Tax Return

Form 1099-INT

2018 Interest Income

Copy B

For Recipient

Department of the Treasury - Internal Revenue Service

This is important tax information and is

being furnished to the IRS. If you are

required to file a return, a negligence

penalty or other sanction may be

imposed on you if this income is

taxable and the IRS determines that it has

not been reported.

OMB No. 1545-0112

CORRECTED (if checked) PAYER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.

PAYER’S TIN RECIPIENT’S TIN

RECIPIENT’S name

Street address (including apt. no.)

City or town, state or province, country, and ZIP or foreign postal code

FATCA filing requirement

Account number (see instructions)

Payer's RTN (optional)

1 Interest income

$ 2 Early withdrawal penalty

$ 3 Interest on U.S. Savings Bonds and Treas. obligations

$ 4 Federal income tax withheld

$ 5 Investment expenses

$ 6 Foreign tax paid

$ 7 Foreign country or U.S. possession

8 Tax-exempt interest

$

9 Specified private activity bond interest

$ 10 Market discount

$

11 Bond premium

$ 12 Bond premium on Treasury obligations

$ 13 Bond premium on tax-exempt bond

$ 14 Tax-exempt and tax credit

bond CUSIP no. 15 State 16 State identification no. 17 State tax withheld

$ $

Form 1099-INT (keep for your records) www.irs.gov/Form1099INT