceeds
$1e Cost or other basis
$1f Code, if any 1g Adjustments
$2 Type of gain or loss:
Short-term
Long-term
3 Check if basis reported to IRS
4 Federal income tax withheld
$5 Check if noncovered
security
6 Reported to IRS:
Gross proceeds
Net proceeds
7 Check if loss is not allowed based on amount in 1d
8 Pro�t or (loss) realized in 2015 on closed contracts
$
9 Unrealized pro�t or (loss) on open contracts—12/31/2014
$10 Unrealized pro�t or (loss) on
open contracts—12/31/2015
$
11 Aggregate pro�t or (loss) on contracts
$12 13 Bartering
$
14 State name 15 State identi�cation no. 16 State tax withheld
$$
Form 1099-B
VOID CORRECTED
Form 1099-B
Proceeds From Broker and
Barter Exchange Transactions
Copy CFor Payer
OMB No. 1545-0715
For Privacy Act and Paperwork
Reduction Act Notice, see the
Instructions for
Certain Information
Returns.
PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
PAYER'S federal identi�cation number RECIPIENT'S identi�cation number
RECIPIENT'S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions) 2nd TIN not.
CUSIP number
Applicable check box on Form 8949
1a Description of property (Example 100 sh. XYZ Co.)
1b Date acquired 1c Date sold or disposed
1d Proceeds
$1e Cost or other basis
$1f Code, if any 1g Adjustments
$2 Type of gain or loss:
Short-term
Long-term
3 Check if basis reported to IRS
4 Federal income tax withheld
$5 Check if noncovered
security
6 Reported to IRS:
Gross proceeds
Net proceeds
7 Check if loss is not allowed based on amount in 1d
8 Pro�t or (loss) realized in 2015 on closed contracts
$
9 Unrealized pro�t or (loss) on open contracts—12/31/2014
$10 Unrealized pro�t or (loss) on
open contracts—12/31/2015
$
11 Aggregate pro�t or (loss) on contracts
$12 13 Bartering
$
14 State name 15 State identi�cation no. 16 State tax withheld
$$
Form 1099-B
Form 1099-C
Cat. No. 26280W
Cancellation of Debt
Copy AFor
Internal Revenue Service Center
Department of the Treasury - Internal Revenue Service
File with Form 1096.
OMB No. 1545-1424
For Privacy Act and Paperwork Reduction
Act Notice, see the
Instructions for Certain Information
Returns.
8585 VOID CORRECTEDCREDITOR'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
CREDITOR'S federal identi�cation number DEBTOR'S identi�cation number
DEBTOR'S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)
1 Date of identi�able event
2 Amount of debt discharged
$3 Interest if included in box 2
$4 Debt description
5 Check here if the debtor was personally liable for repayment of the debt . . . . . . . . �
6 Identi�able event code 7 Fair market value of property
$Form 1099-C www.irs.gov/form1099c
Do Not C ut or S epa ra t e F orms on T his P a ge — Do Not C ut or S epa ra t e F orms on T his P a ge
Form 1099-C
Cat. No. 26280W
Cancellation of Debt
Copy AFor
Internal Revenue Service Center
Department of the Treasury - Internal Revenue Service
File with Form 1096.
OMB No. 1545-1424
For Privacy Act and Paperwork Reduction
Act Notice, see the
Instructions for Certain Information
Returns.
8585 VOID CORRECTEDCREDITOR'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
CREDITOR'S federal identi�cation number DEBTOR'S identi�cation number
DEBTOR'S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)
1 Date of identi�able event
2 Amount of debt discharged
$3 Interest if included in box 2
$4 Debt description
5 Check here if the debtor was personally liable for repayment of the debt . . . . . . . . �
6 Identi�able event code 7 Fair market value of property
$Form 1099-C www.irs.gov/form1099c
Do Not C ut or S epa ra t e F orms on T his P a ge — Do Not C ut or S epa ra t e F orms on T his P a ge
Form 1099-C
Cat. No. 26280W
Cancellation of Debt
Copy AFor
Internal Revenue Service Center
Department of the Treasury - Internal Revenue Service
File with Form 1096.
OMB No. 1545-1424
For Privacy Act and Paperwork Reduction
Act Notice, see the
Instructions for Certain Information
Returns.
8585 VOID CORRECTEDCREDITOR'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
CREDITOR'S federal identi�cation number DEBTOR'S identi�cation number
DEBTOR'S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)
1 Date of identi�able event
2 Amount of debt discharged
$3 Interest if included in box 2
$4 Debt description
5 Check here if the debtor was personally liable for repayment of the debt . . . . . . . . �
6 Identi�able event code 7 Fair market value of property
$Form 1099-C www.irs.gov/form1099c
Do Not C ut or S epa ra t e F orms on T his P a ge — Do Not C ut or S epa ra t e F orms on T his P a ge
Form 1099-C
Cancellation of Debt
Copy BFor Debtor
Department of the Treasury - Internal Revenue Service
This is important tax information and is being furnished to the Internal Revenue Service. If you
are required to �le a return, a negligence
penalty or other sanction may be
imposed on you if taxable income results
from this transaction and the IRS determines
that it has not been reported.
OMB No. 1545-1424
CORRECTED (if checked)CREDITOR'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
CREDITOR'S federal identi�cation number DEBTOR'S identi�cation number
DEBTOR'S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)
1 Date of identi�able event
2 Amount of debt discharged
$3 Interest if included in box 2
$4 Debt description
5 If checked, the debtor was personally liable for repayment of the debt . . . . . . . . �
6 Identi�able event code 7 Fair market value of property
$Form 1099-C (keep for your records) www.irs.gov/form1099c
Form 1099-C
Cancellation of Debt
Copy BFor Debtor
Department of the Treasury - Internal Revenue Service
This is important tax information and is being furnished to the Internal Revenue Service. If you
are required to �le a return, a negligence
penalty or other sanction may be
imposed on you if taxable income results
from this transaction and the IRS determines
that it has not been reported.
OMB No. 1545-1424
CORRECTED (if checked)CREDITOR'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
CREDITOR'S federal identi�cation number DEBTOR'S identi�cation number
DEBTOR'S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)
1 Date of identi�able event
2 Amount of debt discharged
$3 Interest if included in box 2
$4 Debt description
5 If checked, the debtor was personally liable for repayment of the debt . . . . . . . . �
6 Identi�able event code 7 Fair market value of property
$Form 1099-C (keep for your records) www.irs.gov/form1099c
Form 1099-C
Cancellation of Debt
Copy BFor Debtor
Department of the Treasury - Internal Revenue Service
This is important tax information and is being furnished to the Internal Revenue Service. If you
are required to �le a return, a negligence
penalty or other sanction may be
imposed on you if taxable income results
from this transaction and the IRS determines
that it has not been reported.
OMB No. 1545-1424
CORRECTED (if checked)CREDITOR'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
CREDITOR'S federal identi�cation number DEBTOR'S identi�cation number
DEBTOR'S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)
1 Date of identi�able event
2 Amount of debt discharged
$3 Interest if included in box 2
$4 Debt description
5 If checked, the debtor was personally liable for repayment of the debt . . . . . . . . �
6 Identi�able event code 7 Fair market value of property
$Form 1099-C (keep for your records) www.irs.gov/form1099c
Form 1099-C
Cancellation of Debt
Copy CFor Creditor
Department of the Treasury - Internal Revenue Service
OMB No. 1545-1424
For Privacy Act and Paperwork
Reduction Act Notice, see the
Instructions for Certain Information
Returns.
VOID CORRECTEDCREDITOR'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
CREDITOR'S federal identi�cation number DEBTOR'S identi�cation number
DEBTOR'S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)
1 Date of identi�able event
2 Amount of debt discharged
$3 Interest if included in box 2
$4 Debt description
5 Check here if the debtor was personally liable for repayment of the debt . . . . . . . . �
6 Identi�able event code 7 Fair market value of property
$Form 1099-C www.irs.gov/form1099c
Form 1099-C
Cancellation of Debt
Copy CFor Creditor
OMB No. 1545-1424
For Privacy Act and Paperwork
Reduction Act Notice, see the
Instructions for Certain Information
Returns.
VOID CORRECTEDCREDITOR'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
CREDITOR'S federal identi�cation number DEBTOR'S identi�cation number
DEBTOR'S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)
1 Date of identi�able event
2 Amount of debt discharged
$3 Interest if included in box 2
$4 Debt description
5 Check here if the debtor was personally liable for repayment of the debt . . . . . . . . �
6 Identi�able event code 7 Fair market value of property
$Form 1099-C
Form 1099-C
Cancellation of Debt
Copy CFor Creditor
OMB No. 1545-1424
For Privacy Act and Paperwork
Reduction Act Notice, see the
Instructions for Certain Information
Returns.
VOID CORRECTEDCREDITOR'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
CREDITOR'S federal identi�cation number DEBTOR'S identi�cation number
DEBTOR'S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)
1 Date of identi�able event
2 Amount of debt discharged
$3 Interest if included in box 2
$4 Debt description
5 Check here if the debtor was personally liable for repayment of the debt . . . . . . . . �
6 Identi�able event code 7 Fair market value of property
$Form 1099-C
Copy A
Your reliable source for Payroll Software, W2/1099 Software and tax forms.1010
Most Popular Preprinted 1099 Forms• IRS - compliant forms guaranteed compatible with
W2 Mate or your 1099 filing Software
• Each 8½” x 11” sheet is developed in compliance with IRS regulations
• Order the quantity equal to the number of recipients for which you file
• Taxable Distributions Received from Cooperatives
Item Number Description Envelope
PATRFED08RB 1099-PATR Federal Copy A –PATRREC08RB 1099-PATR Recipient Copy B 3UPENVRB
PATRPAY08RB 1099-PATR Payer Copy C –
1099-PATR Forms
1099-OID Forms• Original Issue Discount
Item Number Description Envelope
OIDFED08RB 1099-OID Federal Copy A –OIDREC08RB 1099-OID Recipient Copy B 2UPENVRB
OIDPAY08RB 1099-OID Payer Copy C –
1099-PATR FederalCopy A
#PATRFED08RB1099-PATR Recipient
Copy B#PATRREC08RB
1099-OID RecipientCopy B
#OIDREC08RB
1099-PATR PayerCopy C
#PATRPAY08RB
1099-OID PayerCopy C
#OIDPAY08RB
1099-OID FederalCopy A
#OIDFED08RB
1099-OID / 1099-PATR /1099-K Forms
• Payment Card and Third Party Network Transactions
Item Number Description Envelope
KFED08RB 1099-K Federal Copy A –KREC08RB 1099-K Recipient Copy B 2UPENVRB
KPAY08RB 1099-K Payer Copy C –
1099-K Forms
1099-K FederalCopy A
#KFED08RB 1099-K RecipientCopy B
#KREC08RB 1099-K PayerCopy C
#KPAY08RB
Form 1099-OID
Cat. No. 14421R
Original Issue Discount
For Internal Revenue
Service Center
Department of the Treasury - Internal Revenue Service
File with Form 1096.
OMB No. 1545-0117
For Privacy Act and Paperwork
Reduction Act Notice, see the
Instructions for Certain
Information Returns.
9696 VOID CORRECTEDPAYER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
PAYER’S federal identi�cation number RECIPIENT’S identi�cation number
RECIPIENT’S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
FATCA �ling requirement
Account number (see instructions) 2nd TIN not.
1 Original issue discount for 2016
$2 Other periodic interest
$3 Early withdrawal penalty
$
4 Federal income tax withheld
$5 Market discount
$
6 Acquisition premium
$ 7 Description
8 Original issue discount on U.S. Treasury obligations
$9 Investment expenses
$
10 Bond premium
$11 State 12 State identi�cation no. 13 State tax withheld
$$
Copy A
Form 1099-OID www.irs.gov/form1099oid
Do Not C ut or S e pa ra t e F orms on T his P a ge — Do Not C ut or S e pa ra t e F orms on T his P a ge
Form 1099-OID
Cat. No. 14421R
Original Issue Discount
For Internal Revenue
Service Center
Department of the Treasury - Internal Revenue Service
File with Form 1096.
OMB No. 1545-0117
For Privacy Act and Paperwork
Reduction Act Notice, see the
Instructions for Certain
Information Returns.
9696 VOID CORRECTEDPAYER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
PAYER’S federal identi�cation number RECIPIENT’S identi�cation number
RECIPIENT’S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
FATCA �ling requirement
Account number (see instructions) 2nd TIN not.
1 Original issue discount for 2016
$2 Other periodic interest
$3 Early withdrawal penalty
$
4 Federal income tax withheld
$5 Market discount
$
6 Acquisition premium
$ 7 Description
8 Original issue discount on U.S. Treasury obligations
$9 Investment expenses
$
10 Bond premium
$11 State 12 State identi�cation no. 13 State tax withheld
$$
Copy A
Form 1099-OID www.irs.gov/form1099oid
Do Not C ut or S e pa ra t e F orms on T his P a ge — Do Not C ut or S e pa ra t e F orms on T his P a ge
Form 1099-OID
Original Issue Discount
Copy B
For Recipient
Department of the Treasury - Internal Revenue Service
This is important tax
Service. If you are required to �le a
penalty or other sanction may be
this income is
determines that it has not been
OMB No. 1545-0117
CORRECTED (if checked)PAYER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
PAYER’S federal identi�cation number RECIPIENT’S identi�cation number
RECIPIENT’S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
FATCA �ling requirement
Account number (see instructions)
1 Original issue discount for 2016*
$2 Other periodic interest
$3 Early withdrawal penalty
$
4 Federal income tax withheld
$5 Market discount
$
6 Acquisition premium
$ 7 Description
8 Original issue discount on U.S. Treasury obligations*
$
* This may not be the correct �gure to report on your income tax return. See instructions on the back.
9 Investment expenses
$
10 Bond premium
$11 State 12 State identi�cation no. 13 State tax withheld
$$
Form 1099-OID (keep for your records) www.irs.gov/form1099oid
Form 1099-OID
Original Issue Discount
Copy B
For Recipient
Department of the Treasury - Internal Revenue Service
This is important tax
being furnished to
Service. If you are required to �le a
penalty or other
imposed on you if this income is
has not been reported.
OMB No. 1545-0117
CORRECTED (if checked)PAYER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
PAYER’S federal identi�cation number RECIPIENT’S identi�cation number
RECIPIENT’S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
FATCA �ling requirement
Account number (see instructions)
1 Original issue discount for 2016*
$2 Other periodic interest
$3 Early withdrawal penalty
$
4 Federal income tax withheld
$5 Market discount
$
6 Acquisition premium
$ 7 Description
8 Original issue discount on U.S. Treasury obligations*
$
* This may not be the correct �gure to report on your income tax return. See instructions on the back.
9 Investment expenses
$
10 Bond premium
$11 State 12 State identi�cation no. 13 State tax withheld
$$
Form 1099-OID (keep for your records) www.irs.gov/form1099oid
Form 1099-OID
Original Issue Discount
Copy C
For Payer
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0117
For Privacy Act and Paperwork
Reduction Act Notice, see the
Instructions for
Certain Information
Returns.
VOID CORRECTEDPAYER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
PAYER’S federal identi�cation number RECIPIENT’S identi�cation number
RECIPIENT’S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
FATCA �ling requirement
Account number (see instructions) 2nd TIN not.
1 Original issue discount for 2016
$2 Other periodic interest
$3 Early withdrawal penalty
$
4 Federal income tax withheld
$5 Market discount
$
6 Acquisition premium
$7 Description
8 Original issue discount on U.S. Treasury obligations
$9 Investment expenses
$
10 Bond premium
$11 State 12 State identi�cation no. 13 State tax withheld
$$
Form 1099-OID www.irs.gov/form1099oid
Form 1099-OID
Original Issue Discount
Copy C
For Payer
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0117
For Privacy Act and Paperwork
Reduction Act Notice, see the
Instructions for
Certain Information
Returns.
VOID CORRECTEDPAYER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
PAYER’S federal identi�cation number RECIPIENT’S identi�cation number
RECIPIENT’S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
FATCA �ling requirement
Account number (see instructions) 2nd TIN not.
1 Original issue discount for 2016
$2 Other periodic interest
$3 Early withdrawal penalty
$
4 Federal income tax withheld
$5 Market discount
$
6 Acquisition premium
$7 Description
8 Original issue discount on U.S. Treasury obligations
$9 Investment expenses
$
10 Bond premium
$11 State 12 State identi�cation no. 13 State tax withheld
$$
Form 1099-OID www.irs.gov/form1099oid
Form 1099-PATR
Cat. No. 14435F
Taxable Distributions
Received From Cooperatives
Copy AFor
Internal Revenue Service Center
Department of the Treasury - Internal Revenue Service
File with Form 1096.
OMB No. 1545-0118
For Privacy Act and Paperwork
Reduction Act Notice, see the
Instructions for
Certain Information Returns.
9797 VOID CORRECTEDPAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
PAYER’S federal identi�cation number RECIPIENT’S identi�cation number
RECIPIENT’S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions) 2nd TIN not.
1 Patronage dividends
$2 Nonpatronage distributions
$3 Per-unit retain allocations
$4 Federal income tax withheld
$5 Redemption of nonquali�ed
notices and retain allocations
$
6 Domestic production activities deduction
$7 Investment credit
$8 Work opportunity credit
$9 Patron’s AMT adjustment
$10 Other credits and deductions
$Form 1099-PATR www.irs.gov/form1099patr
Do Not C ut or S e pa ra t e F orms on T his P a ge — Do Not C ut or S e pa ra t e F orms on T his P a ge
Form 1099-PATR
Cat. No. 14435F
Taxable Distributions
Received From Cooperatives
Copy AFor
Internal Revenue Service Center
Department of the Treasury - Internal Revenue Service
File with Form 1096.
OMB No. 1545-0118
For Privacy Act and Paperwork
Reduction Act Notice, see the
Instructions for
Certain Information Returns.
9797 VOID CORRECTEDPAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
PAYER’S federal identi�cation number RECIPIENT’S identi�cation number
RECIPIENT’S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions) 2nd TIN not.
1 Patronage dividends
$2 Nonpatronage distributions
$3 Per-unit retain allocations
$4 Federal income tax withheld
$5 Redemption of nonquali�ed
notices and retain allocations
$
6 Domestic production activities deduction
$7 Investment credit
$8 Work opportunity credit
$9 Patron’s AMT adjustment
$10 Other credits and deductions
$Form 1099-PATR www.irs.gov/form1099patr
Do Not C ut or S e pa ra t e F orms on T his P a ge — Do Not C ut or S e pa ra t e F orms on T his P a ge
Form 1099-PATR
Cat. No. 14435F
Taxable Distributions
Received From Cooperatives
Copy AFor
Internal Revenue Service Center
Department of the Treasury - Internal Revenue Service
File with Form 1096.
OMB No. 1545-0118
For Privacy Act and Paperwork
Reduction Act Notice, see the
Instructions for
Certain Information Returns.
9797 VOID CORRECTEDPAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
PAYER’S federal identi�cation number RECIPIENT’S identi�cation number
RECIPIENT’S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions) 2nd TIN not.
1 Patronage dividends
$2 Nonpatronage distributions
$3 Per-unit retain allocations
$4 Federal income tax withheld
$5 Redemption of nonquali�ed
notices and retain allocations
$
6 Domestic production activities deduction
$7 Investment credit
$8 Work opportunity credit
$9 Patron’s AMT adjustment
$10 Other credits and deductions
$Form 1099-PATR www.irs.gov/form1099patr
Do Not C ut or S e pa ra t e F orms on T his P a ge — Do Not C ut or S e pa ra t e F orms on T his P a ge
Form 1099-PATR
Taxable Distributions
Received From Cooperatives
Copy BFor Recipient
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0118
This is important tax information and is
being furnished to the Internal Revenue
Service. If you are required to �le 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.
CORRECTED (if checked)PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
PAYER’S federal identi�cation number RECIPIENT’S identi�cation number
RECIPIENT’S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)
1 Patronage dividends
$2 Nonpatronage distributions
$3 Per-unit retain allocations
$4 Federal income tax withheld
$5 Redemption of nonquali�ed
notices and retain allocations
$
6 Domestic production activities deduction
$7 Investment credit
$8 Work opportunity credit
$9 Patron’s AMT adjustment
$10 Other credits and deductions
$Form 1099-PATR (keep for your records) www.irs.gov/form1099patr
Form 1099-PATR
Taxable Distributions
Received From Cooperatives
Copy BFor Recipient
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0118
This is important tax information and is
being furnished to the Internal Revenue
Service. If you are required to �le 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.
CORRECTED (if checked)PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
PAYER’S federal identi�cation number RECIPIENT’S identi�cation number
RECIPIENT’S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)
1 Patronage dividends
$2 Nonpatronage distributions
$3 Per-unit retain allocations
$4 Federal income tax withheld
$5 Redemption of nonquali�ed
notices and retain allocations
$
6 Domestic production activities deduction
$7 Investment credit
$8 Work opportunity credit
$9 Patron’s AMT adjustment
$10 Other credits and deductions
$Form 1099-PATR (keep for your records) www.irs.gov/form1099patr
Form 1099-PATR
Taxable Distributions
Received From Cooperatives
Copy BFor Recipient
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0118
This is important tax information and is
being furnished to the Internal Revenue
Service. If you are required to �le 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.
CORRECTED (if checked)PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
PAYER’S federal identi�cation number RECIPIENT’S identi�cation number
RECIPIENT’S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions)
1 Patronage dividends
$2 Nonpatronage distributions
$3 Per-unit retain allocations
$4 Federal income tax withheld
$5 Redemption of nonquali�ed
notices and retain allocations
$
6 Domestic production activities deduction
$7 Investment credit
$8 Work opportunity credit
$9 Patron’s AMT adjustment
$10 Other credits and deductions
$Form 1099-PATR (keep for your records) www.irs.gov/form1099patr
Form 1099-PATR
Taxable Distributions
Received From Cooperatives
Copy C
For Payer
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0118
For Privacy Act and Paperwork
Reduction Act Notice, see the
Instructions for
Certain Information Returns.
VOID CORRECTEDPAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
PAYER’S federal identi�cation number RECIPIENT’S identi�cation number
RECIPIENT’S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions) 2nd TIN not.
1 Patronage dividends
$2 Nonpatronage distributions
$3 Per-unit retain allocations
$4 Federal income tax withheld
$5 Redemption of nonquali�ed
notices and retain allocations
$
6 Domestic production activities deduction
$7 Investment credit
$8 Work opportunity credit
$9 Patron’s AMT adjustment
$10 Other credits and deductions
$Form 1099-PATR www.irs.gov/form1099patr
Form 1099-PATR
Taxable Distributions
Received From Cooperatives
Copy C
For Payer
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0118
For Privacy Act and Paperwork
Reduction Act Notice, see the
Instructions for
Certain Information Returns.
VOID CORRECTEDPAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
PAYER’S federal identi�cation number RECIPIENT’S identi�cation number
RECIPIENT’S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions) 2nd TIN not.
1 Patronage dividends
$2 Nonpatronage distributions
$3 Per-unit retain allocations
$4 Federal income tax withheld
$5 Redemption of nonquali�ed
notices and retain allocations
$
6 Domestic production activities deduction
$7 Investment credit
$8 Work opportunity credit
$9 Patron’s AMT adjustment
$10 Other credits and deductions
$Form 1099-PATR www.irs.gov/form1099patr
Form 1099-PATR
Taxable Distributions
Received From Cooperatives
Copy C
For Payer
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0118
For Privacy Act and Paperwork
Reduction Act Notice, see the
Instructions for
Certain Information Returns.
VOID CORRECTEDPAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
PAYER’S federal identi�cation number RECIPIENT’S identi�cation number
RECIPIENT’S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions) 2nd TIN not.
1 Patronage dividends
$2 Nonpatronage distributions
$3 Per-unit retain allocations
$4 Federal income tax withheld
$5 Redemption of nonquali�ed
notices and retain allocations
$
6 Domestic production activities deduction
$7 Investment credit
$8 Work opportunity credit
$9 Patron’s AMT adjustment
$10 Other credits and deductions
$Form 1099-PATR www.irs.gov/form1099patr
Form 1099-K
Cat. No. 54118B
Payment Card and Third Party
Network Transactions
Copy A For
Internal Revenue Service Center
File with Form 1096.
Department of the Treasury - Internal Revenue Service
OMB No. 1545-2205
For Privacy Act and Paperwork
Reduction Act Notice, see the
Instructions for Certain Information
Returns.
1010 VOID CORRECTED FILER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
Check to indicate if FILER is a (an):
Payment settlement entity (PSE)
Electronic Payment Facilitator (EPF)/Other third party
Check to indicate transactions reported are:Payment card
Third party network PAYEE’S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
PSE'S name and telephone number
Account number (see instructions) 2nd TIN not.
FILER’S federal identi�cation no.
PAYEE’S taxpayer identi�cation no.
1a Gross amount of payment card/third party network transactions
$ 1b Card Not Present
transactions
$
2 Merchant category code
3 Number of payment transactions
4 Federal income tax withheld
$5a January
$ 5b February
$ 5c March
$ 5d April
$ 5e May
$ 5f June
$ 5g July
$ 5h August
$ 5i September
$ 5j October
$ 5k November
$ 5l December
$ 6 State 7 State identi�cation no. 8 State income tax withheld
$$
Form 1099-K www.irs.gov/form1099k
Do Not Cut or S eparate Forms on This Page — Do Not Cut or S eparate Forms on This Page
Form 1099-K
Cat. No. 54118B
Payment Card and Third Party
Network Transactions
Copy A For
Internal Revenue Service Center
File with Form 1096.
Department of the Treasury - Internal Revenue Service
OMB No. 1545-2205
For Privacy Act and Paperwork
Reduction Act Notice, see the
Instructions for Certain Information
Returns.
1010 VOID CORRECTED FILER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
Check to indicate if FILER is a (an):
Payment settlement entity (PSE)
Electronic Payment Facilitator (EPF)/Other third party
Check to indicate transactions reported are:Payment card
Third party network PAYEE’S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
PSE'S name and telephone number
Account number (see instructions) 2nd TIN not.
FILER’S federal identi�cation no.
PAYEE’S taxpayer identi�cation no.
1a Gross amount of payment card/third party network transactions
$ 1b Card Not Present
transactions
$
2 Merchant category code
3 Number of payment transactions
4 Federal income tax withheld
$5a January
$ 5b February
$ 5c March
$ 5d April
$ 5e May
$ 5f June
$ 5g July
$ 5h August
$ 5i September
$ 5j October
$ 5k November
$ 5l December
$ 6 State 7 State identi�cation no. 8 State income tax withheld
$$
Form 1099-K www.irs.gov/form1099k
Do Not Cut or S eparate Forms on This Page — Do Not Cut or S eparate Forms on This Page
Form 1099-K
Payment Card and Third Party
Network Transactions
Copy B For Payee
Department of the Treasury - Internal Revenue Service
This is important tax information and is being furnished to
the Internal Revenue Service. If you are
required to �le a return, a negligence
penalty or other sanction may be
imposed on you if taxable income
results from this transaction and the
IRS determines that it has not been
reported.
OMB No. 1545-2205CORRECTED (if checked)
FILER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
Check to indicate if FILER is a (an):
Payment settlement entity (PSE)
Electronic Payment Facilitator (EPF)/Other third party
Check to indicate transactions reported are:Payment card
Third party network PAYEE’S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
PSE'S name and telephone number
Account number (see instructions)
FILER’S federal identi�cation no.
PAYEE’S taxpayer identi�cation no.
1a Gross amount of payment card/third party network transactions
$ 1b Card Not Present
transactions
$
2 Merchant category code
3 Number of payment transactions
4 Federal income tax withheld
$5a January
$ 5b February
$ 5c March
$ 5d April
$ 5e May
$ 5f June
$ 5g July
$ 5h August
$ 5i September
$ 5j October
$ 5k November
$ 5l December
$ 6 State 7 State identi�cation no. 8 State income tax withheld
$$
Form 1099-K (Keep for your records) www.irs.gov/form1099k
Form 1099-K
Payment Card and Third Party
Network Transactions
Copy B For Payee
Department of the Treasury - Internal Revenue Service
This is important tax information and is being furnished to
the Internal Revenue Service. If you are
required to �le a return, a negligence
penalty or other sanction may be
imposed on you if taxable income
results from this transaction and the
IRS determines that it has not been
reported.
OMB No. 1545-2205CORRECTED (if checked)
FILER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
Check to indicate if FILER is a (an):
Payment settlement entity (PSE)
Electronic Payment Facilitator (EPF)/Other third party
Check to indicate transactions reported are:Payment card
Third party network PAYEE’S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
PSE'S name and telephone number
Account number (see instructions)
FILER’S federal identi�cation no.
PAYEE’S taxpayer identi�cation no.
1a Gross amount of payment card/third party network transactions
$ 1b Card Not Present
transactions
$
2 Merchant category code
3 Number of payment transactions
4 Federal income tax withheld
$5a January
$ 5b February
$ 5c March
$ 5d April
$ 5e May
$ 5f June
$ 5g July
$ 5h August
$ 5i September
$ 5j October
$ 5k November
$ 5l December
$ 6 State 7 State identi�cation no. 8 State income tax withheld
$$
Form 1099-K (Keep for your records) www.irs.gov/form1099k
Form 1099-K
Payment Card and Third Party
Network Transactions
Copy C For FILER
Department of the Treasury - Internal Revenue Service
OMB No. 1545-2205
For Privacy Act and Paperwork
Reduction Act Notice, see the
Instructions for Certain Information
Returns.
VOID CORRECTED FILER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
Check to indicate if FILER is a (an):
Payment settlement entity (PSE)
Electronic Payment Facilitator (EPF)/Other third party
Check to indicate transactions reported are:Payment card
Third party network PAYEE’S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
PSE'S name and telephone number
Account number (see instructions) 2nd TIN not.
FILER’S federal identi�cation no.
PAYEE’S taxpayer identi�cation no.
1a Gross amount of payment card/third party network transactions
$ 1b Card Not Present
transactions
$
2 Merchant category code
3 Number of payment transactions
4 Federal income tax withheld
$5a January
$ 5b February
$ 5c March
$ 5d April
$ 5e May
$ 5f June
$ 5g July
$ 5h August
$ 5i September
$ 5j October
$ 5k November
$ 5l December
$ 6 State 7 State identi�cation no. 8 State income tax withheld
$$
Form 1099-K www.irs.gov/form1099k
Form 1099-K
Payment Card and Third Party
Network Transactions
Copy C For FILER
Department of the Treasury - Internal Revenue Service
OMB No. 1545-2205
For Privacy Act and Paperwork
Reduction Act Notice, see the
Instructions for Certain Information
Returns.
VOID CORRECTED FILER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
Check to indicate if FILER is a (an):
Payment settlement entity (PSE)
Electronic Payment Facilitator (EPF)/Other third party
Check to indicate transactions reported are:Payment card
Third party network PAYEE’S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
PSE'S name and telephone number
Account number (see instructions) 2nd TIN not.
FILER’S federal identi�cation no.
PAYEE’S taxpayer identi�cation no.
1a Gross amount of payment card/third party network transactions
$ 1b Card Not Present
transactions
$
2 Merchant category code
3 Number of payment transactions
4 Federal income tax withheld
$5a January
$ 5b February
$ 5c March
$ 5d April
$ 5e May
$ 5f June
$ 5g July
$ 5h August
$ 5i September
$ 5j October
$ 5k November
$ 5l December
$ 6 State 7 State identi�cation no. 8 State income tax withheld
$$
Form 1099-K www.irs.gov/form1099k
www.PayrollMate.com • 1-800-507-1992 1111
Available in both Self Seal and Moisture Seal
This envelope works perfectly with 2UP printed forms and 2UP perforated paper.
• Order this envelope along with 2UP perforated paper listed below.
• Save Time and Money no need to add address labels. Order by the number of employees.
W-2 2UP Double Window Envelope
2UP Blank Laser or Inkjet Paper without instructions
This perforated blank paper is designed to give you professional looking forms.
• Use this perforated paper with W-2, 1099 MISC, 1099-B, 1099-DIV, 1099-R, 1099-INT &1099-OID forms.
W-2 2UP Double Window Envelope
#W2UPENVRB
W-2 2UP Envelopes and Perforated Paper
Item Number Description Overall Size
W2UPENVRB 2UP Envelope 5¾” x 8¾”2UPB08RB 2UP Blank Paper 8½” x 11”
W-2 4UP Double Window EnvelopeAvailable in Self Seal Only
This envelope works perfectly with 4UP printed forms.
• Order this envelope along with 4UP perforated paper listed below.
• Save Time and Money no need to add address labels. Order by the number of employees.
4UP Blank Laser or Inkjet Paper with instructions
This perforated blank paper with pre-printed instructions on the back is designed to give you professional looking W-2 forms as you can print all four copies (B,C,2, and 2) on one page, fold this form and insert inside W-2 4UP envelopes and mail out.
• Use this perforated paper with W-2 Forms.
• Order by the number of employees.
W-2 4UP Double Window Envelope#4UPENVRB
W-2 Envelopes and Perforated Paper
2UP Blank Laser or Inkjet Paperwithout instructions
#2UPB08RB
4UP Blank Laser or Inkjet Paperwith instructions
#4UPB08RBW-2 4-UP Envelopes and Perforated Paper
Item Number Description Overall Size
4UPENVRB 4UP Envelope 5¾” x 8¾”4UPB08RB 4UP Blank Paper 8½” x 11”
IMPORTANT TAX RETURN DOCUMENT ENCLOSED
IMPORTANT TAX RETURN DOCUMENT ENCLOSED
IMPORTANT TAX RETURN DOCUMENT ENCLOSED
DET
ACH
BEF
ORE
MA
ILIN
G
Your reliable source for Payroll Software, W2/1099 Software and tax forms.1212
Available in both Self Seal and Moisture Seal
This envelope works perfectly with 2UP printed forms and 2UP perforated paper for (1099 MISC, 1099-B, 1099-DIV-
• Order this envelope along with 2UP perforated paper listed below.
• Save Time and Money no need to add address labels.Order by the number of recipients.
1099 2UP Double Window Envelope
2UP Blank Laser or Inkjet Paper without Instructions
This perforated blank paper is designed to give you professional looking forms.
• Use this perforated paper with W-2, 1099 MISC, 1099-B,1099-DIV, 1099-K, 1099-R, 1099-INT, 1098 and 1099-OID.
1099 3UP Double Window EnvelopeAvailable in both Self Seal and Moisture Seal
This envelope works perfectly with 3UP printed forms and 3UP perforated paper for 1099-A, 1099-C, 1099-S, 1098-T, and 1099-PATR forms. You can order thisenvelope along with 3UP perforated paper listed below.
• Save Time and Money no need to add address labels. Order by the number of recipients.
3UP Blank Laser or Inkjet Paper without Instructions
This perforated blank paper is designed to give you professional looking forms.
• Use this perforated paper with 1099-A, 1099-C, 1099-S, 1099-T and 1099-PATR forms.
1099 2UP Envelopes and Perforated Paper
Item Number Description Overall Size
1099UPENVRB 2UP Envelope 5¾” x 8¾”2UPB08RB 2UP Blank Paper 8½” x 11”
2UP Double Window Envelope#1099UPENVRB
3UP Double Window Envelope#3UPENVRB
2UP Blank Laser or Inkjet Paperwithout instructions#2UPB08RB
3UP Blank Laser or Inkjet Paperwithout instructions#3UPB08RB
1099 Envelopes and Perforated Paper
1099 3UP Envelopes and Perforated Paper
Item Number Description Overall Size
3UPENVRB 3UP Envelope 37/8” X 81/4”3UPB08RB 3UP Blank Paper 8½” x 11”
IMPORTANT TAX RETURN DOCUMENT ENCLOSED
IMPORTANT TAX RETURN DOCUMENT ENCLOSED
1099-K, 1099-R, 1099-INT, 1098, & 1099-OID) forms.
Form 1099-MISC
Miscellaneous Income
Copy CFor Payer
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0115
For Privacy Act and Paperwork
Reduction Act Notice, see the
2015 General Instructions for
Certain Information
Returns.
VOID CORRECTEDPAYER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
PAYER’S federal identi�cation number RECIPIENT’S identi�cation number
RECIPIENT’S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions) FATCA �ling requirement
2nd TIN not.
1 Rents
$2 Royalties
$3 Other income
$4 Federal income tax withheld
$5 Fishing boat proceeds
$
6 Medical and health care payments
$7 Nonemployee compensation
$
8 Substitute payments in lieu of dividends or interest
$9 Payer made direct sales of
$5,000 or more of consumer products to a buyer (recipient) for resale �
10 Crop insurance proceeds
$11 12
13 Excess golden parachute payments
$
14 Gross proceeds paid to an attorney
$15a Section 409A deferrals
$
15b Section 409A income
$
16 State tax withheld
$$
17 State/Payer’s state no. 18 State income
$$
Form 1099-MISC www.irs.gov/form1099misc
Form 1099-MISC
Miscellaneous Income
Copy CFor Payer
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0115
For Privacy Act and Paperwork
Reduction Act Notice, see the
2015 General Instructions for
Certain Information
Returns.
VOID CORRECTEDPAYER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
PAYER’S federal identi�cation number RECIPIENT’S identi�cation number
RECIPIENT’S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions) FATCA �ling requirement
2nd TIN not.
1 Rents
$2 Royalties
$3 Other income
$4 Federal income tax withheld
$5 Fishing boat proceeds
$
6 Medical and health care payments
$7 Nonemployee compensation
$
8 Substitute payments in lieu of dividends or interest
$9 Payer made direct sales of
$5,000 or more of consumer products to a buyer (recipient) for resale �
10 Crop insurance proceeds
$11 12
13 Excess golden parachute payments
$
14 Gross proceeds paid to an attorney
$15a Section 409A deferrals
$
15b Section 409A income
$
16 State tax withheld
$$
17 State/Payer’s state no. 18 State income
$$
Form 1099-MISC www.irs.gov/form1099misc
Form 1099-MISC
Miscellaneous Income
Copy BFor Recipient
Department of the Treasury - Internal Revenue Service
This is important tax information and is being furnished to
the Internal Revenue Service. If you are
required to �le 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.
OMB No. 1545-0115CORRECTED (if checked)
PAYER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
PAYER’S federal identi�cation number RECIPIENT’S identi�cation number
RECIPIENT’S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions) FATCA �ling requirement
1 Rents
$2 Royalties
$3 Other income
$4 Federal income tax withheld
$5 Fishing boat proceeds
$
6 Medical and health care payments
$7 Nonemployee compensation
$
8 Substitute payments in lieu of dividends or interest
$9 Payer made direct sales of
$5,000 or more of consumer products to a buyer (recipient) for resale �
10 Crop insurance proceeds
$11 12
13 Excess golden parachute payments
$
14 Gross proceeds paid to an attorney
$15a Section 409A deferrals
$
15b Section 409A income
$
16 State tax withheld
$$
17 State/Payer’s state no. 18 State income
$$
Form 1099-MISC (keep for your records) www.irs.gov/form1099misc
Form 1099-MISC
Miscellaneous Income
Copy BFor Recipient
Department of the Treasury - Internal Revenue Service
This is important tax information and is being furnished to
the Internal Revenue Service. If you are
required to �le 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.
OMB No. 1545-0115CORRECTED (if checked)
PAYER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
PAYER’S federal identi�cation number RECIPIENT’S identi�cation number
RECIPIENT’S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions) FATCA �ling requirement
1 Rents
$2 Royalties
$3 Other income
$4 Federal income tax withheld
$5 Fishing boat proceeds
$
6 Medical and health care payments
$7 Nonemployee compensation
$
8 Substitute payments in lieu of dividends or interest
$9 Payer made direct sales of
$5,000 or more of consumer products to a buyer (recipient) for resale �
10 Crop insurance proceeds
$11 12
13 Excess golden parachute payments
$
14 Gross proceeds paid to an attorney
$15a Section 409A deferrals
$
15b Section 409A income
$
16 State tax withheld
$$
17 State/Payer’s state no. 18 State income
$$
Form 1099-MISC (keep for your records) www.irs.gov/form1099misc
Form 1099-MISC
Cat. No. 14425J
Miscellaneous Income
Copy AFor
Internal Revenue Service Center
Department of the Treasury - Internal Revenue Service
File with Form 1096.
OMB No. 1545-0115
For Privacy Act and Paperwork
Reduction Act Notice, see the
Instructions for
Certain Information
Returns.
9595 VOID CORRECTEDPAYER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
PAYER’S federal identi�cation number RECIPIENT’S identi�cation number
RECIPIENT’S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions) FATCA �ling requirement
2nd TIN not.
1 Rents
$2 Royalties
$3 Other income
$4 Federal income tax withheld
$5 Fishing boat proceeds
$
6 Medical and health care payments
$7 Nonemployee compensation
$
8 Substitute payments in lieu of dividends or interest
$9 Payer made direct sales of
$5,000 or more of consumer products to a buyer (recipient) for resale �
10 Crop insurance proceeds
$11 12
13 Excess golden parachute payments
$
14 Gross proceeds paid to an attorney
$15a Section 409A deferrals
$
15b Section 409A income
$
16 State tax withheld
$$
17 State/Payer’s state no. 18 State income
$$
Form 1099-MISC www.irs.gov/form1099misc
Do Not C ut or S e pa ra t e F orms on T his P a ge — Do Not C ut or S e pa ra t e F orms on T his P a ge
Form 1099-MISC
Cat. No. 14425J
Miscellaneous Income
Copy AFor
Internal Revenue Service Center
Department of the Treasury - Internal Revenue Service
File with Form 1096.
OMB No. 1545-0115
For Privacy Act and Paperwork
Reduction Act Notice, see the
Instructions for
Certain Information
Returns.
9595 VOID CORRECTEDPAYER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
PAYER’S federal identi�cation number RECIPIENT’S identi�cation number
RECIPIENT’S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions) FATCA �ling requirement
2nd TIN not.
1 Rents
$2 Royalties
$3 Other income
$4 Federal income tax withheld
$5 Fishing boat proceeds
$
6 Medical and health care payments
$7 Nonemployee compensation
$
8 Substitute payments in lieu of dividends or interest
$9 Payer made direct sales of
$5,000 or more of consumer products to a buyer (recipient) for resale �
10 Crop insurance proceeds
$11 12
13 Excess golden parachute payments
$
14 Gross proceeds paid to an attorney
$15a Section 409A deferrals
$
15b Section 409A income
$
16 State tax withheld
$$
17 State/Payer’s state no. 18 State income
$$
Form 1099-MISC www.irs.gov/form1099misc
Do Not C ut or S e pa ra t e F orms on T his P a ge — Do Not C ut or S e pa ra t e F orms on T his P a ge
Form 1099-MISC
Miscellaneous Income
Copy 2
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0115CORRECTED (if checked)
PAYER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
PAYER’S federal identi�cation number RECIPIENT’S identi�cation number
RECIPIENT’S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions) FATCA �ling requirement
1 Rents
$2 Royalties
$3 Other income
$4 Federal income tax withheld
$5 Fishing boat proceeds
$
6 Medical and health care payments
$7 Nonemployee compensation
$
8 Substitute payments in lieu of dividends or interest
$9 Payer made direct sales of
$5,000 or more of consumer products to a buyer (recipient) for resale �
10 Crop insurance proceeds
$11 12
13 Excess golden parachute payments
$
14 Gross proceeds paid to an attorney
$15a Section 409A deferrals
$
15b Section 409A income
$
16 State tax withheld
$$
17 State/Payer’s state no. 18 State income
$$
Form 1099-MISC www.irs.gov/form1099misc
To be �led with recipient's state
income tax return, when required.
Form 1099-MISC
Miscellaneous Income
Copy 2
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0115CORRECTED (if checked)
PAYER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
PAYER’S federal identi�cation number RECIPIENT’S identi�cation number
RECIPIENT’S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions) FATCA �ling requirement
1 Rents
$2 Royalties
$3 Other income
$4 Federal income tax withheld
$5 Fishing boat proceeds
$
6 Medical and health care payments
$7 Nonemployee compensation
$
8 Substitute payments in lieu of dividends or interest
$9 Payer made direct sales of
$5,000 or more of consumer products to a buyer (recipient) for resale �
10 Crop insurance proceeds
$11 12
13 Excess golden parachute payments
$
14 Gross proceeds paid to an attorney
$15a Section 409A deferrals
$
15b Section 409A income
$
16 State tax withheld
$$
17 State/Payer’s state no. 18 State income
$$
Form 1099-MISC www.irs.gov/form1099misc
To be �led with recipient's state
income tax return, when required.
Form 1099-MISC
Miscellaneous Income
Copy 1For State Tax
Department
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0115VOID CORRECTED
PAYER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
PAYER’S federal identi�cation number RECIPIENT’S identi�cation number
RECIPIENT’S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions) FATCA �ling requirement
1 Rents
$2 Royalties
$3 Other income
$4 Federal income tax withheld
$5 Fishing boat proceeds
$
6 Medical and health care payments
$7 Nonemployee compensation
$
8 Substitute payments in lieu of dividends or interest
$9 Payer made direct sales of
$5,000 or more of consumer products to a buyer (recipient) for resale �
10 Crop insurance proceeds
$11 12
13 Excess golden parachute payments
$
14 Gross proceeds paid to an attorney
$15a Section 409A deferrals
$
15b Section 409A income
$
16 State tax withheld
$$
17 State/Payer’s state no. 18 State income
$$
Form 1099-MISC www.irs.gov/form1099misc
Form 1099-MISC
Miscellaneous Income
Copy 1For State Tax
Department
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0115VOID CORRECTED
PAYER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
PAYER’S federal identi�cation number RECIPIENT’S identi�cation number
RECIPIENT’S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions) FATCA �ling requirement
1 Rents
$2 Royalties
$3 Other income
$4 Federal income tax withheld
$5 Fishing boat proceeds
$
6 Medical and health care payments
$7 Nonemployee compensation
$
8 Substitute payments in lieu of dividends or interest
$9 Payer made direct sales of
$5,000 or more of consumer products to a buyer (recipient) for resale �
10 Crop insurance proceeds
$11 12
13 Excess golden parachute payments
$
14 Gross proceeds paid to an attorney
$15a Section 409A deferrals
$
15b Section 409A income
$
16 State tax withheld
$$
17 State/Payer’s state no. 18 State income
$$
Form 1099-MISC www.irs.gov/form1099misc
Form 1099-MISC
Miscellaneous Income
Copy CFor Payer
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0115
For Privacy Act and Paperwork
Reduction Act Notice, see the
2015 General Instructions for
Certain Information
Returns.
VOID CORRECTEDPAYER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
PAYER’S federal identi�cation number RECIPIENT’S identi�cation number
RECIPIENT’S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions) FATCA �ling requirement
2nd TIN not.
1 Rents
$2 Royalties
$3 Other income
$4 Federal income tax withheld
$5 Fishing boat proceeds
$
6 Medical and health care payments
$7 Nonemployee compensation
$
8 Substitute payments in lieu of dividends or interest
$9 Payer made direct sales of
$5,000 or more of consumer products to a buyer (recipient) for resale �
10 Crop insurance proceeds
$11 12
13 Excess golden parachute payments
$
14 Gross proceeds paid to an attorney
$15a Section 409A deferrals
$
15b Section 409A income
$
16 State tax withheld
$$
17 State/Payer’s state no. 18 State income
$$
Form 1099-MISC www.irs.gov/form1099misc
Form 1099-MISC
Miscellaneous Income
Copy CFor Payer
Department of the Treasury - Internal Revenue Service
OMB No. 1545-0115
For Privacy Act and Paperwork
Reduction Act Notice, see the
2015 General Instructions for
Certain Information
Returns.
VOID CORRECTEDPAYER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
PAYER’S federal identi�cation number RECIPIENT’S identi�cation number
RECIPIENT’S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions) FATCA �ling requirement
2nd TIN not.
1 Rents
$2 Royalties
$3 Other income
$4 Federal income tax withheld
$5 Fishing boat proceeds
$
6 Medical and health care payments
$7 Nonemployee compensation
$
8 Substitute payments in lieu of dividends or interest
$9 Payer made direct sales of
$5,000 or more of consumer products to a buyer (recipient) for resale �
10 Crop insurance proceeds
$11 12
13 Excess golden parachute payments
$
14 Gross proceeds paid to an attorney
$15a Section 409A deferrals
$
15b Section 409A income
$
16 State tax withheld
$$
17 State/Payer’s state no. 18 State income
$$
Form 1099-MISC www.irs.gov/form1099misc
Form 1099-MISC
Miscellaneous Income
Copy BFor Recipient
Department of the Treasury - Internal Revenue Service
This is important tax information and is being furnished to
the Internal Revenue Service. If you are
required to �le 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.
OMB No. 1545-0115CORRECTED (if checked)
PAYER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
PAYER’S federal identi�cation number RECIPIENT’S identi�cation number
RECIPIENT’S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions) FATCA �ling requirement
1 Rents
$2 Royalties
$3 Other income
$4 Federal income tax withheld
$5 Fishing boat proceeds
$
6 Medical and health care payments
$7 Nonemployee compensation
$
8 Substitute payments in lieu of dividends or interest
$9 Payer made direct sales of
$5,000 or more of consumer products to a buyer (recipient) for resale �
10 Crop insurance proceeds
$11 12
13 Excess golden parachute payments
$
14 Gross proceeds paid to an attorney
$15a Section 409A deferrals
$
15b Section 409A income
$
16 State tax withheld
$$
17 State/Payer’s state no. 18 State income
$$
Form 1099-MISC (keep for your records) www.irs.gov/form1099misc
Form 1099-MISC
Miscellaneous Income
Copy BFor Recipient
Department of the Treasury - Internal Revenue Service
This is important tax information and is being furnished to
the Internal Revenue Service. If you are
required to �le 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.
OMB No. 1545-0115CORRECTED (if checked)
PAYER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
PAYER’S federal identi�cation number RECIPIENT’S identi�cation number
RECIPIENT’S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions) FATCA �ling requirement
1 Rents
$2 Royalties
$3 Other income
$4 Federal income tax withheld
$5 Fishing boat proceeds
$
6 Medical and health care payments
$7 Nonemployee compensation
$
8 Substitute payments in lieu of dividends or interest
$9 Payer made direct sales of
$5,000 or more of consumer products to a buyer (recipient) for resale �
10 Crop insurance proceeds
$11 12
13 Excess golden parachute payments
$
14 Gross proceeds paid to an attorney
$15a Section 409A deferrals
$
15b Section 409A income
$
16 State tax withheld
$$
17 State/Payer’s state no. 18 State income
$$
Form 1099-MISC (keep for your records) www.irs.gov/form1099misc
Form 1099-MISC
Cat. No. 14425J
Miscellaneous Income
Copy AFor
Internal Revenue Service Center
Department of the Treasury - Internal Revenue Service
File with Form 1096.
OMB No. 1545-0115
For Privacy Act and Paperwork
Reduction Act Notice, see the
Instructions for
Certain Information
Returns.
9595 VOID CORRECTEDPAYER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
PAYER’S federal identi�cation number RECIPIENT’S identi�cation number
RECIPIENT’S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions) FATCA �ling requirement
2nd TIN not.
1 Rents
$2 Royalties
$3 Other income
$4 Federal income tax withheld
$5 Fishing boat proceeds
$
6 Medical and health care payments
$7 Nonemployee compensation
$
8 Substitute payments in lieu of dividends or interest
$9 Payer made direct sales of
$5,000 or more of consumer products to a buyer (recipient) for resale �
10 Crop insurance proceeds
$11 12
13 Excess golden parachute payments
$
14 Gross proceeds paid to an attorney
$15a Section 409A deferrals
$
15b Section 409A income
$
16 State tax withheld
$$
17 State/Payer’s state no. 18 State income
$$
Form 1099-MISC www.irs.gov/form1099misc
Do Not C ut or S e pa ra t e F orms on T his P a ge — Do Not C ut or S e pa ra t e F orms on T his P a ge
Form 1099-MISC
Cat. No. 14425J
Miscellaneous Income
Copy AFor
Internal Revenue Service Center
Department of the Treasury - Internal Revenue Service
File with Form 1096.
OMB No. 1545-0115
For Privacy Act and Paperwork
Reduction Act Notice, see the
Instructions for
Certain Information
Returns.
9595 VOID CORRECTEDPAYER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.
PAYER’S federal identi�cation number RECIPIENT’S identi�cation number
RECIPIENT’S name
Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Account number (see instructions) FATCA �ling requirement
2nd TIN not.
1 Rents
$2 Royalties
$3 Other income
$4 Federal income tax withheld
$5 Fishing boat proceeds
$
6 Medical and health care payments
$7 Nonemployee compensation
$
8 Substitute payments in lieu of dividends or interest
$9 Payer made direct sales of
$5,000 or more of consumer products to a buyer (recipient) for resale �
10 Crop insurance proceeds
$11 12
13 Excess golden parachute payments
$
14 Gross proceeds paid to an attorney
$15a Section 409A deferrals
$
15b Section 409A income
$
16 State tax withheld
$$
17 State/Payer’s state no. 18 State income
$$
Form 1099-MISC www.irs.gov/form1099misc
Do Not C ut or S e pa ra t e F orms on T his P a ge — Do Not C ut or S e pa ra t e F orms on T his P a ge
www.W2Mate.com • 1-800-507-1992 9
W-2 /1099 SetsW2 Traditional Laser or Ink Jet Sets• IRS-Compliant forms guaranteed compatible with W2 Mate, Payroll Mate
or your W2 printing software• 2up format is for two different employees per page; print each
copy as a batch, then separate and collate for each employee• Each 8½” x 11” sheet is developed in compliance with IRS regulations• Order the quantity equal to the number of employees for which you file
Set 1 Includes 6 Parts, 5 W3 Forms and Self-Seal Envelopes
Set 2 includes 4 Parts
1099-Misc Traditional Laser or Ink Jet Sets• IRS-Compliant forms guaranteed compatible with W2 Mate or
your 1099 printing software• 2up format is for two different recipients per page; print each
copy as a batch, then separate and collate for each recipient• Each 8½” x 11” sheet is developed in compliance with IRS regulations• Order the quantity equal to the number of recipients for which you file
Set 1 Includes 5 Parts, 5 1096 Forms and Self-Seal Envelopes
Set 2 includes 3 Parts
SET 2 W-2 2UP 4-Part Traditional Preprinted Laser Set#W2S408RB
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13
Do Not Staple 6969
Form 1096Department of the Treasury Internal Revenue Service
Annual Summary and Transmittal of U.S. Information Returns
OMB No. 1545-0108
FILER'S name
Street address (including room or suite number)
City or town, state or province, country, and ZIP or foreign postal code
Name of person to contact Telephone number
Email address Fax number
For O�cial Use Only
1 Employer identi�cation number 2 Social security number 3 Total number of forms 4 Federal income tax withheld
$
5 Total amount reported with this Form 1096
$6 Enter an “X” in only one box below to indicate the type of form being �led.
W-2G 32
1097-BTC 50
1098 81
1098-C 78
1098-E 84
1098-Q 74
1098-T 83
1099-A 80
1099-B 79
1099-C 85
1099-CAP 73
1099-DIV 91
1099-G 86
1099-INT 92
1099-K 10
1099-LTC 93
1099-MISC 95
1099-OID 96
1099-PATR 97
1099-Q 31
1099-R 98
1099-S 75
1099-SA 94
3921 25
3922 26
5498 28
5498-ESA 72
5498-SA 27
7 If this is your �nal return , enter an “X” here . . . . . �
Return this entire page to the Internal Revenue Service. Photocopies are not acceptable.
Under penalties of perjury, I declare that I have examined this return and accompanying documents, and, to the best of my knowledge and belief, they are true, correct, and complete.
Signature � Title � Date �
InstructionsFuture developments. For the latest information about developments related to Form 1096, such as legislation enacted after it was published, go to www.irs.gov/form1096.Reminder. The only acceptable method of �ling information returns with Internal Revenue Service/Information Returns Branch is electronically through the FIRE system. See Pub. 1220, Speci�cations for Electronic Filing of Forms 1097, 1098, 1099, 3921, 3922, 5498, and W-2G.Purpose of form. Use this form to transmit paper Forms 1097, 1098, 1099, 3921, 3922, 5498, and W-2G to the Internal Revenue Service. Do not use Form 1096 to transmit electronically. For electronic submissions, see Pub. 1220.Caution. If you are required to �le 250 or more information returns of any one type, you must �le electronically. If you are required to �le electronically but fail to do so, and you do not have an approved waiver, you may be subject to a penalty. For more information, see part F in the 2015 General Instructions for Certain Information Returns.Who must �le. The name, address, and TIN of the �ler on this form must be the same as those you enter in the upper left area of Forms 1097, 1098, 1099, 3921, 3922, 5498, or W-2G. A �ler is any person or entity who �les any of the forms shown in line 6 above.
Enter the �ler’s name, address (including room, suite, or other unit number), and TIN in the spaces provided on the form.
When to �le. File Form 1096 as follows.• With Forms 1097, 1098, 1099, 3921, 3922, or W-2G, file by February 29, 2016.• With Forms 5498, file by May 31, 2016.
Where To FileSend all information returns �led on paper with Form 1096 to the following.
If your principal business, o�ce or agency, or legal residence in
the case of an individual, is located in
Use the following three-line address
� �
Alabama, Arizona, Arkansas, Connecticut, Delaware, Florida, Georgia, Kentucky, Louisiana, Maine, Massachusetts, Mississippi, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Pennsylvania, Rhode Island, Texas, Vermont, Virginia, West Virginia
Department of the Treasury Internal Revenue Service Center
Austin, TX 73301
Cat. No. 14400O Form 1096
22222a Employee’s social security number
OMB No. 1545-0008
b Employer identi�cation number (EIN)
c Employer’s name, address, and ZIP code
d Control number
e Employee’s �rst name and initial Last name Su�.
f Employee’s address and ZIP code
1 Wages, tips, other compensation 2 Federal income tax withheld
3 Social security wages 4 Social security tax withheld
5 Medicare wages and tips 6 Medicare tax withheld
7 Social security tips 8 Allocated tips
9 10 Dependent care bene�ts
11 Nonquali�ed plans 12a Co d e
12bCo d e
12cCo d e
12dCo d e
13 Statutory employee
Retirement plan
Third-party sick pay
14 Other
15 State Employer’s state ID number 16 State wages, tips, etc. 17 State income tax 18 Local wages, tips, etc. 19 Local income tax 20 Locality name
Form W-2 Wage and Tax Statement
Department of the Treasury—Internal Revenue Service
22222a Employee’s social security number
OMB No. 1545-0008
b Employer identi�cation number (EIN)
c Employer’s name, address, and ZIP code
d Control number
e Employee’s �rst name and initial Last name Su�.
f Employee’s address and ZIP code
1 Wages, tips, other compensation 2 Federal income tax withheld
3 Social security wages 4 Social security tax withheld
5 Medicare wages and tips 6 Medicare tax withheld
7 Social security tips 8 Allocated tips
9 10 Dependent care bene�ts
11 Nonquali�ed plans 12a Co d e
12bCo d e
12cCo d e
12dCo d e
13 Statutory employee
Retirement plan
Third-party sick pay
14 Other
15 State Employer’s state ID number 16 State wages, tips, etc. 17 State income tax 18 Local wages, tips, etc. 19 Local income tax 20 Locality name
Form W-2 Wage and Tax Statement
Department of the Treasury—Internal Revenue Service
22222a Employee’s social security number
OMB No. 1545-0008
b Employer identi�cation number (EIN)
c Employer’s name, address, and ZIP code
d Control number
e Employee’s �rst name and initial Last name Su�.
f Employee’s address and ZIP code
1 Wages, tips, other compensation 2 Federal income tax withheld
3 Social security wages 4 Social security tax withheld
5 Medicare wages and tips 6 Medicare tax withheld
7 Social security tips 8 Allocated tips
9 10 Dependent care bene�ts
11 Nonquali�ed plans 12a Co d e
12bCo d e
12cCo d e
12dCo d e
13 Statutory employee
Retirement plan
Third-party sick pay
14 Other
15 State Employer’s state ID number 16 State wages, tips, etc. 17 State income tax 18 Local wages, tips, etc. 19 Local income tax 20 Locality name
Form W-2 Wage and Tax Statement
Department of the Treasury—Internal Revenue Service
22222a Employee’s social security number
OMB No. 1545-0008
b Employer identi�cation number (EIN)
c Employer’s name, address, and ZIP code
d Control number
e Employee’s �rst name and initial Last name Su�.
f Employee’s address and ZIP code
1 Wages, tips, other compensation 2 Federal income tax withheld
3 Social security wages 4 Social security tax withheld
5 Medicare wages and tips 6 Medicare tax withheld
7 Social security tips 8 Allocated tips
9 10 Dependent care bene�ts
11 Nonquali�ed plans 12a Co d e
12bCo d e
12cCo d e
12dCo d e
13 Statutory employee
Retirement plan
Third-party sick pay
14 Other
15 State Employer’s state ID number 16 State wages, tips, etc. 17 State income tax 18 Local wages, tips, etc. 19 Local income tax 20 Locality name
Form W-2 Wage and Tax Statement
Department of the Treasury—Internal Revenue Service
22222a Employee’s social security number
OMB No. 1545-0008
b Employer identi�cation number (EIN)
c Employer’s name, address, and ZIP code
d Control number
e Employee’s �rst name and initial Last name Su�.
f Employee’s address and ZIP code
1 Wages, tips, other compensation 2 Federal income tax withheld
3 Social security wages 4 Social security tax withheld
5 Medicare wages and tips 6 Medicare tax withheld
7 Social security tips 8 Allocated tips
9 10 Dependent care bene�ts
11 Nonquali�ed plans 12a Co d e
12bCo d e
12cCo d e
12dCo d e
13 Statutory employee
Retirement plan
Third-party sick pay
14 Other
15 State Employer’s state ID number 16 State wages, tips, etc. 17 State income tax 18 Local wages, tips, etc. 19 Local income tax 20 Locality name
Form W-2 Wage and Tax Statement
Department of the Treasury—Internal Revenue Service
22222a Employee’s social security number
OMB No. 1545-0008
b Employer identi�cation number (EIN)
c Employer’s name, address, and ZIP code
d Control number
e Employee’s �rst name and initial Last name Su�.
f Employee’s address and ZIP code
1 Wages, tips, other compensation 2 Federal income tax withheld
3 Social security wages 4 Social security tax withheld
5 Medicare wages and tips 6 Medicare tax withheld
7 Social security tips 8 Allocated tips
9 10 Dependent care bene�ts
11 Nonquali�ed plans 12a Co d e
12bCo d e
12cCo d e
12dCo d e
13 Statutory employee
Retirement plan
Third-party sick pay
14 Other
15 State Employer’s state ID number 16 State wages, tips, etc. 17 State income tax 18 Local wages, tips, etc. 19 Local income tax 20 Locality name
Form W-2 Wage and Tax Statement
Department of the Treasury—Internal Revenue Service
22222a Employee’s social security number
OMB No. 1545-0008
b Employer identi�cation number (EIN)
c Employer’s name, address, and ZIP code
d Control number
e Employee’s �rst name and initial Last name Su�.
f Employee’s address and ZIP code
1 Wages, tips, other compensation 2 Federal income tax withheld
3 Social security wages 4 Social security tax withheld
5 Medicare wages and tips 6 Medicare tax withheld
7 Social security tips 8 Allocated tips
9 10 Dependent care bene�ts
11 Nonquali�ed plans 12a Co d e
12bCo d e
12cCo d e
12dCo d e
13 Statutory employee
Retirement plan
Third-party sick pay
14 Other
15 State Employer’s state ID number 16 State wages, tips, etc. 17 State income tax 18 Local wages, tips, etc. 19 Local income tax 20 Locality name
Form W-2 Wage and Tax Statement
Department of the Treasury—Internal Revenue Service
22222a Employee’s social security number
OMB No. 1545-0008
b Employer identi�cation number (EIN)
c Employer’s name, address, and ZIP code
d Control number
e Employee’s �rst name and initial Last name Su�.
f Employee’s address and ZIP code
1 Wages, tips, other compensation 2 Federal income tax withheld
3 Social security wages 4 Social security tax withheld
5 Medicare wages and tips 6 Medicare tax withheld
7 Social security tips 8 Allocated tips
9 10 Dependent care bene�ts
11 Nonquali�ed plans 12a Co d e
12bCo d e
12cCo d e
12dCo d e
13 Statutory employee
Retirement plan
Third-party sick pay
14 Other
15 State Employer’s state ID number 16 State wages, tips, etc. 17 State income tax 18 Local wages, tips, etc. 19 Local income tax 20 Locality name
Form W-2 Wage and Tax Statement
Department of the Treasury—Internal Revenue Service
22222a Employee’s social security number
OMB No. 1545-0008
b Employer identi�cation number (EIN)
c Employer’s name, address, and ZIP code
d Control number
e Employee’s �rst name and initial Last name Su�.
f Employee’s address and ZIP code
1 Wages, tips, other compensation 2 Federal income tax withheld
3 Social security wages 4 Social security tax withheld
5 Medicare wages and tips 6 Medicare tax withheld
7 Social security tips 8 Allocated tips
9 10 Dependent care bene�ts
11 Nonquali�ed plans 12a Co d e
12bCo d e
12cCo d e
12dCo d e
13 Statutory employee
Retirement plan
Third-party sick pay
14 Other
15 State Employer’s state ID number 16 State wages, tips, etc. 17 State income tax 18 Local wages, tips, etc. 19 Local income tax 20 Locality name
Form W-2 Wage and Tax Statement
Department of the Treasury—Internal Revenue Service
22222a Employee’s social security number
OMB No. 1545-0008
b Employer identi�cation number (EIN)
c Employer’s name, address, and ZIP code
d Control number
e Employee’s �rst name and initial Last name Su�.
f Employee’s address and ZIP code
1 Wages, tips, other compensation 2 Federal income tax withheld
3 Social security wages 4 Social security tax withheld
5 Medicare wages and tips 6 Medicare tax withheld
7 Social security tips 8 Allocated tips
9 10 Dependent care bene�ts
11 Nonquali�ed plans 12a Co d e
12bCo d e
12cCo d e
12dCo d e
13 Statutory employee
Retirement plan
Third-party sick pay
14 Other
15 State Employer’s state ID number 16 State wages, tips, etc. 17 State income tax 18 Local wages, tips, etc. 19 Local income tax 20 Locality name
Form W-2 Wage and Tax Statement
Department of the Treasury—Internal Revenue Service
22222a Employee’s social security number
OMB No. 1545-0008
b Employer identi�cation number (EIN)
c Employer’s name, address, and ZIP code
d Control number
e Employee’s �rst name and initial Last name Su�.
f Employee’s address and ZIP code
1 Wages, tips, other compensation 2 Federal income tax withheld
3 Social security wages 4 Social security tax withheld
5 Medicare wages and tips 6 Medicare tax withheld
7 Social security tips 8 Allocated tips
9 10 Dependent care bene�ts
11 Nonquali�ed plans 12a Co d e
12bCo d e
12cCo d e
12dCo d e
13 Statutory employee
Retirement plan
Third-party sick pay
14 Other
15 State Employer’s state ID number 16 State wages, tips, etc. 17 State income tax 18 Local wages, tips, etc. 19 Local income tax 20 Locality name
Form W-2 Wage and Tax Statement
Department of the Treasury—Internal Revenue Service
22222a Employee’s social security number
OMB No. 1545-0008
b Employer identi�cation number (EIN)
c Employer’s name, address, and ZIP code
d Control number
e Employee’s �rst name and initial Last name Su�.
f Employee’s address and ZIP code
1 Wages, tips, other compensation 2 Federal income tax withheld
3 Social security wages 4 Social security tax withheld
5 Medicare wages and tips 6 Medicare tax withheld
7 Social security tips 8 Allocated tips
9 10 Dependent care bene�ts
11 Nonquali�ed plans 12a Co d e
12bCo d e
12cCo d e
12dCo d e
13 Statutory employee
Retirement plan
Third-party sick pay
14 Other
15 State Employer’s state ID number 16 State wages, tips, etc. 17 State income tax 18 Local wages, tips, etc. 19 Local income tax 20 Locality name
Form W-2 Wage and Tax Statement
Department of the Treasury—Internal Revenue Service
22222a Employee’s social security number
OMB No. 1545-0008
b Employer identi�cation number (EIN)
c Employer’s name, address, and ZIP code
d Control number
e Employee’s �rst name and initial Last name Su�.
f Employee’s address and ZIP code
1 Wages, tips, other compensation 2 Federal income tax withheld
3 Social security wages 4 Social security tax withheld
5 Medicare wages and tips 6 Medicare tax withheld
7 Social security tips 8 Allocated tips
9 10 Dependent care bene�ts
11 Nonquali�ed plans 12a Co d e
12bCo d e
12cCo d e
12dCo d e
13 Statutory employee
Retirement plan
Third-party sick pay
14 Other
15 State Employer’s state ID number 16 State wages, tips, etc. 17 State income tax 18 Local wages, tips, etc. 19 Local income tax 20 Locality name
Form W-2 Wage and Tax Statement
Department of the Treasury—Internal Revenue Service
22222a Employee’s social security number
OMB No. 1545-0008
b Employer identi�cation number (EIN)
c Employer’s name, address, and ZIP code
d Control number
e Employee’s �rst name and initial Last name Su�.
f Employee’s address and ZIP code
1 Wages, tips, other compensation 2 Federal income tax withheld
3 Social security wages 4 Social security tax withheld
5 Medicare wages and tips 6 Medicare tax withheld
7 Social security tips 8 Allocated tips
9 10 Dependent care bene�ts
11 Nonquali�ed plans 12a Co d e
12bCo d e
12cCo d e
12dCo d e
13 Statutory employee
Retirement plan
Third-party sick pay
14 Other
15 State Employer’s state ID number 16 State wages, tips, etc. 17 State income tax 18 Local wages, tips, etc. 19 Local income tax 20 Locality name
Form W-2 Wage and Tax Statement
Department of the Treasury—Internal Revenue Service
22222a Employee’s social security number
OMB No. 1545-0008
b Employer identi�cation number (EIN)
c Employer’s name, address, and ZIP code
d Control number
e Employee’s �rst name and initial Last name Su�.
f Employee’s address and ZIP code
1 Wages, tips, other compensation 2 Federal income tax withheld
3 Social security wages 4 Social security tax withheld
5 Medicare wages and tips 6 Medicare tax withheld
7 Social security tips 8 Allocated tips
9 10 Dependent care bene�ts
11 Nonquali�ed plans 12a Co d e
12bCo d e
12cCo d e
12dCo d e
13 Statutory employee
Retirement plan
Third-party sick pay
14 Other
15 State Employer’s state ID number 16 State wages, tips, etc. 17 State income tax 18 Local wages, tips, etc. 19 Local income tax 20 Locality name
Form W-2 Wage and Tax Statement
Department of the Treasury—Internal Revenue Service
22222a Employee’s social security number
OMB No. 1545-0008
b Employer identi�cation number (EIN)
c Employer’s name, address, and ZIP code
d Control number
e Employee’s �rst name and initial Last name Su�.
f Employee’s address and ZIP code
1 Wages, tips, other compensation 2 Federal income tax withheld
3 Social security wages 4 Social security tax withheld
5 Medicare wages and tips 6 Medicare tax withheld
7 Social security tips 8 Allocated tips
9 10 Dependent care bene�ts
11 Nonquali�ed plans 12a Co d e
12bCo d e
12cCo d e
12dCo d e
13 Statutory employee
Retirement plan
Third-party sick pay
14 Other
15 State Employer’s state ID number 16 State wages, tips, etc. 17 State income tax 18 Local wages, tips, etc. 19 Local income tax 20 Locality name
Form W-2 Wage and Tax Statement
Department of the Treasury—Internal Revenue Service
22222 Voida Employee’s social security number For O�cial Use Only �
OMB No. 1545-0008
b Employer identi�cation number (EIN)
c Employer’s name, address, and ZIP code
d Control number
e Employee’s �rst name and initial Last name Su�.
f Employee’s address and ZIP code
1 Wages, tips, other compensation 2 Federal income tax withheld
3 Social security wages 4 Social security tax withheld
5 Medicare wages and tips 6 Medicare tax withheld
7 Social security tips 8 Allocated tips
9 10 Dependent care bene�ts
11 Nonquali�ed plans 12a See instructions for box 12Co d e
12bCo d e
12cCo d e
12dCo d e
13 Statutory employee
Retirement plan
Third-party sick pay
14 Other
15 State Employer’s state ID number 16 State wages, tips, etc. 17 State income tax 18 Local wages, tips, etc. 19 Local income tax 20 Locality name
Form W-2 Wage and Tax Statement
Copy A For Social Security Administration — Send this entire page with Form W-3 to the Social Security Administration; photocopies are not acceptable.
Department of the Treasury—Internal Revenue Service For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 10134D
Do Not Cut, Fold, or Staple Forms on This Page
22222 Voida Employee’s social security number For O�cial Use Only �
OMB No. 1545-0008
b Employer identi�cation number (EIN)
c Employer’s name, address, and ZIP code
d Control number
e Employee’s �rst name and initial Last name Su�.
f Employee’s address and ZIP code
1 Wages, tips, other compensation 2 Federal income tax withheld
3 Social security wages 4 Social security tax withheld
5 Medicare wages and tips 6 Medicare tax withheld
7 Social security tips 8 Allocated tips
9 10 Dependent care bene�ts
11 Nonquali�ed plans 12a See instructions for box 12Co d e
12bCo d e
12cCo d e
12dCo d e
13 Statutory employee
Retirement plan
Third-party sick pay
14 Other
15 State Employer’s state ID number 16 State wages, tips, etc. 17 State income tax 18 Local wages, tips, etc. 19 Local income tax 20 Locality name
Form W-2 Wage and Tax Statement
Copy A For Social Security Administration — Send this entire page with Form W-3 to the Social Security Administration; photocopies are not acceptable.
Department of the Treasury—Internal Revenue Service For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 10134D
Do Not Cut, Fold, or Staple Forms on This Page
22222 Voida Employee’s social security number For O�cial Use Only �
OMB No. 1545-0008
b Employer identi�cation number (EIN)
c Employer’s name, address, and ZIP code
d Control number
e Employee’s �rst name and initial Last name Su�.
f Employee’s address and ZIP code
1 Wages, tips, other compensation 2 Federal income tax withheld
3 Social security wages 4 Social security tax withheld
5 Medicare wages and tips 6 Medicare tax withheld
7 Social security tips 8 Allocated tips
9 10 Dependent care bene�ts
11 Nonquali�ed plans 12a See instructions for box 12Co d e
12bCo d e
12cCo d e
12dCo d e
13 Statutory employee
Retirement plan
Third-party sick pay
14 Other
15 State Employer’s state ID number 16 State wages, tips, etc. 17 State income tax 18 Local wages, tips, etc. 19 Local income tax 20 Locality name
Form W-2 Wage and Tax Statement
Copy A For Social Security Administration — Send this entire page with Form W-3 to the Social Security Administration; photocopies are not acceptable.
Department of the Treasury—Internal Revenue Service For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 10134D
Do Not Cut, Fold, or Staple Forms on This Page
22222 Voida Employee’s social security number For O�cial Use Only �
OMB No. 1545-0008
b Employer identi�cation number (EIN)
c Employer’s name, address, and ZIP code
d Control number
e Employee’s �rst name and initial Last name Su�.
f Employee’s address and ZIP code
1 Wages, tips, other compensation 2 Federal income tax withheld
3 Social security wages 4 Social security tax withheld
5 Medicare wages and tips 6 Medicare tax withheld
7 Social security tips 8 Allocated tips
9 10 Dependent care bene�ts
11 Nonquali�ed plans 12a See instructions for box 12Co d e
12bCo d e
12cCo d e
12dCo d e
13 Statutory employee
Retirement plan
Third-party sick pay
14 Other
15 State Employer’s state ID number 16 State wages, tips, etc. 17 State income tax 18 Local wages, tips, etc. 19 Local income tax 20 Locality name
Form W-2 Wage and Tax Statement
Copy A For Social Security Administration — Send this entire page with Form W-3 to the Social Security Administration; photocopies are not acceptable.
Department of the Treasury—Internal Revenue Service For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 10134D
Do Not Cut, Fold, or Staple Forms on This Page
DO NOT STAPLE
33333a Control number For O�cial Use Only �
OMB No. 1545-0008
b Kind of Payer (Check one)
941 Military 943 944
CT-1Hshld. emp.
Medicare govt. emp.
Kind of Employer (Check one)
None apply 501c non-govt.
State/local non-501c State/local 501c Federal govt.
Third-party sick pay
(Check if
applicable)
c Total number of Forms W-2 d Establishment number
e Employer identi�cation number (EIN)
f Employer’s name
g Employer’s address and ZIP code
h Other EIN used this year
1 Wages, tips, other compensation 2 Federal income tax withheld
3 Social security wages 4 Social security tax withheld
5 Medicare wages and tips 6 Medicare tax withheld
7 Social security tips 8 Allocated tips
9 10 Dependent care bene�ts
11 Nonquali�ed plans 12a Deferred compensation
12b13 For third-party sick pay use only
14 Income tax withheld by payer of third-party sick pay15 State Employer’s state ID number
16 State wages, tips, etc. 17 State income tax 18 Local wages, tips, etc. 19 Local income tax
Employer's contact person Employer's telephone number For O�cial Use Only
Employer's fax number Employer's email address
Under penalties of perjury, I declare that I have examined this return and accompanying documents and, to the best of my knowledge and belief, they are true, correct, and complete.
Signature � Title � Date �
Form W-3 Transmittal of Wage and Tax Statements Department of the Treasury Internal Revenue Service
Send this entire page with the entire Copy A page of Form(s) W-2 to the Social Security Administration (SSA). Photocopies are not acceptable. Do not send Form W-3 if you �led electronically with the SSA. Do not send any payment (cash, checks, money orders, etc.) with Forms W-2 and W-3.
ReminderSeparate instructions. See the 2016 General Instructions for Forms W-2 and W-3 for information on completing this form. Do not �le Form W-3 for Form(s) W-2 that were submitted electronically to the SSA.
Purpose of FormA Form W-3 Transmittal is completed only when paper Copy A of Form(s) W-2, Wage and Tax Statement, is being �led. Do not �le Form W-3 alone. All paper forms must comply with IRS standards and be machine readable. Photocopies are not acceptable. Use a Form W-3 even if only one paper Form W-2 is being �led. Make sure both the Form W-3 and Form(s) W-2 show the correct tax year and Employer Identi�cation Number (EIN). Make a copy of this form and keep it with Copy D (For Employer) of Form(s) W-2 for your records. The IRS recommends retaining copies of these forms for four years.
E-FilingThe SSA strongly suggests employers report Form W-3 and Forms W-2 Copy A electronically instead of on paper. The SSA provides two free e-�ling options on its Business Services Online (BSO) website:• W-2 Online. Use �ll-in forms to create, save, print, and submit up to 50 Forms W-2 at a time to the SSA.• File Upload. Upload wage �les to the SSA you have created using payroll or tax software that formats the �les according to the SSA’s Speci�cations for Filing Forms W-2 Electronically (EFW2).
W-2 Online �ll-in forms or �le uploads will be on time if submitted by www.socialsecurity.gov/
employer . First time �lers, select “ Go to Register ”; returning �lers select “Go To Log In .”
When To FileMail Form W-3 with Copy A of Form(s) W-2 by February 28, 2017.
Where To File Paper FormsSend this entire page with the entire Copy A page of Form(s) W-2 to:
Social Security Administration Data Operations Center Wilkes-Barre, PA 18769-0001
Note: If you use “Certi�ed Mail” to �le, change the ZIP code to “18769-0002.” If you use an IRS-approved private delivery service, add “ATTN: W-2 Process, 1150 E. Mountain Dr.” to the address and change the ZIP code to “18702-7997.” See Publication 15 (Circular E), Employer’s Tax Guide, for a list of IRS-approved private delivery services.
For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions.
IMPORTANT TAX RETURN DOCUMENT ENCLOSED
IMPORTANT TAX RETURN DOCUMENT ENCLOSED
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