Form 1098 - Mortgage Interest Statement - 2010 Page 4
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1
2
3
4
5VOID
CORRECTED
RECIPIENT’S/LENDER’S name, address, and telephone number
OMB No. 1545-0901
Mortgage
2010
Interest
Statement
1098
Form
RECIPIENT’S federal identification no.
PAYER’S social security number
1
Mortgage interest received from payer(s)/borrower(s)
Copy C
$
For
Recipient/Lender
PAYER’S/BORROWER’S name
2
Points paid on purchase of principal residence
For Privacy Act
and Paperwork
$
Reduction Act
Street address (including apt. no.)
3
Refund of overpaid interest
Notice, see the
$
2010 General
City, state, and ZIP code
4
Mortgage insurance premiums
Instructions for
$
Certain
Information
5
Account number (see instructions)
Returns.
1098
Form
Department of the Treasury - Internal Revenue Service
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