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Get Information Return For Publicly Offered Original Issue Discount Instruments

E in duplicate 2 Issuer s taxpayer identification number Present address (including number, street, apt. or suite no., or P.O. box, city or town, state, and ZIP code) 3a Name of representative (See instructions.) 3b Telephone number ( ) Present address (if different from issuer s) 4 CUSIP number 7 Type of instrument (See instructions.) 5 8 Issue date Issue price (percent of principal amount) 6 9 Maturity date Stated interest rate (See instructions.) Check if variable or c.

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