Form 1098 - Mortgage Interest Statement - 2012 Page 5
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6VOID
CORRECTED
OMB No. 1545-0901
RECIPIENT’S/LENDER'S name, address, and telephone number
Mortgage
2012
Interest
Statement
1098
Form
Copy C
RECIPIENT’S
PAYER'S social security number
1 Mortgage interest received from payer(s)/borrower(s)
federal identification no.
$
For
Recipient/Lender
PAYER'S/BORROWER'S name
2 Points paid on purchase of principal residence
For Privacy Act
and Paperwork
$
Reduction Act
3 Refund of overpaid interest
Street address (including apt. no.)
Notice, see the
$
2012 General
4
City, state, and ZIP code
Instructions for
Certain
Account number (see instructions)
Information
Returns.
1098
Form
Department of the Treasury - Internal Revenue Service
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