EFTA01222598.pdf

❑ CORRECTED Of checked) PAYER'S name. street address. city or town. state or province. country, ZIP Payer's RTN (optional) OMB No. 1545.0112 or foreign postal code. and telephone no. Interest 1 Interest income 018 Income $ Form 1099-INT 2Earlywithdrawalperially Copy PAYERS TIN RECIPIENT'S 11N $ For Recipient 3 Interest on U.S. Savings Bonds and Treas. obligations $ RECIPIENT'S name 4 Federal income tax withheld S Investment expenses This is important tax information and is $ $ being furnished to the 6 Foreign tax paid 7 Foregn cowry or U.S. possession IRS. II you are Street address gncludirg apt. no.) $ required to file a 8 Tax-exempt interest 9 Speofied private activity bond return, a negligence 'rarest penalty or other sanction may be City or town. state or province. country. and ZIP or foreign postal code $ $ imposed on you if 10 Market discount 11 Bond premium this income is taxable and the IRS determines that It has FATCA Sing $ $ not been reported. requirement 12 Barxl premum al Tieasw otOgitris 13 Bond fawn 0.1 tax-exempt had 0 $ $ Account number (see instructions) 14 Tax-exempt and tax credit 15 State 16 Slate dentdcai,on no. 17 State tax withheld bond CUSIP no. $ S Form 1099-INT (keep for your records) www.irs.gov/Forrn1099INT Department of the Treastay - Internal Revenue Sews EFTA01222598