1099form.pdf

Form 1099-INT

2018 Interest
Income

Copy B

For Recipient

Department of the Treasury – Internal Revenue Service

This is important tax
information and is

being furnished to the
IRS. If you are

required to file a
return, a negligence

penalty or other
sanction may be

imposed on you if
this income is

taxable and the IRS
determines that it has

not been reported.

OMB No. 1545-0112

CORRECTED (if checked)
PAYER’S name, street address, city or town, state or province, country, ZIP
or foreign postal code, and telephone no.

PAYER’S TIN RECIPIENT’S TIN

RECIPIENT’S name

Street address (including apt. no.)

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

FATCA filing
requirement

Account number (see instructions)

Payer’s RTN (optional)

1 Interest income

$
2 Early withdrawal penalty

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

$
13 Bond premium on tax-exempt bond

$
14 Tax-exempt and tax credit

bond CUSIP no.
15 State 16 State identification no. 17 State tax withheld

$
$

Form 1099-INT (keep for your records) www.irs.gov/Form1099INT

User
Typewritten Text
Orlando National Bank
9871 Disney Way
Orlando, FL 32801

User
Typewritten Text
60-7654321

User
Typewritten Text
266-15-1966

User
Typewritten Text
Alexander T. Smith

User
Typewritten Text
1234 Buena Vista Drive

User
Typewritten Text
Orlando, FL 32830

User
Typewritten Text
1,475.88