Statement for
Recipients of 1 81

Type or print
PAYER’S Interest Income
name, address,
ZIP code, and
Federal
identifying Copy C
number, For Payer
Recipient's identifying number 1 Interest qualifying for exclusion 2 Interest not qualifying for exclusion 3 Amount of forfeiture
Type or print RECIPIENT'S name, address, and ZIP code below. 4 reveln iat paid (If eligible for foreign | 5 Foreign country or U.S, possession
tax credit)
Form 1099-INT Ye U, S. GOVERNMENT PRINTING OFFICE 1980 313-109 108-134-8180 Department of the Treasury—Internal Revenue Service
Statement for
Recipients of 1
Type or print
PAYER'S Interest Income
name, address,
ZIP code, and
Federal
identifying Copy C
number, For Payer
Recipient's identifying number 1 Interest qualifying for exclusion 2 Interest not qualifying for exclusion | 3 Amount of forfeiture
Type or print RECIPIENT'S name, address, and ZIP code below. 4 Foreign, te paid (i iil for freien | & Foreign country or U.S. possesion
x cred
Form 1099-INT U.S. GOVERNMENT PRINTING OFFICE 1980 J313-109 113-194-8150 Department of the Treasury—internal Revenue Service
Statement for
Recipients of 1
Type or print
PAYER'S Interest Income
name, address,
ZIP code, and
Federal
identifying Copy C
number. For Payer
Recipient's identifying number | 1 Interest qualifying for exclusion 2 Interest not qualifying for exclusion 3 Amount of forfeiture
Type or print RECIPIENT'S name, address, and ZIP code below. 4 Fovegn tax paid (UF liebe for foreign | 5 Foreign ecunty or U.S. possession
tax credit

Form 1099-INT ‘Ye U.S, GOVERNMENT PRINTING OFFICE 1980 J313-109 113-134-8150 Department of the Treasury—internal Revenue Service


Instructions For Payee:

The amount listed in Box 1 is the amount of interest
that qualifies for the partial exclusion of dividends and
interest. You are allowed an exclusion of $200 ($400 in
the case of a joint return) of the total of the amounts
received during the tax year as qualifying domestic divi-
dends or interest.

Instructions For Payee:

The amount listed in Box 1 is the amount of interest
that qualifies for the partial exclusion of dividends and
interest. You are allowed an exclusion of $200 ($400 in
the case of a joint return) of the total of the amounts
received during the tax year as qualifying domestic divi-
dends or interest.

Instructions For Payee:

The amount listed in Box 1 is the amount of interest
that qualifies for the partial exclusion of dividends and
interest. You are allowed an exclusion of $200 ($400 in
the case of a joint return) of the total of the amounts
received during the tax year as qualifying domestic divi-
dends or interest.

Report the total of boxes 1 and 2 on the Interest In-
come line of your income tax return. Use the amount in
box 1, together with qualifying dividend income, to ar-
rive at the proper amount of the exclusion for the year.
See the instructions for your income tax return for more
information on how to report the income and take the
exclusion.

13-14-8150

Report the total of boxes 1 and 2 on the Interest In-
come line of your income tax return. Use the amount in
box 1, together with qualifying dividend income, to ar-
rive at the proper amount of the exclusion for the year.
See the instructions for your income tax return for more
information on how to report the income and take the
exclusion.

13-194-8150

Report the total of boxes 1 and 2 on the Interest In-
come line of your income tax return. Use the amount in
box 1, together with qualifying dividend income, to ar-
rive at the proper amount of the exclusion for the year.
See the instructions for your income tax return for more
information on how to report the income and take the
exclusion.

13-134-8150


For Official Use Only |

Statement for
Recipients of

1981

Type or print

Interest Income

PAYER’S.
name, address,
ZIP code, and
| Federal Copy A
identifying For Internal
number. Revenue Service Center

20

4
Recipient’s identifying number

1 Interest qualifying for exclusion

2 Interest not qualifying for exclusion

| 3 Amount of forfeiture

Type or print RECIPIENT'S name, address, and ZIP code below (Name must
aline with arrow).

‘4 Foreign tax paid (If eligible for foreign

tax credit)

5 Foreign country or U.S. possession

For instructions on completing this form, see
“Instructions for Form 1096.”

Form 1099-INT

3 U.S. GOVERNMENT PRINTING OFFICE 1980 313-109

19-134-8150

Department of the Treasury—Internal Revenue Service

Statement for
Recipients of

1981

Type or print

Interest Income

PAYER'S
name, address,
ZIP code, and
Federal Copy A
identifying For Internal
number. Revenue Service Center
Recipient's identifying number 1 Interest qualifying for exclusion 2 Interest not qualifying for exclusion ‘3 Amount of forfeiture
20 ]
Type o print RECIPIENT'S name, address, and ZIP code below (Name must J 4 Foreign tax paid (If eligible for foreign | 5 Foreign country or U.S. possession
aline with arrow). tax credit)
Name >

For instructions on completing this form, see
“Instructions for Form 1096.”

Form 1099-INT

3 U.S, GOVERNMENT PRINTING OFFICE 1980 J313-109

193-134-8160

Department of the Treasury—Internal Revenue Service

Statement for
For Official Use Only Recipients of
Type or print
PAYER'S Interest Income
name, address,
ZIP code, and
Federal Copy A
identifying For Internal
number. Revenue Service Center
Recipient's identifying number T Interest qualifying fer exclusion 2 Interest not qualifying for exclusion 3 Amount of forfeiture
zo]
Type or print RECIPIENT'S name, address, and ZIP code below (Name must 4 Foreign tox paid (If eligible for foreign J 5 Foreign country or U.S. possession
aline with arrow). tax credit)
Name >

For instructions on completing this form, see
“Instructions for Form 1096.”

Form 1099-INT 3¢ U.S, GOVERNMENT PRINTING OFFICE 1980J313-109 13-134-6150 Department of the Treasury—internal Revenue Service




Type or print
PAYER'S
name, address,
ZIP code, and
Federal
identifying
number.

Statement for
Recipients of

1981

Interest Income
Copy B For Recipient

You may be able to deduct part or all
‘of an amount in box 3, Amount of for-
feiture, even if you do not itemize your
deductions.

Recipient's identifying number 1 Interest qualifying for exclusion

2 Interest not qualifying for exclusion

3 Amount of forfeiture

Type or print RECIPIENT'S name, address, and ZIP code below.

4 Foreign tax paid (If eligible for foreign
tax credit)

5 Foreign country or U.S. possession

If this form shows two or more recipients, the recipient whose Federal
identifying number is shown should file a Form 1087-INT with the Internal
Revenue Service for each of the other recipients and provide each with a
copy. However, a husband or wife is not required to file a Form 1087-INT

to show payments for the other.

This information is being furnished to the Internal Revenue Service.

Form 1099-INT

Yr U.S, GOVERNMENT PRINTING OFFICE 1980J313-109  13-1348150

Type or print
PAYER’S
name, address,
ZIP code, and
Federal
identifying
number.

Department of the Treasury—Internal Revenue Service

Statement for
Recipients of

1981

Interest Income
Copy B For Recipient

You may be able to deduct part or all
‘of an amount in box 3, Amount of for.
feiture, even if you donot itemize your
deductions.

Recipient's identifying number 1 Interest qualifying for exclusion

2 Interest nat qualifying for exclusion

3 Amount of forfeiture

Type or print RECIPIENT'S name, address, and ZIP code below.

‘4 Foreign tax paid (If eligible for foreign
tax credit)

5 Foreign country or U.S. possession

If this form shows two or more recipients, the recipient whose Federal
identifying number is shown should file a Form 1087-!NT with the Internal
Revenue Service for each of the other recipients and provide each with a
copy. However, a husband or wife is not required to file a Form 1087-INT

to show payments for the other.

This information is being furnished to the Internal Revenue Seivice.

Form 1099-INT

Ye U. 8. GOVERNMENT PRINTING OFFICE 1980 J313-109 123-134-8180

Type or print
PAYER'S.
name, address,
ZIP code, and
Federal
identifying
number.

Department of the Treasury—Internal Revenue Service

Statement for
Recipients of 1981
Interest Income
Copy B For Recipient
Wranahaunt im box Se Ameunt of for

feiture, even if you do not itemize your
deductions.

Recipient's identifying number 1 Interest qualifying for exclusion

2 Interest not qualifying for exclusion

3 Amount of forfeiture

Type or print RECIPIENT'S name, address, and ZIP code below.

4 Foreign tax paid (If eligible for foreign
tax credit)

5 Foreign country or U.S. possession

If this form shows two or more recipients, the recipient whose Federal
identifying number is shown should file a Form 1087-INT with the Internal
Revenue Service for each of the other recipients and provide each with a
copy. However, a husband or wife is not required to file a Form 1087-INT

to show payments for the other.

This information is being furnished to the Internal Revenue Service.

Form 1099-INT

‘Ye U.S. GOVERNMENT PRINTING OFFICE 1980 J313-109 13-134-8150

Department of the Treasury—Internal Revenue Service