4444                  VOID           CORRECTED
PAYER’S name, street address, city, state, ZIP code, and telephone no.  1  Total payments OMB No. 1545-2140
                                                                            
                                                                        $                                   Airline Payments
                                                                                             Form  8935                             Report
                                                                                                                                     
                                                                                              (March 2009)
 
PAYER’S federal identification no.  RECIPIENT’S identification number            Year             Amount                            Copy    A
                                                                                                                                         For
RECIPIENT’S   name                                                       2a               2b                           Internal Revenue
                                                                                          $                            Service Center
                                                                         3a               3b                            
                                                                                          $  
Street address (including apt. no.)                                     4a                4b                                    For Privacy Act
                                                                                                                                and Paperwork
                                                                                          $                                     Reduction Act
City, state, and ZIP code                                               5a                5b                                     Notice, see 
                                                                                                                                 the separate
                                                                                          $                                     Instructions for
                                                                         6a               6b                                        Form 8935
                                                                                          $                                     (March 2009).
                                                                                                                                 
Form 8935    (3-2009)                                              Cat. No. 37750T        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
                                                                                  

                                                            CORRECTED (if checked)
PAYER’S name, street address, city, state, ZIP code, and telephone no.1     Total payments OMB No. 1545-2140
                                                                             
                                                                      $                                       Airline Payments
                                                                                              Form  8935                          Report
                                                                                                                                   
                                                                                               (March 2009)
PAYER’S federal identification no.   RECIPIENT’S identification number
                                                                                   Year             Amount
RECIPIENT’S   name                                                     2a                   2b
                                                                                                                                   Copy B
                                                                                           $                             For Recipient
                                                                                           3b
                                                                       3a                                                This     is important
                                                                                           $                                      tax information
Street address (including apt. no.)                                   4a                   4b                                     and is being
                                                                                                                         furnished to the
                                                                                           $                             Internal Revenue
City, state, and ZIP code                                             5a                    5b                                        Service.
                                                                                           $                                           
                                                                       6a                   6b
                                                                                           $  
Form 8935    (3-2009)                                (keep for your records)                Department of the Treasury - Internal Revenue Service
                                                      

 Instructions for Recipient
The information on Form 8935 is submitted to the          You can contribute the payment(s) reported on this
Internal Revenue Service by the commercial passenger     form to a Roth IRA within 180 days of the date you
airline carrier to report payment(s) made to you under   received the payment or before June 23, 2009,
an order of a Federal bankruptcy court in a case filed   whichever is later. See chapter 2 of Pub. 590 for more
after September 11, 2001, and before January 1, 2007,    information.
for your interest in a bankruptcy claim against the      Box 1. Shows the amount you received that can be
carrier, any note of the carrier (or amount paid in lieu contributed to a Roth IRA.
of a note being issued), or any other fixed obligation of 
the carrier to pay a lump sum amount.                    Boxes 2a-6a. Shows each year in which you received
                                                         payments.
 You received the payment(s) shown on this form           
because you are a current or former employee of a        Boxes 2b-6b. Shows the amount you received each
commercial passenger airline carrier and you             year.
participated in the carrier’s defined benefit plan which  
was terminated or became subject to certain
restrictions.
 

                                            VOID          CORRECTED
PAYER’S name, street address, city, state, ZIP code, and telephone no.1  Total payments OMB No. 1545-2140
                                                                          
                                                                      $                                   Airline Payments
                                                                                           Form  8935                             Report
                                                                                                                                   
                                                                                            (March 2009)
PAYER’S federal identification no.   RECIPIENT’S identification number
                                                                                Year             Amount
RECIPIENT’S   name                                                     2a               2b                                        Copy    C
                                                                                        $                                      For Payer
                                                                       3a               3b                                    For Privacy Act
                                                                                                                              and Paperwork
                                                                                        $                                     Reduction Act
Street address (including apt. no.)                                   4a                4b                                     Notice, see 
                                                                                                                               the separate
                                                                                        $                                     Instructions for
City, state, and ZIP code                                             5a                5b                                       Form 8935
                                                                                        $                                     (March 2009).
                                                                       6a               6b                                     
                                                                                        $  
Form 8935    (3-2009)                                                                   Department of the Treasury - Internal Revenue Service
              

 Instructions for Payers
What’s new. This form is used to provide information   File Copy A of this form with the Internal Revenue
to current and former employees to whom you made      Service within 90 days of payment, or, if later, by
payments of any money or other property for certain   March 23, 2009. If you file electronically, you must
claims made in certain bankruptcy proceedings.        have software that generates a file according to the
                                                      specifications in Announcement 2009-7, 2009-10
 Specific form instructions are provided as a separate
                                                      I.R.B., Update and Correction to Pub. 1220,
product. You should use the Instructions for Form
                                                      Specifications for Filing Forms 1098, 1099, 5498, and
8935 (March 2009), to complete this form. To order
                                                      W-2G Electronically, containing formatting information
these instructions and additional forms, visit the IRS
                                                      for Form 8935. IRS does not provide a fill-in form
website at www.irs.gov or call 1-800-TAX-FORM
                                                      option.
(1-800-829-3676).
                                                       
                                                      Need help? If you have questions about reporting on
Due dates. Furnish Copy B of this form to the
                                                      Form 8935, call the information reporting customer
recipient within 90 days of payment, or, if later, by
                                                      service site toll free at 1-866-455-7438 or
March 23, 2009.
                                                      304-263-8700 (not toll free). For TTY/TDD equipment,
 
                                                      call 304-579-4827 (not toll free).