1099-int_form | Document Preview

VOID

CORRECTED

PAYER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.

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PAYER'S TIN

RECIPIENT'S TIN

Payer’s RTN (optional)

1	Interest income
$

OMB No. 1545-0112 Form 1099-INT (Rev. January 2024)

For calendar year

2024

Interest
Income

2	Early withdrawal penalty
$
3	Interest on U.S. Savings Bonds and Treasury obligations
$

RECIPIENT'S name

Street address (including apt. no.)

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

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FATCA filing requirement checkbox

4	Federal income tax withheld
$

5	Investment expenses
$

6	Foreign tax paid
$

7	Foreign country or U.S. territory
$

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
$

Account number (see instructions)

2nd TIN not. checkbox

14	Tax-exempt and tax credit bond CUSIP no
$

15	State

16	State identification no

17	State tax withheld
$