Form 1099-OID Original Issue Discount

Please complete the form below by entering the information EXACTLY as it appears on your Form 1099-OID
Use the Tab key to move to the next field. An asterisk ( * ) indicates a required field.

* Your email Address:

* PAYER’S name, street address, city, state, ZIP code, and telephone no.

1 Original issue discount
for 2001**

2001

2 Other periodic interest

Form 1099-OID

* PAYER’S Federal ID number

* RECIPIENT'S ID number

3 Early withdrawal penalty

4 Federal income tax withheld

* RECIPIENT'S name, street address, city, state, and ZIP code

5 Description

6 Original issue discount on U.S. Treasury obligations**

7 Investment expenses

Account number (optional)

** This may not be the correct figure to report on your income tax return. See instructions for this form.

Form 1099-OID

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