Form 1098-E Student Loan Interest Statement

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Page 1 of 6 of Form 1098-E (Page 2 is Blank) 1
The type and rule above prints on all proofs including departmental
reproduction proofs. MUST be removed before printing.

Date

Date

Signature

O.K. to print
T:FP:F
O.K. to print
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scan organization
Revised proofs
requested

INK: Red, J-6983 - Separation for Form 1098-E Page 1
INK: Black - Separation for Form 1098-E Page 1

8484

VOID

CORRECTED

RECIPIENT’S/LENDER’S name, address, and telephone number

OMB No. 1545-1576

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RECIPIENT’S federal identification no.

BORROWER’S social security number

1

2011
Form

1098-E

Student loan interest received by lender

$

Street address (including apt. no.)

City, state, and ZIP code

Form

1098-E

2

Check if box 1 does not include loan origination
fees and/or capitalized interest, and the loan was
made before September 1, 2004

Cat. No. 25088U

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Copy A
For
Internal Revenue
Service Center

BORROWER’S name

Account number (see instructions)

Student
Loan Interest
Statement

File with Form 1096.
For Privacy Act and
Paperwork Reduction
Act Notice, see the
2011 General
Instructions for
Certain Information
Returns.

Department of the Treasury - Internal Revenue Service

Do Not Cut or Separate Forms on This Page