Fillable Form 1000 - Ownership Certificate printable pdf download

Form 1000 - Ownership Certificate

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1000

Ownership Certificate

Form

OMB No. 1545-0054

(Rev. September 2016)

Department of the Treasury

Information about Form 1000 is at

▶

Internal Revenue Service

To be used by a U.S. citizen, resident individual, fiduciary, partnership, or nonresident partnership all of whose members are citizens or residents, in connection with

interest on bonds of a corporation containing a tax-free covenant and issued before January 1, 1934.

Owner of bonds

U.S. identifying number

Name of withholding agent

Employer identification number

Address of owner (number and street, city or town, state or province, country, ZIP or

U.S. address of withholding agent (number and street, city or town, state, and

foreign postal code)

ZIP code)

Name of bond and date of issue

Date interest due

Date interest paid