Form 1097-Btc - Bond Tax Credit - 2011 Page 3
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1
2
3
4
5
6CORRECTED (if checked)
FORM 1097-BTC ISSUER'S name, street address, city, state, and ZIP code,
OMB No. 1545-2197
and telephone no.
11
20
Bond
Tax
Credit
1097-BTC
Form
1a March 15, 2011,
1b March 15, 2011,
FORM 1097-BTC ISSUER'S federal
RECIPIENT'S federal identification
allowance date credit
identification number
number
allowance date credit
identification no.
$
Copy B
For Recipient
RECIPIENT'S name
2a June 15, 2011,
2b June 15, 2011,
allowance date credit
allowance date credit
identification no.
$
Street address (including apt. no.)
3a September 15, 2011,
3b September 15, 2011,
This is important tax
allowance date credit
allowance date credit
information and is
identification no.
being furnished to the
$
Internal Revenue
Service. If you are
City, state, and ZIP code
4a December 15, 2011,
4b December 15, 2011,
required to file a return,
allowance date credit
allowance date credit
a negligence penalty or
identification no.
other sanction may be
$
imposed on you if an
5 Other allowance date
Form 1097-BTC issuer is (check one):
amount of tax credit
exceeding the amount
reported on this form is
Issuer of bond or its agent filing initial 2011
claimed on your
Form 1097-BTC for credit being reported
income tax return.
5a Other allowance date
5b Other allowance date
credit identification no.
credit
An entity or a person that received a 2011 Form 1097-BTC
for credit being reported
$
1097-BTC
(keep for your records)
Form
Department of the Treasury - Internal Revenue Service
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