Cvoio

(I CORRECTED

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

Payer’s RTN (optional)

‘OMB No. 1545-0112

Interest Income

1989

Statement for
Recipients of
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. Copy Cc
$ For Payer
RECIPIENT'S name (first, middle, last) 2 Early withdrawal penalty 3 US. Savings Bonds, etc. For Paperwork
Reduction Act
Notice and
; yyy instructions for
Street address ‘4 Federal income tax 17/]/, completing this
$ HL TMM form, see
City, state, and ZIP code 5 Foretgn tax paid (if eligible for | 6 Foreign country or U.S. Instructions for
foreign tax credit) possession Forms 1099,
‘Account number (optional) 1098, 5498,
$ 1096, and W-2G.

Form 1099-INT

Cvoio

(CORRECTED

Department of the Treasury - Internal Revenue Service

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

Payer’s RTN (optional)

‘OMB No. 1545-0112

Interest Income

1989

Statement for
Recipients of

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

Street address.

City, state, and ZIP code

$

4 Federal income tax withheld

$

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

‘Account number (optional)

PAYER’S Federal identification number | RECIPIENT'S identification number deposits, bearer certificates of deposit, etc. Copy C
$ For Payer

RECIPIENT'S name (first, middle, last) 2 Early withdrawal penalty 3 U.S. Savings Bonds, etc. For Paperwork
Reduction Act

Notice and

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

Yi WW

6 Foreign country or U.S.
Possession

Form 1099-INT

[voip

(J corRECTED

Department of the Treasury - Internal Revenue Service

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

Payer’s RTN (optional)

OMB No. 1545-0112

Interest Income

1989

Statement for
Recipients of

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

PAYER’S Federal identification number | RECIPIENT'S identification number deposits, bearer certificates of deposit, et. Copy C
$ For Payer
RECIPIENT'S name (first, middie, last) 2 Early withdrawal penalty 3 U.S. Savings Bonds, etc. For Paperwork
Reduction Act
Notice and
$ instructions for

Street address 4 Federal income tax withheld +
completing this
$ form, see
City, state, and ZIP code 5 Foreign taxpaid (eid for| 6 Foregn country or US. Instructions for
foreign tax credit) possession Forms 1099,
‘Account number (optional) 1098, 5498,
$ 1096, and W-2G.
Form 1099-INT Department of the Treasury - 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 single class REMIC
(as defined in regulations under section 67(c)), the amount
in Box 1 includes your share of investment expenses of the
REMIC, which are deductible as a “Miscellaneous
Deduction” on Schedule A (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 single class REMIC
(as defined in regulations under section 67(c)), the amount
in Box 1 includes your share of investment expenses of the
REMIC, which are deductible as a “Miscellaneous
Deduction” on Schedule A (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 single class REMIC
(as defined in regulations under section 67(c)), the amount
in Box 1 includes your share of investment expenses of the
REMIC, which are deductible as a “Miscellaneous
Deduction” on Schedule A (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.

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.

Nominees.—'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.

Nominees.— 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.

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,

Nominees.—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 payinents for the other.


9292 Cvow

(I CoRRECTED

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

1989

Statement for
Recipients of

Interest Income

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 (first, middle, fast) 2 Early withdrawal penalty 3 U.S. Savings Bonds, etc. Service Center
For Paperwork
$ $ Reduction Act
a Fe T WYYYIIYJYyy Notice and
Street address ‘ederal income tax withheld Vf YY] instructions for
$ VIM,» cornppleting this
City, state, and ZIP code 5 Foreign tax paid (if eligible for} 6 Foreign country or U.S. form, see
foreign tax credit) possession Instructions for
Forms 1099,
Account number (optional) 1098, 5498,
$ 1096, and W-2G.

Form 1099-INT

q292 voi

Do NOT Cut or Separate Forms on This Page

(1 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

1989

Statement for
Recipients of

Interest Income

T Earnings from savings and foan associations, credit unions, bark Copy A
PAYER’S Federal identification number | RECIPIENT'S identification number deposits, bearer cettificates of deposit, etc. -

For Internal

$ Revenue

“Type or machine print RECIPIENT'S name (fist, middie, last) 2 Early withdrawal penalty 3 US. Savings Bonds, etc. Service Center

For Paperwork

$ $ Reduction Act

rc income Ta WT) __ Notice and

ret address, 44 Federal income tax withheld // / instructions for

$ MM completing this

City, state, and ZIP code '5 Foreign tax paid ff" eligible for | 6 Foreign country or U.S. form, see

foreign tax credit 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

9292 Oivoip

(I CORRECTED

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

1989

Statement for
Recipients of

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, etc.

CopyA
For Internal
Revenue

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

2 Early withdrawal penalty

3 U.S. Savings Bonds, etc.

Service Center
For Paperwork

$ $ Reduction Act

YY jlotice and

Street address 4 Federal income taxwithheld YJ Y/ instructions for
$ MMMM completing this

City, state, and ZIP code '5 Foreign tax paid (if eligible for] 6 Foreign country or US. form, see
foreign tax credit) possession Instructions for

Forms 1099,

‘Account number (optional) 1098, 5498,
$ 1096, and W-26.

Form 1099-INT

Department of the Treasury - Internal Revenue Service




(I CORRECTED (if

checked)

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

Payer’s RTN (optional)

OMB No. 1545-0112

Interest Income

1989

Statement for
Recipients of

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

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

deposits, bearer certificates of

$_

Copy B
For Recipient
This is important tax

deposit, etc.

RECIPIENT'S name (first, middle, last)

2 Early withdrawal penalty

3 U.S. Savings Bonds, etc. information and is
being furnished to

the Internal Revenue

$ Service. If you are

Street address 4 Federal income tax withheld required to file a

return, a negligence

$ penalty or other

City, state, and ZIP code '5 Foreign tax paid (if eligible for| 6 Foreign country or U.S. sanction will be

» foreign tax credit) possession imposed on you if this
income is taxable and

the IRS determines

Account number (optional) that it has not been
$ 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

Interest Income

1989

Statement for
Recipients of

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 is important tax

deposit, etc.

RECIPIENT'S name (first, middle, last)

Street address

City, state, and ZIP code

2 Early withdrawal penalty

$

3 U.S. Savings Bonds, etc. information and is
being furnished to
the Internal Revenue

$ Service. If you are

4 Federal income tax withheld

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
income is 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

Interest Income

1989

Statement for
Recipients of

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

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

deposits, bearer certificates of

$

Copy B
For Recipient
This is important tax

deposit, etc.

RECIPIENT'S name (first, middle, last)

Street address

City, state, and ZIP code

2 Early withdrawal penalty

4 Federal income tax withheld

$

3 US. Savings Bonds, etc. information and is
being furnished to
the Internal Revenue
Service. If you are
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
reported.

6 Foreign country or U.S.
Possession

Form 1099-INT

Department of the Treasury - Internal Revenue Service