Form 1099-K - Merchant Card And Third Party Network Payments - 2011
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1CORRECTED
FILER’S name, street address, city, state, ZIP code, and telephone no.
FILER’S federal identification no.
OMB No. 1545-2205
Merchant Card
and Third Party
2011
Network Payments
PAYEE’S taxpayer identification no.
1099-K
Form
1
Gross amount of merchant
2
Copy B
card/third party network
payments
For Payee
$
If checked, FILER is Payment Settlement Entity (PSE)
4
3
OR
This is important tax
If checked, FILER is Electronic Payment Facilitator (EPF)/
information and is
Third Party Payer (TPP)
being furnished to the
PAYEE’S name
5a
January
5b
February
Internal Revenue
$
$
Service. If you are
required to file a
5c
March
5d
April
return, a negligence
Street address (including apt. no.)
$
penalty or other
$
sanction may be
5e
May
5f
June
imposed on you if
$
$
taxable income
results from this
5g
July
5h
August
transaction and the
City, state, and ZIP code
IRS determines that it
$
$
has not been
5i
September
5j
October
reported.
PSE’S name and telephone number
$
$
5k
November
5l
December
$
$
Account number (see instructions)
1099-K
Form
(Keep for your records)
Department of the Treasury - Internal Revenue Service
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