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

Statement for
Recipients of

1977

Interest Income
Copy C For Payer

‘Any amount shown in box 3, Amount of
lure, may be deducted from the
ipient's gross income to arrive at
‘adjusted gross income on Form 1040 for
Federal tax purposes even if deductions
are not itemized.

1 Earnings from savings and loan associations,
eredit unions, etc

2 Other interest or
(Bo not includ

nk deposits, ete.
amounts. from’ box 1)

‘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

“ U. S. GOVERNMENT PRINTING OFFICE. 1976—?18-093-61 362441915

Form 1099-INT

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

Department of the Treasury—Internal Revenue Service

Statement for
Recipients of

1977

Interest_ Income
Copy C For Payer

Any amount shown in box 3, Amount of
forfeiture, may be deducted from the
tecipient’s gross income to arrive at
‘adjusted gross income on Form 1040 for
Federal tax purposes even if deductions
are not itemize’

Recipient's Identifying number 1 Earnings from savings and loan associations,

credit unions, ete.

2 Other interest on bank deposits, etc.
{Do not include amounts from’ box 1)

‘3 Amount of forfeiture

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

‘4 Foreign tax paid (If eligible for foreign

5 Foreign Country or U.S, Possession

2 US. GOVERNMENT PRINTING OFFICE, 1976-218-093-£1 362641915,

1099-INT

Form

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

Department of the Treasury—Internal Revenue Service

Statement for
Recipients of

1977

Interest Income
Copy C For Payer

‘Any amount shown in box 3, Amount of
forfeiture, may be deducted from the
recipient's gross income to arrive at
adjusted gross income on Form 1040 for
Federal tax purposes even if deductions.
are not itemized.

Recipient's Identifying number 1 Earnings from savings and loan associations,

credit unions, ete.

2 Other interest on bank deposits, ete.
(Do not include amounts from’ box 1)

3 Amount of forfeiture

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

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

5 Foreign Country or U.S. Possession

BUS. GOVERNMENT PRINTING OFFICE, 1976-218.003 61 362441915

Form 1099-INT

Department of the Treasury—Internal Revenue Service




ror ofl Use Only |

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

Statement for

rivet TOUT

Interest_ Incom
Copy A For Internal Revenue
Service Center

Ray amount shown in box 3, Amount of
forfeiture, may be deducted from the

recipi ross income to arrive at
adjusted gross income on Form 1040 for
Federal tax purposes even if deductions
ara not itemized.

Recipient's Identifying number

1 Earnings from savings and loan associations,
credit unions, ete.

2 Other interest on bank deposits, etc.
(Oo not include amounts from ‘box 1)

3 Amount of forfeiture

| aline with arrow).

Type or print RECIPIENT'S name, address, and ZIP code below (Name must

“A 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.”

Department of the Treasury—Internal Revenue Service

Form 1099-INT

U.S. GOVERNMENT PRINTING OFFICE, 1976—218-098-61362441915,

|

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

Statement for

renonsst TOUT

Interest_ Income
Copy A For Internal Revenue

Service Center

‘Any amount shown in box 3, Amount of
forleiture, may be deducted from the
recipient's gross income to arrive at
adjusted gross income on Form 1040 for
Federal tax purposes even if deductions
are not itemize

Recipient's identifying number 1 Earnings from savings and loan associations,

credit unions, ete.

2 Other interest on bank ceposits, ete.
(Bo not include amounts from ‘box 1)

3 Amount of forfeit

20
Type or print RECIPIENT'S name, address, and ZIP code below (Name must | 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 EU. S. GOVERNMENT PRINTING OFFICE: 1976—216-093-E1 362441915 Department of the Treasury—Internal Revenue Service
Statement for
For Official Use Only Recipients of
Type or print Interest_ Income
PAYER'S Copy A For Internal Revenue
name, address, | Service Center
ZIP code, and | {ny amount shown in box 3, Amount of
Federal fareiie. may be deducted fromthe
ipient’s ‘gross income to. arrive a
identifying fujusted gross tncome on Form 1040 for
number. Federal tax purposes even if deductions
are not itemized
Recipient's identifying number 1 Eamings from savings and loan associations, [J 2 Other interest on bank deposits, etc. 3 Amount of forfeiture
unions, etc. (Do not include amounts from box 1)
20
Type or print RECIPIENT'S name, address, and ZIP code below (Name must [| 4 Foreign tax paid (If eligible for foreizn I § 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

4 U, S. GOVERNMENT PRINTING OFFICE: 1976—-218.08:

62441915

Department of the Treasury—Internal Revenue Service




Statement for
Recipients of

1977

Interest Income

Copy B For Recipient
‘Any amount shown in box 3, Amount of

Type or print
PAYER'S
name, address,
ZIP code, and

Any amount shown in box

Federal may be deducted from the

i gross income to. artive at
identifying ‘adjusted gross income on Form 1040 for
number. Federal tax purposes even if deductions

are not itemized.

Recipient's Identifying number 2 Other interest on bank deposits, etc. | 3 Amount of forfeiture

(Oo not include amounts from’ box 1)

3 from savings and loan associations,
credit unions, etc.

5 Foreign Country or U.S. Possession

Af eligible for foreign

‘Type or print RECIPIENT'S name, address, and ZIP code below. 4 Foreign tax pi

tax credit)

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.
FU, S. GOVERNMENT PRINTING OFFICE, 1976—718-093£1 362441915 Department of the Treasury—Internal Revenue Service

1977

Interest Income

Form 1099-INT

Statement for
Recipients of

‘Type or print

PAYER'S a

name, address, | Copy B For Recipient

ZIP code, and | Any amount shown in box 3, Amount of

Federal forfeiture, may be deducted from’ the
evi fecipient's gross income to arrive at

identifying adjusted gross income on Form 1040 for

number. Federal tax purposes even if deductions,

are not itemized.
‘3 Amount of forfeiture

2 Other interest on bank deposits, etc.

Recipient's Identifying number
(Do not include amounts from’ box 1)

1 Earnings from savings and loan associations,
credit unions, etc.

4 Foreign tax paid (If eligible for foreign | 5 Foreign Country or U.S, Possession

tax credit)

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

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.
Department of the Treasury—Internal Revenue Service

1977

+4 U. S, GOVERNMENT PRINTING OFFICE: 1976 218-099-£1 362441915

Form 1099-INT

Statement for
Recipients of

Type or print

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

Interest Income
Copy B For Recipient

‘Any amount shown in box 3, Amount of
forfeiture, may be deducted from the
recipient's gross income to arrive at
adjusted gross income on Form 1040 for
Federal tax purposes even if deductions
are not itemized.

2 Other interest on bank deposits, ete

Recipiont’s Identifying number
(Do not include amounts from’ box 1)

T Earnings from savings and loan associations,
credit unions, etc.

3 Amount of forfeiture

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

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

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.
Department of the Treasury—Internal Revenue Service

7% U. 5. GOVERNMENT PRINTING OFFICE, 1976—216-093-61 362441915

Form 1099-INT