Form 1099-Int - Interest Income - 2013 Page 3
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8VOID
CORRECTED
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 1
$
PAYER’S federal identification number RECIPIENT’S identification number
For State Tax
3 Interest on U.S. Savings Bonds and Treas. obligations
Department
$
RECIPIENT’S name
4 Federal income tax withheld
5 Investment expenses
$
$
Street address (including apt. no.)
6 Foreign tax paid
7 Foreign country or U.S. possession
City or town, province or state, country, and ZIP or foreign postal code
$
8 Tax-exempt interest
9 Specified private activity bond
interest
$
$
Account number (see instructions)
10 Tax-exempt bond CUSIP no. 11 State 12 State identification no. 13 State tax withheld
$
$
1099-INT
Form
Department of the Treasury - Internal Revenue Service
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