Form 8281

(Rev. September 2014)

Information Return for Publicly Offered
Original Issue Discount Instruments OMB No. 1545-0887
Department of the Treasury
Internal Revenue Service ▶ Information about Form 8281 and its instructions is at www.irs.gov/form8281.
Part I Issuer Information
1a Issuer’s name 2 Issuer’s taxpayer identification number

1b Present address (number, street, apt. or suite no., or P.O. box)

1c City 1d State 1e ZIP code

3a Name of representative (see instructions) 3b Telephone number

3c Present address (if different from issuer’s)

3d City 3e State 3f ZIP code

Part II Debt Instrument Information

4 CUSIP number 5a Issue date 5b SEC registration date 6 Maturity date

7 Type of instrument (see instructions) 8 Issue price (percent of principal amount) 9a Stated interest rate (see instructions) 9b Variable
Fixed rate Inflation-indexed 9c Contingent
Variable rate Contingent payment
10 Interest payment dates

11 Amount of OID for entire issue 12 Yield to maturity 13 Stated redemption price at maturity of the entire issue. If the redemption price
of each debt instrument within the issue is other than $1,000, indicate the
stated redemption price of each debt instrument.

14 Description of debt instruments

15 Attach a schedule of OID per $1,000 principal amount for the life of the instrument. If the principal amount is other than $1,000, indicate the actual OID per principal
amount per year. The schedule must be based on a 6-month accrual period. It must show the daily portion of OID for each accrual period and the total OID for each
calendar year. For additional requirements, see the instructions.

Part III Signature. Within 30 days after the date of issuance of an OID debt instrument or, if registered with the
SEC after the date of issuance, within 30 days after the date the OID debt instrument is registered with
the SEC, send two copies of Form 8281 and any attachments to: Department of the Treasury, Internal
Revenue Service, Ogden, UT 84201-0209.
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge
Please and belief, it is true, correct, and complete.

Sign
Here
▲

Signature Title Date

For Paperwork Reduction Act Notice, see instructions. Cat. No. 62024G www.irs.gov/form8281 Form 8281 (Rev. 9-2014)
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General Instructions 2. Instruments on which OID is de minimis, as defined in

section 1273(a)(3) and Regulations section 1.1273-1(d).
Section references are to the Internal Revenue Code unless 3. Tax-exempt obligations (interest on them is not taxable).
otherwise noted.
4. Short-term obligations (those that mature in 1 year or less
Future Developments from their issue date).
For the latest information about developments related to Form 5. Certificates of deposit (CDs) issued by banks or other
8281, such as legislation enacted after this form and financial institutions.
instructions were published, go to www.irs.gov/form8281. 6. CDs that are sold by brokers or other middlemen.
Purpose of Form 7. A public offering of stripped bonds or stripped coupons,
including instruments issued under the Department of the
If you are the issuer of publicly offered debt instruments having Treasury’s STRIPS program and instruments that constitute
original issue discount (OID), file Form 8281 to provide the ownership interests in U.S. Treasury securities.
information required by section 1275(c). The reporting
requirements of section 1275(c) were designed to facilitate the When To File
IRS’s collection and publication of the OID information needed
by brokers and middlemen in order for them to provide File two Forms 8281 and any attachments within 30 days after
information returns to holders of OID debt instruments. Since the date of issuance of an OID debt instrument or, if registered
1984, the IRS has compiled the OID information reported by the with the SEC after the date of issuance, within 30 days after the
issuer on Form 8281 and made that information available to the date the OID debt instrument is registered with the SEC. File a
public in the OID tables, which can be found at separate Form 8281 for each issue.
www.irs.gov/pub1212 by clicking the link under Recent
Developments. Definitions
Original issue discount means the excess of the stated
Use and Availability of Information on This redemption price at maturity over the issue price.
Form Stated redemption price at maturity means the sum of all
For each year a debt instrument is outstanding, the following payments provided by the debt instrument other than qualified
information reported on Form 8281 will be published in the OID stated interest payments. Generally, qualified stated interest is
tables, which can be found at www.irs.gov/pub1212 by clicking stated interest unconditionally payable in cash at least annually
the link under Recent Developments. at a single fixed rate.
1. The issuer’s name. Issue price, in the case of publicly offered instruments not
issued for property, means the first price at which a substantial
2. The CUSIP number. amount of such instruments was sold to the public (excluding
3. The issue date. bond houses and brokers).
4. The maturity date. For more information about OID instruments and the OID
5. The issue price. reporting requirements, see Pub. 1212, Guide to Original Issue
Discount (OID) Instruments.
6. The annual stated interest rate.
7. The yield to maturity. Penalty
8. The daily OID per $1,000 of maturity value for each accrual An issuer who fails to timely file Form 8281 will be subject to a
period. penalty of 1% of the aggregate issue price of the debt
instruments, unless such failure is due to reasonable cause and
9. The OID per $1,000 of maturity value for each calendar not to willful neglect. The maximum penalty with respect to any
year. issue is $50,000.
10. The total OID as of the beginning of the calendar year.
Specific Instructions
Who Must File
An issuer of a publicly offered debt instrument (obligation) Part I. Issuer Information
having OID, such as a bond, debenture, or note, must file Form For serial obligations, complete boxes 1 through 3 and attach a
8281. Publicly offered debt instruments also may include: list showing the information for boxes 4 through 15 for each
1. Serial obligations. obligation within the series. For all other obligations, complete
all boxes.
2. Debt instruments issued in exchange for other debt
instruments or for stock. To revise a form, write “Revised” across the top of this form
and staple a copy of the previously filed form to this form.
3. A debt instrument sold together with options or warrants Complete all boxes on this form.
(an investment unit).
Boxes 3a-3f. Enter the name, address, and telephone number
4. Sinking fund instruments. of an official or representative of the issuing company who has
5. Convertible instruments. personal knowledge of this offering and who can be contacted if
An obligation registered with the Securities and Exchange additional information is needed.
Commission (SEC) is a publicly offered debt instrument. An Part II. Debt Instrument Information
obligation exempt from SEC registration may be publicly
offered. See Regulations section 1.1275-1(h). Box 4. Enter the Committee on Uniform Security Identification
Procedures (CUSIP) number assigned to the instruments.
Exceptions. Do not file this form for the following:
Box 5a. Enter the date the issue was first sold to the public at
1. Regular interests of a real estate mortgage investment
the issue price.
conduit (REMIC) or collateralized debt obligations (CDOs).
REMICs and issuers of CDOs must file Form 8811, Information Box 5b. Enter the date the issue was registered with the SEC
Return for Real Estate Mortgage Investment Conduits (REMICs) for OID debt instruments not registered at the time of issuance.
and Issuers of Collateralized Debt Obligations.
Form 8281 (Rev. 9-2014) Page 4

Box 7. Check the appropriate box for type of instrument. Box 15. You must attach two copies of the schedule of OID per
• A fixed rate debt instrument (including a zero coupon debt $1,000 principal amount for the life of the instrument. However,
instrument), if the principal amount is other than $1,000, indicate the actual
OID per principal amount per year and specify the actual
• A variable rate debt instrument, principal amount. The schedule must be based on a 6-month
• A contingent payment debt instrument, or accrual period. It must show the daily portion of OID for each
accrual period and the total OID for each calendar year. Also, if
• An inflation-indexed debt instrument. you checked box 9b (Variable) or box 9c (Contingent), explain
Box 8. Enter the issue price as a percentage of the principal how the interest rate will be determined.
amount. For example, XYZ bonds were first offered to the public To compute the OID allocable to a short accrual period for a
at $900 with a principal amount of $1,000. The issue price of debt instrument, you may use any reasonable method. Indicate
$900 expressed as a percentage of principal is 90. If the what method you used.
percentage is 100 or more, explain in box 14.
If the instrument is part of an investment unit or exchange Paperwork Reduction Act Notice. We ask for the information
offering, attach a description of the method used to determine on this form to carry out the Internal Revenue laws of the United
the issue price. States. You are required to give us the information. We need it
Box 9. Enter the annual stated interest rate or coupon rate. If to ensure that you are complying with these laws and to allow
zero, enter “0.” If the interest rate is variable or contingent, us to figure and collect the right amount of tax.
check the appropriate box and explain in box 15 how the rate You are not required to provide the information requested on
will be determined. a form that is subject to the Paperwork Reduction Act unless
Box 10. Enter the interest payment dates. Attach additional the form displays a valid OMB control number. Books or
information as necessary. records relating to a form or its instructions must be retained as
long as their contents may become material in the
Box 11. Enter the amount of OID for the entire issue. For administration of any Internal Revenue law. Generally, tax
example, if the issue price for the entire issue totals $890,000, returns and return information are confidential, as required by
and the stated redemption price at maturity totals $1 million, the section 6103.
OID for the entire issue is $110,000.
The time needed to complete and file this form will vary
Box 12. Enter the yield to maturity as a percentage rounded to depending on individual circumstances. The estimated average
two decimal points. For example, if the yield to maturity is time is:
9.5784%, enter 9.58%. The yield to maturity should be based
on semiannual compounding. If the debt instrument is a variable Recordkeeping . . . . . . . . . . . 5 hr., 15 min.
rate debt instrument, enter the yield to maturity of the equivalent Learning about the
fixed rate debt instrument. If the debt instrument is a contingent law or the form . . . . . . . . . . . . . 30 min.
payment debt instrument, enter the comparable yield.
Preparing, copying,
Box 14. Provide a complete description of the instrument, assembling, and
including any terms and conditions (for example, put or call sending the form to the IRS . . . . . . . . . 37 min.
options) that could affect the stated payment schedule of the
If you have comments concerning the accuracy of these time
instrument. For a contingent payment debt instrument, provide
estimates or suggestions for making this form simpler, we would
the projected payment schedule. In addition, indicate whether
be happy to hear from you. You can send us comments from
the instrument is:
www.irs.gov/formspubs/. Click on “More Information” and then
• Part of an investment unit, on “Give us feedback.” Or you can write to Internal Revenue
• Issued in an exchange offering described in section 368(a), or Service, Tax Forms and Publications Division,
SE:W:CAR:MP:TFP, 1111 Constitution Ave., NW, IR-6526,
• Part of a serial issue. Washington, DC 20224. Do not send this form to this address.
You may provide two copies of the prospectus or offering Instead, send Form 8281 to the address shown on the form.
circular instead of the required description.