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 3 Interest on U.S. Savings Bonds and Treas. obligations

$

RECIPIENT’S name 4 Federal income tax withheld 5 Investment expenses

$ $

Street address (including apt. no.) 6 Foreign tax paid

$

Specified private activity

bond interest

City, state, and ZIP code 8 Tax-exempt interest 9

Account number (see instructions) 2nd TIN not.

$

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

Form 1099-INT

Foreign country or U.S.

possession

7

$

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

2009 General

Instructions for

Forms 1099,

1098, 3921, 3922, 

5498, and W-2G.

2 Early withdrawal penalty

$

1 Interest income

$ 2009
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

RECIPIENT’S name

Street address (including apt. no.)

City, state, and ZIP code

Account number (see instructions)

$

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

3 Interest on U.S. Savings Bonds and Treas. obligations

$

4 Federal income tax withheld 5 Investment expenses

$ $

6 Foreign tax paid

$

Specified private activity

bond interest

8 Tax-exempt interest 9

Foreign country or U.S.

possession

7

$

2 Early withdrawal penalty

$

1 Interest income

$ 2009
Instructions for Recipient

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

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

also show the total amount of the credits from clean renewable

energy bonds, Gulf tax credit bonds, qualified forestry conservation

bonds, new clean renewable energy bonds, qualified energy

conservation bonds, qualified zone academy bonds, and Midwestern

tax credit bonds that must be included in your interest income.

These amounts were treated as paid to you during 2009 on the

credit allowance dates (March 15, June 15, September 15, and

December 15). For more information, see Form 8912, Credit to

Holders of Tax Credit Bonds.

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.

Box 2. Shows interest or principal forfeited because of early withdrawal of time savings. You may deduct this amount to figure your

adjusted gross income on your income tax return. See the instructions for Form 1040 to see where to take the deduction. Nominees. If this form includes amounts belonging to another

person(s), you are considered a nominee recipient. Complete a Form

1099-INT for each of the other owners showing the income allocable

to each. File Copy A of the form with the IRS. Furnish Copy B to

each owner. List yourself as the “payer” and the other owner(s) as

the “recipient.” File Form(s) 1099-INT with Form 1096 with the

Internal Revenue Service Center for your area. 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 all be taxable.

See Pub. 550. 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 28% rate if you did not furnish your taxpayer identification number (TIN) or you did not furnish the correct TIN to the

payer. See Form W-9. 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.

Account number. May show an account or other unique number the

payer assigned to distinguish your account.

Box 8. Shows tax-exempt interest, including exempt-interest

dividends from a mutual fund or other regulated investment

company, paid to you during the calendar year by the payer. Report

this amount on line 8b of Form 1040 or Form 1040A. This amount

may be subject to backup withholding. See box 4.

Box 9. Shows tax-exempt interest subject to the alternative minimum

tax. This amount is included in box 8. See the Instructions for Form

6251.
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

RECIPIENT’S name

City, state, and ZIP code

Account number (see instructions) 2nd TIN not.

$

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

Form 1099-INT

For Payer

For Privacy Act

and Paperwork

Reduction Act

Notice, see the

2009 General

Instructions for

Forms 1099,

1098, 3921, 3922,

5498, and W-2G.

Copy C

Street address (including apt. no.)

3 Interest on U.S. Savings Bonds and Treas. obligations

$

4 Federal income tax withheld 5 Investment expenses

$ $

6 Foreign tax paid

$

Specified private activity

bond interest

8 Tax-exempt interest 9

Foreign country or U.S.

possession

7

2 Early withdrawal penalty

$

1 Interest income

$

$

2009
Instructions for Payers

General and specific form instructions are provided as

separate products. The products you should use to complete

Form 1099-INT are the 2009 General Instructions for Forms

1099, 1098, 3921, 3922, 5498, and W-2G and the 2009

Instructions for Forms 1099-INT and 1099-OID. To order

these instructions and additional forms, visit the IRS website

at www.irs.gov, or call 1-800-TAX-FORM (1-800-829-3676).

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

February 1, 2010.

File Copy A of this form with the IRS by March 1, 2010. If

you file electronically, the due date is March 31, 2010. To file

electronically, you must have software that generates a file

according to the specifications in Pub. 1220, Specifications

for Filing Forms 1098, 1099, 3921, 3922, 5498, and W-2G

Electronically. IRS does not provide a fill-in form option.

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. See

the instructions for Form 1098 for information on reporting

mortgage interest.

Foreign recipient. If the recipient 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

Entities.

Caution: Because paper forms are scanned during

processing, you cannot file with the IRS Forms 1096, 1098,

1099, 3921, 3922, or 5498 that you print from the IRS

website.

Need help? If you have questions about reporting on Form

1099-INT, call the information reporting customer service site

toll free at 1-866-455-7438 or 304-263-8700 (not toll free).

For TTY/TDD equipment, call 304-267-3367 (not toll free).