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

Statement for
Recipients of

1978

Interest Income
Copy C For Payer

Any amount shown in box 3, Amount of
forfeiture, ‘may be deducted from the

recip ross 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 from savings and loan associations,

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

(Do not include amounts from’ box

‘3 Amount of forfeiture

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

U.S. GOVERNMENT PRINTING OFFICE: 1977--235.099 El 362441915

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

1978

Interest Income
Copy C For Payer

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

credit unions, etc.

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

3 Amount of forfeiture

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

US. GOVERNMENT PRINTING OFFICE, 197-235-099 E1 367441915

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

1978

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
are not itemized.

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

ient’s Identifying number 1 Earnings from savings and loan associations,

credit unions, etc.

3 Amount of forfeiture

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

1% US. GOVERNMENT PRINTING OFFICE: 1977--235-099 El 362441915

Form 1099-INT

Department of the Treasury—Internal Revenue Service




For Official Use Only |

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

Statement for

recpensor 1908

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 even if deductions
are not itemized.

1 Earnings from savings and loan associations,
credit unions, etc.

Recipient's Ide

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

3 Amount of forfeiture

2
Type or print RECIPIENT'S name, address, and ZIP code below (Name must J 4 Foreign tax paid (If eligible for foreign | 5 Foreign Country or U.S. Possession
J aine wit arrow. tex credit)
nom > J
For instructions on completing this form, see “Instructions
for Form 1096.
Form 1099-INT 5 US. GOVERNMENT PRINTING OFFICE: 1977—235-099 El 362441915 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 a
identifying fcjusted gross income on Form 1040 for
number. Federal tax purposes even if deductions
are not itemized.
Recipient's ider 1 Earnings from savings and loan associations, | 2 Other interest on bank deposits, etc. 3 Amount of forfeiture
eredit unions, ete, (o' not include amounts. trom box 1
20

Type or print RECIPIENT'S name, address, and ZIP code below (Name must
aline with arrow).

4 Foreign tax paid (If eligible for foreign
tax credit)

5 Foreign Country or U.S. Possession

Name >
For instructions on completing this form, see “Instructions
for Form 1096.’
Form 1099-INT FOS GOVERNMENT PRIITING OFFICE. 1977—705.099 £1 362441915 Department of the Treasury—Internal Revenue Service
‘ci | 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 ot
Federal forfeiture, may be Seducted fi e
reeipiont’s ‘grass income to_ are
identifying adjusted gross income on Form 1040 for
number. Federal tax purposes even if deductions
are not itemize.
Recipient's Identifying number 1 Earnings from savings and loan associations, { 2 Other interest on bank deposits, etc. 3 Amount of forfeiture
‘credit unions, etc. (Do not include amounts from box 1)
20
Type of 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. Passession
aline with arrow). tax credit)
Name >

For instructions on completing this form, see “Instructions

for Form 1096.""

Form 1099-INT

U.S. GOVERNMENT PRINTING OFFICE. 1977 —735-099 61367447015

Department of the Treasury —Intesnal Revenue Service




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

Statement for
Recipients of

1978

Interest Income
Copy B For Recipient

‘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
are not itemized.

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

credit unions, etc.

2 Other interest on bank deposits, etc.
(Oo 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

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.
“US. GOVERNMENT PRINTING OFFICE. 1977235099 | 362441915 Department of the Treasury—Internal Revenue Service

Form 1099-INT

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

Statement for
Recipients of

1978

Interest Income
Copy B For Recipient

Any amount shown in box 3, Amount of
forfeiture, may be deducted from the
Tecipient's ‘grass income. to. arrive at
justed gross income on Form 1040 for

a
Federal tax purposes even if deductions
are not itemized.

Recipient's Identifying number 1 Earnings from savings and loan associations,
cr

redit unions, etc.

2 Other interest on bank deposits, ete.
(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

5 Foreign Country or U.S. Possession

tax credit)

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.
US, GOVERNMENT PRINTING OFFICE, 1977—-235.099 EI 67421915 Department of the Treasury—Internal Revenue Servi

1978

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 trom, 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 itemize
‘3 Amount of forfeiture

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

credit unions, etc.

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

'5 Foreign Country or U.S. Possession

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

tax credit)

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.
US. GOVERNMENT PRINTING OFFICE, 197-235-099 E1 362441915 Department of the Treasury—Internal Revenue Service

Form 1099-INT