Form 1097-Btc - Bond Tax Credit - Department Of Treasury - 2013 Page 3
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1
2
3
4
5
6CORRECTED (if checked)
FORM 1097-BTC ISSUER'S name, street address, city or town, province or
1 Total
OMB No. 1545-2197
state, country, ZIP or foreign postal code, and telephone no.
13
20
$
Bond
2a Code
Tax
Credit
1097-BTC
Form
2b Unique Identifier
FORM 1097-BTC ISSUER'S federal
RECIPIENT'S federal identification
identification number
number
3 Bond type
4
Copy B
For Recipient
RECIPIENT'S name
5a January
5b February
$
$
5c March
5d April
$
$
Street address (including apt. no.)
This is important tax
information and is
5e May
5f June
being furnished to the
$
$
Internal Revenue
Service. If you are
City or town, province or state, country, and ZIP or foreign postal code
5g July
5h August
required to file a return,
$
$
a negligence penalty or
other sanction may be
5i September
5j October
imposed on you if an
$
$
Form 1097-BTC issuer is (check one):
amount of tax credit
exceeding the amount
5k November
5l December
reported on this form is
Issuer of bond or its agent filing 2013
$
$
claimed on your
Form 1097-BTC for credit being reported
income tax return.
6 Comments
An entity or a person that received or should have received
a 2013 Form 1097-BTC and is distributing part or all of that
credit to others
(keep for your records)
1097-BTC
Department of the Treasury - Internal Revenue Service
Form
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