Get IRS 1094-B 2016
Structions is at www.irs.gov/form1094b. 1 Filer's name 2 Employer identification number (EIN) 3 Name of person to contact 4 Contact telephone number 5 Street address (including room or suite no.) 6 City or town For Official Use Only 7 State or province 9 Total number of Forms 1095-B submitted with this transmittal . 8 Country and ZIP or foreign postal code . . . . . . . . . . . . . Under penalties of perjury, I declare that I have examined this return and accompanying.
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