![]() ![]() NAME OF COURT or PLAINTF or BANK ADDRESS CITY STATE ZIP (XXX) 123 4567Ħ Original issue discount on U.S. PAYER’S name, street address, city, state, ZIP code, and telephone no. See IRS Publications 1141, 1167, 1179 and other IRS resources for information about printing these tax forms. To order official IRS forms, call 1-800-TAX-FORM (1-80) or Order Information Returns and Employer Returns Online, and we’ll mail you the scannable forms and other products. A penalty of $50 per information return may be imposed for filing forms that cannot be scanned. The official printed version of this IRS form is scannable, but the online version of it, printed from this website, is not. Copy A appears in red, similar to the official IRS form. ![]() Attention: This form is provided for informational purposes only.
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