Cvoiw

(_] CORRECTED

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

Payer’s RTN (optional)

‘OMB No. 1545-0112

Interest Income

1987

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

$

deposit, ete.

Copy C
For Payer

RECIPIENT'S name (first, middle, last)

Street address

City, state, and ZIP code

2 Early withdrawal penalty

3 USS. Savings Bonds, ete For Paperwork

Reduction Act

‘Account number (optional)

Notice and
$ s instructions for
4 Federal income tax withheld tons 10

completing this

$ 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

Cvoip

(_] 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

1987

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. Copy C
$ For Payer
RECIPIENT'S name (first, middie, last) 2 Early withdrawal penalty 3 USS, Savings Bonds, ete. 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 tax paid (if eligible for] 6 Foreign country or U.S. Instructions for

foreign tax credit jossession
foreign tax credit) possess Forms 1099,
‘Account number (optional) 1098, 5498,
$ 1096, 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)

‘OMB No. 1545-0112

1987

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
deposit, etc.

deposits, bearer certificates of

$

Copy C
For Payer

RECIPIENT'S name (first, middle, last)

Street address

City, state, and ZIP code

2 Early withdrawal penalty

3 U.S, Savings Bonds, etc. For Paperwork

Reduction Act

‘Account number (optional)

Notice and
$ $ instructions for
4 Federal income tax withheld ‘

completing this.

$ 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

Department of the Treasury - Internal Revenue Service


Instructions for Recipient

Box 1.—Interest paid to you during the calendar year by
the payer, except interest included 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.

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 or local
income taxes.

Box 4.—Backup withholding. For example, persons not
furnishing their taxpayer identification number to the payer

Instructions for Recipient

Box 1.—Interest paid to you during the calendar year by
the payer, except interest included 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.

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 or local
income taxes.

Box 4.—Backup withholding. For example, persons not
furnishing their taxpayer identification number to the payer

Instructions for Recipient

Box 1.—Interest paid to you during the calendar year by
the payer, except interest included 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.

Box 2.—lInterest 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 or 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, Payer’s Request for Taxpayer Identification
Number and Certification, for information on backup
withholding. Include this amount on your income tax
return as tax withheld.

lf 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.

U.S. GOVERNMENT PRINTING OFFICE: 1966-493-167

become subject to backup withholding at a 20% rate. See
Form W-9, Payer's 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.

U.S. GOVERNMENT PRINTING OFFICE: 1986-498-167

become subject to backup withholding at a 20% rate. See
Form W-9, Payer’s 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.

U.S. GOVERNMENT PRINTING OFFICE: 1986-493-167


4292 Dvoio

(_] 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

Interest Income

1987

Statement for
Recipients of
T 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
— $ r Sond Revenue
‘Type or machine print RECIPIENT'S name (first, middle, last) 2 Early withdrawal penalty ‘3 US. Savings Bonds, ete. Service Center
For Paperwork
$ $ Reduction Act
Notice and
Street ada ‘4 Federal income tax withheld iH
$ completing this

City, state, and ZIP code

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

‘Account number (optional)

6 Foreign country or U.S.
possession

form, see
Instructions for
Forms 1099,
1098, 5498,

$

1096, and W-2G.

Form 1099-INT

9292 L\volo

Do NOT Cut or Separate Forms on This Page

(] CorRRECTED

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

Interest Income

1987

Statement for

Recipients of
T 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, last)

2 Early withdrawal penalty

3 USS. Savings Bonds, etc. Service Center

For Paperwork

$ $ Reduction Act
F Notice and

7
Street address ‘4 Federal income tax withheld y/ 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 tax credit) possession Instructions for
Forms 1099,
Account number (optional) 1098, 5498,
$ 1096, and W-2G.

Form 1099-INT

Do NOT Cut or Separate Forms on This Page

5252 L1voip

(J 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

Interest Income

1987

Statement for
Recipients of

T 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, last) 2 Early withdrawal penalty 3 U.S. Savings Bonds, etc. Service Center
For Paperwork

$ Reduction Act

Notice and

Street address,

4 Federal income tax withheld

$

oS

instructions for
completing this

City, state, and ZIP code

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

‘Account number (optional)

1

6 Foreign country or U.S.
possession

form, see
Instructions for
Forms 1099,
1098, 5498,

1096, 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

Payer’s RTN (optional)

OMB No. 1545-0112

Interest Income

1987

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

d it, ete
posit ete 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 U.S. Savings Bonds, ete.

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 country or U.S.
possession

reported.

Form 1099-INT

[J 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

1987

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

$

Copy B

deposit, ete. For Recipient

RECIPIENT'S name (first, middle, last)

Street address

City, state, and ZIP code

2 Early withdrawal penalty

This is important tax

3 U.S. Savings Bonds, ete. information and is

being furnished to

the Internal Revenue

$ $ Service. If you are
7 required to file a

4 Federal income tax withheld return, a negligence
$ penalty or other

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

Account number (optional)

‘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

1987

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

deposit, etc.
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 U.S. Savings Bonds, etc.

44 Federal income tax withheld

L$

required to file a
return, a negligence
penalty or other

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

Account number (optional)

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