Form 8912 - Credit To Holders Of Tax Credit Bonds - 2016 Page 3
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Form 8912 (2017)
Page
Name(s) shown on return
Identifying number
Part IV
Bond credit(s) from bonds held by you and/or your nominee(s) not reported to you on
Form(s) 1097-BTC (see instructions)
15
a Bond Issuer's name, city or town, and state
b Bond Issuer's employer identification number
16
a Date bond issued
b Date bond matures
17
Date bond disposed of (if applicable)
(a) CUSIP number. If CUSIP number
(b) Outstanding bond
(c) Credit rate
(d) Multiply
(e) %
(f) Multiply (d) x (e)
not issued, enter principal payment
principal (or for build
(b) x (c)
dates. (Clean renewable energy bonds:
America bonds, interest
Include CUSIP number and principal
payable)
payment dates. Build America bonds:
Include CUSIP number and interest
payment dates.)
18
19
Add the amounts on line 18, column (f) .
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19
20
For a new clean renewable energy bond or a qualified energy conservation bond, multiply the
amount on line 19 by 70% (0.70) and enter the result here. For a clean renewable energy bond,
qualified zone academy bond, qualified school construction bond, or build America bond, enter the
amount from line 19 here. Enter the line 20 amount on line 2. See the instructions for how to report
as interest income .
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8912
Form
(2017)
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