Form 1098-T - Tuition Statement - 2012 Page 2
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2
3
4
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68383
VOID
CORRECTED
FILER’S name, street address, city, state, ZIP code, and telephone number
1 Payments received for
OMB No. 1545-1574
qualified tuition and related
expenses
2012
Tuition
$
Statement
2 Amounts billed for
qualified tuition and
related expenses
1098-T
$
Form
Copy A
FILER’S federal identification no.
3 Check if you have changed your
STUDENT'S social security number
reporting method for 2012
For
Internal Revenue
STUDENT'S name
4 Adjustments made for a
5 Scholarships or grants
prior year
Service Center
File with Form 1096.
$
$
6 Adjustments to
7 Check this box if the
Street address (including apt. no.)
For Privacy Act and
amount in box 1 or 2
scholarships or grants
Paperwork Reduction
includes amounts for
for a prior year
Act Notice, see the
an academic period
City, state, and ZIP code
2012 General
beginning January -
$
March 2013
Instructions for
▶
Certain Information
8 Check if at least
9 Check if a graduate
10 Ins. contract reimb./refund
Service Provider/Acct. No. (see instr.)
Returns.
half-time student
student
.
.
.
.
$
1098-T
Form
Cat. No. 25087J
Department of the Treasury - Internal Revenue Service
Do Not Cut or Separate Forms on This Page — Do Not Cut or Separate Forms on This Page
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