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1099 INT
Step
1
of
2
50%
Email
*
Select Tax Year
2022
2021
2020
Payer's Information
PAYER'S name, street address, city or town, state or province, country, ZIP
Payer's TIN
Recipient’s Information
Recipient’s Name
Recipient’s TIN
Street Address(including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Interest Income
Account Number
Payer's RTN
Untitled
2nd TIN not.
FATCA Filing Requirement
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)
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
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?
Yes
No
15b. State (Line 2)
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
16b. State Identification Number (Line 2)
17b. State Income Tax Withheld (Line 2)
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1099-INT
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