(voip

(] CORRECTED

PAYER'S name, street address, city, state, and ZIP code

Payer's RTN (optional)

OMB No. 1545-0112

1990

Statement for
Recipients of

Interest Income

T Earnings from savings and loan

PAYERS Federal identification number

RECIPIENT'S identification number

deposits, bearer certificates of

‘associations, credit unions, bank
deposit, ete

RECIPIENT'S name

Street address

City, state, and ZIP code

2 Early withdrawal penalty

$

4 Federal income tax withheld

$

5 Foreign tax paid

‘Account number (optional)

3 U.S. Savings Bonds, etc.

YY
Y//
HM

possession

Copy C
For Payer

For Paperwork
Reduction Act
Notice and
instructions for
completing this
form, see
Instructions for
Forms 1099,
1098, 5498,
and W-2G.

Form 1099-INT

Cvoio

(J CORRECTED

Department of the Treasury Internal Revenue Service

PAYER'S name, street address, city, state, and ZIP code

Payer's RTN (optional)

poo

OMB No. 1545-0112

{990

Statement for
Recipients of

Interest Income

1 Earnings trom savings and loan associations, credit unions, bank|

1990

Statement for
Recipients of

PAYER’S Federal identification number | RECIPIENT'S identification number deposits, bearer certificates of deposit, etc. Copy C
$ For Payer
RECIPIENT'S name 2 Early withcrawa! penalty 3 U.S. Savings Bonds, etc. For Paperwork
Reduction Act
$ Notice and
Street address 4 Federal income tax withheld instructions for
completing this
$ form, see
City, state, and ZIP code 5 Foreign tax paid 6 Foreign country or U.S. Instructions for
Possession Forms 1099,
‘Account number (optional) 1098, 5498,
and W-2G.
$
Form 1099-INT Department of the Treasury - Internal Revenue Service
Civoip (J) CORRECTED
PAYER’S name, street address, city, state, and ZIP code Payer's RTN (optional) ‘OMB No. 1545-0112

Interest Income

PAYER'S Federal identification number

RECIPIENT'S identification number

T Earnings from savings and loan
deposits, bearer certificates of

associations, credit unions, bank]
deposit, ete.

RECIPIENT'S name

Street address

City, state, and ZIP code

2 Early withdrawal penalty

4 Federal income tax withheld

$

3 U.S. Savings Bonds, etc

5 Foreign tax paid

Account number (optional)

6 Foreign country or U.S
possession

Copy C
For Payer

For Paperwork
Reduction Act
Notice and
instructions for
completing this
form, see
Instructions for
Forms 1099,
1098, 5498,
and W-2G.

Form 1099-INT

Department of the Treasury Internal Revenue Service


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.

If you receive a Form 1099-INT for interest paid on a tax-exempt
obligation, please 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 your Federal
income tax return only on the specific line of Form 1040 under
“Adjustments to income.”

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. For example, persons not
furnishing their taxpayer identification number to the payer
become subject to backup withholding at a 20% rate. See Form

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.

If you receive 2 Form 1099-INT for interest paid on a tax-exempt
obligation, please 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 your Federal
Income tax return only on the specific line of Form 1040 under
“Adjustments to Income.”

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 loca! income taxes. This interest
fs not Included in Box 1.

Box 4.—Shows backup withholding. For example, persons not
furnishing their taxpayer identification number to the payer
become subject to backup withholding at a 20% rate. See Form

Instructions for Recipient
Box 1.~—Shows interest paid to you during the calendar year by
the payer. This does not inciude interest shown in Box 3.

\f you receive a Form 1099-iNT for interest paid on a tax-exempt
obligation, please 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 your Federal
income tax return only on the specific line of Form 1040 under
“Adjustments to Income."

Box 3.—Shows interest on U.S. Savings Bonds, Treasury bills,
Treasury bonds, and Treasury notes. This may or may not be al!
taxable. See Pub. 550, investment Income and Expenses. This
interest is exempt from state ano local income taxes. This interest
ts not included in Box 1.

Box 4.—Shows backup withholding, For example, persons not
furnishing their taxpayer identification number to the payer
become subject to backup withholding at a 20% rate. 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.—Shows foreign tax paid. You may choose to claim this tax
as a deduction or a credit on your Federal income tax return. See
Pub. 514, Foreign Tax Credit for Individuals.

Nominees.—'f your Federal identification number is shown on
this form and the 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
amounts 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, Annua! Summary and Transmittal of U.S.
information Returns, with the Interna! 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
@ nominee return to show amounts owned by the ather.

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.—Shows foreign tax paid. You may choose to claim this tax
as a deduction or a credit on your Federai income tax return. See
Pub. 514, Foreign Tax Credit for Individuals.

Nominees.—/f your Federal! identification number is shown on
this form and the form inciudes 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
amounts allocable to each. You must aiso 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.

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.—Shows foreign tax paid. You may choose to claim this tax
as a deduction or a credit on your Federal income tax return, See
Pub. 514, Foreign Tax Credit for Individuals.

Nominees. —If your Federal identification number is shown on
this form and the 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
amounts 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 Interna! 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.


92592 (voiD ~~ [[) CORRECTED
‘Type or machine print PAYER'S name, street address, city, state. end ZIP code | Payer's RTN (optional) ‘OMB No. 1545-0112
1990 | Interest Income
Statement for
Recipients of
1 Earnings from savings and loan associations, credit unions, bank Copy A
PAYER'S Federal identification number | RECIPIENT'S identification number deposits, bearer certificates of deposit, etc.
For Internal
$ Revenue
‘Type or machine print RECIPIENT'S name 2 Early withdrawal penalty 3 U.S, Savings Bonds, etc. Service Center
For Paperwork
$ $ Reduction Act
Street address 4 Federal income tax withheld ange Notice and
instructions for
completing this
City, state, end ZIP code 5 Foreign tax paid 6 Foreign country or U.S. form, see
possession Instructions for
Forms 1099,
Accourt number (optional) 1098, 5498,
$ and W-2G,

Form 1099-INT

9252 E\voio

(CORRECTED

Department of the Treasury - Interna! Revenue Service

Do NOT Cut or Separate Forms on This Page

‘Type or machine print PAYER'S name, street address, city, state, and ZIP code | Payer’s RTN (optional) OMB No. 1545-0112
1990 Interest Income
Statement for
Recipients of
1 Earnings from savings and joan associations, credit unions, bank Copy A
PAYER'S Federal identification number | RECIPIENT'S identification number Geposits, bearer certificates of deposit 7
For Internat
$ Revenue

‘Type or machine print RECIPIENT'S name

2 Early withdrawal penalty

$

Street adaress

“4 Federal income tax withheld

3 U.S, Savings Bonds, etc.

$

Service Center
For Paperwork
Reduction Act
Notice and
instructions for
completing this

q252 Ooi

(1 CORRECTED

‘Type or machine print PAYER’S name, street address, city, state, and ZIP code

Payer's RTN (optional)

OMB No. 1545-0112

1990

Statement for
Recipients of

City, state, end ZIP code 5 Foren tax paid 6 Foreign country or U.S. form, see
possession Instructions for
Forms 1099,
Account number (optional) 1098, 5498,
$ and W-2G.

Form 1099-INT Dey yf the Tr ot TR Ser
om Do NOT Cut or Separate Forms on This Page Partment of the Treasury Internal Revenus Service

Interest Income

PAYER'S Federal identification number | RECIPIENT'S identification number

Geposits, bearer certificates of

$

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

Copy A
For Internal
Revenue

‘Type or machine print RECIPIENT'S name

2 Early withdrawat penalty

3 U.S. Savings Bonds, ete.

Service Center
For Paperwork

$ Reduction Act

Street address Federal mcome tax withheld ____ Notice and
instructions for

$ completing this

City, state, and ZIP code 5 Foreign tax paid 6 Foresgn country or U. form, see
Possession instructions for

Forms 1099,

Account number (optional) 1098, 5498,
$ and W-2G.

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




{([] CORRECTED (if checked)

PAYER'S name, street address, city, state, and ZIP code

Payers RTN (optional) OMB No. 1545-0112

1990

Statement for
Recipients of

interest Income

1 Earnings from savings and loan essociations, credit unions, bank

PAYER'S Federal identification number | RECIPIENT'S identification number

deposits, bearer certificates of deposit, etc.

$

Copy 8
For Recipient
This 1s important tax

RECIPIENT'S name.

Street address

City, state, and ZIP code.

3 U.S. Savings Bonds, ete.

2 Early withdrawal penatty

Yh HH
6 Foreign courtry or US
possession

'5 Foreign tax paid

Account number (optional)

information and is
being furnished to
the Internal Revenue
Service. If you are
required to file a
return, a negligence
penalty or other
sanction mav be
imposed on you if this,
income is taxable and
the IRS determines
that it has not been
reported.

Form 1099-INT

Department of the Treasury -

(2 CORRECTED (if checked)

PAYER'S name, street address, city, state, and ZIP code

Payer's RTN (optional) ‘OMB No, 1545-0112

1990

Statement for
Recipients of

Internal Revenue Service

Interest Income

T Earnings from savings and loan associations, credit unions, bank

PAYER’S Federal identification number | RECIPIENT'S identification number

deposits, bearer certificates of deposit, ete
$

Copy B
For Recipient
This 1s important tax

RECIPIENT'S name

Street address

City, state, and ZIP code

2 Early withdrawal penalty 3 US. Savings Bonds, etc.

$

6 Foreign country or
possession

5 Foreign tax paid

‘Account number (optional)

information and is
being furnished to
the Internal Revenue
Service. If you are
required to file a
return, 2 negligence
penalty or other
sanction may be
imposed cn you if this
income is taxable and
the IRS determines
that it has not been
reported.

Form 1099-INT

Department of the Treasury -

(CJ CORRECTED (if checked)

PAYER'S name, street address, city, state, and ZIP code:

Payer’ RTN (optional) OMB No. 1545-0112

1990

Statement for
Recipients of

Internal Revenue Service

Interest Income

‘1 Earnings from savings and loan associations, credit unions, bank

PAYER'S Federal identification number | RECIPIENT'S identification number

deposits, bearer certificates of deposit, etc
$

RECIPIENT'S name

Street address

City, state, and ZIP code

Account number (optional)

2 Early withdrawal penalty 3 US. Savings Bonds, etc.

4 Federal income tax withheld

$

5 Foreign tax pad

possession

Copy B
For Recipient
Thus 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 an you if this
income is taxable and
the IRS determines
that it has not been
reported.

Form 1099-INT

Department of the Treasury - internal Revenue Service