Form 1098-T - Tuition Statement - 2012 Page 3
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1
2
3
4
5
6CORRECTED
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 B
FILER’S federal identification no.
STUDENT'S social security number
3 If this box is checked, your educational institution
has changed its reporting method for 2012
For Student
STUDENT'S name
4 Adjustments made for a
5 Scholarships or grants
prior year
$
$
This is important
tax information
6 Adjustments to
7 Checked if the amount in
Street address (including apt. no.)
and is being
scholarships or grants
box 1 or 2 includes
furnished to the
for a prior year
amounts for an academic
City, state, and ZIP code
Internal Revenue
period beginning January -
Service.
March 2013
▶
$
8 Check if at least
9 Checked if a graduate
10 Ins. contract reimb./refund
Service Provider/Acct. No. (see instr.)
half-time student
student
.
.
.
.
$
1098-T
Form
(keep for your records)
Department of the Treasury - Internal Revenue Service
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