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

Statement for
Recipients of

1979

Interest Income
Copy C For Payer

recipient's gross incor 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,

2 Other interest on bank deposits, ete.
credit unions, etc. y

(Oo not include amounts from box

‘3 Amount of forfeiture

‘Type or print RECIPIENT'S name, address, and ZIP code below. 4 Foreign tax paid (Wt eligible for foreign
re

tax er

5 Foreign Country or U.S, Possession

‘YF US, GOVERNMENT PRINTING OFFICE : 197—-0-263-097 62-0237640

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

1979

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

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

2 Other interest. on bank deposits, etc.
credit unions, etc. y

(Do not include amounts from box

3 Amount of forfeiture

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

4 Foreign tax paid (It eicible for foreign | § Forelgn Country or U.S. Possession
credit

‘fy US, GOVERNMENT PRINTING OFFICE : 192—-0-263-097 §2-0237640

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

1979

Interest Income
Copy C For Payer

‘Any amount shown in box 3, Amount of
forfeiture, may be deducted from the
recipient's grass 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 {rom savings and loan associations,

2 Other interest on bank deposits, ete.
credit unions, etc. )

(Do not include 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

‘fy US, GOVERNMENT PRINTING OFFICE : 192—-0-263-097 52-0237640

Form 1099-INT

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 forfeiture, may be deducted from the
recipient’s ‘grass income to arrive at
identifying adjusted gross income on Form 1040 for
number. Federal fax Purposes even if deductions
— are not itemized.
Recipient's Identifying number 1 ings from savings and loan associations, [J 2 Other interest on bank deposits, etc. 3 Amount of forfeiture
credit unions, etc. (Do not include amounts from box 1)
27]
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.""

3 US, GOVERNMENT PRINTING OFFICE : 197—O-263-097 §2-0237640

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

recnents ot 1909

Interest_ Income
Copy A For Internal Revenue

Service Center

‘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 oven if deductions
are not itemize:

20

2 Other interest on bank deposits, ete.

I Earnings from savings and loan associations,
(Do not include amounts from ‘box 1)

credit unions, ete.

W's Identifying number

3 Amount of forfeiture

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 ‘Yy U.S, GOVERNMENT PRINTING OFFICE : 1879—-O-263-097 520237640 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 | Any amount shown in box 3, Amount of
Federal forfeiture, may be deducted from the
; recipient's ‘gross income to arrive at
identifying adjusted gross income on Form 1040 for
number. Federal tax purposes even if deductions
are not itemized.
-_

29

2 Other interest on bank deposits, etc.

T Earnings from savings and loan associations,
(Do not include amounts from ‘box 1)

Recipient's Identifying number
credit unions, ete.

3 Amount of forfeiture

Name

‘A Foreign tax paid (If eligible for foreign

‘Type or print RECIPIENT'S name, address, and ZIP code below (Name must :
tax credit)

aline with arrow).

5 Foreign Country or U.S. Possession

For instructions on completing this form, see “Instructions

for Form 1096.”

“Yr U.S, GOVERNMENT PRINTING OFFICE : 197-0-263-097 52.0237640

Form 1099—-INT

Department of the Treasury—Internal Revenue Service




Statement for
Recipients of

1979

Interest Income

Type or print

PAYER'S an
name, address, | Copy B For Recipient

ZIP code, and Any amount shown in box 3, Amount of
Federal iture, may be deducted from the
i recipient's gross income to arrive
identifying adjusted gross income on Form 1040 for
number. Federal tax purposes even if deductions

are not itemiz

Recipient's Ident '3 Amount of forfeiture

1 Earnings from savings and loan associations,

2 Other interest on bank deposits, etc.
credit unions, etc.

(Do not include amounts from’ box’ 1)

4 Foreign tax pi
tax credit)

‘Type or print RECIPIENT'S name, address, and ZIP code below. (if eligible for foreign | 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.
“Zr US. GOVERNMENT PRINTING OFFICE ; 1978—O-269-097 2-0237640,

Department of the Treasury—Internal Revenue Service

1979

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
; recipient's gross income to arrive at

identifying adjusted gross income on Form 1040 for

number. Federal tax purposes even if deductions

are not itemized.

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

Recipient's Identifying number 1 Earnings from savings and loan associations, ‘3 Amount of forfeiture

credit unions, etc.

4 Foreign tax paid (If el 5 Foreign Country or U.S. Possession

tax credit)

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

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.
“Zr US. GOVERNMENT PRINTING OFFICE : 1978-~-O-263-097 §2-0237640, Department of the Tre

ury—Internal Revenue Service

1979

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
identi recipient's grass income. to arrive at
identifying ‘adjusted ross income on Form 1040 for
number. Federal tax purposes even if deductions

are not itemized.

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

1 Earnings from savings and loan associations, 3 Amount of forfeiture

credit unions, ete.

Recipient's Identifying number

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.
52.0237640

‘fy US, GOVERNMENT PRINTING OFFICE : 1978-~-263-097 Department of the Treasury—Internal Revenue Service

Form 1099-INT