Mortgage Interest Statement Template - 2015
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1CORRECTED (if checked)
* Caution: The amount shown
OMB No. 1545-0901
RECIPIENT’S/LENDER'S name, street address, city or town, state or province,
may not be fully deductible by you.
country, ZIP or foreign postal code, and telephone number
Mortgage
Limits based on the loan amount
2015
and the cost and value of the
Interest
secured property may apply. Also,
you may only deduct interest to
Statement
the extent it was incurred by you,
actually paid by you, and not
1098
reimbursed by another person.
Form
Copy B
1 Mortgage interest received from payer(s)/borrower(s)*
RECIPIENT’S
PAYER'S social security number
federal identification no.
$
For Payer/Borrower
2 Points paid on purchase of principal residence
PAYER'S/BORROWER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code
The information in boxes 1,
2, and 3 is important tax
information and is being
$
furnished to the Internal
Revenue Service. If you are
required to file a return, a
3 Refund of overpaid interest
negligence penalty or other
sanction may be imposed on
$
you if the IRS determines
that an underpayment of tax
4
results because you
overstated a deduction for
this mortgage interest or for
these points or because you
5
Account number (see instructions)
did not report this refund of
interest on your return.
1098
(keep for your records)
Form
Department of the Treasury - Internal Revenue Service
CORRECTED (if checked)
RECIPIENT’S/LENDER'S name, street address, city or town, state or province,
* Caution: The amount shown
OMB No. 1545-0901
may not be fully deductible by you.
country, ZIP or foreign postal code, and telephone number
Mortgage
Limits based on the loan amount
2015
and the cost and value of the
Interest
secured property may apply. Also,
you may only deduct interest to
Statement
the extent it was incurred by you,
actually paid by you, and not
1098
reimbursed by another person.
Form
Copy B
RECIPIENT’S
PAYER'S social security number
1 Mortgage interest received from payer(s)/borrower(s)*
federal identification no.
$
For Payer/Borrower
2 Points paid on purchase of principal residence
PAYER'S/BORROWER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code
The information in boxes 1,
2, and 3 is important tax
information and is being
furnished to the Internal
$
Revenue Service. If you are
required to file a return, a
3 Refund of overpaid interest
negligence penalty or other
sanction may be imposed on
$
you if the IRS determines
that an underpayment of tax
4
results because you
overstated a deduction for
this mortgage interest or for
these points or because you
Account number (see instructions)
5
did not report this refund of
interest on your return.
1098
(keep for your records)
Department of the Treasury - Internal Revenue Service
Form
CORRECTED (if checked)
RECIPIENT’S/LENDER'S name, street address, city or town, state or province,
* Caution: The amount shown
OMB No. 1545-0901
may not be fully deductible by you.
country, ZIP or foreign postal code, and telephone number
Mortgage
Limits based on the loan amount
2015
and the cost and value of the
Interest
secured property may apply. Also,
you may only deduct interest to
Statement
the extent it was incurred by you,
actually paid by you, and not
1098
reimbursed by another person.
Form
Copy B
1 Mortgage interest received from payer(s)/borrower(s)*
RECIPIENT’S
federal identification no.
PAYER'S social security number
$
For Payer/Borrower
2 Points paid on purchase of principal residence
PAYER'S/BORROWER'S name, street address, city or town, state or province, country, and ZIP or foreign postal code
The information in boxes 1,
2, and 3 is important tax
information and is being
furnished to the Internal
$
Revenue Service. If you are
required to file a return, a
3 Refund of overpaid interest
negligence penalty or other
sanction may be imposed on
$
you if the IRS determines
that an underpayment of tax
4
results because you
overstated a deduction for
this mortgage interest or for
these points or because you
Account number (see instructions)
5
did not report this refund of
interest on your return.
1098
(keep for your records)
Department of the Treasury - Internal Revenue Service
Form
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