Form 1099-Int - Interest Income - 2013 Page 2
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CORRECTED
9292
PAYER’S name, street address, city or town, province or state, country, ZIP
Payer's RTN (optional)
OMB No. 1545-0112
or foreign postal code, and telephone no.
2013
Interest Income
1 Interest income
1099-INT
$
Form
2 Early withdrawal penalty
Copy A
For Internal Revenue
$
PAYER’S country code
Check if branch reporting
Service Center
elected
3 Interest on U.S. Savings Bonds and Treas. obligations
File with Form 1096.
PAYER’S federal identification number RECIPIENT’S identification number
$
RECIPIENT’S name
4 Federal income tax withheld
5 Investment expenses
For Privacy Act and
$
$
Street address (including apt. no.)
Paperwork Reduction
6 Foreign tax paid
7 Foreign country or U.S.
Act Notice, see the
possession
2013 General
Instructions for
City or town, province or state, country, and ZIP or foreign postal code
Certain Information
$
Returns.
8 Tax-exempt interest
9 Specified private activity bond
interest
$
$
Account number (see instructions)
2nd TIN not.
10 Tax-exempt bond CUSIP no.
11 State 12 State identification no. 13 State tax withheld
$
$
1099-INT
Form
Cat. No. 14410K
Department of the Treasury - Internal Revenue Service
Do Not Cut or Separate Forms on This Page — Do Not Cut or Separate Forms on This Page
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