1099 INT

Row Start

Email*

Select Tax Year

Payer's Information

PAYER'S name, street address, city or town, state or province, country, ZIP

Payer's TIN

Recipient’s Name

Recipient’s TIN

Street Address(including apt. no.)

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

Account Number

Payer's RTN

Untitled

1. Interest Income

2. Early Withdrawal Penalty

3. Interest on U.S. Savings Bonds and Treasury 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 U.S. Treasury Obligations

13. Bond Premium on Tax-Exempt Bond

14. Tax-Exempt and Tax Credit Bond CUSIP No.

15a. State (Line 1)

16a. State Identification Number (Line 1)

17a. State Income Tax Withheld (Line 1)

Do you wish to enter a tax income withheld for a second state?

15b. State (Line 2)

16b. State Identification Number (Line 2)

17b. State Income Tax Withheld (Line 2)

Column Break

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