Form 6497 - Information Return Of Nontaxable Energy Grants Or Subsidized Energy Financing Form

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6497
Information Return of Nontaxable Energy
Form
Grants or Subsidized Energy Financing
OMB No. 1545-0232
(Rev. December 2011)
Department of the Treasury
For calendar year
Internal Revenue Service
1
3
Payer’s name
Payer’s employer identification number
2a Number and street and apt. or suite no. (Include P.O. box, if applicable.)
4
Payer is agent for
Type
or Print
b City, state, and ZIP code
5
Program name or number
Complete 6(b) or 6(c)
6(d) Total
6(e) Total amount
6(a) Recipient’s name, address, and
6(c) Recipient’s
6(b) Recipient’s
ZIP code
amount of grant
of financing
employer identification
social security number
number
6497
For Paperwork Reduction Act Notice, see back of form.
Form
(Rev. 12-2011)
Cat. No. 24535C

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