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

PAYER’S federal identification number RECIPIENT’S identification number

For Recipient

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

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

6 Foreign tax paid

7 Foreign country or U.S. possession

return, a negligence

penalty or other

sanction may be

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

imposed on you if

this income is

taxable and the IRS

8 Tax-exempt interest

9 Specified private activity bond

determines that it has

interest

not been reported.

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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