LIA LIB LIC L1096 - taxformfinder.com

1 L1096 MANUFACTURED ON OCR LASER BOND PAPER USING HEAT RESISTANT INKS696941-0852411L10965100 Return this entire page to the Internal revenue Service. Photocopies are not 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 aTitle aDate aInstructionsFuture developments. For the latest information about developments related to Form 1096, such as legislation enacted after it was published, go to The only acceptable method of filing information returns with Internal revenue Service/Information Returns Branch is electronically through the FIRE system. See Pub. 1220, Specifications for Electronic Filing of Forms 1097, 1098, 1099, 3921, 3922, 5498, and of form. Use this form to transmit paper Forms 1097, 1098, 1099, 3921, 3922, 5498, and W-2G to the Internal revenue Service.

2 Do not use Form 1096 to transmit electronically. For electronic submissions, see Pub. If you are required to file 250 or more information returns of any one type, you must file electronically. If you are required to file 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 must file. The name, address, and TIN of the filer 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 filer is any person or entity who files any of the forms shown in line 6 the filer s name, address (including room, suite, or other unit number), and TIN in the spaces provided on the to file. File Form 1096 as follows.

3 With Forms 1097, 1098, 1099, 3921, 3922, or W-2G, file by February 29, 2016. With Forms 5498, file by May 31, To FileSend all information returns filed on paper with Form 1096 to the your principal business, office or agency, or legal residence in the case of an individual, is located inUse the following three-line addressFFAlabama, 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 VirginiaDepartment 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 1096 (2015)

4 DETACH BEFORE MAILINGDo Not StapleForm 1096 Department of the Treasury Internal revenue ServiceAnnual Summary and Transmittal of Information ReturnsOMB No. 1545-01082015 FILER'S nameStreet address (including room or suite number)City or town, state or province, country, and ZIP or foreign postal codeName of person to contactTelephone numberEmail addressFax numberFor Official Use Only1 Employer identification number2 Social security number3 Total number of forms4 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 321097-BTC 501098 811098-C 781098-E 841098-Q 741098-T 831099-A 801099-B 791099-C 851099-CAP 731099-DIV 911099-G 861099-INT 921099-K 101099-LTC 931099-MISC 951099-OID 961099-PATR 971099-Q 311099-R 981099-S 751099-SA 943921 253922 265498 285498-ESA 725498-SA 277 If this is your final return, enter an X here.

5 ALIC DETACH BEFORE MAILINGLIC5122 For Payerand/or State Copy 1 or Copy 2 MANUFACTURED ON OCR LASER BOND PAPER USING HEAT RESISTANT INKSCopy CDepartment of the Treasury - Internal revenue ServiceForm 1099-INTD epartment of the Treasury - Internal revenue ServiceForm 1099-INT2015 Interest IncomeOMB No. 1545-0112 For Privacy Act and Paperwork Reduction Act Notice, see the 2015 General Instructions for Certain Information S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone S federal identification numberRECIPIENT S identification numberFATCA filing requirementAccount number (see instructions)2nd TIN 's RTN (optional)1 Interest income$2 Early withdrawal penalty$3 Interest on Savings Bonds and Treas. obligations$4 Federal income tax withheld$5 Investment expenses$6 Foreign tax paid$7 Foreign country or possession8 Tax-exempt interest$9 Specified private activity bond interest$10 Market discount$11 Bond premium$12 13 Bond premium on tax-exempt bond$14 Tax-exempt and tax credit bond CUSIP State16 State identification State tax withheld$$RECIPIENT'S name, street address, city or town, state or province, country, and ZIP or foreign postal codeFor Payerand/or State Copy 1 or Copy 2 Copy CForm 1099-INT2015 Interest IncomeOMB No.

6 1545-0112 For Privacy Act and Paperwork Reduction Act Notice, see the 2015 General Instructions for Certain Information S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone S federal identification numberRECIPIENT S identification numberFATCA filing requirementAccount number (see instructions)2nd TIN 's RTN (optional)1 Interest income$2 Early withdrawal penalty$3 Interest on Savings Bonds and Treas. obligations$4 Federal income tax withheld$5 Investment expenses$6 Foreign tax paid$7 Foreign country or possession8 Tax-exempt interest$9 Specified private activity bond interest$10 Market discount$11 Bond premium$12 13 Bond premium on tax-exempt bond$14 Tax-exempt and tax credit bond CUSIP State16 State identification State tax withheld$$RECIPIENT'S name, street address, city or town, state or province, country, and ZIP or foreign postal code Signature of Issuing Carrier or its Agentat (place)Executed on (date)Signature of Shipper or his AgentDiversion contrary law commodities, technology or software were exported from the United Statesin accordance with the Export Administration Regulations.

7 Ultimate destinationNot NegotiableIssued byAir WayBillShipper's Name and AddressShipper's Account NumberConsignee's Account NumberConsignee's Name and AddressIssuing Carrier's Agent Name and CityAgent's IATA CodeAccount of Departure (Addr. of First Carrier) and Requested RoutingCopies 1, 2 and 3 of this Air Waybill are originals and have the same InformationToBy First CarriertobytobyRouting and DestinationAirport of DestinationAmount of InsuranceINSURANCE - If carrier offers insurance, and such insurance isrequested in accordance with the conditions thereof, indicate amountto be insured in figures in box marked "Amount of Insurance".CurrencyCHGSCodePPD COLL PPD COLLD eclared Value for CarriageDeclared Value for CustomsHandling InformationSCINo. ofPiecesRCPG rossWeightkglbRate ClassCommodityItem and Quantity of Goods(incl.)

8 Dimensions or Volume)PrepaidWeight ChargeCollectValuation ChargeTa xTotal Other Charges Due AgentTotal Other Charge Due CarrierTotal PrepaidTotal CollectCurrency Conversion RatesCC Charges in Dest. CurrencyCharges at DestinationTotal Collect ChargesFor Carriers Use onlyat DestinationOther ChargesShipper certifies that the particulars on the face hereof are correct and that insofar as any part of the consignmentcontains dangerous goods, such part is properly described by name and is in proper condition for carriage by airaccording to the applicable Dangerous Good is agreed that the goods described herein are accepted in apparent good order and condition(except as noted) for carriage SUBJECT TO THE CONDITIONS OF CONTRACT ON THEREVERSE HEREOF. ALL GOODS MAY BE CARRIED BY ANY OTHER MEANS INCLUDINGROAD OR ANY OTHER CARRIER UNLESS SPECIFIC CONTRARY INSTRUCTIONS AREGIVEN HEREON BY THE SHIPPER, AND SHIPPER AGREES THAT THE SHIPMENT MAY BECARRIED VIA INTERMEDIATE STOPPING PLACES WHICH THE CARRIER DEEMSAPPROPRIATE.

9 THE SHIPPER'S ATTENTION IS DRAWN TO THE NOTICE CONCERNINGCARRIER'S LIMITATION OF LIABILITY. Shipper may increase such limitation of liability bydeclaring a higher f or carriage and paying a supplemental charge if NumberOptional Shipping InformationRequested Flight/DateORIGINAL 3 (FOR SHIPPER) v alueDWMRIMPORTANT TAX RETURN DOCUMENT ENCLOSED7777-1 DWMRLIB DETACH BEFORE MAILINGLIB5121 MANUFACTURED ON OCR LASER BOND PAPER USING HEAT RESISTANT INKSD epartment of the Treasury - Internal revenue ServiceForm 1099-INT(keep for your records)Department of the Treasury - Internal revenue ServiceForm 1099-INT(keep for your records) 1099-INT2015 Interest IncomeCopy BFor RecipientThis is important tax information and is being furnished to the Internal revenue Service. If you are required to file 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 No.

10 1545-0112 CORRECTED (if checked)PAYER S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone S federal identification numberRECIPIENT S identification numberFATCA filing requirementAccount number (see instructions)Payer's RTN (optional)1 Interest income$2 Early withdrawal penalty$3 Interest on Savings Bonds and Treas. obligations$4 Federal income tax withheld$5 Investment expenses$6 Foreign tax paid$7 Foreign country or possession8 Tax-exempt interest$9 Specified private activity bond interest$10 Market discount$11 Bond premium$12 13 Bond premium on tax-exempt bond$14 Tax-exempt and tax credit bond CUSIP State16 State identification State tax withheld$$RECIPIENT'S name, street address, city or town, state or province, country, and ZIP or foreign postal codeForm 1099-INT2015 Interest IncomeCopy BFor RecipientThis is important tax information and is being furnished to the Internal revenue Service.