Form 1099-Int - Interest Income - 2013 (Page 4 of 8) in pdf

Form 1099-Int - Interest Income - 2013 Page 4

CORRECTED (if checked)

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 B

For Recipient

PAYER’S country code

If checked, branch reporting

elected

3 Interest on U.S. Savings Bonds and Treas. obligations

PAYER’S federal identification number RECIPIENT’S identification number

This is important tax

RECIPIENT’S name

4 Federal income tax withheld

5 Investment expenses

information and is

being furnished to the

Internal Revenue

Service. If you are

Street address (including apt. no.)

required to file a return,

6 Foreign tax paid

7 Foreign country or U.S.

a negligence penalty or

possession

other sanction may be

imposed on you if this

City or town, province or state, country, and ZIP or foreign postal code

income is taxable and

the IRS determines that

8 Tax-exempt interest

9 Specified private activity bond

it has not been reported.

interest

Account number (see instructions)

10 Tax-exempt bond CUSIP no.

11 State 12 State identification no. 13 State tax withheld

1099-INT

(keep for your records)

Form

Department of the Treasury - Internal Revenue Service

Form 1099-Int - Interest Income - 2013 Page 4

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