Form 1099-Int - Interest Income - 2013 (Page 7 of 8) in pdf

Form 1099-Int - Interest Income - 2013 Page 7

VOID

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 C

PAYER’S federal identification number RECIPIENT’S identification number

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

For Payer

RECIPIENT’S name

4 Federal income tax withheld

5 Investment expenses

For Privacy Act

and Paperwork

Street address (including apt. no.)

Reduction Act

6 Foreign tax paid

7 Foreign country or U.S. possession

Notice, see the

2013 General

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

Instructions for

Certain

8 Tax-exempt interest

9 Specified private activity bond

Information

interest

Returns.

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

Department of the Treasury - Internal Revenue Service

Form 1099-Int - Interest Income - 2013 Page 7