[]voio

(J CORRECTED

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

Payer's RTN (optional)

(OMB No. 1545-0112

1988

Statement for
Recipients of

Interest Income

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

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

deposits, bearer certificates of

$

deposit, etc

Copy C
For Payer

RECIPIENT S name (first, middle, last)

Street address

City, state, and ZIP code

2 Early withdrawal penalty

3 US. Savings Bonds, ete

For Paperwork
Reduction Act
Notice and

‘Account number (optional)

$ Wy
instructions for
‘4 Federal income tax withheld Y/7 YY Wf completing this
$ Ws MMM form, see
5 Foreign tax paid (if eligible for] 6 Foreign country or U.S. Instructions for
foreign tax credit) possession Forms 1099
1098, 5498,

1096, and W-2G

Form 1099-INT

Cj voio

[] CorRECTED

Department of the Tr

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

Payer's RTN (optional)

(OMB No. 1845-0112

1988

Statement for
Recipients of

reasury - Internal Revenue Service

Interest Income

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

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

RECIPIENT'S name (first, middle, last)

Street address

City, state, and ZIP code

‘Account number (optional)

deposits, bearer certificates of deposit, etc. Copy C
$ For Payer
2 Early withdrawal penalty 3 USS. Savings Bonds, etc For Paperwork

Reduction Act

$ $ Notice and

instructions for

4 Federal income tax withheld {// Y/ Y 7 completing this
Yi) Yi pleting

$ Ml form, see

5 Foreign tax paid (if eligible for| 6 Foreign AL s Instructions for

foreign tax credit) possession Forms 1099,

1098, 5498,

1096, and W-2G

Form 1099-INT

C]voio

[] CORRECTED

Department of the Tr

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

Payer's RTN (optional)

OMB No. 1545-0112

1/988

Statement for
Recipients of

jeasury - Internal Revenue Service

Interest Income

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

|

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

RECIPIENT'S name (first, middle, last)

Street address

City, state, and ZIP code

‘Account number (aptional)

deposits, bearer certificates of deposit, etc Copy C
$ For Payer
2 Early withdrawal penalty 3 USS Savings Bonds, etc For Paperwork

Reduction Act

$ $ Notice and

instructions for

4 Federalincome taxwithhela //7 yyy TT, complet ne this

MMM Pron

$ form, see

5 Foreign tax paid (if eligible for | 6 Foreign country or U.S. Instructions for
foreign tax credit .

foreign tax credit) possession Forms 1099,

1098, 5498,

1096, and W-2G.

Form 1099-INT

Department of the Tr

easury - Internal Revenue Service


Instructions for Recipient

Box 1.—Interest paid to you during the calendar year by
the payer, other than interest shown in Box 3

If you receive a Form 1099-INT for interest paid ona
tax-exempt obligation, please see the instructions for your
income tax return

If you are a regular interest holder in a REMIC that is
substantially similar to a single class investment trust, the
amount in Box 1 includes your share of investment
expenses of the REMIC, which are deductible as a
“Miscellaneous Deduction” on Form 1040 subject to the
2% limit.

Box 2.— 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.—Interest on U.S. Savings Bonds, Treasury bills,
Treasury bonds, and Treasury notes. This may or may not
be all taxable. See Publication 550, Investment Income
and Expenses. This interest is exempt from state and local
income taxes.

Instructions for Recipient

Box 1.—Interest paid to you during the calendar year by
the payer, other than interest shown in Box 3.

If you receive a Form 1099-INT for interest paid ona
tax-exempt obligation, please see the instructions for your
income tax return.

If you are a regular interest holder in a REMIC that is
substantially similar to a single class investment trust, the
amount in Box 1 includes your share of investment
expenses of the REMIC, which are deductible as a
“Miscellaneous Deduction” on Form 1040 subject to the
2% limit
Box 2.— 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.—Interest on U.S. Savings Bonds, Treasury bills,
Treasury bonds, and Treasury notes. This may or may not
be all taxable. See Publication 550, Investment Income
and Expenses. This interest is exempt from state and local
income taxes.

Instructions for Recipient

Box 1.— Interest paid to you during the calendar year by
the payer, other than interest shown in Box 3.

If you receive a Form 1099-INT for interest paid ona
tax-exempt obligation, please see the instructions for your
income tax return.

If you are a regular interest holder in a REMIC that is
substantially similar to a single class investment trust, the
amount in Box 1 includes your share of investment
expenses of the REMIC, which are deductible as a
“Miscellaneous Deduction” on Form 1040 subject to the
2% limit.

Box 2.— 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.—Interest on U.S. Savings Bonds, Treasury bills,
Treasury bonds, and Treasury notes. This may or may not
be all taxable. See Publication 550, Investment Income
and Expenses. This interest is exempt from state and !ocal
income taxes

Box 4.—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.

!f your Federal identification number is shown on this form
and two or more recipients are shown or 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 income allocable to
each. 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 Forms 1099-INT and 1096, you should be listed as the
“payer.” On Form 1099-INT, the other owner(s) should be
listed as the “recipient.” A husband or wife is not required
to file a nominee return to show payments for the other.

Box 4.—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

If your Federal identification number is shown on this form
and two or more recipients are shown or the form includes
amounts belonging to another person, you are considered
anominee recipient. You must file Form 1099-INT for
each of the other owners showing the income allocable to
each. 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 Forms 1099-INT and 1096, you should be listed as the
“payer.” On Form 1099-INT, the other owner(s) should be
listed as the “recipient.” A husband or wife is not required
to file a nominee return to show payments for the other.

Box 4.—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.

If your Federal identification number is shown on this form
and two or more recipients are shown or 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 income allocable to
each. 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 Forms 1099-INT and 1096, you should be listed as the
“payer.” On Form 1099-INT, the other owner(s) should be
listed as the “recipient.” A husband or wife is not required
to file a nominee return to show payments for the other.


9292 {_] voip

{_] CORRECTED

For Official Use Only

‘Type or machine print PAYER'S name, street address, city, state, and ZIP coce

Payer's RTN (optional)

‘OMB No. 1545-0112

1988

Statement for ~
Recipients of

Interest Income

PAYER’S Federal identification number

RECIPIENT'S identification number

1 Earnings from savings and loan’
ceposits, bearer certificates of

$

deposit, etc.

associat ons, credit unions, bank

Copy A
For Internal
Revenue

Type or machine print RECIPIENT'S name (first, middle, last)

2 Early withdrawal penalty

$

$

3 USS. Savings Bonds, etc

Service Center
For Paperwork
Reduction Act

Street address

4 Federal income tax withheld

$

yy Yi

Notice and
instructions for
completing this

City, state, and ZIP code

5 Foreign tax paid (if eligible for
foreign tax credit)

‘Account number (optional)

$

possession

6 Foreign country or U.S.

form, see
Instructions for
Forms 1099,
1098, 5498,
1096, and W-2G.

Form 1099-INT

Do NOT Cut or Separate Forms on This Page

sede {_jvoip

[_] CORRECTED

Department of the Treasury - Internal Revenue Service

For Official Use Only

Type or machine print PAYER'S name, street address, city; state, and ZIP code

Payer's RTN (optional)

OMB No. 1545-0112

1988

Statement for
Recipients of

Interest Income

PAYER’S Federal identification number

RECIPIENT'S identification number

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

deposits, bearer certificates of

$

deposit, ete.

Copy A
For Internal
Revenue

Type or machine print RECIPIENT'S name (first, middle, last)

2 Early withdrawal penalty

3 USS. Savings Bonds, etc

Service Center
For Paperwork

$

$ $ Reduction Act
Notice and

Street adres 4 Federal income tax withheld
reer aeress Y Yj WY instructions for
$ HMM completing this
City, state, and ZIP code 5 Foreign tax paid (eligible for| 6 Foreign country or U.S form, see
foreign tax crecit) possession Instructions for
* Forms 1099,
Account number (optional) 1098, 5498,

1096, and W-2G.

Form 1099-INT

Department of the Treasury - Internal Revenue Service

Do NOT Cut or Separate Forms on This Page

9242 C)voio

(_] CORRECTED

For Official Use Only

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

Bayer’s RTN (optional)

(OMB No. 1545-0112

1988

Statement for
Recipients of

Interest Income

PAYER’S Federal identification number

RECIPIENT'S identification number

1 Earnings from savings and loan associations, credit unions, bank]
deposit, etc

deposits, bearer certificates of

$

Copy A
For Internal
Revenue

Type or machine print RECIPIENT'S name (fist, middle, last)

2 Early withdrawal penalty

3 U.S, Savings Bonds, etc.

Service Center
For Paperwork

$ $ Reduction Act
Notice and

E ‘4 Federal income tax withheld
Street address YY Yy iy instructions for
$ completing this
City, state, and ZIP code 5 Foreign tax paid (if eligible for| 6 Foreign country or U.S. form, see
foreign tex credit) Possession Instructions for
Forms 1099,
Account number (optional) 1098, 5498,

li.
$

1096, and W-2G.

Form 1099-INT

Department of the Treasury - Internal Revenue Service




(J CORRECTED (if

checked)

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

Payer's RTN (optional)

(OMB No, 1545-0112

1988

Statement for
Recipients of

Interest Income

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

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

deposits, bearer certificates of

$

Copy B
For Recipient
This 1s important tax

deposit, etc

| RECIPIENT'S name (first, middie, last)

Street address

City, state, and ZIP code

2 Early withdrawal penalty

information and 's

being furnished to
the Internal Revenue
$ Service, If you are

3 U.S. Savings Bonds, etc

$
4 Federal income tax withhela WY)
$ Wi. MLM.

required to filea
return, a negligence
penalty or other

Account number (optional)

5 Foreign tax paid (if eligible for
foreign tax credit)

sanction will be
imposed on you if this,
incomes taxable and
the IRS determines
that it has not been
reported

6 Foreign country or U.S.
possession

Form 1099-INT

{_] CORRECTED (if

Department of the Treasury - Internal Revenue Service

checked)

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

Payer's RTN (optional)

OMB No. 1545-0112

1988

Statement for
Recipients of

Interest Income

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

T Earnings from savings and loan associations, credit unvons, bank’

deposits, bearer certificates of

$

Copy B

depost, etc Op}
For Recipient

| RECIPIENT'S name (first, middle, last)

Street address

City, state, and ZIP code

2 Early withdrawal penalty

$

This 1s important tax
information and is
being furnished to

the Internal Revenue
Service. If you are

3 U.S. Savings Bonds, etc

4 Federal income tax withheld

$

required to file a
return, a negligence
penalty or other

‘Account number (optional)

'5 Foreign tax paid (if eligible for
foreign tax credit)

sanction will be
imposed on you if this,
income is taxable and
the IRS determines
that it has not been

6 Foreign — vs
possession

reported

Form 1099-INT

|_] CORRECTED (if

Department of the Treasury - Internal Revenue Service

checked)

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

Payer’s RTN (optional)

(OMB No. 1545-0112

1988

Statement for
Recipients of

Interest Income

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

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

deposits, beare” certificates of

$

Copy B

deposit, ete, rae
For Recipient

RECIPIENT'S name (first, middle, last)

Street address,

City, state, and ZIP code

2 Early withdrawal penalty

This is important tax
information and is
being furnished to

the Internal Revenue
Service, If you are

‘3 US. Savings Bonds, ete

$
4 Federal income tax withheld yy WY)
$ Ww YY WWW

required to file a
return, a negligence
penalty or other

Account number (optional)

5 Foreign tax paid (if eligible for
foreign tax credit)

sanction will be
Imposed on you if this
income ts taxable and
the IRS determines,
that it has not been
reported

6 Foreign country or US.
possession

Form 1099-INT

Department of the Treasury - Internal Revenue Service