Form 1098-E - Student Loan Interest Statement - 2012 Page 2

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8484
VOID
CORRECTED
RECIPIENT’S/LENDER’S name, address, and telephone number
OMB No. 1545-1576
Student
2012
Loan Interest
Statement
1098-E
Form
Copy A
RECIPIENT’S federal identification no. BORROWER’S social security number
1 Student loan interest received by lender
$
For
Internal Revenue
BORROWER’S name
Service Center
File with Form 1096.
Street address (including apt. no.)
For Privacy Act and
Paperwork Reduction
Act Notice, see the
City, state, and ZIP code
2012 General
Instructions for
Certain Information
Account number (see instructions)
2 Check if box 1 does not include loan origination fees
and/or capitalized interest, and the loan was made
Returns.
before September 1, 2004
.
.
.
.
.
.
.
1098-E
Form
Cat. No. 25088U
Department of the Treasury - Internal Revenue Service
Do N o t C u t o r S e pa r a t e F or m s o n Th i s P a g e — D o N o t C u t o r S e p a r a t e F o r m s o n Thi s Page

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