Form 1098 - Mortgage Interest Statement - 2016 Page 5
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6VOID
CORRECTED
RECIPIENT'S/LENDER'S name, street address, city or town, state or
OMB No. 1545-0901
province, country, ZIP or foreign postal code, and telephone no.
Mortgage
2016
Interest
Statement
1098
Form
1 Mortgage interest received from payer(s)/borrower(s)
Copy C
$
For Recipient/
2 Outstanding mortgage
RECIPIENT'S/LENDER'S federal
PAYER'S/BORROWER'S taxpayer
Lender
3 Mortgage origination date
principal as of 1/1/2016
identification number
identification no.
$
4 Refund of overpaid
5 Mortgage insurance
interest
premiums
For Privacy Act
$
$
PAYER'S/BORROWER'S name
and Paperwork
6 Points paid on purchase of principal residence
Reduction Act
Notice, see the
$
2016 General
Street address (including apt. no.)
7 Is address of property securing mortgage same as
Instructions for
PAYER'S/BORROWER'S address?
Certain
If Yes, check box .
.
.
.
.
.
.
.
.
.
Information
If No, enter address of property securing mortgage below
Returns.
City or town, state or province, country, and ZIP or foreign postal code
8 Address of property securing mortgage (see instructions)
10 Other
9 If property securing mortgage has no address, provide
description of the property (see instructions)
Account number (see instructions)
1098
Form
Department of the Treasury - Internal Revenue Service
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