PDF document
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                                    Attention: 

Copy A of this form is provided for informational purposes only. Copy A appears in red, 
similar to the official IRS form. The official printed version of Copy A of this IRS form is 
scannable, but the online version of it, printed from this website, is not. Do not print and file 
copy A downloaded from this website; a penalty may be imposed for filing with the IRS 
information return forms that can’t be scanned. See part O in the current General 
Instructions for Certain Information Returns, available at www.irs.gov/form1099, for more 
information about penalties.

Please note that Copy B and other copies of this form, which appear in black, may be 
downloaded and printed and used to satisfy the requirement to provide the information to 
the recipient.

To order official IRS information returns, which include a scannable Copy A for filing with 
the IRS and all other applicable copies of the form, visit www.IRS.gov/orderforms. Click on 
Employer and Information Returns, and we’ll mail you the forms you request and their 
instructions, as well as any publications you may order.

Information returns may also be filed electronically using the IRS Filing Information Returns 
Electronically (FIRE) system (visit www.IRS.gov/FIRE) or the IRS Affordable Care Act 
Information Returns (AIR) program (visit www.IRS.gov/AIR).

See IRS Publications 1141, 1167, and 1179 for more information about printing these tax 
forms.



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            9696                               VOID CORRECTED
PAYER’S name, street address, city or town, state or province, country,  1 Original issue discount for OMB No. 1545-0117
ZIP or foreign postal code, and telephone no.                              the year
                                                                         $
                                                                                                       Form 1099-OID                Original Issue 
                                                                                                       (Rev. October 2019)          Discount
                                                                         2 Other periodic interest
                                                                                                        For calendar year     
                                                                         $                                     20
PAYER’S TIN                        RECIPIENT’S TIN                       3 Early withdrawal penalty    4 Federal income tax withheld
                                                                                                                                    Copy A
                                                                         $                             $
                                                                         5 Market discount             6 Acquisition premium
                                                                                                                                    For 
                                                                                                                                    Internal Revenue 
RECIPIENT’S name
                                                                         $                             $                            Service Center
                                                                         7 Description
                                                                                                                                    File with Form 1096.
Street address (including apt. no.)
                                                                                                                                    For Privacy Act 
                                                                                                                                    and Paperwork 
City or town, state or province, country, and ZIP or foreign postal code 8 Original issue discount on  9 Investment expenses
                                                                           U.S. Treasury obligations                                Reduction Act 
                                                                                                                                    Notice, see the 
                                                                         $                             $                            current General 
                                                    FATCA filing         10 Bond premium               11 Tax-exempt OID
                                                    requirement                                                                     Instructions for 
                                                                                                                                    Certain 
                                                                         $                             $                            Information 
Account number (see instructions)                   2nd TIN not.         12 State 13 State identification no. 14 State tax withheld
                                                                                                                                    Returns.
                                                                                                              $
                                                                                                              $
Form 1099-OID (Rev. 10-2019)       Cat. No. 14421R                       www.irs.gov/Form1099OID         Department of the Treasury - Internal Revenue Service
Do Not Cut or Separate Forms on This Page — Do Not Cut or Separate Forms on This Page



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                                              VOID CORRECTED
PAYER’S name, street address, city or town, state or province, country,  1 Original issue discount for OMB No. 1545-0117
ZIP or foreign postal code, and telephone no.                              the year
                                                                         $
                                                                                                       Form 1099-OID                Original Issue 
                                                                                                       (Rev. October 2019)          Discount
                                                                         2 Other periodic interest
                                                                                                        For calendar year     
                                                                         $                                     20
PAYER’S TIN                        RECIPIENT’S TIN                       3 Early withdrawal penalty    4 Federal income tax withheld
                                                                                                                                    Copy 1
                                                                         $                             $
                                                                         5 Market discount             6 Acquisition premium 
                                                                                                                                    For State Tax 
RECIPIENT’S name                                                         $                             $                            Department
                                                                         7 Description

Street address (including apt. no.)

City or town, state or province, country, and ZIP or foreign postal code 8 Original issue discount on  9 Investment expenses
                                                                           U.S. Treasury obligations
                                                                         $                             $
                                                   FATCA filing          10 Bond premium               11 Tax-exempt OID
                                                   requirement
                                                                         $                             $
Account number (see instructions)                                        12 State 13 State identification no. 14 State tax withheld
                                                                                                              $
                                                                                                              $
Form 1099-OID (Rev. 10-2019)                       www.irs.gov/Form1099OID                               Department of the Treasury - Internal Revenue Service



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                                                    CORRECTED (if checked)
PAYER’S name, street address, city or town, state or province, country,  1 Original issue discount for        OMB No. 1545-0117
ZIP or foreign postal code, and telephone no.                              the year*
                                                                         $
                                                                         * This may not be the correct figure Form 1099-OID                Original Issue 
                                                                         to report on your income tax return. 
                                                                         See instructions on the back.        (Rev. October 2019)          Discount
                                                                         2 Other periodic interest
                                                                                                               For calendar year     
                                                                         $                                         20
PAYER’S TIN                         RECIPIENT’S TIN                      3 Early withdrawal penalty           4 Federal income tax withheld
                                                                                                                                           Copy B
                                                                         $                                    $
                                                                         5 Market discount                    6 Acquisition premium
                                                                                                                                           For Recipient
RECIPIENT’S name                                                         $                                    $ 
                                                                         7 Description

Street address (including apt. no.)                                                                                                        This is important tax 
                                                                                                                                           information and is 
                                                                                                                                           being furnished to 
                                                                                                                                           the IRS. If you are 
City or town, state or province, country, and ZIP or foreign postal code 8 Original issue discount on         9 Investment expenses        required to file a 
                                                                           U.S. Treasury obligations*                                      return, a negligence 
                                                                                                                                           penalty or other 
                                                                         $                                    $                            sanction may be 
                                                    FATCA filing         10 Bond premium                      11 Tax-exempt OID            imposed on you if 
                                                    requirement                                                                            this income is 
                                                                                                                                           taxable and the IRS 
                                                                         $                                    $                            determines that it 
Account number (see instructions)                                        12 State 13 State identification no.      14 State tax withheld   has not been 
                                                                                                                                           reported.
                                                                                                                 $
                                                                                                                 $
Form 1099-OID (Rev. 10-2019)        (keep for your records)              www.irs.gov/Form1099OID                Department of the Treasury - Internal Revenue Service



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Instructions for Recipient
Original issue discount (OID) is the excess of an obligation’s stated redemption     Box 1. Shows the OID on a taxable obligation for the part of the year you owned it. 
price at maturity over its issue price (acquisition price for a stripped bond or     Reportthe  amount in box 1 as interest income on your income tax return. However, 
coupon). OID on a taxable obligation is taxable as interest over the life of the     depending on the type of debt instrument, the issue or acquisition date, and other 
obligation. If you are the holder of a taxable OID obligation, you generally must    factors (for example, if you paid acquisition or bond premium, or the obligation is a 
include an amount of OID in your gross income each year you hold the                 stripped bond or coupon), you may have to figure the correct amount of OID to 
obligation. Obligations that may have OID include a bond, debenture, note,           report on your return. See Pub. 1212 for details on how to figure the correct OID. 
certificate, or other evidence of indebtedness having a term of more than 1 year.    See the instructions above for a covered security acquired with acquisition premium.
For example, the OID rules may apply to certificates of deposit (CDs), time          Box 2. Shows qualified stated interest on this obligation for the year, which is an 
deposits, bonus savings plans, and other deposit arrangements, especially if the     amountseparate    from the OID. If you held the obligation the entire year, report 
payment of interest is deferred until maturity. In addition, the OID rules apply to  this amountas interest income on your tax return. If you disposed of the 
Treasury inflation-protected securities. See Pub. 550 for more information.          obligation or acquired itfrom another holder during the year, see Pub. 550 for 
If, as the record holder, you receive Form 1099-OID showing amounts                  reporting instructions. If thereis an amount in both boxes 2 and 8, the amount in 
belonging to another person, you are considered a nominee recipient. Complete        box 2 is interest on a U.S.Treasury   obligation and is exempt from state and 
a Form 1099-OID for each of the other owners showing the amounts allocable to        local income taxes. If there is an amount in both boxes 2 and 11, the amount in 
each. File Copy A of the form with the IRS. Furnish Copy B to each owner. List       box 2 is tax-exempt interest and is not included in interest income on your tax 
yourself as the “payer” and the other owner as the “recipient.” File Form(s)         return. In general, see how to report tax-exempt interest in the Instructions for 
1099-OID with Form 1096 with the Internal Revenue Service Center for your            Forms 1040 and 1040-SR.
area. On Form 1096, list yourself as the “filer.” A spouse is not required to file a Box 3. Shows interest or principal forfeited if you withdrew the money before 
nominee return to show amounts owned by the other spouse. If you bought or           thematurity date of the obligation, such as from a CD. You may deduct this 
sold an obligation during the year and you are not a nominee, you are not            amount tofigure  your adjusted gross income on your income tax return. See the 
required to issue or file Form 1099-OID showing the OID or stated interest           Instructions forForms  1040 and 1040-SR to see where to take the deduction.
allocable to the seller/buyer of the obligation.                                     Box 4. Shows backup withholding. Generally, a payer must backup withhold if 
The information provided may be different for covered and noncovered                 youdid not furnish your TIN or you did not furnish thecorrect  TIN to the payer. 
securities. For a description of covered securities, see the Instructions for Form   See Form W-9 for information on backup withholding. Include this amount on 
8949. For a covered security acquired with acquisition premium, your payer           yourincome   tax return as tax withheld.
generally must report either (1) a net amount of OID that reflects the offset of     Box 5. For a covered security acquired with OID, if you made an election under 
OID by the amount of acquisition premium amortization for the year, or (2) a         section 1278(b) to include market discount in income as it accrues and you 
gross amount for both the OID and the acquisition premium amortization for the       notified your payer of the election in writing in accordance with Regulations 
year. For a noncovered security acquired with acquisition premium, your payer        section 1.6045-1(n)(5), shows the market discount that accrued on the debt 
is only required to report the gross amount of OID.                                  instrument during the year while held by you. For a tax-exempt obligation that is 
Recipient’s taxpayer identification number (TIN). For your protection, this          a covered security acquired on or after January 1, 2017, and issued with OID, 
form may show only the last four digits of your TIN (social security number          shows the market discount that accrued on the obligation during the year while 
(SSN), individual taxpayer identification number (ITIN), adoption taxpayer           held by you. For a covered security acquired on or after January 1, 2015, market 
identification number (ATIN), or employer identification number (EIN)). However,     discount will be calculated on a constant yield basis unless you notified your 
the issuer has reported your complete TIN to the IRS.                                payer in writing in accordance with Regulations section 1.6045-1(n)(5) that you 
FATCA filing requirement. If the FATCA filing requirement box is checked, the        did not want to make a constant yield election for market discount under section 
payer is reporting on this Form 1099 to satisfy its chapter 4 account reporting      1276(b). The payer may, but is not required to, report the market discount for a 
requirement. You may also have a filing requirement. See the Instructions for        tax-exempt obligation that is a covered security acquired before January 1, 
Form 8938.                                                                           2017. Report the accrued market discount on your income tax return as directed 
Account number. May show an account or other unique number the payer                 in the Instructions for Forms 1040 and 1040-SR. Market discount on a tax-
assignedto  distinguish your account.                                                exempt security is includible in taxable income as interest income.
                                                                                                                                      (Continued on the back of Copy 2)



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                                                   CORRECTED (if checked)
PAYER’S name, street address, city or town, state or province, country,  1 Original issue discount for OMB No. 1545-0117
ZIP or foreign postal code, and telephone no.                              the year
                                                                         $
                                                                                                       Form 1099-OID                Original Issue 
                                                                                                       (Rev. October 2019)          Discount
                                                                         2 Other periodic interest
                                                                                                        For calendar year     
                                                                         $                                     20
PAYER’S TIN                        RECIPIENT’S TIN                       3 Early withdrawal penalty    4 Federal income tax withheld
                                                                                                                                    Copy 2
                                                                         $                             $
                                                                         5 Market discount             6 Acquisition premium
                                                                                                                                    To be filed with 
RECIPIENT’S name                                                         $                             $                            recipient’s state 
                                                                                                                                    income tax 
                                                                         7 Description                                              return, when 
                                                                                                                                    required.
Street address (including apt. no.)

City or town, state or province, country, and ZIP or foreign postal code 8 Original issue discount on  9 Investment expenses
                                                                           U.S. Treasury obligations
                                                                         $                             $
                                                   FATCA filing          10 Bond premium               11 Tax-exempt OID
                                                   requirement
                                                                         $                             $
Account number (see instructions)                                        12 State 13 State identification no. 14 State tax withheld
                                                                                                              $
                                                                                                              $
Form 1099-OID (Rev. 10-2019)                       www.irs.gov/Form1099OID                               Department of the Treasury - Internal Revenue Service



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Instructions for Recipient (continued)
Box 6. For a taxable covered security, shows the amount of acquisition            Box 10. For a taxable covered security, including a Treasury inflation-protected 
premium amortization for the year that reduces the amount of OID that is          security, shows the amount of premium amortization allocable to the interest 
included as interest on your income tax return. If an amount is reported in this  payment(s), unless you notified the payer in writing in accordance with 
box, see the Instructions for Schedule B (Form 1040 or 1040-SR). If an amount     Regulations section 1.6045-1(n)(5) that you did not want to amortize bond 
is not reported in this box for a covered security acquired with acquisition      premium under section 171. If an amount is reported in this box, see the 
premium, the payer has reported a net amount of OID that reflects the offset of   Instructions for Schedule B (Form 1040 or 1040-SR). If an amount is not 
OID that is included in income. If the payer has reported a net amount of OID in  reported in this box for a taxable covered security acquired at a premium and 
box 1 or box 8, you must report the net amount of OID on Schedule B (Form         the payer is reporting premium amortization, the payer has reported a net 
1040 or 1040-SR) and you must not make an adjustment to this amount for           amount of interest in box 2. If the amount in this box is greater than the amount 
acquisition premium on Schedule B (Form 1040 or 1040-SR).                         of interest paid on the covered security, see Regulations section 1.171-2(a)(4).
If there is an amount in both boxes 6 and 11, for a tax-exempt obligation that    If there is an amount in both boxes 10 and 11, for a tax-exempt obligation that 
is a covered security acquired on or after January 1, 2017, and is issued with    is a covered security acquired on or after January 1, 2017, and issued with OID, 
OID, the amount in box 6 shows the amount of acquisition premium                  the amount in box 10 shows the amount of premium amortization for the year 
amortization for the year that reduces the amount of your tax-exempt OID for      that reduces the amount of your tax-exempt interest for the year. The payer 
the year. The payer may, but is not required to, report the acquisition premium   may, but is not required to, report the premium amortization for a tax-exempt 
for a tax-exempt obligation that is a covered security acquired before January 1, obligation that is a covered security acquired before January 1, 2017, and 
2017, and issued with OID. See the instructions above for a covered security      issued with OID.
acquired with acquisition premium.                                                Box 11. For a tax-exempt obligation that is a covered security acquired on or 
Box 7. Shows the identification (CUSIP) number or description of theobligation    after January 1, 2017, shows the tax-exempt OID on the obligation for the part 
(may include the stock exchange, issuer, coupon rate, andyear of maturity).       of the year you owned it. The payer may, but is not required to, report the OID 
Box 8. Shows OID on a U.S. Treasury obligation for the part of the year you       for a tax-exempt obligation that is a covered security acquired before January 1, 
ownedit. Report this amount as interest income on your federal income tax         2017. In general, report the amount of tax-exempt OID on Form 1040 or 
return and seePub. 1212 to figure any appropriate adjustments to this amount.     1040-SR. See the instructions above for a covered security acquired with 
This OID is exemptfrom state and local income taxes and is not included in        acquisition premium. 
box 1. See the instructions above for a covered security acquired with            Boxes 12–14. State income tax withheld reporting.
acquisition premium. If the number in this box is negative, it represents a       Future developments. For the latest information about developments related to 
deflation adjustment. See Pub. 550 for further information on accounting for this Form 1099-OID and its instructions, such as legislation enacted after they were 
adjustment.                                                                       published, go to www.irs.gov/Form1099OID.
Box 9. Any amount shown is your share of investment expenses of a single-
classREMIC.  This amount isincluded in box 2. Note: This amount is not 
deductible.



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                                              VOID CORRECTED
PAYER’S name, street address, city or town, state or province, country,  1 Original issue discount for OMB No. 1545-0117
ZIP or foreign postal code, and telephone no.                              the year
                                                                         $
                                                                                                       Form 1099-OID                Original Issue 
                                                                                                       (Rev. October 2019)          Discount
                                                                         2 Other periodic interest
                                                                                                        For calendar year     
                                                                         $                                     20
PAYER’S TIN                        RECIPIENT’S TIN                       3 Early withdrawal penalty    4 Federal income tax withheld
                                                                                                                                    Copy C
                                                                         $                             $
                                                                         5 Market discount             6 Acquisition premium
                                                                                                                                    For Payer
RECIPIENT’S name                                                         $                             $
                                                                         7 Description

Street address (including apt. no.)
                                                                                                                                    For Privacy Act 
                                                                                                                                    and Paperwork 
City or town, state or province, country, and ZIP or foreign postal code 8 Original issue discount on  9 Investment expenses        Reduction Act 
                                                                           U.S. Treasury obligations                                Notice, see the 
                                                                                                                                    current General 
                                                                         $                             $
                                                   FATCA filing          10 Bond premium               11 Tax-exempt OID            Instructions for 
                                                   requirement                                                                      Certain 
                                                                                                                                    Information 
                                                                         $                             $
Account number (see instructions)                  2nd TIN not.          12 State 13 State identification no. 14 State tax withheld Returns.
                                                                                                              $
                                                                                                              $
Form 1099-OID (Rev. 10-2019)                       www.irs.gov/Form1099OID                               Department of the Treasury - Internal Revenue Service



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Instructions for Payer
To complete Form 1099-OID, use:                                To file electronically, you must have software that generates 
• The current General Instructions for Certain Information     a file according to the specifications in Pub. 1220. The IRS 
Returns, and                                                   does not provide a fill-in form option for Copy A.
•  The current Instructions for Forms 1099-INT and 1099-OID.   Foreign recipient. If the recipient is a nonresident alien, you 
                                                               may have to withhold federal income tax and file Form 1042-S. 
To order these instructions and additional forms, go to        See the Instructions for Form 1042-S and Pub.515. 
www.irs.gov/Form1099OID.
                                                               Need help? If you have questions about reporting on Form 
Caution: Because paper forms are scanned duringprocessing,     1099-OID, call the information reporting customer service site 
you cannot file Forms 1096, 1097,1098, 1099, 3921, or 5498     toll free at 866-455-7438 or 304-263-8700 (not toll free). 
that you print from the IRSwebsite.                            Persons with a hearing or speech disability with access to 
Filing and furnishing. For filing and furnishing instructions, TTY/TDD equipment can call 304-579-4827 (not toll free). 
including due dates, and to request filing or furnishing 
extensions, see the current General Instructions for Certain 
Information Returns.






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