Create 1099-INT Form

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Date

Tax Year And Flags

* Tax Year Account Number

VOID CORRECTED TIN not provided FATCA filing requirement

Payer

* Payer Name * Payer TIN * Street Address City State ZIP Phone

Recipient

* Recipient Name * Recipient TIN * Street Address City State ZIP

1099-INT Amounts

Interest Income Early Withdrawal Penalty Interest on U.S. Savings Bonds Federal Income Tax Withheld Investment Expenses Foreign Tax Paid Foreign Country or U.S. Possession Tax-Exempt Interest Specified Private Activity Bond Interest Market Discount Bond Premium Bond Premium on Treasury Obligations Bond Premium on Tax-Exempt Bond Tax-Exempt Bond CUSIP No. Payer's RTN State Tax Withheld State Income State / Payer State No. State Code State Identification No. State Tax Withheld (2) State Income (2) State Code (2) State Identification No. (2)

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