Form 1099-Int - Interest Income - 2014 Page 6
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9CORRECTED (if checked)
PAYER’S name, street address, city or town, state or province, country, ZIP
Payer's RTN (optional)
OMB No. 1545-0112
or foreign postal code, and telephone no.
2014
Interest Income
1 Interest income
1099-INT
$
Form
2 Early withdrawal penalty
Copy 2
$
PAYER’S federal identification number RECIPIENT’S identification number
3 Interest on U.S. Savings Bonds and Treas. obligations
$
RECIPIENT’S name
4 Federal income tax withheld
5 Investment expenses
To be filed with
$
$
recipient's state
Street address (including apt. no.)
6 Foreign tax paid
7 Foreign country or U.S. possession
income tax
return, when
$
required.
City or town, state or province, country, and ZIP or foreign postal code
8 Tax-exempt interest
9 Specified private activity bond
interest
$
$
10 Market discount
11 Bond premium
$
$
Account number (see instructions)
12 Tax-exempt bond CUSIP no. 13 State 14 State identification no. 15 State tax withheld
$
$
1099-INT
Form
Department of the Treasury - Internal Revenue Service
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