2
I.R.S. SPECIFICATIONS
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INSTRUCTIONS TO PRINTERS
FORM 1096, PAGE 1 of 2
MARGINS: TOP 8 mm (
2
⁄6 "), CENTER SIDES. PRINTS: HEAD to HEAD
PAPER: OCR Bond, SUB. 20 INK: BLACK & Red Flint J-6983
FLAT SIZE: 203 mm (8") 279 mm (11") (or exact match)
PERFORATE: NONE
6969Do Not Staple
OMB No. 1545-0108
Annual Summary and Transmittal of
U.S. Information Returns
Form 1096
Department of the Treasury
Internal Revenue Service
FILER’S name
Street address (including room or suite number)
City, state, and ZIP code
For Official Use Only
Telephone number
()
Total number of
forms
31
Employer identification number
5
Total amount reported with this Form 1096
4
Federal income tax withheld
2 Social security number
$$
Enter an “X” in only one box below to indicate the type of form being filed. If this is your final return, enter an “X” here
1098-T
83
1098-E
84
1099-OID
96
1099-SA
94
1099-MISC
95
1099-LTC
93
1099-H
71
1099-G
86
1099-DIV
91
1099-B
79
1099-A
80
1098
81
W-2G
32
Under 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 complete.
Date
Title
Signature
Return this entire page to the Internal Revenue Service. Photocopies are not acceptable.
Instructions
Purpose of form. Use this form to transmit paper Forms 1099,
1098, 5498, and W-2G to the Internal Revenue Service. Do not
use Form 1096 to transmit electronically or magnetically. For
magnetic media, see Form 4804, Transmittal of Information
Returns Reported Magnetically; for electronic submissions, see
Pub. 1220, Specifications for Filing Forms 1098, 1099, 5498, and
W-2G Electronically or Magnetically.
Preaddressed Form 1096. If you received a preaddressed Form
1096 from the IRS with Package 1099, use it to transmit paper
Forms 1099, 1098, 5498, and W-2G to the Internal Revenue
Service. If any of the preprinted information is incorrect, make
corrections on the form.
If you are not using a preaddressed form, enter the filer’s
name, address (including room, suite, or other unit number), and
TIN in the spaces provided on the form.
Who 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 1099, 1098, 5498, or W-2G. A filer includes a payer; a
recipient of mortgage interest payments (including points) or
student loan interest; an educational institution; a broker; a
barter exchange; a creditor; a person reporting real estate
transactions; a trustee or issuer of any individual retirement
arrangement, a Coverdell ESA, an HSA, an Archer MSA
(including a Medicare Advantage MSA); certain corporations;
certain donees of motor vehicles, boats, and airplanes; and a
lender who acquires an interest in secured property or who has
reason to know that the property has been abandoned.
For more information and the Privacy Act and Paperwork Reduction Act Notice,
see the 2006 General Instructions for Forms 1099, 1098, 5498, and W-2G.
Form 1096 (Rev. 7-2006)
1099-C
85
5498-ESA
72
5498
28
1099-S
75
1099-R
98
1099-PATR
97
Name of person to contact
()
Email address Fax number
Alaska, California, Colorado, District of
Columbia, Hawaii, Idaho, Illinois, Indiana, Iowa,
Kansas, Maryland, Michigan, Minnesota,
Missouri, Montana, Nebraska, Nevada, North
Dakota, Oklahoma, Oregon, South Carolina,
South Dakota, Tennessee, Utah, Washington,
Wisconsin, Wyoming
Kansas City, MO
64999
Alabama, 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 Virginia
Austin, TX 73301
Where To File
Use the following
Internal Revenue
Service Center
address
If your principal business,
office or agency, or legal
residence in the case of an
individual, is located in
Except for Form 1098-C, send all information returns filed on
paper with Form 1096 to the following:
When to file. File Form 1096 as follows.
Cat. No. 14400O
Separation 1: Red (Flint J-6983 or exact match)
Separation 2: Black
1099-Q
31
5498-SA
27
1099-INT
92
1099-CAP
73
Action
Revised proofs
requested
Date Signature
O.K. to print
T:FP:F
O.K. to print
Responsible
scan organization
1098-C
78
20
06
Version B
● With Forms 1099, 1098, or W-2G, file by February 28, 2007.
● With Forms 5498, 5498-ESA, or 5498-SA, file by May 31, 2007.
AUTHERIZED REPRESENTATIVE