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See IRS Publications 1141, 1167, and 1179 for more information about printing these tax forms.
1010 |
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VOID |
CORRECTED |
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FILER’S name, street address, city or town, state or province, country, ZIP |
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FILER’S TIN |
OMB No. 1545-2205 |
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or foreign postal code, and telephone no. |
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Payment Card and |
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Form 1099-K |
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PAYEE’S TIN |
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Third Party |
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(Rev. January 2022) |
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Network |
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1a Gross amount of payment |
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For calendar year |
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Transactions |
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transactions |
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card/third party network |
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20 |
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$ |
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1b Card Not Present |
2 |
Merchant category code |
Copy A |
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transactions |
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Check to indicate if FILER is a (an): |
Check to indicate transactions |
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$ |
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For |
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reported are: |
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Internal Revenue |
Payment settlement entity (PSE) |
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3 Number of payment |
4 |
Federal income tax |
Payment card |
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Service Center |
Electronic Payment Facilitator |
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transactions |
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withheld |
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$ |
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(EPF)/Other third party |
Third party network |
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File with Form 1096. |
PAYEE’S name |
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5a January |
5b February |
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$ |
$ |
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For Privacy Act |
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5c March |
5d April |
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and Paperwork |
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$ |
$ |
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Street address (including apt. no.) |
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Reduction Act |
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5e May |
5f |
June |
Notice, see the |
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$ |
$ |
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current General |
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Instructions for |
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5g July |
5h August |
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Certain Information |
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$ |
$ |
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City or town, state or province, country, and ZIP or foreign postal code |
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Returns. |
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5i September |
5j |
October |
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$ |
$ |
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PSE’S name and telephone number |
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5k November |
5l |
December |
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$ |
$ |
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Account number (see instructions) |
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2nd TIN not. |
6 State |
7 |
State identification no. |
8 State income tax withheld |
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$ |
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$ |
Form 1099-K (Rev. 1-2022) |
Cat. No. 54118B |
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www.irs.gov/Form1099K |
Department of the Treasury - Internal Revenue Service |
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