Form 1097-Btc - Bond Tax Credit - 2011 Page 5
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6VOID
CORRECTED
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 C
For Payer
RECIPIENT'S name
2a June 15, 2011,
2b June 15, 2011,
allowance date credit
allowance date credit
For Privacy Act
identification no.
and Paperwork
$
Reduction Act
Street address (including apt. no.)
3a September 15, 2011,
3b September 15, 2011,
Notice, see the
allowance date credit
allowance date credit
identification no.
2011 General
$
Instructions for
Certain Information
City, state, and ZIP code
4a December 15, 2011,
4b December 15, 2011,
allowance date credit
allowance date credit
Returns.
identification no.
$
5 Other allowance date
Form 1097-BTC issuer is (check one):
Issuer of bond or its agent filing initial 2011
Form 1097-BTC for credit being reported
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
Form
Department of the Treasury - Internal Revenue Service
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