9292 VOID CORRECTED

PAYER’S name, street address, city, state, ZIP code, and telephone no. OMB No. 1545-0112 Payer’s RTN (optional)

Interest Income

PAYER’S Federal identification number RECIPIENT’S identification number 1 Interest income not included in box 3

$

Early withdrawal penalty Interest on U.S. Savings

Bonds and Treas. obligations

RECIPIENT’S name 2 3

$ $

Street address (including apt. no.) 4 Federal income tax withheld

$

Foreign country or U.S.

possession

City, state, and ZIP code 6 Foreign tax paid 7

Account number (optional) 2nd TIN not.

$

Form 1099-INT Cat. No. 14410K Department of the Treasury - Internal Revenue Service

Form 1099-INT

5 Investment expenses

$

Do Not Cut or Separate Forms on This Page — Do Not Cut or Separate Forms on This Page

Copy A

For

Internal Revenue

Service Center

File with Form 1096.

For Privacy Act

and Paperwork

Reduction Act

Notice, see the

2001 General

Instructions for

Forms 1099, 1098,

5498, and W-2G.

2001
CORRECTED (if checked)

PAYER’S name, street address, city, state, ZIP code, and telephone no. OMB No. 1545-0112 Payer’s RTN (optional)

Interest Income

PAYER’S Federal identification number RECIPIENT’S identification number 1 Interest income not included in box 3

$

Early withdrawal penalty Interest on U.S. Savings

Bonds and Treas. obligations

RECIPIENT’S name 2 3

$ $

Street address (including apt. no.) 4 Federal income tax withheld

$

Foreign country or U.S.

possession

City, state, and ZIP code 6 Foreign tax paid 7

Account number (optional)

$

Form 1099-INT Department of the Treasury - Internal Revenue Service

Copy B

For Recipient

This is important tax

information and is

being furnished to the

Internal Revenue

Service. If you are

required to file a return,

a negligence penalty or

other sanction may be

imposed on you if this

income is taxable and

the IRS determines that

it has not been

reported.

(Keep for your records.)

Form 1099-INT

5 Investment expenses

$

2001
Instructions for Recipient

Box 1. Shows interest paid to you during the calendar year

by the payer. This does not include interest shown in box 3.

Box 6. Shows foreign tax paid. You may be able to claim this

tax as a deduction or a credit on your Form 1040. See your

Form 1040 instructions.

If you receive a Form 1099-INT for interest paid on a taxexempt obligation, see the instructions for your income tax

return.

Box 2. Shows interest or principal forfeited because of early

withdrawal of time savings. You may deduct this on the

“Penalty on early withdrawal of savings” line of Form 1040.

Nominees. If this form includes amounts belonging to

another person, you are considered a nominee recipient. You

must file Form 1099-INT for each of the other owners

showing the income allocable to each. You must also furnish

a Form 1099-INT to each of the other owners. File Form(s)

1099-INT with Form 1096, Annual Summary and Transmittal

of U.S. Information Returns, with the Internal Revenue

Service Center for your area. On each Form 1099-INT, list

yourself as the “payer” and the other owner as the

“recipient.” On Form 1096, list yourself as the “filer.” A

husband or wife is not required to file a nominee return to

show amounts owned by the other.

Box 3. Shows interest on U.S. Savings Bonds, Treasury bills,

Treasury bonds, and Treasury notes. This may or may not be

all taxable. See Pub. 550, Investment Income and Expenses.

This interest is exempt from state and local income taxes.

This interest is not included in box 1.

Box 4. Shows backup withholding. Generally, a payer must

backup withhold at a 31% rate if you did not furnish your

taxpayer identification number to the payer. See Form W-9,

Request for Taxpayer Identification Number and Certification,

for information on backup withholding. Include this amount

on your income tax return as tax withheld.

Box 5. Any amount shown is your share of investment

expenses of a single-class REMIC. If you file Form 1040, you

may deduct these expenses on the “Other expenses” line of

Schedule A (Form 1040) subject to the 2% limit. This

amount is included in box 1.
VOID CORRECTED

PAYER’S name, street address, city, state, ZIP code, and telephone no. OMB No. 1545-0112 Payer’s RTN (optional)

Interest Income

PAYER’S Federal identification number RECIPIENT’S identification number 1 Interest income not included in box 3

$

Early withdrawal penalty Interest on U.S. Savings

Bonds and Treas. obligations

RECIPIENT’S name 2 3

$ $

Street address (including apt. no.) 4 Federal income tax withheld

$

Foreign country or U.S.

possession

City, state, and ZIP code 6 Foreign tax paid 7

Account number (optional) 2nd TIN not.

$

Form 1099-INT Department of the Treasury - Internal Revenue Service

Form 1099-INT

5 Investment expenses

$

2001

For Payer

For Privacy Act

and Paperwork

Reduction Act

Notice, see the

2001 General

Instructions for

Forms 1099,

1098, 5498,

and W-2G.

Copy C
Payers, Please Note—

To help make it easier for you to get only the information you

need to complete the Forms 1099, 1098, 5498, and W-2G

you file, we provide general and specific form instructions as

separate products. The products you should use for 2001 are

the General Instructions for Forms 1099, 1098, 5498, and

W-2G, which contain general information concerning Form

1099-INT and other forms in the 1099 series, and the

separate specific instructions for each information return you

file. Specific information needed to complete this form is

given in the 2001 Instructions for Forms 1099-INT and

1099-OID. A chart in the general instructions gives a quick

guide to which form must be filed to report a particular

payment. You can order these instructions and additional

forms by calling 1-800-TAX-FORM (1-800-829-3676). You

can also get forms and instructions from the IRS’s Internet

Web Site at www.irs.gov.

Due dates. Furnish Copy B of this form to the recipient by

January 31, 2002.

File Copy A of this form with the IRS by February 28,

2002. If you file electronically, the due date is April 1, 2002.

Forms 1099-INT and 1098. If you received mortgage interest

in the course of your trade or business, you may have to

report it to the payer of such mortgage interest and to the

IRS on Form 1098, Mortgage Interest Statement. Do not

report mortgage interest to the payer on Form 1099-INT. The

purpose of Form 1098 is to report a mortgage interest

deduction. The purpose of Form 1099-INT is to report

interest income. See the 2001 Instructions for Forms

1099-INT and 1099-OID, and the 2001 Instructions for

Form 1098.

Foreign interest recipient. If the recipient of the interest is a

nonresident alien, you may have to withhold Federal income

tax and file Form 1042-S, Foreign Person’s U.S. Source

Income Subject to Withholding. See the Instructions for

Form 1042-S and Pub. 515, Withholding of Tax on

Nonresident Aliens and Foreign Corporations.

Caution: Because the IRS processes paper forms by

machine (optical character recognition equipment), you

cannot file with the IRS Forms 1096, 1098, 1099, or 5498

that you print from the IRS’s Internet Web Site.
Note: Self Duplicating, Carbon Paper Not Required