Form 1098-E - Student Loan Interest Statement - 2012 Page 3
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2
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6CORRECTED (if checked)
RECIPIENT’S/LENDER’S name, address, and telephone number
OMB No. 1545-1576
Student
2012
Loan Interest
Statement
1098-E
Form
Copy B
RECIPIENT’S federal identification no. BORROWER’S social security number
1 Student loan interest received by lender
$
For Borrower
BORROWER’S name
This is important tax
information and is being
furnished to the Internal
Revenue Service. If you
are required to file a
Street address (including apt. no.)
return, a negligence
penalty or other
sanction may be
imposed on you if the
City, state, and ZIP code
IRS determines that an
underpayment of tax
results because you
Account number (see instructions)
2 If checked, box 1 does not include loan origination
overstated a deduction
fees and/or capitalized interest for loans made before
for student loan interest.
September 1, 2004
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1098-E
Form
(keep for your records)
Department of the Treasury - Internal Revenue Service
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