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530 views1 page

1099 K

This form is a sample document intended for user testing. None of the information provided in this document is accurate or representative of an actual person.

Uploaded by

Anonymous FR8yGDSVg
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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VOID CORRECTED

FILER'S name, street address, city or town, state or province, country, ZIP FILERS federal identification no. OMB No. 1545-2205
or foreign postal code, and telephone no.
59-1234567 Payment Card and
Company, Inc. PAYEES taxpayer identification no.
Third Party
1234 Company Lane
Atlanta, GA 30301
400-00-0123
1a Gross amount of payment
2017 Network
card/third party network
transactions
Transactions
$ 15,165.00 Form 1099-K
1b Card Not Present 2 Merchant category code
transactions Copy 1
Check to indicate if FILER is a (an): Check to indicate transactions $ For State Tax
reported are:
Payment settlement entity (PSE) 3 Number of payment 4 Federal income tax Department
Payment card
transactions withheld
Electronic Payment Facilitator
(EPF)/Other third party Third party network 323 $ 0.00
PAYEES name 5a January 5b February

Jane Smith
$ $
5c March 5d April
Street address (including apt. no.) $ $
5e May 5f June
1234 Payee Place
$ $
5g July 5h August
City or town, state or province, country, and ZIP or foreign postal code $ $
Atlanta, GA 30301 5i September 5j October
PSES name and telephone number $ $
5k November 5l December
$ $
Account number (see instructions) 6 State 7 State identification no. 8 State income tax withheld
$
$
Form 1099-K www.irs.gov/form1099k Department of the Treasury - Internal Revenue Service

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