2012 Form 1099-INT Interest Income

Attention:
This form is provided for informational purposes only. Copy A appears in red, similar to the
official IRS form. Do not file copy A downloaded from this website. The official printed
version of this IRS form is scannable, but the online version of it, printed from this website, is
not. A penalty may be imposed for filing forms that can’t be scanned. See part O in the
current General Instructions for Certain Information Returns for more information about
penalties.
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See IRS Publications 1141, 1167, 1179 and other IRS resources for information about
printing these tax forms.

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VOID

CORRECTED

PAYER’S name, street address, city, state, ZIP code, and telephone no.

Payer's RTN (optional)

OMB No. 1545-0112

2012

1 Interest income

$

Interest Income

2 Early withdrawal penalty

$
PAYER’S federal identification number RECIPIENT’S identification number

Form 1099-INT

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

Copy A

$

For Internal Revenue
Service Center

4 Federal income tax withheld 5 Investment expenses

RECIPIENT’S name

File with Form 1096.

$
6 Foreign tax paid

Street address (including apt. no.)

$

For Privacy Act and
Paperwork Reduction
Act Notice, see the
2012 General
Instructions for
Certain Information
Returns.

7 Foreign country or U.S. possession

$
8 Tax-exempt interest

City, state, and ZIP code

$
Account number (see instructions)

9 Specified private activity bond interest

$

2nd TIN not. 10 Tax-exempt bond CUSIP no. 11 State 12 State identification no. 13 State tax withheld

$
Form 1099-INT

Cat. No. 14410K

Department of the Treasury - Internal Revenue Service

Do Not Cut or Separate Forms on This Page — Do Not Cut or Separate Forms on This Page

CORRECTED (if checked)
PAYER’S name, street address, city, state, ZIP code, and telephone no.

Payer's RTN (optional)
1 Interest income

$

OMB No. 1545-0112

2012

Interest Income

2 Early withdrawal penalty

$
PAYER’S federal identification number RECIPIENT’S identification number

Form 1099-INT
Copy B

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

$
RECIPIENT’S name

4 Federal income tax withheld

$
Street address (including apt. no.)

6 Foreign tax paid

$
City, state, and ZIP code

8 Tax-exempt interest

$
Account number (see instructions)

For Recipient
5 Investment expenses

This is important tax
information and is being
furnished to the Internal
Revenue Service. If you
$
are required to file a
7 Foreign country or U.S. possession
return, a negligence
penalty or other sanction
may be imposed on you if
9 Specified private activity bond interest this income is taxable and
the IRS determines that it
has not been reported.
$

10 Tax-exempt bond CUSIP no. 11 State 12 State identification no. 13 State tax withheld

$
Form 1099-INT

(keep for your records)

Department of the Treasury - Internal Revenue Service

Instructions for Recipient
Recipient's identification number. For your protection, this form may show
only the last four digits of your social security number (SSN), individual taxpayer
identification number (ITIN), or adoption taxpayer identification number (ATIN).
However, the issuer has reported your complete identification number to the IRS
and, where applicable, to state and/or local governments.
Account number. May show an account or other unique number the payer
assigned to distinguish your account.
Box 1. Shows taxable interest paid to you during the calendar year by the payer.
This does not include interest shown in box 3. May also show the total amount
of the credits from clean renewable energy bonds, Gulf tax credit bonds,
qualified forestry conservation bonds, new clean renewable energy bonds,
qualified energy conservation bonds, qualified zone academy bonds,
Midwestern tax credit bonds, qualified school construction bonds, and build
America bonds that must be included in your interest income. These amounts
were treated as paid to you during 2012 on the credit allowance dates (March
15, June 15, September 15, and December 15). For more information, see Form
8912, Credit to Holders of Tax Credit Bonds.
Box 2. Shows interest or principal forfeited because of early withdrawal of time
savings. You may deduct this amount to figure your adjusted gross income on
your income tax return. See the instructions for Form 1040 to see where to take
the deduction.
Box 3. Shows interest on U.S. Savings Bonds, Treasury bills, Treasury bonds,
and Treasury notes. This may or may not all be taxable. See Pub. 550. This
interest is exempt from state and local income taxes. This interest is not
included in box 1.
Box 4. Shows backup withholding. Generally, a payer must backup withhold if
you did not furnish your taxpayer identification number (TIN) or you did not

furnish the correct TIN to the payer. See Form W-9. Include this amount on your
income tax return as tax withheld.
Box 5. Any amount shown is your share of investment expenses of a singleclass REMIC. If you file Form 1040, you may deduct these expenses on the
“Other expenses” line of Schedule A (Form 1040) subject to the 2% limit. This
amount is included in box 1.
Box 6. Shows foreign tax paid. You may be able to claim this tax as a deduction
or a credit on your Form 1040. See your Form 1040 instructions.
Box 8. Shows tax-exempt interest paid to you during the calendar year by the
payer. Report this amount on line 8b of Form 1040 or Form 1040A. This amount
may be subject to backup withholding. See box 4.
Box 9. Shows tax-exempt interest subject to the alternative minimum tax. This
amount is included in box 8. See the Instructions for Form 6251.
Box 10. Shows CUSIP number(s) for tax-exempt bond(s) on which tax-exempt
interest was paid to you during the calendar year and reported in box 8. If blank,
no CUSIP number was issued for the bond(s).
Boxes 11-13. State tax withheld reporting boxes.
Nominees. If this form includes amounts belonging to another person(s), you
are considered a nominee recipient. Complete a Form 1099-INT for each of the
other owners showing the income allocable to each. File Copy A of the form with
the IRS. Furnish Copy B to each owner. List yourself as the “payer” and the
other owner(s) as the “recipient.” File Form(s) 1099-INT with Form 1096 with the
Internal Revenue Service Center for your area. On Form 1096 list yourself as the
“filer.” A husband or wife is not required to file a nominee return to show
amounts owned by the other.

VOID

CORRECTED

PAYER’S name, street address, city, state, ZIP code, and telephone no.

Payer's RTN (optional)

OMB No. 1545-0112

2012

1 Interest income

$

Interest Income

2 Early withdrawal penalty

$
PAYER’S federal identification number RECIPIENT’S identification number

Form 1099-INT
Copy C

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

$
RECIPIENT’S name

4 Federal income tax withheld 5 Investment expenses

$
Street address (including apt. no.)

For Payer

6 Foreign tax paid

For Privacy Act and
Paperwork Reduction
Act Notice, see the
2012 General
Instructions for
Certain Information
Returns.

$
7 Foreign country or U.S. possession

$
City, state, and ZIP code

8 Tax-exempt interest

$
Account number (see instructions)

9 Specified private activity bond interest

$

2nd TIN not. 10 Tax-exempt bond CUSIP no. 11 State 12 State identification no. 13 State tax withheld

$
Form 1099-INT

Department of the Treasury - Internal Revenue Service

Instructions for Payer
General and specific form instructions are provided as
separate products. The products you should use to complete
Form 1099-INT are the 2012 General Instructions for Certain
Information Returns and the 2012 Instructions for Forms 1099INT and 1099-OID. To order these instructions and additional
forms, visit IRS.gov or call 1-800-TAX-FORM
(1-800-829-3676).
Caution: Because paper forms are scanned during
processing, you cannot file with the IRS Forms 1096, 1097,
1098, 1099, 3921, 3922, or 5498 that you print from the IRS
website.
Due dates. Furnish Copy B of this form to the recipient by
January 31, 2013.
File Copy A of this form with the IRS by February 28, 2013.
If you file electronically, the due date is April 1, 2013. To file
electronically, you must have software that generates a file
according to the specifications in Pub. 1220, Specifications for
Filing Forms 1097, 1098, 1099, 3921, 3922, 5498, 8935, and
W-2G Electronically. IRS does not provide a fill-in form option.

Forms 1099-INT and 1098. If you received mortgage interest
in the course of your trade or business, you may have to
report it to the payer of such mortgage interest and to the IRS
on Form 1098, Mortgage Interest Statement. Do not report
mortgage interest to the payer on Form 1099-INT. See the
instructions for Form 1098 for information on reporting
mortgage interest.
Foreign recipient. If the recipient is a nonresident alien, you
may have to withhold federal income tax and file Form 1042S, Foreign Person’s U.S. Source Income Subject to
Withholding. See the Instructions for Form 1042-S and Pub.
515, Withholding of Tax on Nonresident Aliens and Foreign
Entities.
Need help? If you have questions about reporting on Form
1099-INT, call the information reporting customer service site
toll free at 1-866-455-7438 or 304-263-8700 (not toll free). For
TTY/TDD equipment, call 304-579-4827 (not toll free). The
hours of operation are Monday through Friday from 8:30 a.m.
to 4:30 p.m., Eastern time.