Form 1098-T - Tuition Statement - 2016 Page 3

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CORRECTED
FILER'S name, street address, city or town, state or province, country, ZIP or
1 Payments received for
OMB No. 1545-1574
qualified tuition and related
foreign postal code, and telephone number
expenses
2016
Tuition
$
Statement
2
1098-T
Form
Copy B
FILER'S federal identification no.
STUDENT'S taxpayer identification no.
3 If this box is checked, your educational institution
has changed its reporting method for 2016
For Student
STUDENT'S name
4 Adjustments made for a
5 Scholarships or grants
This is important
prior year
tax information
and is being
$
$
furnished to the
6 Adjustments to
7 Checked if the amount
Street address (including apt. no.)
Internal Revenue
Service. This form
scholarships or grants
in box 1 or 2 includes
must be used to
for a prior year
amounts for an academic
City or town, state or province, country, and ZIP or foreign postal code
complete Form 8863
period beginning January
to claim education
— March 2017
$
credits. Give it to the
8 Check if at least
9 Checked if a graduate
10 Ins. contract reimb./refund
Service Provider/Acct. No. (see instr.)
tax preparer or use it to
prepare the tax return.
half-time student
student
.
.
.
.
$
1098-T
Form
(keep for your records)
Department of the Treasury - Internal Revenue Service

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